Mental Health Service Provider’s Perceptions Of The Relationship

Mental Health Service Provider’s Perceptions Of The Relationship Between Physical Activity And The Well-being Of People Aged 55-75

1. Chapter 2: Literature Review

1.1 Introduction

Neurological, mental, and psychiatric disorders among older adults constitute a significant challenge across the globe (Mugisha et al., 2019). Despite the increased risk of the challenges, the issue of mental health services always remains untouched. However, the longevity of mental health concerns is rising among older adults, whereas life expectancy has also risen over the period (Muennig et al., 2018). Considering this, it is important to ensure that the individuals are not only living comparatively longer lives but are also maintaining the optimal level of their mental well-being (Boehm et al., 2018). This literature review aims to discuss and critically evaluate the existing literature on the perspectives of mental health services provided on the concern of promoting mental well-being and addressing the positive role of physical activity interventions in enhancing psychological outcomes among older adults aged 55-75. 

1.2 Critical Review of Existing Literature
1.2.1 Physical Activity Interventions in Mental Health Services in Relation with the Improved Psychological Outcomes

Physical activity includes the involvement of an individual in various movements that can be either moderate or vigorous based on the intensity of the activity. The intervention of physical activity in the mental health service of aged people plays an important role in improving overall psychological outcomes (Dasso et al., 2019). These outcomes include improvement in the symptoms of depression, stress, and anxiety, along with aiding in anger management and irritability (Petruzzello et al., 2020). These interventions can be helpful when friends and family of an individual get involved in creating an environment that can further help in behavioural counselling. However, there is a wide range of interventions that include various activities such as mindfulness practices, regular physical training, social support, community sports programs, structured exercise programs, yoga, etc. (Aditya et al., 2023). 

One of the studies conducted by Belcher et al., 2021, highlighted that being involved in regular physical activity can impact mental health traits, including improved cognition, mood, and self-esteem. The study further explained that exercise therapies are linked with reduced symptoms of depression and anxiety. Another study conducted by Maher et al., 2019, highlighted that people who are involved in regular physical activities feel more energetic, get better sleep, feel more relaxed throughout the day, and perceive positively about themselves and others in general throughout the day.

1.2.2 Perspectives of Mental Health Service Providers in Physical Activity Promotion and Identification of Barriers

The integration and promotion of physical activity (PA) within the domain of mental health services is important for enhancing the mental illness (MI) and overall well-being of individuals (Mugisha et al., 2019). However, in the area of mental health settings, healthcare providers (HCPs) play a crucial and key role in promoting the usefulness of PA for treating Mental Illness (MI). The perception of HCPs indicated that there is a large effect of exercise on reducing symptoms of schizophrenia, clinical anxiety, depression, and stress and moderately improving the quality of life (McCurdy et al., 2020). However, some of the HCPs have identified that being involved in exercises can impact the moods of individuals who are experiencing bipolar disorder. In this condition, exercise can be considered as an important intervention. The National Institute for Clinical Excellence (NICE) has also recommended that HCPs should use PA along with other healthcare programs for treating the symptoms of psychosis (Glowacki et al., 2019). 

Alongside this, the Canadian Network for Mood and Anxiety Treatments (CANMAT) has identified that exercise should be considered as the first line of treatment for patients with mild-to-moderate depression (Ravindran ET AL., 2018). However, the difference in the attitudes towards PA in mental healthcare settings might influence the willingness to promote and prioritise these activities in their treatment practices. Considering the perceptions, many studies have highlighted that including yoga as meditation therapy may set off a physiological reaction, which is known as the relaxation response and can be beneficial in treating mental health issues (Shannahoff-Khalsa et al., 2019). Many researchers have recognised the beneficial impact of yoga on the mental well-being of older adults, but sometimes, it may become the reason for unintended negative consequences on individuals. One of the studies conducted found that older adults who were engaging in resistance training, callisthenics, and aerobic exercises experienced increased psychological well-being (Kekäläinen et al., 2019). Considering these impacts, various barriers that are perceived by HCPs in the course of promoting PA for individuals having MI include ineffective treatment strategies, limited resources, lack of communication, literacy rate, inadequate training, and risk of adverse impacts (Williamson et al., 2021). Understanding these perspectives of HCPs would help in designing strategies and approaches that will aid in providing mental health support to older adults.

1.2.3 Implementation Strategies for Promoting Physical Activity in Mental Health Care Among Older Adults

A more focused and systemic approach is required to introduce intervention strategies among older adults. This can be done by assessing activity-related behaviour that can be measured using the Global Physical Activity Questionnaire (GPAQ), sedentary behaviours, sleep durations, and quality of life using the EUROHIS-QOL 8-item index (Luo et al., 2023). While considering behaviour change techniques, healthcare providers can provide counselling sessions, conduct seminars and workshops, providing education on the benefits of physical activity (Howlett et al., 2019). This can be done by encouraging and offering support. Alongside this, one of the other effective strategies includes the utilisation of the Fraility Instrument of the Survey Health, Ageing and Retirement in Europe, which is measured with the Tilburg Frailty Indicator (TFI). This instrument proved to be one of the reliable methods for identifying frailty in community-dwelling older adults (Zhang et al., 2020). Furthermore, building an environment that supports active engagement and aids in promoting increased physical activity can also be considered. Moreover, engaging older adults in activities like walking, gardening, and climbing stairs can improve their functional capabilities. Building such environments can make it comparatively easier for them to enjoy outdoor PA, which will ultimately contribute to their improved quality of life (Kärmeniemi et al., 2018).

Furthermore, integrating internet -of-Thing (IoT) can help in track their activity of daily life (ADLs) among older adults which will help in supporting the health outcomes of the aging population. However, several barriers are associated with this which include battery/power issues, inaccurate sensory detection, and low usability among the older population (Baig et al., 2019). 

1.3 Theoretical Framework 

1.3.1 Health Belief Model (HBM)

The Health Belief Model (HBM) is a behaviour change framework which is based on enhanced perceptions of personal risks, increasing knowledge of health challenges, and encouraging actions for eliminating the perceived risks. This model predicts that the behavior of an individual depends on the social context. However, the perception of mental healthcare providers of physical activity among older adults resonates with the principle of HBM. This model assesses the perception of susceptibility and seriousness of the issues of older adults. 

1.3.2 Social Cognitive Theory (SCT)

The Social Cognitive Theory (SCT) explores the external and internal social influence on the behavioral actions of individuals (YAKUT et al., 2019). Based on this theory, there are several constructs, including reciprocal determinism, behavioural capability, observational learning, reinforcements, self-efficacy, and expectations (Adhikari et al., 2018). However, the perception of mental health service providers of physical activity aligns with this theory as the HCPs follow their learned experiences that are usually shaped by the observation of their own experiences, their confidence, and others' behaviour while promoting and implementing interventions of physical activity (Ghoreishi et al., 2019). Furthermore, these approaches would help enhance self-efficacy and motivation among the older population, which will make it easier to engage them in physical activities (Zamani-Alavijeh et al., 2019).

1.3.3 Successful Aging Theory

The Successful Agein Theory has three components, including continuous engagement with life, reduced disability, and maintenance of cognitive and physical functioning (Vaccarino et al., 2019). However, the perception of mental health service providers of physical activity aligns with this theory as the HCPs emphasise and strive to implement strategies where older adults age successfully. This can be achieved by involving in physical activities that will boost the cognitive function of the brain and ultimately promote active living later in life (Forrest et al., 2021). Alongside this, by promoting physical activity, introducing smart interventions, and providing support to older adults to achieve the best quality of life, HCPs can resonate with the principles of this theory (McCurdy et al., 2020).

1.4 Statement of Research Questions
1.4.1 Main Research Question

What are mental health service providers' perceptions of the relationship between physical activity and the well-being of individuals aged 55-75?

1.4.2 Sub-research Questions

RQ1: What factors influence mental health service providers' perspectives on the relationship between physical activity and well-being among individuals aged 55-75?

RQ2: What recommendations do mental health service providers have regarding the implementation of physical activity interventions for individuals aged 55-75?

RQ3: What barriers do mental health service providers perceive in promoting physical activity among individuals aged 55-75, and how do they suggest overcoming these barriers?

1.5 Justification for the Study 

This study explores the perception of healthcare providers on the relationship between physical activity and the well-being of individuals aged 55-75, which holds significance for multiple reasons. The most important reason is, currently, across the globe, the population of older adults who are aged 60 live with mental health illness is 10.6%, and almost 25% of the older adults who are 65 and older live with mental health conditions, including depression and anxiety (World Health Organization, 2023). Considering these statistics, there is a growing need to understand the importance and need of introducing physical activity interventions that will impact the overall well-being of older adults. 

Furthermore, practitioners and healthcare providers play an important role in delivering patient-centred care (Kuipers et al., 2021). Working on developing their attitudes and perspectives towards the interventions of physical activity within their clinical settings can help introduce more focused and tailored approaches for improving the mental health situation of older adults. Alongside, by addressing the potential barriers that are identified by the practitioners, including lack of resources, the study aimed to bring the attention of policymakers, stakeholders, and governmental authorities to making joint efforts for the betterment of the mental health of individuals aged 55-75 (Yitbarek et al., 2-21).

1.6 Identified Gaps
1.6.1 Limited Exploration of Influencing Factors

The existing literature has focused on identifying the factors that have influenced the perception of healthcare providers on physical activity, including attitudes, organisational support, and knowledge, but there is still a gap in the in-depth analysis of these factors. Furthermore, a deeper understanding of the dynamic connection between the factors, individuals, and organisations is needed to introduce tailored and effective strategies that will improve the practices of service providers.

1.6.2 Lack of Research Focus

This research focuses specifically on mental health services for the 55-75 age group. However, existing literature often covers the general or any specific population of individuals and patients, including adolescents and adults, ultimately neglecting the experience and perception of healthcare providers on the mental illness of older adults.

Addressing these gaps would help in introducing effective and targeted efforts that will ultimately contribute to a more focused understanding of the perception of mental healthcare providers on physical activity interventions for older adults. This research will also facilitate in developing tailored and effective strategies for promoting physical activity in this population. 

Conclusion 

In conclusion, understanding the perception of mental healthcare service providers and practitioners of interventions for physical activity among people aged 55-75 is considered the most important approach. However, in the area of mental health settings, healthcare providers (HCPs) play a most important and crucial role in promoting the usefulness of PA as part of their treatment strategies and approaches. Alongside this, the difference in the attitudes towards PA in mental healthcare settings might influence the willingness to promote and prioritise these activities in their treatment practices. Furthermore, HBM, SCT, and Successful Aging Theory identified the theoretical approaches that align perfectly with the perception of Healthcare providers. Through the exploration of these factors, several gaps were identified. This study aimed to contribute valuable insights into optimising the promotion of strategies for physical activity. Identification of these gaps will aid in suggesting future interventions and acknowledging diverse perceptions of the healthcare providers, ultimately leading to fostering the overall quality of life of older adults.

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