Understanding the experience of initiating community-based physical activity and social support by people with serious mental illness: a systematic review using a meta-ethnographic approach
Quirk et al. Systematic Reviews
Understanding the experience of initiating community-based physical activity and social support by people with serious mental illness: a systematic review using a meta-ethnographic approach
Helen Quirk 0
Helen Crank 0
Robert Copeland 0
0 Centre for Sport and Exercise Science, Faculty of Health and Wellbeing, Sheffield Hallam University , Collegiate Hall, Collegiate Crescent, Sheffield S10 2BP , UK
Background: People with long-term serious mental illness live with severe and debilitating symptoms that can negatively influence their health and quality of life, leading to outcomes such as premature mortality, morbidity and obesity. An interplay of social, behavioural, biological and psychological factors is likely to contribute to their poor physical health. Participating in regular physical activity could bring symptomatic improvements, weight loss benefits, enhanced wellbeing and when undertaken in a community-based group setting can yield additional, important social support benefits. Yet poor uptake of physical activity by people with serious mental illness is a problem. This review will systematically search, appraise and synthesise the existing evidence that has explored the experience of community-based physical activity initiation and key features of social support within these contexts by adults with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis using the metaethnography approach. This new understanding may be key in designing more acceptable and effective community-based group PA programmes that meet patients' need and expectations. Methods: This will be a systematic review of qualitative studies using the meta-ethnography approach. The following databases will be searched: ASSIA, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, Health Technology Assessment Database, MEDLINE, PsycINFO, Sociological Abstracts, SPORTDiscus and Web of Science. Grey literature will also be sought. Eligible studies will use qualitative methodology; involve adults (≥18 years) with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis; will report community-based group physical activity; and capture the experience of physical activity initiation and key features of social support from the perspective of the participant. Study selection and assessment of quality will be performed by two reviewers. Data will be extracted by one reviewer, tabled, and checked for accuracy by the second reviewer. The metaethnography approach by Noblit and Hare (Meta-ethnography: synthesizing qualitative studies 11, 1988) will be used to synthesise the data. Discussion: This systematic review is expected to provide new insights into the experience of community-based group physical activity initiation for adults who have a serious mental illness to inform person-centred improvements to the management of serious mental illness through physical activity. (Continued on next page)
(Continued from previous page)
Systematic review registration: The protocol has been registered on the International Prospective Register of
Systematic Reviews (PROSPERO) on 22/03/2017; (registration number CRD42017059948).
Serious mental illness
People with long-term serious mental illness (SMI) live
with severe and debilitating symptoms that can
negatively influence the quality of life of themselves, their
families, carers and society. Common SMIs are
schizophrenia, bipolar affective disorder, major depressive
disorder, personality disorder, severe anxiety (including
phobia and obsessive compulsive disorder),
schizophreniform disorder or psychosis (including first episode
psychosis). Individuals with SMI have higher levels of
premature mortality and morbidity [
], and obesity is
more prevalent when compared with the general
]. Many factors contribute to the poor physical
health of people with SMI including social, biological,
psychological and behavioural factors. Attempts to
understand the experience of living with SMI need to
consider the complex individual-level and system-level
influences on behaviour [
]. Social factors include
unequal provision of healthcare [
], stigmatisation and lack
of social support [
]. Biological factors such as chronic
disease and psychotropic medication, and psychological
factors such as low self-esteem and negative thoughts
can also contribute to ill-health and weight gain [
Smoking, poor diet and sedentary behaviour are
behavioural factors contributing to the poor health of people
living with SMI [
]. Modifiable behavioural risk factors
such as low levels of physical activity (PA) have become
an important target in interventions to help improve the
overall physical and psychosocial health of individuals
with SMI [
Physical activity and community-based group programmes
Physical activity is defined as any bodily movement
produced by skeletal muscles that result in a substantial
increase in energy expenditure [
]. In the context of this
review, PA will encompass light, moderate and vigorous
intensity activities and the specific terms ‘exercise’1 and
‘sport’2 will be used when appropriate.
Communitybased approaches to PA involve community members
and leaders from various settings and organisations
coming together to promote PA in an organised and
integrated manner [
]. They can use limited resources to
reach a large number of people and often result in
greater improvements in outcomes and increased
sustainability over time [
]. A community-based approach
is appropriate for PA for SMI groups, whose health is
influenced by complex individual-level and system-level
] and who may have specific needs and barriers
to PA participation [
Health benefits of physical activity for people with SMI
Physical activity has many potential physical health
benefits for people with SMI, including symptomatic
] and weight loss benefits [
systematic reviews have concluded that there is, albeit
mixed, evidence for its beneficial role on measurable
health outcomes such as improved symptoms, quality of
life, PA level, physical fitness, cardiometabolic risk
factors, BMI and weight [
11, 14, 16–18
]. The mixed
findings in the literature are likely to reflect the
methodological quality of primary studies, which have
been criticised for small sample sizes, lack of long-term
follow-up and lack of theoretical framework [
Despite potential health benefits of PA for individuals
with SMI, it is known that individuals with SMI engage
in less exercise, and significantly greater amounts of
sedentary behaviour than the general population [
findings suggest that attention should be given to how to
promote the uptake of PA in this population to bring
about health benefits.
Initiation of physical activity by individuals with SMI
Health organisations such as the Department of Health
in the United Kingdom (UK) recommend
evidencebased PA interventions to improve the physical health of
individuals with SMI [
]. Yet poor uptake of PA by this
population remains a problem [
]. Poor recruitment
to PA interventions is often reported , with patients
citing numerous physical health, psychological and
socio-ecological barriers to PA [
]. Non-uptake of
PA by people with SMI does not necessarily reflect a
lack of motivation or intention to be active; Ussher et al.
] found a high level of interest in PA among people
with SMI, but low levels of activity. This implies that
there might be a gap between intention and behaviour
that can be addressed by exploring the experience of PA
initiation in greater depth.
This review will focus on the initiation of PA, defined as
the period in which people start being more physically
active (also referred to as ‘adoption’ and ‘uptake’). The
experience of initiation is likely to differ from the
maintenance of PA. Soundy et al. [
] illustrated how autonomy
and identity, experiences and needs of people with SMI
change through phases of PA (pre-activity, within activity
and post-activity). In the pre-activity phase, successful
initiation depends on the provision of social support from
introducing the patient to the idea of becoming more
physically active through to introducing patients to the
new activity environment [
]. The current review aims to
further explore the experience of the initial uptake of PA
by individuals with SMI to help inform how interventions
can be designed to increase initiation.
The role of social support
Social support and sustainable supportive relationships
could help with PA initiation barriers in people with
SMI who are known to experience social isolation and
13, 17, 21, 22
]. Physical activity in group
community-based settings has the additional benefits of
social support that may encourage activity engagement
and the creation of a social identity [
]. It is also
possible that the social orientation of the
communitybased activity may be more appealing for individuals
with SMI than the activity itself [
]. There is a need to
hear how people with SMI perceive and experience
group community-based PA to better understand the
key features of social support that may encourage uptake
of PA by people with SMI.
The experience of physical activity
Understanding how patients with SMI perceive their
own illness and experience PA may be key to designing
more acceptable and effective interventions that meet
patients’ expectations and needs. Qualitative
methodologies can capture accounts of patients’ experience of PA
in the patients’ own words [
]. Patient experience
represents a unique account of the journey experienced by
people with health conditions that is challenging to
measure objectively. In the context of this review, the
patient experience will be used to explore how people
with SMI experience the initiation of community-based
group PA, including engagement, satisfaction,
expectations, preferences, perceptions and participation [
In recent years, the patient experience of PA for
people with SMI has been explored. Syntheses of the
qualitative literature using a meta-ethnographic
approach have provided a comprehensive overview of the
available research and practical implications for practice
]. In 2012, Soundy and colleagues 
explored how psychosocial factors impact on barriers
and facilitators to activity among patients with SMI
during the initiation and maintenance phase of
participation. Soundy et al. identified social support as essential
for initiation and called for further research to explore
social support in greater detail, particularly how social
support can be used to support PA uptake [
]. In 2014,
Soundy et al. [
] explored the experiences of PA for
individuals with schizophrenia from the perspective of
patients and HCPs who worked with the individuals.
Reviewers identified psychosocial benefits of PA
including self-initiated changes in behaviour, improved
autonomy, increased confidence and the important social
value of PA. Soundy et al. [
] built upon these findings
in 2015 and explored the broader psychosocial benefits
of sports participation for individuals with SMI. They
found that sport can benefit individuals with SMI by
helping them to overcome the negative effects of social
The findings to date [
] have been important
for going beyond measurable outcomes of PA and
demonstrating the broader psychological, social and
environmental factors influencing the experience of PA and
sport for individuals with SMI. The findings require
further exploration beyond single conditions and specific
contexts to elicit the unique features of social support
within community-based PA programmes for people
with SMI. Exploration of the patient experience of
community-based group PA is needed to help
understand how to overcome barriers and promote initiation
in this population. This new understanding may be key
in designing more acceptable and effective
communitybased group PA programmes that meet patients’
expectations and needs.
This review will aim to address the research question:
How do adults diagnosed with SMI experience the
initiation of community-based group physical activity and
key features of social support within these contexts?
This review will seek to:
Systematically search and appraise the qualitative
research on the experience of initiation of
community-based group PA for people with SMI
Synthesise findings from existing research regarding
the experience of initiation of community-based
group PA and key features of social support within
these contexts for people with SMI
Identify from participants’ experiences the active
ingredients that could inform future PA
programmes and optimise the uptake of
community-based group PA among people with SMI
Methods and design
The review has been registered in the International
Prospective Register of Systematic Reviews (PROSPERO):
CRD42017059948. This will use the meta-ethnographic
approach by Noblit and Hare [
]. If published in time for
our review, we will use new reporting guidelines for
metaethnography developed from the eMERGe study [
protocol has been developed in accordance with the
Preferred Reporting Items for Systematic review and
MetaAnalysis Protocols (PRISMA-P) (see Additional file 1) [
Studies will be selected according to the criteria
A study will be eligible for inclusion if it reports primary
data and has used any type of qualitative methodology.
This includes studies that have used mixed methods,
provided it is possible to extract the findings from the
qualitative strand of the study. Further, included studies
must have been peer reviewed or be theses, or reported
in grey literature. Review papers, editorial and opinion
pieces will be excluded.
To be eligible for inclusion a study must focus on SMI
in adult humans (≥18 years), defined as a primary
diagnosis of schizophrenia, bipolar affective disorder, major
depressive disorder, personality disorder, severe anxiety
(including phobia and obsessive compulsive disorder),
schizophreniform disorder or psychosis (including first
episode psychosis). This includes a first diagnosis or
relapse of a previously diagnosed condition. To be
included, studies must demonstrate that >80% of the
sample has a diagnosis of one or more of these
conditions. Studies that include participants with a diagnosis
of an eating disorder, mild or moderate depression, a
learning disability, or drug and alcohol use disorder, and
where the primary study findings are not attributable to
participants with the included conditions will be
excluded. Populations that include those with
comorbidities, whether physical or mental, will be eligible for
inclusion. Studies that report data on both adults and
children will be eligible for inclusion provided it is
possible to extract the adult data.
Studies that report community-based group PA are
eligible for inclusion in this review. This will include
group-based light, moderate, or vigorous intensity PA in
a community setting and also community-based group
activities described as sport or exercise. For a
multicomponent intervention such as a healthy lifestyle
programme to be eligible for inclusion, a study must
report the PA as one of the main components of the
intervention and the primary study findings must be
attributable to the PA. Studies will not be excluded on
the basis of the type, frequency or duration of the PA.
Any studies involving a community-based group PA
intervention do not need to include a comparator
condition to be eligible for inclusion in the review. Where a
comparison is made, the comparator could be no activity
or any other activity.
Only studies that capture the experience of the initiation
in community-based group PA for people living with
SMI will be eligible for inclusion. Data must be gathered
from the perspective of the participants. The outcomes
reported (i.e., participants’ experiences of initiation of
community-based group PA and key features of social
support within these contexts) need to be based on
having used qualitative data collection and analysis
methods. Studies will be eligible for inclusion
irrespective of whether follow-up outcomes were collected.
When included, the length of follow-up will be reported.
To be considered for inclusion in the review, the setting
for PA must be a community-based group setting.
Resource constraints mean it will not be possible to
consider non-English language papers for inclusion.
Studies will not be excluded based on the date of
publication as this area of research is not sensitive to a
particular period of time.
The bibliographic databases searched will be: ASSIA
(ProQuest interface), CINAHL (EBSCO interface),
Cochrane Central Register of Controlled Trials (Wiley
interface), EMBASE (Ovid interface via NICE), Health
Technology Assessment Database (HTA) (Wiley
interface), MEDLINE (EBSCO interface), PsycINFO
(ProQuest interface), Sociological Abstracts (ProQuest
interface), SPORTDiscus (EBSCO interface) and Web of
Science (Thomson Reuters interface).
In addition, grey literature will be sought using NICE
Evidence Search and searches of targeted organisations
and web resources. All grey literature sources will be
searched from their inception. ProQuest Dissertation
and Thesis (ProQuest interface) will be searched for
Author, citation and reference searches will be
undertaken on papers included in the review. Hand searches
of the contents of key journals and conference
proceedings will also be undertaken. Systematic review
papers will not be considered for inclusion in the review,
but will be used to cross-check that relevant studies have
been identified. Finally, a bibliography of included
studies will be shared among this review team and a
stakeholder group with a view to identifying any relevant,
A draft search strategy has been devised and piloted by
the review team and will also be reviewed by a
The draft search strategy as written for MEDLINE
(EBSCO interface) comprises three facets: ((“mental
illness” OR “mentally ill” OR “mental ill health” OR
depression OR “depressive disorder*” OR bipolar OR
schizophre* OR psychosis OR psychoses OR OR “mood
disorder*” OR “dissociative disorder*” OR “personality
disorder*” OR “obsessive compulsive” OR anxiety OR
phobi* OR mentally ill persons/ OR mental disorders/
OR exp.anxiety disorders/ OR exp.bipolar and related
disorders/ OR exp.dissociative disorders/ OR exp.mood
disorders/ OR exp.personality disorders/ OR
exp.schizophrenia spectrum and other psychotic disorders/) AND
(physical* N3 activ* OR exercis* OR “motor activity” OR
sport* OR “physical therap*” OR “physical training” OR
physical* N3 fit* OR motor activity/ OR exp.exercise/
OR exp.sports/ OR physical fitness/) AND (experience*
OR perspective* OR story OR stories OR narrative* OR
ethnograph* OR qualitative OR narration/ OR
exp.personal narratives/ OR exp.anthropology, cultural/ OR
All search terms will be looked for in the title and
abstract fields, and controlled vocabulary terms will be
used where available. The Boolean operators AND and
OR will be used, alongside truncation (*), phrase
searching (“”) and proximity operators (N). When available as
a search limiter, the results will be filtered to only
include English language publications. No date limits will
Once the final search strategy has been agreed, the
search syntax, and if available the controlled vocabulary
terms, will be adapted for use on the other information
resources to be searched. The literature searches will be
updated towards the end of the review process to ensure
that no newly published studies are missed.
The bibliographic management tool EndNote will be
used to organise the literature in this review. Duplicate
results will be removed within EndNote and both the
number of results before and after duplication will be
recorded. Microsoft Excel 2010 will be used to support the
literature selection and data extraction processes. The
selection and data extraction processes will be preceded
by the review team having completed independent
calibration exercises to ensure familiarity with the IT
tools being used and to refine and maximise consistency
The titles and abstracts of all search results will be
examined for relevancy by one reviewer, and 10% of the
records excluded at title and abstract will be checked by a
second reviewer. The relevancy of a study will be judged
by the inclusion/exclusion information detailed in the
eligibility criteria section and in the order: population,
setting, physical activity, outcomes and study design.
The full-text of studies will be obtained when the
inclusion criteria are met or when it is impossible to
determine the eligibility of a study using only the title
Study selection based on the full-text will use the same
inclusion/exclusion criteria and approach to judging the
relevancy of a study. It will be decided by two
independent reviewers, with discrepancies resolved by discussion.
If necessary, a third team member will be involved.
During the full-text screening process, the reason for
excluding a study will be recorded. The corresponding
author of a study will be contacted via email if further
study details are required. Two attempts will be made to
contact the corresponding author. When the full-text of
a study is not available via the review team’s libraries, it
will be requested from the corresponding author/s or
from the British Library.
None of the reviewers involved in the study selection
process will be blinded to information about the authors,
or the journal title. Inter-rater agreement at both stages
of the selection process will be calculated.
Data collection process
Data will be extracted from all included studies by one
reviewer using a standardised data extraction form
piloted on at least two studies. Data relating to findings
will be extracted verbatim from primary studies, and
quotations will be recorded where appropriate. The data
extraction process will also be used to identify linked
studies or studies using the same data. These studies will
be identified by checking information such as the
authors, the dates a study was undertaken, and the sample
size and characteristics.
All extractions will be checked thoroughly by a second
reviewer who will also have independently completed a
pilot data extraction exercise on at least two studies.
Discrepancies will be resolved by discussion, and with
reference to a third team member if necessary. The data
extracted from each study will then be transposed from
the standardised forms into a tabular presentation which
will provide a summary of the data items and outcomes,
with a different row being used for each study.
Desired data items not reported in a study will be
recorded as not available. If unavailable data is
considered to be of a high priority then two attempts will be
made to contact the corresponding author for
clarification. The bibliographic details of each study will be
extracted, alongside information about sources of
financial and non-financial support when reported. The
details of potentially relevant references will also be
extracted. Study information, including details of the study
location, research question and/or aim and objectives,
data collection methods, validation and recording, and
the data analysis process will be extracted. The
participant information extracted will be selected demographic
information (age, gender, ethnicity, employment status,
other health conditions), SMI diagnosis, length of
diagnosis, if the occurrence of the SMI is first episode or
relapse, information on the resultant disability and the
severity of the SMI, as well as information about contact
with mental health services and care workers more
generally, and details of recruitment and sampling.
Physical activity information extracted will be: type of
activity, if the activity is self-initiated or referred, the
type of environment in which the activity is undertaken,
how the intervention is integrated within the wider
community, details of the intensity, frequency and duration/
distance, if the activity includes elements of a
behavioural change intervention, as well as details of
interactions with mental health services and care
workers as a result of the PA intervention.
Data outcomes to be extracted must fulfil the
following criteria: (1) determined by the author of the
study to be at the least partially attributable to the PA;
and (2) relate to the experience of initiating PA from the
perspective of the participants. Other findings included
in a study, but not fulfilling the aforementioned criteria
will not be extracted. Data on findings will be extracted
thematically and include sub-themes where required.
The method of reporting findings will be recorded (e.g.,
as verbatim quotes from participants or as statements
from the author). The conclusions of the primary
author/s will also be extracted. In addition, reviewers will
record any of their own comments, such as any
limitations of the study or paper.
Quality appraisal of individual studies
Two reviewers will critically appraise each included
study to explore the quality of the methods and
reporting. Whilst critical appraisal is incumbent to a
quantitative systematic review; the inclusion of such a process in
qualitative reviews is supported [
appraisal can identify weaknesses in a study that may
impact on the validity of study findings, and then
collectively the findings reported in the review.
The quality of studies will be assessed using the
Critical Appraisal Skills Programme (CASP) Qualitative
]; a validated instrument that has been used
in previous meta-ethnographies [
30, 34, 35
]. Use of this
checklist will guide the process and offer transparency as
the reviewers will need to consider an identical set of
structured questions. Previous meta-ethnographic
studies that have used the CASP quality assessment tool
(e.g., Atkins et al. [
]) have found it useful to appraise
the quality of the written report and found several
methodological problems that included failure to report the
qualitative approach used, the theoretical orientation of
the researchers, the theoretical framework used, and the
approach to analysis.
Critical appraisal will be performed by one reviewer
and independently double-checked by a second reviewer.
Discrepancies in the assessments made by the reviewers
will be resolved by discussion, with involvement of a
third reviewer if necessary. All reviewers will
independently pilot the quality assessment tool on at least two
studies. None of the reviewers involved in the quality
assessment process will be blinded to information about
the authors, or the journal title. Inter-rater agreement
will be calculated. Studies will not be excluded on the
basis of quality appraisal outcomes, an approach aligned
with Thomas and Harden [
] who assert that ‘there is
little empirical evidence on which to base decisions for
excluding studies based on quality assessment’ (page
The quality assessment across all studies and for all ten
CASP Qualitative Checklist questions will be transposed
into a tabular form. In addition, a descriptive summary of
the methodological quality of each study will be included
as a column in the tabular presentation of the data items
and outcomes extracted from each study.
The tabular presentation summarising each study (data
items and outcomes, and methodological quality) will
help to identify the patterns and relationships within
and between studies, thus facilitating the data synthesis
process. The seven-stage meta-ethnographic approach
developed by Noblit and Hare [
] will be used to
synthesise the data from the studies included (see Fig. 1).
Meta-ethnography is an interpretive approach to
synthesis, rather than the aggregative approach of traditional
meta-synthesis of quantitative research, making it
appropriate for this review. Rather than rigidly adhering to the
steps in sequential order, we will use some flexibility to
allow for ongoing and simultaneous synthesis within an
iterative and organic approach.
Steps 1–3 will involve the systematic literature search,
reading of the articles, quality appraisal and data
extraction outlined above. If during these steps it becomes
clear that a large number of papers meet the inclusion
criteria, through discussion, the authors will develop a
strategy to select a sample of studies based on factors
such as study design, population, intervention and
outcomes. Step 4 will involve determining how the studies
are related. Key themes and concepts identified in
individual studies will be examined in relation to other
studies. Step 5 will involve translating the findings from
primary studies and exploring how these relate to other
studies using Noblit and Hare’s meta-ethnographic
techniques of reciprocal translations, refutational synthesis
and lines of argument synthesis. This will involve
summarising the themes and concepts extracted from
primary studies and comparing them across studies in
attempt to ‘match’ themes if they are deemed sufficiently
similar (reciprocal translations). Primary articles will be
read and re-read and the findings constantly compared
to ensure the translations are grounded in the original
studies. During this phase, any contradictions between
studies will be explored and explained (refutational
synthesis). In Step 6, themes can be reconceptualised and a
new interpretation generated to form a line of argument,
aiming for a final synthesis that is greater than the sum
of its parts (line of argument synthesis). This approach
allows the language used in primary studies to be
maintained while creating new metaphors within the
current synthesis [
]. Emergent themes will be
discussed with the review team. Step 7 will involve
presenting the results.
The possibility of publication bias will be minimised
through the planned inclusion of grey literature searches
and searches for student theses. However, publication
bias achieved as a result of non-publication remains
possible. Any selective reporting of outcomes within studies
included in this review will be recorded. Selective
reporting will be checked for by comparing the outcomes
reported in a study’s methods section with those
reported in the results section.
Confidence in cumulative evidence
The Confidence in the Evidence from Reviews of
Qualitative research (CERQual) framework [
] will be used
as a tool to help evaluate the strength of the review
findings. In doing so it will provide readers of the review
with a level of confidence in the different findings
presented. The quality of the findings will be considered
across the CERQual components as follows:
methodological limitations; relevance; coherence; and adequacy
of data. Finally, for each finding, a descriptive summary
of the strength of the evidence will be produced.
Patient and public involvement
To inform the review, the involvement of local SMI
patient groups will be sought. The group will: i) advise on
study selection wherever necessary; ii) sense check
themes and findings identified during synthesis; and iii)
assist with the drafting of the plain English summary for
the dissemination of findings.
Active lifestyles among people living with a SMI may
help relieve the severe and debilitating symptoms that
can negatively influence their overall health and quality
of life leading to premature mortality, morbidity and
obesity. The proposed review of the qualitative literature
exploring the experience of initiation of
communitybased group PA for people living with a SMI will deepen
the understanding of how PA initiation is experienced
by this population in this context. With this deeper
understanding, researchers, practitioners and policy
makers will be in a better position to understand
patients’ needs and expectations, implement
interventions and promote the initiation of active lifestyles in
1Exercise is a form of PA that is “planned, structured,
repetitive, and purposive in the sense that improvement
or maintenance of one or more components of physical
fitness is an objective” ([
], p. 128).
2Sport will be defined as games with rules that require
motor actions and that can be organised or unorganised
and conducted at competition or leisure level, such as
Additional file 1: Quirk et al. PRISMA-P + checklist.docx - Completed
PRISMA Checklist. (DOCX 36 kb)
CASP: Critical Appraisal Skills Programme; CERQual: Confidence in the
Evidence from Reviews of Qualitative research; PA: Physical activity;
PRISMA-P: Preferred Reporting Items for Systematic reviews and
MetaAnalysis Protocols; PROSPERO: International Prospective Register of
Systematic Reviews; SMI: Serious mental illness
We acknowledge Nicholas Bell, Director of the Research Development Unit,
Sheffield Health and Social Care NHS Foundation Trust, Dr. Michelle
Horspool, Research Development Manager, Sheffield Health and Social Care
NHS Foundation Trust and Professor Scott Weich, School of Health and
Related Research, The University of Sheffield for their help in preparing the
This systematic review and meta-ethnography is funded by Sheffield Health
and Social Care NHS Foundation Trust.
Role of sponsor or funder
The funding will enable staff time to undertake the review. The funder has
been involved in determining the scope of the review with respect to which
long-term serious mental illnesses are included in the review. The funder has
approved the proposed qualitative methodology. The funder will have no
input in conducting the review, interpreting the findings, or writing the
manuscript for publication.
Availability of data and materials
HQ is the guarantor. The scope of the review was designed by all of the
authors. HQ, HC, DH, EH and RC contributed to drafting the protocol. The
rationale for the review was identified primary by HQ and HC. The search
strategy, study selection process and data collection process was developed
by DH and EH. The information sources to be searched and quality appraisal
tools to be used were determined by DH and EH. The identification and
justification of the proposed data synthesis method was primarily led by HQ.
All authors read and approved the final manuscript.
Ethics approval and consent to participate
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
1Centre for Sport and Exercise Science, Faculty of Health and Wellbeing,
Sheffield Hallam University, Collegiate Hall, Collegiate Crescent, Sheffield S10
2BP, UK. 2Centre for Health and Social Care Research, Faculty of Health and
Wellbeing, Sheffield Hallam University, Sheffield, UK. 3School of Health and
Related Research, University of Sheffield, Sheffield, UK. 4The National Centre
for Sport and Exercise Medicine, Sheffield, UK.
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