Factors that influence the implementation of "sit less, move more" interventions in an outpatient mental health care setting

Introduction: Few interventions in outpatient mental health care settings focus on tackling excessive sedentary behaviour in patients with severe mental illness (SMI). In order to develop effective strategies for reducing prolonged sedentary behaviour in these patients, the aim of this study was to understand and identify factors that influence sitting less (and moving more) from the perspectives of both patients and health care practitioners (HCPs).Methods: Qualitative data were gathered from patients with SMI (3 focus groups, 18 participants, mean age 39.8 years, one third female) and HCPs (2 focus groups, 15 participants, mean age 43.7, one third female) in an outpatient mental health care setting in the county of Osona (Barcelona), between January and March 2018. Data were analysed using inductive thematic content analysis. Results: Four factors relating to sitting less and moving more emerged from patients: "social isolation and stig-matization", "lack of social support", "difficulty following advice from HPCs", and "sedation due to medication." HCPs also identified four factors that constrained their ability to introduce strategies for sitting less and moving more with patients with SMI: "emphasis placed on the pathology", "HCPs' inadequate knowledge about the wider consequences of sedentary behaviour", "HCPs' insufficient advice on sitting less and moving more" and "HCPs' lack of tools and time for promoting sitting less and moving more".Discussion: These findings provide practical insights into factors that could enable the introduction of sit less, move more interventions in outpatient mental health care settings. Special focus should be placed on promoting socialization.