Barriers and Facilitators to Health Behavior Change: Perspectives of Individuals with Serious Mental Illness in Health-Promoting Interventions – A Systematic Review of Qualitative Evidence

Abstract Background: Physical health-promoting interventions for individuals with serious mental illness (SMI) have been shown to be clinically effective in improving health outcomes, yet often fall short in meeting participants’ needs, as reflected in high dropout rates.However, studies indicate that individuals with SMI want to improve their physical health. To address this need, a detailed understanding of the barriers to and facilitators of health behavior change for individuals with SMI participating in health-promoting interventions is crucial. Methods: To identify barriers to and facilitators of health behavior change for individuals with SMI in health promoting interventions, a systematic review of qualitative evidence was conducted. Medline, PsycINFO, CINHAL, and SSCI databases were searched for qualitative studies reporting perspectives on health behavior changes among individuals with SMI (18 +) who participated in health-promoting interventions. Health-promoting interventions were defined as those that included at least two aspects of physical health (such as diet and physical activity). The Critical Appraisal Skills Programme (CASP) tool was utilized to assess the quality of the studies. Data were extracted, thematically analyzed, and mapped to the capability, opportunity and motivation for behavior change (COM-B) model. Results: A total of 4242 references were identified and 27 studies, including 547 individuals with SMI, met the eligibility criteria. Informed by the COM-B model, individuals with SMI reported physical and psychological capabilities that led to improvements in physical and mental health as a result of participating in a health-promoting intervention. Physical and social opportunities, such as clear and coherent intervention content or support from trained professionals, were identified as facilitator of behavior change. Additionaly motivation played a crucial role in sustaining health behavior changes among individuals with SMI. Conclusion: This review identifies key factors shaping health behavior change among individuals with SMI, emphasizing that change often depends more on external opportunities than on individual motivation alone. These findings highlight the importance of accessible, inclusive, and socially supportive interventions, and contribute to the development of integrated, person-centered frameworks for research and practice.