Real-world challenges in conducting lifestyle intervention research in mental healthcare: reflections from the MULTI+ trial

BACKGROUND: Real-world effectiveness studies that account for contextual complexities and implementation are essential to bridge the research-to-practice gap. In mental healthcare, this is especially important for lifestyle interventions, which can reduce physical health disparities and support mental health in people with mental illness yet remain insufficiently embedded in routine care.

PURPOSE: This commentary reflects on our experiences conducting research within routine clinical care. It aims to inform future real-world studies, support others doing similar work, and help the field move towards practical, transparent, and useful real-world research.

METHODS: We use the implementation of MUltidisciplinary Lifestyle-focused approach in the Treatment of Inpatients with mental illness (MULTI+) as a case example to explore broader challenges in conducting effectiveness-implementation research in real-world clinical settings. Lifestyle interventions are particularly illustrative of such challenges, as they are intertwined with the context in which they are delivered and rely on sustained behavior change across all key actors.

RESULTS: Through continuous dialogue, we identified ways to generate actionable data for clinical decision-making and navigated challenges such as data fragmentation and missing values. In addition, we refined data collection strategies to enhance inclusivity, for example, by incorporating a visual informed consent to improve participant understanding and engagement.

CONCLUSIONS: Our findings highlight the need for research approaches that are responsive to clinical contexts, enhance real-world applicability, and maintain scientific integrity. We discuss how pragmatic adaptations can strengthen the integration of research within mental healthcare practice, ultimately improving the impact of lifestyle interventions.