Table 5.

Key themes from participants from textual data (online stakeholder survey, key informant consultation) in an integrated, citizen-engaged, mixed-methods initiative to establish a Canadian nutrition and mental health research agenda

Theme 1: Applied and pragmatic

∙‘Natural nutritional supplements: the inadequacy of the knowledge base and lack of quality regulation. Some natural supplements may be very helpful, others not. Consumers need reliable information.’ ∙‘Having research-based data that explains how eating impacts mental health, both positively and negatively, will provide the information needed to motivate government, service providers and those with lived experience (and without) to eat in a way that will benefit them physically and mentally.’ ∙‘Always, my priorities are to see such research focused on relevance and direct application: follow-through. And the funding and infrastructure to make sure changes first occur and then are ongoing.’ ∙‘It must be pragmatic, the need is so great and the time was yesterday. Create a plan that has some more immediate implementation, in order to help stakeholders feel that things are happening. Research and a report for the sake of it kills the energy of those in the front line who witness the pain and suffering daily.’

Theme 2: Inclusive and equity-focused

∙‘It just needs to be more accessible, promoted, equal and positive. It needs to reach rural and small towns in a way that is not intrusive that meets someone on their level. An example, a single mom with previous mental health concerns subsisting on Ontario Works may not know how to be active and engaged with proper nutrition for their developing child or themselves...’ ∙‘I would hope that all research would be informed by an overarching concern for – and consultation with – people with lived experience and with families of those with lived experience.’ ∙‘Food insecurity is, and remains a significant issue for individuals that we serve in our programmes and services. This links directly to the issue of poverty and other social determinants of health. Without understanding these core issues, actions to support nutrition and mental health will be limited in scope.’ ∙‘Addressing social determinants of health will help to address issues of lack of, access to and education about food and nutrition.’ ∙‘Poverty, food security and mental health are interconnected. People most impacted have only PWD as an income source and have limited food options as a result.’ ∙‘I think determining barriers and assessing the impact that the social determinants of health has on a person with a mental health condition is paramount in establishing effective nutrition services for those living with a mental health condition.’

Theme 3: Fostering mental health literacy

∙‘… I would consider both the individual’s perceived benefit, but also exploring the impact of stigma and prejudices and disrespect and how if affects the services that are offered, or not offered to help with meeting nutrition needs.’ ∙‘To me these three questions are the most important because there is so much stigma that exists for people living with mental illness. Coupling that with other barriers (like limited knowledge, access or understanding of how nutrition plays a role in mental health and mental illness) people living with MI will not learn the benefits of how to flourish in life, even when living with a mental illness.’ ∙‘I feel weight bias impact on mental health should be included as part or on its own as larger bodied people are often stigmatized which can lead to poor mental health and health behaviours whereas if people received kind, compassionate care free of weight bias, their other mental health issues (if any) would not be amplified.’ ∙‘Some people seem to fall through the cracks of the system. It is still a stigma, especially in smaller communities.’ ∙‘Time, money, commitment and the desire to drive change and sustainability in the stigma reduction.’ ∙‘It is excellent that you are making this type of research a priority. I hope the outcomes will benefit people with lived experience and not stigmatize their families.’

Theme 4: Interdisciplinary and participatory research

∙‘One thing does not cure everything, i.e. diet is not the be all end all for everyone.’ ∙‘While biochemical research and understanding is necessary, there is a need to understand the environment and determinants of mental health that also affect nutritional intakes and access.’ ∙‘Obesity and mental health (schizophrenia, depression, eating disorder). Two multifactorial disorders requiring interdisciplinary treatment and very common in Canada.’ ∙‘Important to engage community partners in a positive way.’ ∙‘Please collaborate with consumers as peer researchers with equal control of projects.’

PWD, persons with disabilities; MI, mental illness.