Key outcomes
Overall improvements in physical activity levels. Five studies reported
significant increases in PA levels (Chalder et al., 2012; Druss et al., 2010; Harrold et
al., 2017; Pentecost et al., 2015; Van Citters et al., 2010). Specifically, studies
reported: an increase in daily steps measured using pedometers (Harrold et al., 2017;
Matthews et al., 2016), accelerometery data (Aschbrenner et al., 2016; Chalder et al.,
2012; Pentecost et al., 2015; Perlman et al., 2010) and self-report daily diaries
recording bouts of 10 minute exercise (light, moderate and vigorous) the week prior
to assessment (Chalder et al., 2012; Pentecost et al., 2015) with an overall increase in
moderate to vigorous exercise per week. Qualitative data from studies which used
pedometers as PA measures found that participants viewed this tool as useful for
self-monitoring their PA levels (Matthews et al., 2016). Of the studies that collected
accelerometer data, high adherence rates were reported, with one study reporting
92% adherence (Pentecost et al., 2015).
Significant increases in PA were reported in pre-post findings for five studies
(Chalder et al., 2012; Druss et al., 2010; Harrold et al., 2017; Pentecost et al., 2015;
Van Citters et al., 2010) and maintained at follow ups which ranged from three to
nine months. Two studies reported no significant improvements in PA at follow ups
(Matthews et al., 2016; McGale et al., 2011). Three of seven studies that used a
comparison group found improvements in PA levels compared to the control
condition or a usual care group (Chalder et al., 2012; Druss et al., 2010; Pentecost et
al., 2015). One study with a sample of individuals
with intellectual disabilities failed to show any improvements in PA levels;
however individuals had accepted the importance of PA as a method to aid
their mental health recovery (Matthews et al., 2016).
Improvements to mental health. Seven studies found increased mental
wellbeing in participants who engaged in PA interventions (Druss et al., 2010;
Graham et al., 2017; Hoffmann et al., 2015; Malcolm et al., 2013; McGale et al.,
2011; Perlman et al., 2010; Van Citters et al., 2010). Other studies reported reduced
depressive symptoms (McGale et al., 2011), reduced anxiety (Malcolm et al., 2013),
reduced negative symptoms of mental health, such as lethargy, disorientation and
hopelessness affecting willingness to participate in PA (Hoffman et al., 2015; Van
Citters et al., 2010), and increased mental health functioning (Perlman et al., 2010;
Van Citters et al., 2010). Two studies reported no significant improvements in mood
or reduction of medication use (Chalder et al., 2012; Matthews et al., 2016).
Exercise-related psychosocial benefits. Nine studies demonstrated positive
change across a variety of psychosocial outcomes (Druss et al., 2010; Graham et al.,
2017; Hoffmann et al., 2015; Lesley & Livingood, 2015; Malcolm et al., 2013;
McGale et al., 2011; Pentecost et al., 2015; Perlman et al., 2010; Van Citters et al.,
2010). Participants experienced greater levels of enjoyment (Graham et al., 2017;
Lesley & Livingood, 2015), greater mood and increased alertness (Graham et al.,
2017; Hoffman et al., 2015). Participants reported gains in personal autonomy, with
increased self-efficacy, self-esteem and overall satisfaction with their fitness
(Graham et al., 2017; Malcolm et al., 2013; Van Citters et al., 2010).
Participants’ experienced reduced stigma associated with poor mental health and
mental illness (Graham et al., 2017) and an increased drive towards PA engagement
as well as increased behavioural activity (an individual’s self-management capacity,
Druss et al., 2010). The use of mHealth technology and social media was found to
increase participants’ motivation towards PA, further facilitating their self-
monitoring of PA engagement (Aschbrenner et al., 2016).
Nine studies found overall increases in general health, social wellbeing,
mental wellbeing and participants’ health-related quality of life (Druss et al., 2010;
Graham et al., 2017; Hoffmann et al., 2015; Lesley & Livingwood, 2015; Malcolm
et al., 2013; McGale et al., 2011; Pentecost et al., 2015; Perlman et al., 2010; Van
Citters et al., 2010). One study found improvements for participants in psychosocial
functioning and emotional role functioning, which was further sustained post-
intervention after attending the 15 sessions (Perlman et al., 2010). Group-based PA
sessions resulted in increased self-monitoring ability
and a reduction in isolated engagement through a group process effective in
encouraging positive behaviour change (Perlman et al., 2010). Findings from another
study reported a significant reduction in depression scores, leading to a greater
number of individuals viewing their lives in a more positive manner by the end of
the intervention period (McGale et al., 2011).
Knowledge relating to self-care. Results from four studies reported
improvements in knowledge about nutrition and PA, and the importance of PA for
positive mental health (Harrold et al., 2017; Matthews et al., 2016; Pentecost et al.,
2015; Van Citters et al., 2010). Participants included PA into daily routines to engage
in positive PA behaviour change (Pentecost et al., 2015). Results indicated that
participants had an increased drive to engage in PA following educational sessions
on positive behaviour change and lifestyle choices (Pentecost et al., 2015). One study
reported that participants experienced improvements in their feelings of comfort in
disclosing their mental health problems (Malcolm et al., 2013).
This was a result of positive feedback from others, the removal of barriers associated
with PA engagement, and individuals feeling motivated and better educated to make
positive behaviour choices (Malcolm et al., 2013).
One study found that individuals at both six and 12-month follow ups
commented that they began to feel self-driven and encouraged to try other things
whilst exercising on their own (Graham et al., 2017). However, results from a
different study found that individuals’ increased their willingness to engage in PA
through group influences, positive feedback from others and enhanced enjoyment of
PA (Van Citters et al., 2010). Group behaviour was reported to have a greater
influence on the motivation of individuals in the pre-contemplative stage of
behaviour change (Harrold et al., 2017).
Improved social connections. Seven studies reported benefits of a group-
based approach (Aschbrenner et al., 2016; Graham et al., 2017; Hoffmann et al.,
2015; Malcolm et al., 2013; McGale et al., 2011; Perlman et al., 2010; Van Citters et
al., 2010). Group processes were highly valued as effective for encouraging positive
behaviour change through lived experience (Van Citters et al., 2010). Opportunities
for sharing experiences and advice, listening to similar others and gaining mutual
support from fellow group peers facilitated engagement in PA sessions (Van Citters
et al., 2010). Community interventions provided the foundations for generating a
peer support network which extended outside of treatment sessions (Aschbrenner et
al., 2016).
Nine studies found a significant increase in perceived social support within
the PA interventions (Aschbrenner et al., 2016; Graham et al., 2017; Harrold et al.,
2017; Hoffmann
et al., 2015; Lesley & Livingood, 2015; Malcolm et al., 2013; McGale et al., 2011;
Pentecost et al., 2015; Perlman et al., 2010). Qualitative data demonstrated that
through a sense of relatedness to peers, they placed greater emphasis on the
importance of social interactions which were therefore key to their motivation
towards increased PA engagement (Graham et al., 2017). Participants named peers
as ‘social motivators’ thriving off positive feedback given by others, leading to
increased daily steps count due to motivation from peers (Graham et al., 2017).
Three studies focused on providing individualised sessions tailored to each
participant’s needs (Chalder et al., 2012; Lesley & Livingood, 2015; Pentecost et
al., 2015). This personalised approach was viewed positively, and alongside
structured support, was strongly associated with positive mental health and PA
behaviour (Lesley & Livingood, 2015). The bond formed between the participant
seeking behaviour change, and the peer/activity leader change agent, was an
important element of the working alliance within community-based PA
interventions for MHSU (Lesley & Livingood, 2015). The interpersonal
relationship contributed to the participant’s desire to continue routine PA workouts
(Lesley & Livingood, 2015).
Additionally, one study reported an increase in perceived social support by
participants in the exercise condition compared to a control condition (McGale et al.,
2011). However, this result did not stand when compared to the sport condition,
which received the greatest level of peer support (McGale et al., 2011). In contrast,
whilst results from a different study reported increased feelings of relatedness
between the peers and participants, there were also conflicts experienced between
peer volunteers and participants (Graham et al., 2017).
Discussion
The aim of this scoping review was to explore the current literature on
community- based PA interventions that have used a peer support approach for
MHSU. The number of studies aimed at PA promotion among individuals with
poor mental health research is increasing. However, the literature on peer support
community-based PA interventions for this specialist population group is still in
early stages of maturity and warrants greater intervention development and
implementation (Castro, Ng, Novoradovskaya, Bosselut, & Hassandra, 2017).
Overall, findings support a positive, significant effect of peer support within
community-based PA interventions on increasing PA levels. However, only the
positives of using peer support within community programmes for MHSU were
reported in this review, as the search terms did not bring the challenges of using
peer support to light.
This caveat highlights that challenges will have been present and provides scope to
consider this within future research.
Existing literature has evidenced that PA interventions aimed at MHSU result
in improved health behaviours and improved psychological wellbeing, increased
positive affect, decreased depressive and anxiety symptoms, and improved quality of
life (Dunn, Trivedi, Kampert, Clark, & Chambliss, 2005; Evans et al., 2017; Martin,
Church, Thompson, Earnest, & Blair, 2009; Stathopoulou, Powers, Berry, Smits, &
Otto, 2006). A protocol paper for conducting a systematic review using a meta-
ethnographic approach investigating community-based PA interventions and general
social support for serious mental illness has recently been published (Quirk et al.,
2017). Yet to our knowledge, this is the first scoping review of the literature on
community-based PA interventions for MHSU specifically incorporating a peer
support element of social support. The scoping review aimed to present an overview
of the under researched and potentially broad and diverse body of literature around
community-based PA programmes incorporating peer support (Pham et al., 2014).
Support from peers through social affiliation and group processes has shown
to be a facilitator of PA engagement and participation (Perlman et al., 2010).
Participants thrive in group-based PA sessions which facilitate social inclusion
(Perlman et al., 2010). As found by Graham and colleagues (2017), community
integration was key to increased social interactions leading to improvements in PA
levels and mental wellbeing. This can be explained by the creation of a social
identity within the group-based environment encouraging PA engagement (Soundy
et al., 2012). It has also been said that the social orientation of community-based
activities may be more appealing to MHSU than the activity itself (Quirk et al.,
2017).
Interventions that were individually tailored to participants’ needs led to an
increase in participant uptake of PA (Chalder et al., 2012; Matthews et al., 2016).
One study detailed the potential life changing impact of participation, reporting that
one participant who had rarely left their house in nine years prior to the
intervention had since gained greater confidence. This confidence through strong
connections with their health mentor led to the utilisation of resources within the
community and the individual returned to competitive employment (Van Citters et
al., 2010). This example supports that psychological benefits of community-based
interventions, as well as the clinically important ways that interventions can aid
individual recovery.
A community-based participatory research (CBPR) approach is based on
mutual trust and respect for the roles in the partnership, critical for the development
and implementation
of research with a vulnerable population in a community setting (Hacker, 2015). This
means that MHSU have an equal opportunity to contribute expertise, and share
decision making and ownership during intervention design, planning and
implementation (Graham et al., 2017; Hoffmann et al., 2015). Generally, theory-
based interventions have a positive impact on the PA behaviour of intervention
participants (Gourlan et al., 2016). Evidence from SDT informed studies suggests
that working with individuals to support empowerment, understanding, control and
influence over personal and social circumstances, and autonomy produces sustained
positive health behaviour changes and psychological wellbeing (Ryan et al., 2008).
This was independently reflected by MHSUs who identified the desire for peer-led
programmes to build on community-based strengths, foster engagement,
empowerment and use expertise within the community (Graham et al., 2017).
Several studies in the current review did not underpin design with any theory and
none used theories that considered automatic processes (emotion) as well as
individuals’ intentions and beliefs (e.g. Affective- reflective theory; Brand &
Ekkekakis, 2017). Future research should clearly outline the behaviour change
techniques and underpinning motivational or behaviour change theories used for
interventions. Specifically, SDT appears to be an appropriate theory to employ.
CBPR is a research approach used to identify social, structural and
environmental inequalities and engage in community action (Israel et al., 2005).
Although SDT is used to support individuals in positive behaviour change, the
incorporation of two congruent approaches - SDT and CBPR - were used to inform
the work of Graham and colleagues (2017) which allowed engagement and behaviour
change to be considered both on an individual and community level. Research should
consider adopting this approach to facilitate integration of participants’ voices into
the design of peer support community-based interventions. Existing reviews
including studies who have focused on MHSU have concluded that health promotion
interventions in general, and interventions incorporating PA, that are based on
explicitly described theoretical concepts, are more effective than those without a
theoretical underpinning (Dale et al., 2014; Ginis, Nigg, & Smith, 2013). Further
research is needed to specifically address the effectiveness of theory-based
interventions within community settings to promote PA among MHSU.
PA was measured in a variety of ways including both objective and self-
report (Chalder et al., 2012; Pentecost et al., 2015). Research has shown that
pedometers are a tool to enhance individuals’ motivation to increase their PA levels
(Gardner & Campagna, 2011; Rebar & Taylor, 2017; Vetrovsky et al., 2017).
However, a limitation of objective PA measures specifically for MHSU is that
participants who struggle with memory issues may
fail to wear the device (e.g., a wrist-watch) continuously for the entire seven-day
period (Harrold et al., 2017). Even in conjunction with a daily diary, accurate data
relies on a participant’s self-reported PA levels so results should be taken with
caution (Pentecost et al., 2015. More research is needed to look at both the
effectiveness and feasibility of using objective PA measures in this population
group (Chapman, Fraser, Brown, & Burton, 2016).
Twelve studies did not incorporate a comparable condition to the intervention
condition. One study reported improvements in PA levels, however stated that it was
difficult to disentangle the effect of the project as a whole from the effects of the
exercise on participants (Malcolm et al., 2013). The possible changes from baseline
to the three month follow ups could be a result of remission of mental health rather
than the effects of exercise, or the increased PA may be a result of the positive
feedback from others which increased mood, or the gaining of a new skill which in
turn generated greater self-esteem (Malcolm et al., 2013). This highlights the
complex nature of PA and mental health and supports the need for future research to
implement frameworks to successfully evaluate an intervention and its outcomes
where an experimental design is not appropriate. For example the RE-AIM (Reach,
Effectiveness, Adoption, Implementation, and Maintenance) framework which
follows a logical sequence to understand essential programme elements that can
improve the sustainable adoption and implementation of evidence based
interventions (Glasgow, Vogt, & Boles, 1999) and Medical Research Council
guidance provides for conducting and reporting process evaluation for complex
interventions (Moore et al., 2015).
Few studies included in this review reported follow up periods greater than
six months. Among MHSU, maintaining or sustaining positive health behaviours,
such as regular PA engagement, is equally as important as achieving improvements
to PA levels (Harrold et al., 2017). This highlights the importance of implementing
longer follow up periods when designing PA interventions for MHSU.
The ‘relaxed ethos’ and ‘forgiving flexibility’ approach was adopted by two
studies where participants were not constrained to a set program but encouraged to
engage at a level they felt most comfortable with, suiting their individual needs
(Malcolm et al., 2013; Graham et al., 2017) or where there was an understanding
participants would need opportunities to leave and pick up again depending on
relapse from mental illness (Malcolm et al., 2013).
This helped to mitigate barriers linked to feelings of pressure to attend, or
expectations placed on individuals by themselves or others. However, such an
approach may be a contributing factor in the difficulty of retaining participants for
the duration of the intervention (Malcolm et al., 2013). Set paperwork and processes
were not completed (either due to staff/peer
absence or an imbalance of the volunteer-to-participant ratio) resulting in data only
being collected from those individuals who were regularly engaged in the project,
failing to capture the thoughts and experiences of those who had disengaged.
Apprehension over PA intervention dropout and relapse rates is collective; it is
important to explore the processes involved in lapse and dropout behaviour
(Kinnafick, Thøgersen-Ntoumani, & Duda, 2014). Given that the relaxed
ethos/forgiving flexibility approach does have its benefits, it is important as
researchers to improve implementation effectiveness to robustly assess the
effectiveness of interventions. Therefore, future research is necessary to incorporate
both implementation and evaluation approaches to monitor drop-out rates and
disengagement from community-based PA interventions among MHSU (Stubbs et
al., 2016).
Sources of support such as from peers and peer leaders have been shown to be
driving forces in both the adoption and adherence phases of PA interventions
(Kinnafick et al., 2014). It is therefore important to find a good working relationship
between peers delivering the PA sessions and participants attending them,
remembering that each individual (both peer and participant) has their own mental
health issues to manage and control (Davidson et al., 2012). Created through social
interactions and based on mutual understanding, a strong bond can form because of
reciprocal respect between the participant and the change agent (i.e., fitness
instructor, health mentor or peer leader; Malcom et al., 2013). Findings demonstrate
the importance of peers and peer support in facilitating PA engagement and positive
health behaviour change (Malcom et al., 2013). It is important to note that one study
reported conflicts between peer volunteers and participants (Graham et al., 2017).
Peer leads felt participants often did not attend as they agreed, whilst participants felt
peer leads were unsupportive towards them. Considering conflicting views, peer
leads concluded that they did not have the adequate skills for conflict resolution. This
highlights the importance of peers receiving training prior to PA interventions to
ensure individuals are well equipped in peer support delivery and conflict
management (Davidson et al., 2012).
Despite MHSU being a hard to reach participant group (Pentecost et al.,
2015), it is important to consider the implications of using incentives on long-term
positive health behaviour change. The use of tangible extrinsic rewards, such as
financial or monetary incentives, to help motivate adherence and performance in
healthy lifestyle and PA interventions is a practice that is widespread (Moller,
Deci, & Elliot, 2010). Previously conducted healthy lifestyle interventions
targeting PA and lasting more than a few days include some form of extrinsic
compensation for participating (e.g., money, tokens or gifts; Moller et al., 2013).
In the current review, three studies provided participants with an
incentive of either money or free equipment for their good attendance to the PA
sessions (Graham et al., 2017; Hoffmann et al., 2015), or in other cases for achieving
the targeted health behaviour of increased daily steps (Harrold et al., 2017).
However, the use of economic incentives for research participation may have
resulted in participants being motivated by compensation rather than wanting to
engage. Alternatively, incentivisation may lead to an increased risk of dropout once
the incentive ends or is removed (Graham et al., 2017).
Self-determination theory is one theory of human motivation that may
provide insight into why some health behaviour interventions emphasising financial
incentives struggle to achieve successful maintenance of positive health behaviour
change over time (Deci & Ryan, 1985, 2000). At the centre of SDT is the concept of
self-determined (autonomous) motivation which is characterised by feeling a sense of
freedom from external pressure (Deci & Ryan, 2000). This is in contrast to less self-
determined motivation (controlled) whereby individuals may experience feelings of
coercion from tangible rewards or punishments, or by emotional pressure generated
by others or by themselves (Deci & Ryan, 2000). The study using SDT included in
this current review supports the idea, as findings reported changes in relationships
with participants’ self via increased autonomy, competence and relatedness (Graham
et al., 2017). Although SDT traditionally conceptualises behaviour change as
occurring at an individual level (Deci & Ryan, 2000), study findings suggest that
autonomy, competence and relatedness also reside within interactions and
relationships at the level of peers and relatedness to the wider community (Graham et
al., 2017). However, the two definitions for autonomous and controlled motivation
might demonstrate how financial incentives lead to an increase in controlled
motivation, reducing individuals’ autonomous motivation towards a targeted
behaviour such as PA. It is therefore important to consider how to optimise sustained
engagement in positive health behaviours for MHSU.
Scoping review implications
This scoping review demonstrates a paucity of literature investigating peer-
delivered and peer-led community-based interventions to promote PA among
MHSU. Studies that did incorporate peer support made a significant contribution
towards increasing PA behaviours and mental wellbeing (Aschbrenner et al., 2016;
Graham et al., 2017; Harrold et al., 2017; Malcolm et al., 2013). Peer specialists
(defined as ‘mental health consumers in recovery from illness who have received
special training enabling them to work as paid mental health staff to support other
consumers) are a rapidly growing segment of the wider community mental health
workforce (Clossey, Gillen, Frankel, & Hernandez, 2016, pg 408). Community-
based
PA interventions create opportunities for social contact and interactions (Mason
& Holt, 2012). Striving to facilitate peer-to-peer support is proposed as the next
step in the advancement of the emerging science of lifestyle and positive health
behaviour change for MHSU (Quirk et al., 2017).
The emphasis of research moving forward should focus on how PA
interventions within the community evaluate their implementation to establish
intervention effectiveness and improve self-care, as failure to seek help for mental
health distress can escalate leading to more intensive long-term illness, and an
increased burden on the NHS (Rebar & Taylor, 2017). Despite strong, growing
evidence that PA has mental health and wellbeing benefits within a non-clinical
population (Rebar et al., 2015) and clinical populations (Bailey et al., 2017;
Rosenbaum et al., 2014), there remains a translational gap. Therefore, research is
needed to demonstrate the effectiveness of different interventions in engaging and
treating individuals with mental illness in the real world (Rebar & Taylor, 2017).
Some studies reported that the centres which hosted components of the
intervention had close referral and recommended relationships with healthcare
partner agencies (Jones, Kimberlee, Deave, & Evans, 2013). This aided with the
connection and ease of embedding activities into participants’ everyday lives. It is
important to establish strong connections between peers and participants, but also
within the wider community to enhance the uptake of participants to engage in PA
interventions. Further research is required to examine aspects of the intervention
environment and to consider how best to utilise community settings to enhance PA
engagement of MHSU. For instance, peer-delivered interventions may be more
effective in one-to-one situations than in groups so that the peer can tailor
information to the recipient’s needs. On the other hand, individuals may prefer
group-based sessions to facilitate social interaction and group unity within making
positive health behaviour changes (Druss et al., 2010; Graham et al., 2017).
Limitations of a systematic scoping review
This systematic scoping review followed a traditional approach (Arksey &
O’Malley, 2005) using a rigorous, systematic method for searching, evaluating and
reporting evidence in terms of intervention length, follow-ups, behavioural and
psychosocial measures, and whether peers were included in the intervention
delivery. Whilst the review considered a wide range of study designs and methods by
answering a broader research question, the review did not appraise the quality of the
evidence. The lack of critical appraisal leads to an inability to draw firm conclusions
about the target specific behaviour of physical health on individual’s mental health.
Studies themselves were varied in follow up times, intervention
length and intervention content which may be useful in generalising data in terms
of wider impact on health promotion given largely the positive effects.
Specifically, there was a lack of detailed reporting of peer support definitions,
and definitions of community settings. Therefore, specifics of peer support impact
within community interventions could not be identified. Previous research
highlighted the individuality of PA behaviour change processes in individuals with
mental illness, where individuals reported professional support and accessibility was
important for the initiation of PA (Hargreaves, Lucock, & Rodriguez, 2017).
However, individuals stated that having individually meaningful PA experiences was
important for PA maintenance (Hargreaves et al., 2017). Such findings highlight that
there is no ‘one size fits all’ approach to PA interventions as they may not be suitable
for MHSU. Interventions within community settings need to be adaptable to
individual differences and dynamic nature of mental illness symptoms, responses to
medication, PA motivation and ongoing mental health recovery processes
(Hargreaves et al., 2017). Future research would benefit from detailing peer support
components to provide the foundations of what works or does not work for future
intervention designs. This scoping review incorporated all mental health diagnoses,
however this made it difficult to conclude any definitive results for any specific
diagnosis.
Nevertheless, incorporating all mental health diagnoses provides a closer
representation of a community PA programme inclusive of a range of mental health
problems and severity.
The conclusions of the scoping review informed the approach taken in the
subsequent empirical chapters. The current systematic scoping review highlighted
key areas for further research, one of which was the need for more longitudinal study
designs (Harandi et al., 2016; Wang et al., 2018). Building on this and informing
chapter 3, a quantitative longitudinal study was conducted to provide a holistic,
contemporary foundation looking at specific psychological variables of PA, social
support, motivation and mental wellbeing of MHSU taking part in a peer-based
community PA programme. Findings from this chapter then informed the subsequent
chapters whereby qualitative research allowed for more detailed exploration of
MHSU’ experiences of peer support within the community programme, allowing for
nuances to be highlighted.
A further conclusion from the scoping review was the requirement for
exploration beyond single contexts (Quirk et al., 2017). Research is required to
demonstrate the effectiveness of different interventions in engaging and treating
MHSU in real world settings and examine aspects of the intervention environment to
consider the best way to utilise community settings to enhance PA engagement of
MHSU. Therefore, chapter 4 and a two-
study inquiry considered participant experiences of peer support both face to face
within PA sessions, and via an online peer support community platform. There is a
need to explore features of peer support that is incorporated into community PA
programmes for MHSU. Participant experiences are therefore paramount to help
understand the barriers towards PA participant to promote PA engagement. Such
experiences were captured through conducting focus groups, phone interviews and
online messenger interviews within chapter 4, and through focus groups and phone
interviews with peer volunteers within chapter 5. Qualitative data can then be used to
inform the design and implementation of community programmes which need to be
adaptable to individual needs and the dynamic nature of mental illness symptoms,
responses to medication, motivation towards PA and individuals’ ongoing mental
health journey.
Overall, the key findings from the scoping review support the positive
effects of peer support within a community-based PA programme on PA levels of
MHSU (Druss et al., 2010; Graham et al., 2017; Malcolm et al., 2013). That being
said, it was evident that this particular field of study is relatively immature,
therefore warranting greater investigation.
Findings from the studies included in the systematic scoping review only reported
the positives of using peer support within community-based programmes for
MHSU. The search terms tended to privilege the positives of using peer support,
highlighting a caveat that challenges may have been present and warrants further
research. This led to the subsequent studies (chapter 4 and 5) where experiences of
peer support were explored from multiple perspectives (peer support recipients and
peer support providers) to consider a more rounded exploration of peer support
within a community PA programme for MHSU. Qualitative research was deemed
appropriate to explore this research idea. The structure of the focus groups provided
opportunities for data to be captured and progress along undetermined routes,
therefore, building upon the concepts identified within the scoping review via
interpretations of peers and peer volunteers’ own lived experiences in the context of
the community programme.
Conclusion
This systematic scoping review looked at existing literature on the inclusion
of peer support in community-based PA interventions for MHSU. Based on the
results of the scoping review, community-based PA interventions for MHSU were
reported as successful for improving PA levels and psychosocial variables such as
health-related quality of life and mental wellbeing. Community PA interventions
may offer an alternative, more acceptable intervention environment for those with
mental health problems, who are reluctant to engage
with interventions based in more formal, clinical settings. This scoping review has
implications for several audiences, including participants and peers, and those
designing interventions for MHSU to consider peer support within PA programmes.
With further research, peer support within PA interventions has the potential to help
aid MHSU in their recovery. Mental health and PA are not unidirectional therefore
should not be studied as an isolated cause of behaviour on a mental health outcome,
but as a reciprocal process that changes over time and differs for individuals and
contexts (Rebar & Taylor, 2017). Greater understanding is key when designing
effective community-based PA programmes that meet the needs and expectations of
MHSU. Community settings are important to allow for opportunities for peer support
to be provided and received by individuals. Greater focus is required to implement
peer support into community interventions to facilitate PA engagement with
individuals who have mental health problems or mental illness.
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