Using photovoice to understand and improve healthy lifestyles of people diagnosed with serious mental illness.

WHAT IS KNOWN ON THE SUBJECT?: People diagnosed with serious mental illness (SMI): Live 10 to 20 years less than the general population, and this can be related to lifestyle factors such as poor diet and low levels of physical activity. Have a good understanding of what healthy lifestyle comprises of, but face barriers and challenges related to their mental health, treatment, and life situation. There is limited participatory research that considers the specific beliefs of people diagnosed with SMI about what "being healthy" means to them. People diagnosed with SMI value health and are often already engaged in activities that promote both physical and mental health. They experience the "vicious cycle" of barriers to engage in healthier lifestyle, including medication effects, poor sleep routines, fatigue, low mood and establishing a routine, but this shows how healthy activities can improve their mental health. The importance of meaningful places and their role in supporting healthy lifestyles was identified Some people diagnosed with SMI face significant socio-economic challenges (such as lack of cooking facilities; limited money for purchasing healthy food) to support healthy lifestyles. To truly understand the perspectives of people with SMI, who are typically voiceless and disempowered, research methods need to allow the participants to set the agenda for discussion, to not only provide rich data but also have the added benefit of empowerment and enhanced engagement. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses should: Explore the practical barriers to healthy lifestyle such as financial concerns and ensure that people can access support to obtain what they need from the local community resources. Instigate a mental health and/or medication review if mental health symptoms or medication side effects are a barrier to healthy lifestyles Explore what places have meaning and consider how to use meaningful places as motivating factors for healthy lifestyles and promoting mental well being. INTRODUCTION: People diagnosed with serious mental illness (SMI) live 10-20 years less than the general population, due in part to co-existing physical illness linked to lifestyle factors. To inform individualized care plans to promote healthy lifestyles, it is important to understand the views of people diagnosed with SMI. To truly understand their lived experience, research methods should allow participants to set the agenda for discussion, enhancing engagement and empowerment in the research process. To use a participatory research approach to capture what healthy lifestyle means to people who are diagnosed with SMI. Eight people diagnosed with SMI participated in six, weekly focus groups using Photovoice. Data were analysed using thematic analysis. The overarching theme was 'mental health is the main priority', and the other themes were barriers to a healthy lifestyle, represented as a vicious cycle, and three themes, which were facilitators - the importance of place, meaningful activities, and the importance of others. The methodology allowed participants to choose images that reflected their lived experience. The themes describe the interaction of physical and mental health and practical barriers and will inform the design of individualized care plans. In co-designing care plans, mental health nurses should draw on peoples' preferences and explore the barriers identified in this study.

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© 2022 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.