Targeted Health Dialogues for Individuals With Psychosis Spectrum Disorders

In Sweden, individuals with schizophrenia are often treated at a psychiatric outpatient clinic where staff and patients build therapeutic relationships. Therapeutic relationships between patients and staff are considered essential for high-quality care in those settings and can contribute to patients adhering to treatment even during extended care periods, common in psyotic spectrum disorders. In Sweden, during psychiatric outpatient care, data is collected yearly regarding self-reported health-related quality of life, alcohol and drug consumption, smoking habits, length, weight, blood pressure, lipid profile, fasting glucose and HbA1c mmol/mol value. All data, together with information on completed health consultations (not specifically defined), shall be reported for each patient to the Swedish bipolar and psychosis registry. Since individuals with schizophrenia may disengage from community care but often stay in contact with a specialist mental health nurse at a psychiatric outpatient clinic, it may be possible to integrate targeted health dialogues during consultation in outpatient care in order to support positive lifestyle changes to prevent noncommunicable diseases.

Project description A prospective approach will be used in order to investigate possible associations between exposure to targeted health dialogues and blood tests collected from patients' records and selected health-related measures. Moreover, interviews will be performed with participants about their experiences and the perceived effects of targeted health dialogues. Age, sex, diagnosis, disease duration, pharmacological treatment, and number of visits will beretrieved from the patient records during project duration.

The study will include the following measurements. Blood test values collected from patient records (lipid profile (total-cholesterol, triglycerides, HDL-Cholesterol and LDL-cholesterol) fasting glucose, HbA1C). Blood pressure, waist-to hip ratio, Body Mass Index (BMI). Health literacy, S-FHL (Skala för funktionell hälsolitteracitet) (Wångdahl \& Mårtensson, 2015), to support the specialist nurses in the adjustment of the dialogue to participants' ability to comprehend, and utilize health information. Three-dimensional Health questionnaire rendering The Health curve (Hälsokurvan).

Health-related quality of life (HRQoL) measures (RAND-36 and EQ VAS). Participants will be one-on-one interviewed regarding perception of feasibility and acceptability, and any perceived effects. Sample The sample will be consecutive. Inclusion criteria: adult patients with psychotic spectrum disorders (PSD) (schizophrenia, schizoaffective, psychosis NOS), mentally stable in their illness, and adequate Swedish language skills.

Targeted health dialogues Targeted health dialogues will be implemented utilizing a visual tool, the "Health curve" (Hälsokurvan). The "Health curve" displays the individual health profile, which is derived from participants' responses to three health domains. The domains under investigation encompass Dietary patterns, Levels of physical activity, and aggregated Alcohol and tobacco use, as well as Psychosocial circumstances and Hereditary predispositions to diabetes and cardiovascular diseases. The "Health curve" has three colors, ranging from green to red, with red indicating high risk. The conversation will be conducted as a person-centred dialogue, focusing on the participant's own motivation and goals for lifestyle changes.

Staff training Nursing staff will participate in a one-hour education and training session on using targeted health dialogues. The education and training sessions will be led by a nurse specialized in mental health care.

Settings and procedures Patients with a history of PSD (> 5 years from admission) cared for at any psychiatric outpatient clinic in Region Uppsala will be invited to participate in the intervention. A power analysis was conducted to estimate the required sample size to enable comparisons of mean differences given an effect size of 0.5. A total of 60 participants will be approached to account for an anticipated attrition rate of approximately 30%. Those who meet the inclusion criteria will receive information about the study and an invitation to participate in connection with a call to their routine 1-year follow-up. Informed consent will be obtained when participants come to the clinic for the follow-up at baseline. After giving informed consent, information about the participant's diagnosis, disease duration, number of visits, and blood test values lipid profile (total-cholesterol, triglycerides, HDL Cholesterol and LDL-cholesterol) fasting glucose, HbA1C will be retrieved from the patient records. These blood tests are part of ordinary routine care before the yearly follow-up visit at the outpatient clinic. Demographic information will be retrieved from patient records and participating patients will answer the health literacy questionnaire, two HRQoL questionnaires, and the health questionnaire. This procedure will take approximately 30 minutes, followed by a one-hour-long targeted health dialogue. After this first health dialogue, participants will have their blood pressure, waist-to-hip ratio and Body Mass Index (BMI) assessed. At 6 months, participants will answer the health questionnaire and participate in a one-hour long targeted health dialogue. Afterwards participants will have their blood pressure, waist-to hip ratio and BMI assessed.

When the patients come to their routine 1-year follow-up, after 12 months from baseline, blood test values lipid profile (total-cholesterol, triglycerides, HDL-Cholesterol and LDL cholesterol) fasting glucose, HbA1C will be retrieved from the patient records. Participants will answer the two HRQoL questionnaires and the health questionnaire and have their blood pressure, waist-to-hip ratio and Body Mass Index (BMI) assessed. All patients will also be invited to participate in audio-recorded one-on-one interviews regarding perception of feasibility and acceptability, and any perceived effects of the targeted health dialogue. The interview will be conducted at the outpatient clinic, online, or at telephone according to the participants choice.

Analyses Statistical analyses will include paired tests of changes over time in selected variables, between time points, and strength and direction of correlations between variables. Regression analyses will be used to assess predictive value of patient caracteristics at baselinewith regard to the defined outcome measures. Data from the concluding interviews will be transcribed verbatim and a collaborative qualitative data analysis will be performed