Promoting exercise behaviour in a secure mental health setting: health care assistant perspectives

Individuals with severe mental illness engage in significantly less amounts of physical activity than the general population. A secure mental health setting can exacerbate barriers to exercise, and facilitate physical inactivity and sedentary behaviour. Health Care Assistants are intimately involved in the daily lives of patients and therefore, should be considered integral to exercise promotion in secure mental health settings. Our aim was to explore Health Care Assistants perceptions of exercise and their attitudes to exercise promotion for adult patients in a secure mental health hospital. Qualitative semi-structured interviews were conducted with 11 Health Care Assistants from a large UK based secure mental health hospital. Topics included Health Care Assistants personal experiences of exercise within a secure facility, their perceptions of exercise as an effective treatment tool for mental health, and their perceived roles and responsibilities for exercise promotion. Thematic analysis was used to analyse the data. Three main themes were identified; 1) exercise as multiply beneficial for patients, 2) perceived barriers to effective exercise promotion, and 3) strategies for effectives exercise promotion. Health Care Assistants considered exercise to hold patient benefits. However, core organisational and individual barriers limited Health Care Assistants exercise promotion efforts. An informal approach to exercise promotion was deemed most effective to some, whereas others committed to more formal strategies including compulsory sessions. With education and organisational support, we propose Health Care Assistants are well placed to identify individual needs for exercise promotion. Their consultation could lead to more efficacious, person-sensitive interventions.