Identifying barriers and facilitators for health risk behaviours among people with severe mental illness in Bangladesh and Pakistan: a qualitative study

Badur Un Nisa; Imogen Featherstone; Gerardo A. Zavala; Humaira Bibi; Md Badruddin Saify; Mahmudul Hasan; Faiza Aslam; Asad Tamizuddin Nizami; Rumana Haque; Najma Siddiqi; Richard I.G. Holt; Hannah Jennings

doi:10.1017/gmh.2025.10016

Identifying barriers and facilitators for health risk behaviours among people with severe mental illness in Bangladesh and Pakistan: a qualitative study

Badur Un Nisa, Imogen Featherstone, Gerardo A. Zavala^*, Humaira Bibi, Md Badruddin Saify, Mahmudul Hasan, Faiza Aslam, Asad Tamizuddin Nizami, Rumana Haque, Najma Siddiqi, Richard I.G. Holt, Hannah Jennings

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

People with severe mental illness (SMI) are at greater risk of obesity, cardiovascular disease and diabetes than the general population, due to a higher prevalence of health risk behaviours. Research is needed to inform tailored interventions to improve the health behaviours (diet, physical activity and sleep) of people with SMI in South Asia as these behaviours are closely linked to obesity. The study aimed to explore the barriers and facilitators to healthy diet, physical activity and good sleep among individuals with SMI. A qualitative design was employed using photovoice, semi-structured interviews and focus group discussions. Participants included 16 people with SMI, 16 caregivers and 17 health professionals in Bangladesh and Pakistan. Data were analysed thematically, informed by the socio-ecological framework. A complex interplay of individual, familial and societal factors influenced these health behaviours. Individual factors include knowledge, beliefs and mental health limitations. Caregivers play a crucial role in influencing behaviour. At the societal level, gender expectations, financial constraints and religious influences significantly impact these behaviours. The insights from this research can inform tailored interventions for this vulnerable group and highlight the need for integrated services, financial support and improved urban planning.

Original language	English
Article number	e63
Number of pages	9
Journal	Cambridge Prisms: Global Mental Health
Volume	12
Early online date	30 May 2025
DOIs	https://doi.org/10.1017/gmh.2025.10016
Publication status	E-pub ahead of print - 30 May 2025

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identifying-barriers-and-facilitators-for-health-risk-behaviours-among-people-with-severe-mental-illness-in-bangladesh-and-pakistan-a-qualitative-studyFinal published version, 332 KBLicence: CC BY

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Nisa, B. U., Featherstone, I., Zavala, G. A., Bibi, H., Saify, M. B., Hasan, M., Aslam, F., Nizami, A. T., Haque, R., Siddiqi, N., Holt, R. I. G., & Jennings, H. (2025). Identifying barriers and facilitators for health risk behaviours among people with severe mental illness in Bangladesh and Pakistan: a qualitative study. Cambridge Prisms: Global Mental Health, 12, Article e63. Advance online publication. https://doi.org/10.1017/gmh.2025.10016

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abstract = "People with severe mental illness (SMI) are at greater risk of obesity, cardiovascular disease and diabetes than the general population, due to a higher prevalence of health risk behaviours. Research is needed to inform tailored interventions to improve the health behaviours (diet, physical activity and sleep) of people with SMI in South Asia as these behaviours are closely linked to obesity. The study aimed to explore the barriers and facilitators to healthy diet, physical activity and good sleep among individuals with SMI. A qualitative design was employed using photovoice, semi-structured interviews and focus group discussions. Participants included 16 people with SMI, 16 caregivers and 17 health professionals in Bangladesh and Pakistan. Data were analysed thematically, informed by the socio-ecological framework. A complex interplay of individual, familial and societal factors influenced these health behaviours. Individual factors include knowledge, beliefs and mental health limitations. Caregivers play a crucial role in influencing behaviour. At the societal level, gender expectations, financial constraints and religious influences significantly impact these behaviours. The insights from this research can inform tailored interventions for this vulnerable group and highlight the need for integrated services, financial support and improved urban planning.",

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Nisa, BU, Featherstone, I , Zavala, GA, Bibi, H, Saify, MB, Hasan, M, Aslam, F, Nizami, AT, Haque, R, Siddiqi, N, Holt, RIG & Jennings, H 2025, 'Identifying barriers and facilitators for health risk behaviours among people with severe mental illness in Bangladesh and Pakistan: a qualitative study', Cambridge Prisms: Global Mental Health, vol. 12, e63. https://doi.org/10.1017/gmh.2025.10016

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AU - Featherstone, Imogen

AU - Zavala, Gerardo A.

AU - Bibi, Humaira

AU - Saify, Md Badruddin

AU - Hasan, Mahmudul

AU - Aslam, Faiza

AU - Nizami, Asad Tamizuddin

AU - Haque, Rumana

AU - Siddiqi, Najma

AU - Holt, Richard I.G.

AU - Jennings, Hannah

PY - 2025/5/30

Y1 - 2025/5/30

N2 - People with severe mental illness (SMI) are at greater risk of obesity, cardiovascular disease and diabetes than the general population, due to a higher prevalence of health risk behaviours. Research is needed to inform tailored interventions to improve the health behaviours (diet, physical activity and sleep) of people with SMI in South Asia as these behaviours are closely linked to obesity. The study aimed to explore the barriers and facilitators to healthy diet, physical activity and good sleep among individuals with SMI. A qualitative design was employed using photovoice, semi-structured interviews and focus group discussions. Participants included 16 people with SMI, 16 caregivers and 17 health professionals in Bangladesh and Pakistan. Data were analysed thematically, informed by the socio-ecological framework. A complex interplay of individual, familial and societal factors influenced these health behaviours. Individual factors include knowledge, beliefs and mental health limitations. Caregivers play a crucial role in influencing behaviour. At the societal level, gender expectations, financial constraints and religious influences significantly impact these behaviours. The insights from this research can inform tailored interventions for this vulnerable group and highlight the need for integrated services, financial support and improved urban planning.

AB - People with severe mental illness (SMI) are at greater risk of obesity, cardiovascular disease and diabetes than the general population, due to a higher prevalence of health risk behaviours. Research is needed to inform tailored interventions to improve the health behaviours (diet, physical activity and sleep) of people with SMI in South Asia as these behaviours are closely linked to obesity. The study aimed to explore the barriers and facilitators to healthy diet, physical activity and good sleep among individuals with SMI. A qualitative design was employed using photovoice, semi-structured interviews and focus group discussions. Participants included 16 people with SMI, 16 caregivers and 17 health professionals in Bangladesh and Pakistan. Data were analysed thematically, informed by the socio-ecological framework. A complex interplay of individual, familial and societal factors influenced these health behaviours. Individual factors include knowledge, beliefs and mental health limitations. Caregivers play a crucial role in influencing behaviour. At the societal level, gender expectations, financial constraints and religious influences significantly impact these behaviours. The insights from this research can inform tailored interventions for this vulnerable group and highlight the need for integrated services, financial support and improved urban planning.

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Identifying barriers and facilitators for health risk behaviours among people with severe mental illness in Bangladesh and Pakistan: a qualitative study

Abstract

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