Table 2.

10 core components of MULTI + and application into routine clinical care

Core components of MULTI + a	Application of core components
Routine daily structure and sleep	Wards offer a routine structure in a day-to-day program which includes standard mealtimes, sports-related activities, work-related activities, psychoeducation, and skills training. HCPs pay attention to the circadian rhythm and sleep hygiene of patients. It is intended that patients participate in at least two activities per day, such as walking in the morning and psychoeducation in the afternoon. HCPs motivate patients to engage in activities
Physical activity	Decreasing sedentary behaviour and increasing PA with the credo: “doing some physical activity is better than doing none” as a starting point. The eventual aim is to meet the (inter)national physical activity guidelines of ≥ 150 min of moderate-intensity PA every week, spread over several days [36, 37]. Additionally, patients engage in muscle- and bone-strengthening activities at least twice a week. Elderly patients combine these with balance exercises
Attention to nutrition and eating habits	Attention for the nutritional value and composition of meals and snacks in compliance with the Dutch national guidelines [38], as well as eating habits such as mealtimes and mindful eating. There are (preventive) consultations with dietitians on (clinical) indication of patients or HCPs
Substance use	Smoking cessation is encouraged in both HCPs and patients, and patients are supported by smoking interventions on (clinical) indication of patients or HPCs. For other substance use, patients are referred to addiction specialists
Multidisciplinary approach	Various disciplines are involved in the guidance of a single patient based on the patients’ needs and wishes, such as practitioners, nurses, exercise professionals and dietitians. These HCPs discuss the progress and compliance of individual patients in multidisciplinary consultations led by the chief physicians
Skills training	Daily living skills training and activities for patients, such as making a grocery list, shopping and cooking are embedded in the day-to-day program. Evidence-based behavioural techniques such as goal setting, planning and use of rewards are applied
Psychoeducation	Psychoeducation for patients, such as information about side-effects of medication, oral hygiene, sleep hygiene or nutrition is offered and embedded in the day-to-day program
Critical review of obesogenic environment and existing policies	HCPs examine the (obesogenic) environment and existing policies such as the availability of (un)healthy food and beverages, the use of personal transport and designated smoking areas, and adjust these if necessary. Behavioural change techniques such as choice-architecture and nudging are used
Active participation of HCPs	It is intended that at least one HCP participates in activities of the day-to-day program. HCPs do not engage in adverse health behaviours around patients, such as smoking and unhealthy eating as they have an exemplary function. HCPs motivate patients to improve their lifestyle factors
Training of HCPs	HCPs make use of the available educational resources and follow courses and training such as motivational interviewing or moral deliberation. These activities can support HCPs in motivating and educating patients, and facilitates awareness and culture change

HCPs Healthcare Professionals, PA Physical Activity

^aCross-compliance for implementation of core elements: culture change, peer support, co-designing, tailoring