Table 1.

Summary of Study Themes and Subthemes.

Themes/Subthemes	Summary of Results	Stakeholder Groups
Consumer–provider interactions in the medical encounter: Consumer level
Avoidance of overt disagreement	Social norms dictate respect, and consumers should not overtly question doctors. Deference to authority could undermine consumers’ involvement in medical visits.	Consumers, primary care providers
Mistrust	Mistrust of medical institutions restricted consumer willingness to question doctors’ advice to avoid mistreatment. Mistrust can result in consumers entering the medical encounter in a defensive stance because of high levels of suspicion.	Consumers
Consumers’ body image	Cultural norms favored a fuller body image as a sign of good health. Provider inattention to cultural norms associated with body image can inadvertently create resistance to losing weight.	Consumers, friends/relatives, primary care providers
Consumer–provider interactions in the medical encounter: Provider level
Ambivalence about delivering physical health care	Mental health clinicians’ ambivalence about delivering physical health care can result in barriers to the integration of physical and mental health services. Ambivalence originates from professional boundary issues and limited education and training in preventive medicine and managing chronic disease. Tipping-point phenomenon: For acute, life-threatening medical issues, professional boundary issues were set aside and mental health providers were willing to intervene.	Administrators, mental health clinicians
Misattribution of physical symptoms to mental disorders	Unraveling the physical health needs of consumers is difficult and requires skill to untangle the physical from the mental. Consumer health concerns, as related to consumer mental health conditions, are often misinterpreted by primary care providers. Physicians question the reliability of the medical information they obtain from consumers.	Primary care providers, mental health clinicians, relatives
Stigmatization	The combination of stigma and racism contributes to consumers entering the medical encounter resigned to receiving poor medical care. Medical providers view consumers with SMI as dangerous and unmanageable, evoking fear and resistance toward treating them. Lack of training and experience working with people with SMI contributes to stigmatization.	Administrators, mental health clinicians, relatives, faith-based leaders, primary care providers
Consumer interactions with their environment
Consumers’ food environments	Consumers’ limited income places constraints on their dietary choices. There was a lack of available and affordable healthy food options in consumers’ communities. Consumers reported easy access to fast food establishments in their communities. For some consumers, the food served in day treatment programs is an important part of their diet.	Administrators, consumers, mental health clinicians, primary care providers
Social norms associated with dietary practices	Some consumers internalized the view that low-income minority people live unhealthy lives because they eat unhealthy foods. Consumers acknowledged how difficult it is to change unhealthy dietary habits. Consumers endorsed the perception that culturally meaningful foods are unhealthy.	Consumers, mental health clinicians, primary care providers, faith- based leaders
Social context influences consumers’ engagement in physical activity	Consumers are aware of the importance of exercise for their health but varied in their engagement in daily physical activity. Not having access to a safe environment deterred consumers from engaging in regular physical activity. Consumers face multiple barriers to engaging in and maintaining physical activity. Most consumers expressed interest in exercise groups offered in mental health clinics that provided opportunities for cultural expression and promoted healthy lifestyles.	Consumers