Edinburgh Napier University

  Introduction: Physical activity (PA) is beneficial for improving both physical and mental health. However, people with mental health conditions are more likely to be inactive. In order to encourage adherence to PA, the Scottish Association for Mental Health (SAMH) developed the Active Living Becomes Achievable (ALBA) intervention, which aimed to help people with poor physical and/or mental health to increase and maintain their PA levels. The main aim of this thesis was to evaluate the effectiveness of the ALBA intervention at increasing PA levels, improving mental wellbeing, self-efficacy for exercise, self-esteem and patient activation.
Method: A mixed method approach was adopted for evaluating the ALBA intervention, which formed the basis of four studies:
Study 1: a formative investigation, in the form of a systematic review was conducted to assess the effectiveness of cognitive-behavioural interventions at increasing adherence to PA in mental health populations.
Study 2: a qualitative process evaluation, using focus groups with participants. Barriers and facilitators to adhering to the intervention were identified using the Theoretical Domains Framework (TDF).
Study 3: a qualitative process evaluation using focus groups with the Behaviour Change Practitioners (BCP) who delivered the ALBA intervention. Thematic analysis was used to identify themes, which were then mapped onto the TDF, to identify the barriers and facilitators to the implementation of the intervention.
Study 4: A quantitative outcome evaluation, with a before and after design was carried out to assess the effectiveness of the intervention. Participants completed 5 outcome measures and wore an activity tracker for 16 weeks. Participants who opted into the long-term study were monitored for up to 12-months.
Results: The outcome evaluation revealed that 53% of the participants adhered to the intervention, however, the intervention did not appear to increase adherence to PA guidelines. The ALBA intervention had a significant positive impact on mental wellbeing, patient activation and self-efficacy, but not self-esteem. The qualitative evaluation suggested the intervention helped participants overcome the barriers they faced which prevented them from becoming active. There was a particular focus on role the BCP’s played in encouraging engagement in PA. The barriers to the delivery faced by the BCP’s mainly related to organisational and contextual factors.
Conclusions: The ALBA intervention was effective at improving mental wellbeing but did not have a significant effect on PA levels. This suggests that the additional support offered through the ALBA intervention was key to improving wellbeing and encouraging PA in mental health population should be considered in a wider context of recovery.