Barriers and facilitators of inpatients and healthcare professionals prior to the implementation of a Multidisciplinary Lifestyle-Focused Approach in the Treatment of Inpatients With Mental Illness (MULTI+): The MULTI+ Study II.

Abstract

Background: Despite the efficacy of lifestyle interventions for the physical and mental health of people with mental illness, there is little change in clinical care. Understanding barriers and facilitators of implementation can help interpret intervention effectiveness and aid implementation. This cross-sectional study identifies barriers and facilitators before implementing a multidisciplinary lifestyle approach in the treatment of inpatients with mental illness (MULTI+). Additionally, we analyze associations between barriers and facilitators, and recipients' health and demographic characteristics.

Method: This study used baseline data from an open cohort stepped wedge cluster randomized trial. The Measurement Instrument for Determinants of Innovations was used to investigate barriers and facilitators associated with the innovation (MULTI+), user (recipients and deliverers), and organization. Data was collected through semi-structured interviews for recipients and an online survey for deliverers. We explored associations between barriers and facilitators, and recipients' health and demographic characteristics through multiple regression models.

Results: We included 134 recipients and 125 deliverers. Perceived barriers to implementing MULTI+ included complexity, incomplete information, and incompatibility with current treatment. Recipients and deliverers reported personal barriers, including a lack of personal benefits, potential drawbacks, and insufficient knowledge. Facilitators such as the recognized importance of lifestyle-focused care, social support, and organizational commitment could enhance implementation. Being hospitalized for more than a year was negatively associated with determinants such as compatibility, patient relevance, and satisfaction (range between β = -.25 and β = -.45). Regression models indicated few other associations. Suggestions to address barriers were made.

Conclusions: This study is one of the first to analyze barriers and facilitators before the large-scale implementation of a multicomponent lifestyle-focused approach in mental healthcare. Recipients and deliverers experience barriers and facilitators across all domains. Addressing these factors through patient-level tailoring, structured training, the use of champions, and sustained organizational support may enhance implementation and sustainability.

Trial registration: ClinicalTrials.gov registration. Identifier: NCT04922749. Retrospectively registered 3rd of June 2021.