A Collaborative Approach to Health Promotion Targeting People with Mental Illness at Risk of Diabetes—A Process Evaluation

People with mental illness (users) have a notable higher risk of developing type 2 diabetes than the general population. Recent studies show that traditional lifestyle interventions focusing solely on exercise and diet targeting users have small effect. Studies suggest that collaborative approaches as a starting point for health behavior change is more beneficial, but implementation into practice is a challenge. Using the Medical Research Council’s guidance for process evaluation, we explored implementation of a collaborative approach in health promotion activities targeting users at risk of diabetes. The collaborative approach focused on involvement of users in the agenda setting and reflection about readiness to change health behavior and was supported by dialogue tools (e.g., quotes and games), developed in collaboration with users. Educators received three days of training in applying the approach. Collected data included questionnaires for users (n=154) and educators (n=158), interviews with users (n=14) and educators (n=10) and observations of health activities (n=37). Data were analyzed using descriptive statistics and systematic text condensation. The majority of educators tested the approach in their practice and tried at least one tool (96%). Users expressed that the approach supported them in expressing their thoughts regarding their health and directed focus on their needs rather than the agenda of the educator. Most users strongly agreed that educators were open-minded and responsive (93%). However, observations showed that some educators overlooked cues from users regarding motivation for health behavior change. Furthermore, educators pointed to lack of involvement from their managers as a barrier for implementation. Implementation of a collaborative approach was feasible in practice. However, training of educators in active listening and involvement of managers prior to implementation should be prioritized further.