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Table 3 Aims for the lifestyle behaviour screening and the follow-up phase in the lifestyle intervention

From: Design of the Lifestyle Interventions for severe mentally ill Outpatients in the Netherlands (LION) trial; a cluster randomised controlled study of a multidimensional web tool intervention to improve cardiometabolic health in patients with severe mental illness

Aim Description of aim per phase
Lifestyle behaviour screening phase
1 Identify unhealthy lifestyle behaviours. The tool uses a traffic light principle for a clear visible presentation of possible health risks related to certain lifestyle behaviours, with green colours representing behaviours with low or no health related risk and red colours representing behaviours with high health related risks (see Fig. 2b).
2 Increase patient’s and nurse’s knowledge of healthy lifestyle behaviours. The tool provides direct feedback on what healthy behaviours are according to (inter)national guidelines and gives additional information to increase patient’s and nurse’s knowledge on healthy lifestyle behaviours (see Fig. 2b).
3 Create awareness. Patients are challenged to discuss identified risk factors and nurses support patients in deciding what lifestyle behaviours to change. Nurses use MI and stages-of-change techniques to assist patients in identifying their problems and overcoming ambivalence or resistance to behaviour change. It is supported by regularly classifying the patient’s current stage-of-change.
4 Create a lifestyle plan with concrete and reachable goals. Based on the lifestyle anamnesis and discussion with the nurse, patients set maximum three goals to achieve according to the criteria of S.M.A.R.T.-goals [58]. The nurse’s role is to support patients in setting realistic goals. Patients explore which interventions are available and seem attractive, and what is needed to reach goals. Active self-management of patients is encouraged, support of family and friends is explored and, when available and deemed necessary, incorporated in the plan.
Follow-up phase
6 Evaluating lifestyle goals systematically on a regular basis. During every regular care visit, a new follow-up file is uploaded and filled in by patient and nurse. By doing this, continuity is ensured and this repetitive character will lead to more sustainable behaviour change.
7 Barriers and facilitators in achieving lifestyle goals are indicated. Patient and nurse discuss which factors are helpful in achieving goals and which factors limit achieving goals in order to increase the success of achieving the goals in the following period. Again, nurses use motivational interviewing techniques and the stages-of-change of the transtheoretical model.