Introduction. The objective of this research was to explore the factors that influence the food choice behaviors of community-dwelling adults diagnosed with a severe mental illness (SMI) and to examine their diet quality and patterns of dietary intake.

Methods. This exploratory mixed-methods study involved the use of qualitative and quantitative data collection methods. Semi-structured interviews were conducted with 20 individuals with SMI and 10 mental health staff; data were analyzed using a grounded theory approach. To assess dietary intake three nonconsecutive 24-hour food recalls, using the USDA 5-step multi-pass method, were completed with each participant. Average daily intake of kcal, eight selected nutrients, and food groups were assessed. Comparisons between groups of participants were made using independent samples t-tests for equality of means.

Results. Six dominant themes influencing the food choice behavior of adults with SMI in this study emerged from the interviews: food availability, preference for simple food preparation, cost, difficulty making healthy food choices, relative importance of making healthy choices, and medication effects. Two self-described eating styles related to food choice behavior were identified. Ten participants were identified as self-described healthy eaters and ten as self-described non-healthy eaters. The group of all participants consumed more than the recommended amount of grains and less than the recommended amounts of fruit, vegetables, and milk. They consumed more than the recommended fat, saturated fat, and sodium; and less than the recommended fiber and calcium. Healthy eaters had a statistically significant higher mean percent recommendation consumed for the meat and beans category and the vegetables category than non-healthy eaters. Self-described non-healthy eaters consumed more carbohydrate, fat and saturated fat grams than self-described healthy eaters.

Conclusions. This research identified influences on the food choice behavior of individuals with SMI and found that self-described healthy eaters are more likely to consume healthier diets than self-described non-healthy eaters. Understanding the differences in the perceptions regarding personal eating behaviors between the two groups can be beneficial in understanding motivators and barriers for eating healthy and can aid in designing effective nutritional interventions for individuals with SMI residing in the community.