Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Chizimuzo Okoli and Dr. Lillian Findlay

Clinical Mentor

Dr. Julie Perry

Committee Member

Stephen Ranft


Purpose: The purpose of this study was to evaluate the effects of a group-based, psychoeducational program on the knowledge of healthy diet and eating behaviors of adults with mental-health diagnoses in an inpatient psychiatric setting.

Background and Significance: In a given year, adults with mental-health diagnoses have a higher risk of mortality relative to the general population. Mortality from natural causes among individuals with mental-health disorders is similar to the leading causes of death found nationwide, including cardiovascular diseases. There is a growing body of evidence showing a relationship between the health of clients’ hearts and brains. Thus, it is critical to link ‘heart health’ and ‘brain health’ in healthcare delivery. As many cardiovascular disease risk factors are modifiable, controlling such risk factors may be one of the most expedient and cost-effective approaches in protecting brain health. Game-based activities can improve health-related skills, enhance self-esteem and self-efficacy, promote social support, and ultimately motivate positive changes in health behaviors among physically ill clients. Thus, a game-based intervention to promote healthy diet and eating behaviors may be a promising method, worthy of further exploration with people with mental-health diagnoses.

Procedures: This study examined retrospective program data (six-month period) from the Healthy-Heart, Healthy- Brain Program (H3B) and clients’ medical charts at a large state mental health hospital. A univariate descriptive design was used to assess participation rates and client satisfaction with the program. A retrospective, one-group pre-test and post-test design was used to determine changes in clients’ knowledge of healthy diets and attitudes toward healthy eating behaviors.

Results: An average of 22% of the unit census joined the activity daily. The sample was predominantly female (53.5 %) and Caucasian (98.8%). The mean age was 57.1 (SD = 13.6) years. Most participants (33.7%) had a primary diagnoses of psychotic disorders. There was no significant differences in changes in knowledge of heart-healthy diets or engagement in heart-healthy eating behaviors between the pre- and post-test group. However, participants from the post-test group were more likely to get at least 80% correct responses [48% vs. 52%, p = .049], and the post-test group had a slightly higher mean score in their willingness to engage in heart-healthy eating behaviors [Mean = 4.35 (SD = .911) vs. Mean = 4.38 (SD = .987)]. The mean scores on clients’ satisfaction with the group activity and educational content, based on a five-point Likert scale, were 4.6 (SD = 0.8) and 4.5 (SD = 0.8), respectively.

Implication for Nursing Practice This innovative, group-based, psychoeducational board game may improve mental-health clients’ healthy eating knowledge and behaviors. Nurses and other health-care providers may consider adapting the program to other facets of clients’ health and well-being. Ideally, such an intervention could lead to a step forward in mental-health education and provider-client relationships as providers and clients learn to have fun together while learning.