Abstract
Background: There is increasing evidence that patients with serious mental illness (SMI) are at increased risk of long-term poor physical health outcomes as a result of weight-related medication side effects. Few previous studies have used a nutrition education and cooking programme as the principal component to elicit healthy eating behaviour changes, with none to our knowledge in the First Episode Psychosis (FEP) population. The present study is the second part of an ongoing study, the Totara House Healthy Eating Study (THHES), aiming to develop a ‘user-created’ nutrition education and cooking programme for the clients of Totara House. Totara House is an early intervention in psychosis outpatient service within the Canterbury District Health Board (CDHB). THHES Part 1 found that Totara House clients, families and staff would value and support a nutrition education and cooking programme.
Objective: To design and pre-test the resources for an evidence-based nutrition education and cooking programme for FEP clients, informed by the results of the THHES Part One and relevant literature, to prevent excessive antipsychotic medication induced weight-gain.
Methods: The study consisted of two parts; design of the content and resources for a nutrition education and cooking programme (Ka Pai Kai), and pre-testing of the resources. The study used an experiential qualitative study design. Semi-structured interviews and focus groups were conducted with Totara House clients, family and staff members, and mental health dietitians/nutritionists to explore stakeholders’ feedback on the proposed programme structure and educational resources. Inductive thematic analysis was used to analyse the data. The results of the analysis allowed participants’ worldviews and feedback on the programme structure and content to be compared and contrasted. The resources were altered to reflect these views to finalise the ‘user-created’ programme.
Results: Overall, 38 participants took part in the study. Thirteen clients, eight family members, and two staff members completed semi-structured interviews, and 10 Totara House staff members and five dietitians/nutritionists, participated in two separate focus groups. Four major themes emerged from the thematic analysis: “Programme structure and components”, “Effects of Medication and Psychosis”, “Positive Feedback” and “Clarifications and Suggestions”. These themes described the content and structure that participants believed to be integral to the proposed programme; the effects of antipsychotic medications and psychosis on clients’ abilities to engage in the proposed programme and make sustained behaviour change; participants’ overall thoughts on the proposed programme content; and additional content and suggested adjustments to be made to the proposed programme. Changes were then made to the educational materials to create a finalised programme based on these themes.
Conclusions: Overall, participants liked the structure and content of the proposed programme. The use of colour, pictures, budget appropriate ideas and simple recipes were thought to be appropriate for clients. The effects of psychosis and anti-psychotics guided the changes made to the session number, length and amount of content. The programme structure and content has been altered to reflect the views of participants, and to be as beneficial to clients as possible. To our knowledge this is the first ‘user-created’ nutrition education and cooking programme to be developed specifically for FEP patients. It is soon to be implemented at Totara House and potentially within the wider community.