Speak for yourself: usability and acceptability of audio diaries to explore physical activity, sedentary and sleep behaviours of those living with severe mental illness.

Abstract

Background: People living with severe mental illness (SMI) face significant health inequalities, including reduced quality of life and life expectancy. Evidence has shown that people living with SMI are highly sedentary, face challenges when seeking to engage in physical activity (PA), and experience sleep difficulties. Motivation, mood and energy have been identified as critical determinants of these behaviours. PA and sleep are traditionally measured in isolation using quantitative approaches, limiting our understanding of the contexts and interactive ways in which these occur, especially for this population. Here, we adopted a flexible and holistic approach, using audio diaries to explore the usability and acceptability of capturing movement behaviours in people living with SMI.

Methods: This study employed a qualitative design. Data were collected with 10 participants self-identifying as living with SMI, who completed 7-days of audio diaries, pre and post diary use interviews. Reflexive thematic analysis was used to analyse participants' movement behaviours and their experiences of using the audio diaries.

Results: Audio diaries were perceived as acceptable to participants and their use for data capture was feasible, with participants experiencing their use as a flexible and empowering method of data capture. Within the exploratory data generated we identified four themes relating to participants' movement behaviours: finding themselves in a "vicious circle" with physical and mental issues impacting movement behaviours; a daily internal fight and dialogue concerning fear of feeling guilty and wasting time; a determination to "not let fatigue win" by pushing through the day; and the mixed effects of understanding the importance of movement behaviours yet finding it challenging to engage.

Conclusion: Audio diaries offered an easy to use and relatively inclusive means of exploring movement behaviours for people living with SMI, especially their context and interrelated nature. Our findings reinforced the well-established link between mental and physical health, and their influence on 24 h movement behaviours, identifying population-specific challenges derived from medication side effects, rigid engagement opportunities, and illness symptoms. Given this, co-production involving individuals with lived experience is crucial for developing tailored recommendations and support to promote sleep and movement among those living with SMI. We emphasized the need for holistic measurement approaches and opportunities that consider the interconnected impact of disrupted sleep and movement.