Evaluating the effectiveness of a healthy lifestyle clinician in addressing the chronic disease risk behaviours of community mental health clients

A healthy lifestyle clinician will be embedded in one community-based mental health service in a regional area in the state of New South Wales (NSW), Australia, with the specific role of providing assessment, advice and referral to evidence based behaviour change services to modify the chronic disease risk behaviours of clients (smoking, poor nutrition, inadequate physical activity and harmful alcohol consumption). The clinician will be a mental health clinician with experience in delivering mental health care in a community setting. Clients allocated to the intervention condition will receive a 40-minute face-to-face consultation and follow-up call with the healthy lifestyle clinician, in addition to care they might receive in the context of their routine mental health consultations. The intervention will be implemented according to a manualised protocol based on motivational interviewing principles, with the aims of fostering client motivation for modification of risk behaviours and uptake of telephone coaching services (NSW Quitline (smoking) and NSW Get Healthy Information and Coaching Service (poor nutrition, physical inactivity, alcohol consumption and weight management)). The manual will guide the healthy lifestyle clinician to: 1) Assess risk. The healthy lifestyle clinician will assess the client’s chronic disease risk behaviours through a structured questionnaire evaluating the clients risk status in accordance with national guidelines. The clinician will assess abdominal adiposity as a sequelae of physical inactivity and inadequate fruit and vegetable consumption. The clinician will also ask the client if they have any concerns in relation to their weight or nutrition more broadly than fruit and vegetable consumption. 2) Advise. The clinician will provide brief feedback to the client in a non-judgemental manner as to how their behaviours compare against national guidelines. Clients identified as meeting the national guidelines for one or more of the behaviours will be provided positive feedback on the health benefits of their behaviour. If the client is identified as being at-risk according to the national guidelines for any one or more of the behaviours, the healthy lifestyle clinician will provide brief advice to modify the behaviour. Further intervention based on motivational interviewing techniques will be provided for the risk behaviours, which is designed to address any ambivalence regarding the current behaviour and motivate for change. Specific strategies utilised and content discussed will be tailored to each client and may include: education about current levels of behaviour and associated health impacts; further information about guidelines and recommendations reinforcing positive intentions to change behaviour; consideration of the barriers to change; and building self-efficacy. 3) Refer. Clients who are at-risk for smoking will be offered a referral to the NSW Quitline and in line with care offered by the NSW Get Healthy Information and Coaching Service, clients who are at-risk and/or express concern about their physical activity, weight, nutrition or alcohol consumption will be offered a referral to the Get Healthy Information and Coaching Service. If appropriate, clients will be offered a referral to both telephone services. The NSW Get Healthy Information and Coaching Service offers ten free individual coaching sessions over a six-month period to support individuals in setting and achieving weight-related behaviour change goals. The NSW Quitline offers six free individual telephone coaching sessions to support individuals to stop smoking. In line with clinical practice guidelines, all clients will be referred to their general practitioner for assessment of metabolic risks. Approximately one week following the consultation with the healthy lifestyle clinician, the clinician will call the client to follow-up on any referrals made and briefly discuss their progress. The call will take approximately 20 minutes. Positive feedback will be provided to clients who have had contact with the telephone services and/or attended the appointment with their GP, to further encourage behaviour change. Where clients have not yet taken up referrals made, the clinician will provide encouragement to do so and seek to identify and address any barriers the client may have. To monitor adherence, a checklist will be used by the healthy lifestyle clinician to record the aspects of the intervention that were delivered. In addition, the clinician will have regular supervision and feedback from a senior clinician with expertise in motivational interviewing.