Background
Methods
Design and setting
Sampling
Data collection
Overall statements |
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It is important that instructors learn about the treatment of schizophrenia spectrum disorders and how the disorders affect people’s lives. |
It is important that instructors learn about the concept of recovery and how exercise can support personal recovery. |
It is important that instructors learn about adapting the exercise content, so it is safe and relevant for people with schizophrenia spectrum disorders. |
Examples of specific questions for stakeholder groups | |
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Clinical staff from outpatient mental health services | What can exercise instructors do in order for community-based exercise to complement outpatient mental health services? |
Exercise instructors with/without experience in coaching people with SSD | What concerns do you have about facilitating community-based exercise targeting young adults with schizophrenia? |
Physiotherapists working in mental health services. | What is important to consider when working with community-based exercise targeting young adults with schizophrenia? |
Relatives of individuals with SSD | What do exercise instructors need to be aware of to meet the needs of relatives in relation to community-based exercise targeting young adults with schizophrenia? |
Young adults with SSD | What is important for supervised community-based exercise to facilitate long-term physical active behaviour? |
Data analysis
Results
Characteristics of informants
Stakeholder group | Inclusion criteria | Recruitment | Setting | Participant characteristics |
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Clinical staff at mental health outpatient clinic | Professional experience from working with young adults with SSD | Personal email to team leader at two outpatient clinics who distributed the invitation all staff at the outpatient clinic. | Conference rooms, outpatient clinics | Two groups: (N = 4, N = 5) 3 men and 6 women Nurses (n = 3), social workers (n = 4), occupational therapists (n = 2) 2–30 years’ experience working in mental health 1–16 years’ experience working in an outpatient mental health clinic |
Young adults with SSD | Lived experience of having a SSD diagnosis (F20–29)* Treated at an outpatient mental health clinic and diagnosed with SSD | Email invitation distributed by peer-board coordinator | Conference room, University of Copenhagen | One group: (N = 4) 2 men, 2 women Full-time (n = 1), between jobs (n = 1), student (n = 2) 2–17 years in diagnosed with SSD |
Relatives of individuals with SSD | Lived experience of being a relative to an individual with SSD | Email invitation distributed by a manager of an outpatient clinic | Conference room, University College of Northern Denmark, Aalborg One relative participated via a Microsoft Teams due to COVID-19 | One group: (N = 4) Mothers of individuals with SSD Work in healthcare (nurse, occupational therapist, healthcare worker, physician) Tine since children’s diagnosis 1.5–4 years |
Physiotherapists working in mental health centres | Experience working with physical activity and exercise for people SSD | Personal invitation to team leader at a department of physiotherapy, who distributed the invitation to all physiotherapist at the department. | Conference room, mental health services, Capital Region of Denmark | One group: (N = 4) 4 Women Educated from 1993–2019, 1.5–25 years’ experience working in the psychiatric field |
Exercise instructors with/without experience in coaching people with SSD | At least two years’ experience working as exercise instructor and/or experience with coaching people with SSD | Personal email to exercise instructors coaching people with SSD as part of previous feasibility study** Email invitation distributed by fitness chain | For geographical reasons Microsoft Teams was used | One group: (N = 9) 6 men, 3 women Previous experience coaching people with SSD (n = 3), no experience (n = 6), student (n = 4), full-time personal trainer (n = 2) 2–8 years’ experience as an exercise instructor |
Findings
Required educational elements | Categories | Subcategories | Illustrative quotes |
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a) Basic knowledge in core symptoms of SSD with particular focus on negative symptoms. b) Understanding the impact of antipsychotic medication side effects on the body. c) Analysis of cases demonstrating how symptoms and medical side effects can influence behaviour. d) Reflection on internalized stigma among individuals with SSD. | Awareness and understanding of mental illness | Knowledge kills prejudice | It would be nice to know something about the illness [SSD] before you start as an instructor… it would be nice to confirm or deny some common myths and assumptions regarding schizophrenia. (Exercise instructor) |
Lack of meaning | It makes me think about the shame… the feeling of: “Why is this so awkward? Why am I making it awkward? Why can’t I figure out how to be in company with other people?” I have thought a lot about that. (Young adult with SSD) | ||
Extra compassion | The process in getting better is long and thus it may be beneficial to focus on the small things, like “I see you look happier today” or “you could do 20 [repetition of an exercise] and now you can easily do 30”. So, you look at what is small, good, or on the way. (Clinical staff at mental health outpatient clinic) | ||
a) Reflections on the concept of mental health versus mental illness. b) Practice of respectful and inquisitive communication. c) Knowledge about social inclusion and personal recovery. d) Understanding the concept of proximal zone of development. | Protecting youth identity | Person before the diagnosis | Two people with the same diagnosis can have totally different symptoms and functional level… they are so much more than just a diagnosis. (Clinical staff at mental health outpatient clinic) |
Stepping out of the patient role | So, she [a young adult with SSD] can take a selfie for her friends and tag it with “going to the gym, smiley” helping her maintain an identity similar to her friends. (Relative of an individual with SSD) | ||
Good and bad days | Once, I heard on the radio that you can climb a hill in different ways. You can run, you can walk, and you can crawl…but we all need to get up there. (Young adult with SSD) | ||
a) Guidelines and procedures for contacting appropriate parties if needed. b) Strategies for combining group facilitation with selective participation. c) reflection on non-fitness related goals in community-based exercise. | Promoting exercise as shared activity | Safe space | Trust that others [health professionals] have the responsibility to address this, not themselves [instructors]. They are just one part of the journey for the young person to feel better. No further demands should be imposed on the instructors besides doing the best they can and knowing that they are doing something good. (Relative of an individual with SSD) |
Making exercise meaningful | Having a playful part at the beginning [of an exercise class] really loosened up the atmosphere…playing around positively affected the dynamic… and ending the class well…having a good experience to go home with. (Exercise instructor) | ||
Alone and together | They can give each other so much. Somebody may contribute with more motivation. Sometimes, you may come up with your own goals, but you may also be inspired by others, and suddenly, you have a common goal. (Physiotherapists working in mental healthcare) |