Better together: Service user and delivery staff experiences of the SPACES physical activity intervention for people with severe mental illness - a qualitative study of a feasibility trial.

Background: Life expectancy is reduced by around 15-20 years for people with severe mental illness (SMI) compared to those without SMI, and this gap is widening. Increased physical activity is one way to reduce this mortality gap. The SPACES programme was designed to develop and test an intervention that supports people with SMI in increasing their physical activity. This paper presents the findings of a qualitative study conducted within the SPACES feasibility trial, which explores the experiences of both participants who received the SPACES intervention and those who delivered it. Methods: Qualitative semi-structured interviews were conducted with thirteen people with SMI who participated in the intervention, as well as six Physical Activity Coordinators (PACs) who delivered the intervention within the NHS. The interviews explored the participants' perceptions of the intervention, including its feasibility, acceptability, potential benefits and insights into its implementation. The transcripts were analysed, and themes were generated using Framework analysis. Results: The SPACES physical activity intervention was perceived positively. Both PACs and people with SMI identified key enablers and barriers to implementation and continued engagement in physical activity. Key enablers were primarily social and included aspects such as social connectedness, personalised one-on-one support from professionals, and the welcoming and accepting atmosphere of community venues. Barriers included small group sizes, which did not lead to social connections, logistical challenges, inconvenient venue locations and travel issues. The PACs who delivered the intervention felt well-equipped to anticipate and address potential challenges in future intervention implementations. Conclusion: The co-designed SPACES physical activity intervention was acceptable to people with SMI and was considered feasible by PACS delivering the intervention. The results have wider implications for understanding how to achieve and maintain engagement in physical activity for this population. They further highlight the need for more holistic approaches to physical activity programmes tailored for people with SMI. Such approaches should emphasise social connectedness, foster welcoming community-based centres, and provide ongoing personalised support and guidance to help individuals with SMI integrate into community-based physical activity opportunities.