Identifying barriers and facilitators for health risk behaviours among people with severe mental illness in Bangladesh and Pakistan: a qualitative study.

People with severe mental illness (SMI) are at greater risk of obesity, cardiovascular disease and diabetes than the general population, due to a higher prevalence of health risk behaviours. Research is needed to inform tailored interventions to improve the health behaviours (diet, physical activity and sleep) of people with SMI in South Asia as these behaviours are closely linked to obesity. The study aimed to explore the barriers and facilitators to healthy diet, physical activity and good sleep among individuals with SMI. A qualitative design was employed using photovoice, semi-structured interviews and focus group discussions. Participants included 16 people with SMI, 16 caregivers and 17 health professionals in Bangladesh and Pakistan. Data were analysed thematically, informed by the socio-ecological framework. A complex interplay of individual, familial and societal factors influenced these health behaviours. Individual factors include knowledge, beliefs and mental health limitations. Caregivers play a crucial role in influencing behaviour. At the societal level, gender expectations, financial constraints and religious influences significantly impact these behaviours. The insights from this research can inform tailored interventions for this vulnerable group and highlight the need for integrated services, financial support and improved urban planning.