UCSF

The portion of older adults with schizophrenia is growing and their physical health status is poor. Many factors contribute to poor physical health including unhealthy lifestyles, poorly managed chronic diseases, and socio-demographic factors. The purpose of this dissertation was to explore how older adults with schizophrenia understand their physical health

A quantitative secondary data analysis was conducted based on a randomized lifestyle intervention program for older persons with schizophrenia or schizoaffective disorder and diabetes mellitus recruited from board-and-care facilities and day treatment programs to explore the relationship between the symptoms of schizophrenia experienced and response to the intervention. The qualitative aspect was conducted using a grounded theory approach to guide interviews with 28 older adults with schizophrenia or schizoaffective disorder recruited from three mental health facilities to explore the individual understanding of physical health.

The quantitative study revealed a significant condition by symptom interaction for diabetes knowledge. The difference between change in knowledge for intervention and control groups depends on prevalence and severity of total, negative, and general symptoms. There was not a significant condition by positive symptom interaction for diabetes knowledge. A significant main effect was found between total, negative, positive, and general symptoms in the total sample for diabetes self-efficacy. Higher prevalence and severity of symptoms was negatively associated with improvement in diabetes self-efficacy.

The qualitative data revealed that while discussing conceptions of physical health, participants spoke about a sense of belonging as one of the key factors supporting feeling healthy. A sense of belonging could be derived from a sense of connection with others, a physical place, social relationships, and a sense of meaning and purpose. Also, the concept of trust between participants, health care providers, and the health care system emerged as a dynamic process that was built with factors of respect, caring, advocacy, and consistency and eroded through factors of disrespect, not being heard, lack of time, provider inaction, and stigmatization.

The symptoms and experience of schizophrenia, the health care system, and health care providers are critical factors to consider in the development of targeted interventions to improve the physical health of this population.