Article Title

Making Health Changes: Following Preventive Service Guidelines and Changing Behavior Among Individuals With Serious Mental Illnesses

Publication Date



behavior change, preventive service use


Background/Aims: People with serious mental illnesses generally experience greater morbidity and earlier mortality than individuals without mental health diagnoses. Understanding factors that influence preventive service use and assist people in making healthy behavior changes may reduce health disparities in this population.

Methods: This mixed-methods study, conducted in an integrated health system, federally qualified health centers and safety net clinics, derived diagnoses and needed preventive services from the electronic medical record to identify a sample (N = 142) representing a range of prevention needs. Individuals from four diagnostic groups (schizophrenia spectrum disorders [n = 41], bipolar disorders/affective psychoses [n = 48], major depressive disorders [n = 33], anxiety disorders [n = 20]) completed questionnaires and semi-structured interviews. Survey data were analyzed using SPSS; interviews were transcribed verbatim and coded using Atlas.ti.

Results: Nearly 50% of participants reported they would be “extremely likely” to make changes their doctor recommended on completing lab work, mammogram screenings, getting a flu shot and completing colon cancer screening. Only 20% reported they were extremely likely to improve nutrition or increase exercise, even with doctor recommendations. Among smokers, 28% reported they were “not at all likely” to follow doctor recommendations to stop or cut back. Reported likelihood did not differ by gender, diagnostic group or study site. While 46% reported they were “extremely” or “very confident” in following through with recommended health changes, 78% reported they could use at least “a little more support” with making recommended changes. Narrative analyses revealed three themes related to making changes: 1) making and sustaining health-related behavioral changes (e.g. losing weight/stopping smoking) were difficult compared with completing preventive services (e.g. doing lab work), 2) additional targeted support was needed to make and sustain complex changes (e.g. weight loss), and 3) lack of knowledge about reasons for preventive care inhibits completion of some services (e.g. colorectal screening).

Conclusion: Among people with serious mental illnesses, likelihood of following doctor recommendations is relatively low for important behavioral changes such as stopping smoking or increasing exercise. Additional support is needed to encourage completion of some difficult or invasive preventive services and for making and sustaining significant changes in health-related behaviors.




July 5th, 2016


August 12th, 2016