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Implement Sci. 2017 Nov 14;12(1):134. doi: 10.1186/s13012-017-0663-z.

Utilization of the Behavior Change Wheel framework to develop a model to improve cardiometabolic screening for people with severe mental illness.

Author information

1
Department of Psychiatry, Weill Institute for Neurosciences, UCSF at Zuckerberg San Francisco General (ZSFG), 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA. Christina.Mangurian@ucsf.edu.
2
UCSF Center for Vulnerable Populations at ZSFG, San Francisco, CA, USA. Christina.Mangurian@ucsf.edu.
3
Department of Psychiatry, Weill Institute for Neurosciences, UCSF at Zuckerberg San Francisco General (ZSFG), 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA.
4
UCSF Center for Vulnerable Populations at ZSFG, San Francisco, CA, USA.
5
UCSF Department of Medicine, Division of General Internal Medicine at ZSFG, 1001 Potrero Avenue, 1320A, San Francisco, CA, 94110, USA.
6
Department of Clinical Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Rm 241, Boca Raton, FL, 33431, USA.
7
UCSF Department of Epidemiology and Biostatistics, 550 16th Street, San Francisco, CA, 64158, USA.

Abstract

BACKGROUND:

Individuals with severe mental illness (e.g., schizophrenia, bipolar disorder) die 10-25 years earlier than the general population, primarily from premature cardiovascular disease (CVD). Contributing factors are complex, but include systemic-related factors of poorly integrated primary care and mental health services. Although evidence-based models exist for integrating mental health care into primary care settings, the evidence base for integrating medical care into specialty mental health settings is limited. Such models are referred to as "reverse" integration. In this paper, we describe the application of an implementation science framework in designing a model to improve CVD outcomes for individuals with severe mental illness (SMI) who receive services in a community mental health setting.

METHODS:

Using principles from the theory of planned behavior, focus groups were conducted to understand stakeholder perspectives of barriers to CVD risk factor screening and treatment identify potential target behaviors. We then applied results to the overarching Behavior Change Wheel framework, a systematic and theory-driven approach that incorporates the COM-B model (capability, opportunity, motivation, and behavior), to build an intervention to improve CVD risk factor screening and treatment for people with SMI.

RESULTS:

Following a stepped approach from the Behavior Change Wheel framework, a model to deliver primary preventive care for people that use community mental health settings as their de facto health home was developed. The CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness) model focuses on engaging community psychiatrists to expand their scope of practice to become responsible for CVD risk, with significant clinical decision support.

CONCLUSION:

The CRANIUM model was designed by integrating behavioral change theory and implementation theory. CRANIUM is feasible to implement, is highly acceptable to, and targets provider behavior change, and is replicable and efficient for helping to integrate primary preventive care services in community mental health settings. CRANIUM can be scaled up to increase CVD preventive care delivery and ultimately improve health outcomes among people with SMI served within a public mental health care system.

KEYWORDS:

Behavior change wheel; Cardiometabolic screening; Severe mental illness

PMID:
29137666
PMCID:
PMC5686815
DOI:
10.1186/s13012-017-0663-z
[Indexed for MEDLINE]
Free PMC Article

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