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Authors; Country | Aim | Healthcare practitioner types1 and sample size/number of participants2 | Setting | Mental health conditions being treated | Data collection and saturation | Barriers identified in the study (using the terminology adopted for coding in this review) | Limitations |
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Ball et al. [29] United Kingdom | To explore multidisciplinary staff attitudes towards exercise promotion and facilitation in British National Health Service (NHS) inpatient mental health services | Occupational therapist × 6 Nurse (various) × 8 Psychiatrist × 2 Psychologist × 3 Support worker × 2 Nursing assistant × 4 N = 25 | Inpatient mental health services | Serious mental illness | Individual semistructured interviews; data saturation achieved | Lack of awareness of evidence base (implied); insufficient staff; someone else’s responsibility; perceived physical health risk; lack of knowledge and confidence on how to prescribe exercise; lack of physical resources; perceived unwillingness of person with mental illness | Some professions were underrepresented (e.g., clinical psychology and psychiatry); limited participants from other professions prohibited conclusions about differences in attitudes across disciplines; although efforts were made to ensure methodological rigour, member checking would have improved this |
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Carlbo et al. [30] Sweden | To describe nurses’ experience, including personal motivation, in using physical activity as a complementary treatment in patients with schizophrenia | Nurses and nursing assistants N = 12 | Inpatient unit and associated outpatient unit for adult patients with schizophrenia | Schizophrenia | Focus group interviews | Lack of awareness of evidence base; lack of knowledge and confidence on how to prescribe exercise; insufficient staff; lack of time; lack of leadership; perceived risk to mental health; perceived unwillingness of person with mental illness; structural issues; someone else’s responsibility | Small number of participants may limit generalisability; responses possibly affected as authors worked in the same organisation as participants |
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Garvey et al. [31] Australia | To investigate: (i) mental health clinicians’ understanding of the relationship between exercise and mental health, (ii) if and how exercise is used in their treatment approach of consumers with depression and anxiety, and (iii) the barriers to prescription of exercise | Mental health nurses × 3 Social workers × 2 Psychologists × 4 Mental health general practitioner × 1 N = 10 | Community health organisation providing a range of mental health services to young people | Various mental illnesses | Individual semistructured interviews; data saturation achieved | Lack of knowledge and confidence on how to prescribe exercise; lack of knowledge rerole of EPs and referral pathways; perceived risk to physical and mental health; someone else’s responsibility | Results may not be generalisable beyond the community context; the study was undertaken during the COVID-19 pandemic impacting recruitment of HCPs |
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Harding [32] USA Mixed method-qualitative aspect | To examine the perceived barriers and resource needs related to physical activity in mental health group homes from the perspective of direct care staff | Direct care staff (healthcare assistants) working in mental health group homes at least one shift a week with at least 40 hours of mental health training N = 73 | Community group care homes | Serious mental illness | Paper-based survey; qualitative aspect asked open-ended questions | Insufficient staff; lack of time; someone else’s responsibility; lack of knowledge or confidence on how to prescribe exercise (in particular remotivational strategies); lack of physical resources | Demographic information was not available; due to the setting, the results may not be generalisable |
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Kinnafick et al. [33] United Kingdom | To explore healthcare assistants’ perceptions of exercise and attitudes to its promotion for adult patients in a secure mental health hospital | Healthcare assistants who had worked in the institution for a minimum of 6 months N = 11 | Secure mental health hospital | Serious mental illness | Individual semistructured interviews | Lack of awareness of evidence base (implied); insufficient staff; lack of time; lack of knowledge or confidence on how to prescribe exercise; someone else’s responsibility; perceived risk to physical and mental health; perceived unwillingness of person with mental illness; lack of leadership; structural issues | Possible influence of interviews being conducted at participants’ place of work; possible participation bias |
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Leyland et al. [34] United Kingdom | To use the theory of planned behaviour to identify the beliefs of mental healthcare professionals working in community settings regarding motivation for advising health-related physical activity | Nurse × 13 Support worker × 10 Clinical psychologist × 4 Team leader (member of healthcare staff) × 3 Psychiatrist × 2 N = 32 N (HCP) = 29 | Community mental health teams | Serious mental illness | Focus group interviews; data saturation achieved | Insufficient staff; lack of time; lack of physical resources; someone else’s responsibility; lack of knowledge or confidence on how to prescribe exercise; lack of leadership; perceived risk to physical and mental health; perceived unwillingness of person with mental illness; structural issues | Small number of participants; however, “data saturation” was achieved after the first two focus groups completed |
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Martland et al. [35] United Kingdom | To qualitatively investigate, inpatient, carer, and staff groups, perspectives on implementing HIIT interventions for service users in inpatient settings, including perceived barriers and enablers | Psychiatrist × 1 Mental health nurse × 7 Healthcare assistant × 1 Undisclosed × 1 N = 39 N (HCP) = 10 | Inpatient mental health services | Serious mental illness | Focus group interviews; data saturation achieved | Perceived impact of patient choice and control; insufficient staff; lack of time; lack of physical resources; perceived risk to physical and mental health; perceived unwillingness of person with mental illness | Data possibly missed due to lack of audio recording of focus groups; possible participation bias |
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Matthews et al. [36] Ireland | To carry out a multistakeholder exploration of structured and unstructured PA experiences in outpatient rehabilitation and recovery mental health services | Mental health nurse × 4 Prescribing psychiatric doctor × 1 Occupational therapist × 1 N = 15 N (HCP) = 6 | Rehabilitation and recovery mental health services | Serious mental illness | Individual interviews using photo elicitation and open-ended questions | Insufficient staff; lack of time; lack of knowledge or confidence on how to prescribe exercise; perceived risk to physical and mental health; perceived unwillingness of person with mental illness; lack of leadership | Only one participant from some disciplines and small numbers from others reduced the potential generalisability of findings |
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Searle et al. [37] United Kingdom | To determine general practitioners’ views of physical activity for managing depression and the extent that GPs promote and legitimise engagement in physical activity as a potential treatment option and their awareness of evidence and guidelines to support its use | General practitioners N = 15 | General practices in the Bristol and Exeter areas | Depression | Individual semistructured interviews | Lack of awareness of evidence base; lack of physical resources; perceived risk to mental health; perceived unwillingness of person with mental illness | Concurrence with patient intervention and possible participant interaction with those patients may have affected HCP’s responses; possible participation bias; brevity of interviews |
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Shrestha et al. [38] Australia | To explore the attitudes and practices of mental health professionals in recommending more physical activity and less sedentary behaviour to their clients | Nurse × 2 Psychologist × 12 Social worker × 1 Clinical lead/psychologist × 4 N = 17 | Australia’s national youth mental health service network (headspace) | Various mental illnesses | Semistructured focus group interviews; data saturation achieved | Lack of knowledge or confidence on how to prescribe exercise; lack of awareness of evidence base (implied) | Small number of participants from a specific setting, may not be generalisable; focus groups took place after the HCPs received an intervention to increase their own PA; possible researcher interpretation bias, mitigated through reflexivity component and involvement or researchers from outside the specialty area |
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Way et al. [39] Australia and New Zealand | To further investigate self-reported barriers to the prescription of exercise for mental health, faced by a range of HCPs in Australia and New Zealand | Psychologist × 136 Social worker × 72 General practitioner × 25 Mental health nurses × 20 Occupational therapist × 12 Psychiatrist × 8 Mental health manager × 8 Support workers × 22 Counsellors × 20 Other × 2 N = 325 N (HCP) = 318 | Various mental health settings | Various mental illnesses | Qualitative aspect elicited individual written responses to the question “what reasons do you consider to prevent you from prescribing exercise to manage mental health concerns” | Lack of knowledge or confidence on how to prescribe exercise; perceived risk of damage to therapeutic relationship; perceived unwillingness of person with mental illness; lack of physical resources; perceived risk to physical and mental health; lack of leadership; insufficient staff; lack of time; lack of awareness of evidence base; someone else’s responsibility | Relatively small representations in the participants’ number for general practitioners, mental health nurses, occupational therapists, and psychiatrists reducing generalisability; social desirability bias may have been a confound; likely that due to the self-selection nature of the survey, sample biased towards HCPs with an interest in and appreciation of exercise |
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