Table 5.

Participant focus group feedback relating to program factors.

Program Factors	Sub-Themes	Participant Feedback (positive)	Participant Feedback (negative)
Program location, access, timing and environment	Location and Access: Environment: Timing:	“it was fairly easy to get to … less than 5-minute walk from the train station.” “relaxed environment … not as busy as some gyms … You’re in control of what you’re doing, and it’s just a good experience.” “there’s other people that come at the same time, … there’s other people working out as well, so you feel like you’re in a normal environment.” “Because it’s a Uni- it’s got that extra edge to it. All the students walking around, learning, smart.” “it’s not too early … you can travel after rush-hour…”	“… I have to travel quite a way to get here.” “… it costs quite a lot of money to get here, so it may be easier for me to find a local gym.”
Program design and content: Health Behavior education sessions	Design: Content:	“it was kind of an open discussion on options we have over our lifestyle rather than like you’re not eating this or you’re not eating that or get out and do that! … make your own decisions based on our recommendations … which was good.” “Every week was different … It wasn’t the same old thing, it was very varied.” “I like the talking and nutrition part.” “Yes, saying how big the portion is, you only need a small amount where I thought you needed a lot. … Yes, the nutrition ones were good.” “I liked the tasting session as well, when we tried new things, healthy snacks….” “I also liked learning about drugs, I found it interesting.” “new ideas from sessions before the gym.”	“I much preferred the exercise part. I already knew a lot of what was being said. I would have preferred to spend longer doing the sports things, but I understand that some people found it really beneficial so I didn’t mind.” “At one point he suggested dips and crackers, as a substitute for crisps and things. I noticed if you bought a tub of dip or whatever, it would go off within 2 days, and you have to have quite a lot of crackers over the two days, rather than having it once a week or twice a week, you are having to have it quite a lot to use it all and not waste it.” “I found mindfulness difficult to do as I was thinking about lots of things.” “I have tried the vapour cigarettes but I didn’t like them.”
Program Design and Content: Exercise Sessions	Design: Content:	“I learnt how to use the fitness equipment. … should be alright for me to work the machinery on my own.” “Learning the new equipment, … getting to grips with that because it’s something that’s alien to me.” “I think it’s worthwhile doing it (goal setting), so you know what you’re trying to achieve, rather than just coming in and not really having a goal.” “… the gym an adequate length, and we’ve got the opportunity to stay after the session is over, so the length of that isn’t a problem.” “using the gym facilities … particularly like the rowing machine and treadmill.” “Handball. … that was my favourite. That broke up the programme as well, doing something a bit different every time, so that was quite good.” “My favourite activity … basketball.” “I enjoyed Pilates, it was relaxing. Good for strengthening the muscles.” “ … body balance has been my favourite”	“I was worried about using the equipment, and how to use it.” “I actually used the gym probably for about half an hour longer. It seemed a bit too short.” “I found the weights difficult.” “Pilates was okay, not really something I would normally do.” “I found the Tai Chi difficult to follow.”
Supporting Tools: (pedometer, water bottle, tape measure, cookery book		“The books help … something else to focus on, and to try things that you wouldn’t ordinarily try.” “I got given a pedometer … then I knew I supposed to have 10,000 a day so that kind of came quite addictive then.” “I still check my step counter all the time” “I wouldn’t have walked this far had I not had to do it, and it (step counter) made me increase the activity level, and walking around outside of the times as well.”	“it (step-counter) could have been done earlier. … we could have looked to see how much everybody had walked, and do it week on week to see if we’ve increased. Or do it start to end and see the progress.” “….an app would be really useful to log activity every day or to say everyone get something like my fitness pal like an app that already exists.”
Program Engagement		“I was hesitant at first, not sure whether I would like it or not, whether there were people there I wouldn’t get on with, so I was a bit hesitant, but eventually said yes. “I remember there were people waiting in the entrance on the first week, telling us where to come and introducing us, so that was quite handy.” “I was a lot more unstable to start with, as the programs gone on my mood has become more stable.” “I was suffering from really bad anxiety and panic attacks, and I really didn’t want to go. I really had to force myself to go, but I survived the first time, which made me persevere.” “After the first week of doing it, I wanted to keep doing it, to keep helping me.” “I don’t think there is anything that would put me off from what I experienced in the first week so if someone would drop out its probably to do with their own problems rather than the group.”	“sometimes, for someone with psychosis or schizophrenia, sometimes it can be difficult to cope.” “ the size of the group at the start was a bit overwhelming.”
Program adherence	Structure/Routine: Feeling better/sense of accomplishment: Program commitment: Intrinsic Motivation:	“I quite liked how it structured my day, … you feel like you’ve accomplished something after coming and that’s good for my self-esteem.” “It feels good to have a constant routine coming to the gym every Thursday. I have more energy.” “it is good and has got me into a routine again.” “also, the structure to your day, when I get home I feel like I’ve done something.” “I feel differently when I haven’t been like I feel less productive, it’s part of my routine now.” “once I’ve done the exercise, and I’ve done it, I feel loads better, like a weight has been lifted, it enables me to carry on for the day, for the rest of the week. It really motivates me, just by the fact that it lifts me.”“…I do feel better immediately after the exercise.” “I always feel like on Thursday is like a really happy time because I finish SHAPE then I feel rewarded for going out and doing something … I feel like I have accomplished something after coming and that’s good for my self-esteem.” “Although it got better each time, it wasn’t the nicest, but once I got into it, into the session, it got easier and then gradually over the weeks it got easier still.” “the two things that have changed the most is my concentration and mood … I was a lot more unstable to start with, as the programmes gone on my mood has become more stable” “Sometimes I wake up and I don’t feel like doing anything, but because I’m committed to coming I force myself to go.” “I didn’t feel well, but I thought I should go as it’s the last week, … I felt better afterwards.” “quite good having that on Thursday then I find myself going to the gym on Friday and Saturday because it’s motivating.” “there’s loads of things. It’s fun, it’s worthwhile doing, you make friends, it gets you fit, helps with your motivation.” “I think that my motivation has got better because before I … just sat in my room at home.”	“I had to force myself to come, to make myself do it, because I thought once I was here, I would go and do it, but it seemed like such an effort at times to just get in, and be here.”
Social identity and group cohesion		“it was good to start off with a chat, and see which people were with their t-shirts on.” “you could tell who else was in the group as well, and kind of feel together, sense of identity.”
Social support		“… I felt like I’d made a friend, and then more friends, and it was easier than just being on your own, because you felt like you were going with somebody.” “as the group got smaller, you kind of got to know people better … you had regular contact with a regular person which was nice.” “… to see other people in your situation benefitting from the same things as you, it’s quite reassuring.” “the group is much better, because you can do more things. …The group was one of the reasons I wanted to do it, because I wasn’t really seeing anyone, so that was the main thing – to do something that I enjoyed but also improve socially I suppose.” “… get to know people better, and you find out you might have other activities that you do together so, that helps and you learn things about each other which is quite fun.” “… you can’t do sports on your own, so the sports I enjoyed.” “the person who I came along with grew in confidence throughout and more importantly gained a friendship has led to the two of them carrying on at the Gym and meeting up on a weekly basis.” (peer support worker)	“I’ve been talking to X about membership, so then I would have someone to go with, because I wouldn’t do it on my own.” “… I can go by myself. I have been to a gym outside of this, I don’t really mind going on my own.”
Carer support and feedback		“My husband helped– we changed our diet together.” “Yes, they can see how it’s helped me, it’s improved my confidence.” “My dad said I’ve lost weight, he usually only says that if it’s true.” “… It has just transformed him. Not only is he back in shape – almost to his old self – but he is so much more positive and confident. … He is taking much more interest in his own wellbeing which is what SHAPE is about – not just the exercise. He is looking good so we have been clothes shopping and he taking an interest in how he dresses … The 12 weeks are up but he remains just as motivated which couldn’t be better illustrated by the fact that he, and another fellow on the course, are keeping up the same routine and are still going to the centre. From my point of view, SHAPE has given me my son back.” (carer)
Impact on Clinical Outcomes: weight, BMI, heart rate		“I haven’t eaten less, but my waist circumference has gone down, and my BMI has gone down.” “I have lost a stone so far, I can also feel it in my clothes.” “The sessions have been worthwhile and I have gotten more fit and I have lost weight.” “My heart rate is a bit lower.”	“well I have actually put on weight but I think I have put on muscle in my legs and my belly.” “not everyone wants to just lose weight so like if I said I want to get stronger then maybe you could take arm measurements … instead of just saying you have gained or lost weight.”
Impact on health risk behavior: Diet and healthy eating		“I am trying to eat more fruit and veg now.” “I have cut down on eating and I am eating healthier food.” “we try to get extra portions of vegetables into our meal, and find new, creative ways to incorporate them … and extra fruit and things like that.” “because of the nutrition side of things, I’m trying to concentrate more on healthy eating and things.” “I did some research, and found that wheat sort of puffs you up, so trying to cut that out.” “I’m doing more cooking on my own now. I’m eating much more now but I feel healthier, my appetite has increased.”
Impact on health risk behavior: Physical activity and Sedentary behavior		“I can walk quicker without losing breath. Before I’d have to walk slow.” “Feel fitter, easier to move around without getting out of breath.” “I can actually run up the stairs now.” “it’s good to have exercise as a form of release or, as I know I do feel better if I am having a really bad day, if I exercise, the rush or whatever you get, you feel better for like an hour or two and removes me from it for a while.”
Impact on health risk behavior: Smoking		“I was a smoker before and even though I really enjoyed smoking did reluctantly want to stop, I have now” “I reduced smoking from 30 a day to 5 a day over the last 2 months.” “I just feel a bit like I have a bit more energy. I think my heart’s a lot healthier now because like before obviously smoking and not exercising for quite a while, I feel like my stamina is better.”
Impact on Wider Functioning		“I am starting swimming, gym and exercise classes. The SHAPE gym helped me get motivated.” “now I quite like to cycle down the road … then walk the rest of the way into town.” “It has made me change my routine on other days as well. …. I’ve started doing it in the morning, then setting up my day with it, just to get that level of activity and to make me feel just a little bit better.” “I had a car accident about 5 years ago, and my knees have been weakened since, and I think walking here and the activities we’ve been doing here has helped strengthen them.” “I think that my motivation has got better because before I felt like I was just sat in my room at home.”	“I still struggle with my fears and bad feelings. At home I’m always so-so, when people ask me how I am I say so-so. I haven’t noticed a big change.” “I was struggling to continue after the weeks weren’t taught, it was a bit more of a push to actually get there, for me anyway.”