Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: A qualitative evidence synthesis.

Abisola Balogun-Katung,Richard Holt,Jan R Boehnke,Peter Coventry,Najma Siddiqi,Charlotte Kitchen,Rowena Jacobs,Ian Kellar,Sue Bellass,Ben Young,Emily Peckham,David Shiers,Ramzi Ajjan,Judy Wright,Claire Carswell,Sarah Alderson,Jennie Lister,Jennifer Valeska Elli Brown ,Jacqui Taylor

doi:10.1371/journal.pone.0258937

Abstract

People living with severe mental illness (SMI) have a reduced life expectancy by around 15-20 years, in part due to higher rates of long-term conditions (LTCs) such as diabetes and heart disease. Evidence suggests that people with SMI experience difficulties managing their physical health. Little is known, however, about the barriers, facilitators and strategies for self-management of LTCs for people with SMI. To systematically review and synthesise the qualitative evidence exploring facilitators, barriers and strategies for self-management of physical health in adults with SMI, both with and without long-term conditions. CINAHL, Conference Proceedings Citation Index- Science, HMIC, Medline, NICE Evidence and PsycInfo were searched to identify qualitative studies that explored barriers, facilitators and strategies for self-management in adults with SMI (with or without co-morbid LTCs). Articles were screened independently by two independent reviewers. Eligible studies were purposively sampled for synthesis according to the richness and relevance of data, and thematically synthesised. Seventy-four articles met the inclusion criteria for the review; 25 articles, reporting findings from 21 studies, were included in the synthesis. Seven studies focused on co-morbid LTC self-management for people with SMI, with the remaining articles exploring self-management in general. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the burden of SMI; living with co-morbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; and routine, structure and planning. The synthesis identified a range of barriers and facilitators to self-management, including the burden of living with SMI, social support, attitudes towards self-management and access to resources. To adequately support people with SMI with co-morbid LTCs, healthcare professionals need to account for how barriers and facilitators to self-management are influenced by SMI, and meet the unique needs of this population.

Highlights

Seven studies focused on co-morbid long-term conditions (LTCs) self-management for people with severe mental illness (SMI), with the remaining articles exploring self-management in general
The synthesis identified a range of barriers and facilitators to self-management, including the burden of living with SMI, social support, attitudes towards self-management and access to resources
To adequately support people with SMI with co-morbid LTCs, healthcare professionals need to account for how barriers and facilitators to self-management are influenced by SMI, and meet the unique needs of this population

Summary

Introduction

Severe mental illnesses (SMI) such as schizophrenia and bipolar disorder affect around 1% of the population [1] and are associated with a reduced life expectancy by around 15–20 years compared with the general population [2]. This is mostly explained by poorer physical health including higher rates of non-communicable long-term conditions (LTCs) such as diabetes and heart disease, and worse self-management of those conditions [3]. People living with severe mental illness (SMI) have a reduced life expectancy by around 15– 20 years, in part due to higher rates of long-term conditions (LTCs) such as diabetes and heart disease. About the barriers, facilitators and strategies for self-management of LTCs for people with SMI

Methods

Results

Conclusion