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Published in: BMC Psychiatry 1/2017

Open Access 01-12-2017 | Research article

Qualitative process evaluation of a psycho-educational intervention targeted at people diagnosed with schizophrenia and their primary caregivers in Jordan

Authors: Abd Al-HadiHasan, Patrick Callaghan, Joanne S. Lymn

Published in: BMC Psychiatry | Issue 1/2017

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Abstract

Background

Schizophrenia is a serious form of mental illness that often requires long term care. Empirical findings indicate that combining a psycho-educational intervention (PEI) with neuroleptic medication to treat schizophrenia is effective. However, there is little information on the therapeutic mechanism of PEIs.

Methods

A qualitative process evaluation was conducted with a purposive sample of people diagnosed with schizophrenia (PDwS, n = 8) and their Primary Caregivers (PCs, n = 9) who had received PEI as a part of an exploratory randomized controlled trial. Semi-structured interviews were conducted to explore potential processes underpinning any observed effect. Thematic analysis was used to analyze and identify prominent patterns in the data. Interviews were conducted between April 2013 and August 2013.

Results

Three themes emerged from the qualitative interviews, ‘Awareness of schizophrenia’, ‘Positive impact on health and wellbeing’, ‘empowerment and enhanced confidence’, which described the variety of experiences with the intervention, although most reported that the intervention was acceptable and valued.

Conclusion

This study identified that individual understanding varied between PDwS and PCs and led to differences in the ways that they used knowledge gained from the PEI in everyday situations. These data support the importance of improving understanding of schizophrenia by PDwS and their PCs to enable them to benefit more fully from medication.

Trial registration

Current Controlled Trials ISRCTN78084871. Retrospectively registered 28 December 2015.
Literature
1.
go back to reference Almeida OP, Howard R, Levy R, David AS. Psychotic states arising in late life (late paraphrenia) psychopathology and nosology. Br J Psychiatry. 1995;166(2):205–14.CrossRefPubMed Almeida OP, Howard R, Levy R, David AS. Psychotic states arising in late life (late paraphrenia) psychopathology and nosology. Br J Psychiatry. 1995;166(2):205–14.CrossRefPubMed
2.
go back to reference Olesen J, Gustavsson A, Svensson M, Wittchen HU, Jönsson B. The economic cost of brain disorders in Europe. Eur J Neurol. 2012;19(1):155–62.CrossRefPubMed Olesen J, Gustavsson A, Svensson M, Wittchen HU, Jönsson B. The economic cost of brain disorders in Europe. Eur J Neurol. 2012;19(1):155–62.CrossRefPubMed
3.
go back to reference Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull. 1998;24(1):1–10.CrossRefPubMed Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull. 1998;24(1):1–10.CrossRefPubMed
4.
6.
go back to reference Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, Pitkin R, Rennie D, Schulz KF, Simel D. Improving the quality of reporting of randomized controlled trials: the CONSORT statement. JAMA. 1996;276(8):637–9.CrossRefPubMed Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, Pitkin R, Rennie D, Schulz KF, Simel D. Improving the quality of reporting of randomized controlled trials: the CONSORT statement. JAMA. 1996;276(8):637–9.CrossRefPubMed
7.
go back to reference Mohamed S, Rosenheck R, McEvoy J, Swartz M, Stroup S, Lieberman JA. Cross-sectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia. Schizophr Bull. 2009;35(2):336–46.CrossRefPubMed Mohamed S, Rosenheck R, McEvoy J, Swartz M, Stroup S, Lieberman JA. Cross-sectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia. Schizophr Bull. 2009;35(2):336–46.CrossRefPubMed
8.
go back to reference Xia J, Merinder LB, Belgamwar MR. Psychoeducation for schizophrenia. Cochrane Database Syst Rev. 2011;6. Xia J, Merinder LB, Belgamwar MR. Psychoeducation for schizophrenia. Cochrane Database Syst Rev. 2011;6.
9.
go back to reference Hooley JM. Expressed emotion and relapse of psychopathology. Annu Rev Clin Psychol. 2007;3:329–52.CrossRefPubMed Hooley JM. Expressed emotion and relapse of psychopathology. Annu Rev Clin Psychol. 2007;3:329–52.CrossRefPubMed
10.
go back to reference Bhugra D, McKenzie K. Expressed emotion across cultures. Adv Psychiatr Treat. 2003;9(5):342–8.CrossRef Bhugra D, McKenzie K. Expressed emotion across cultures. Adv Psychiatr Treat. 2003;9(5):342–8.CrossRef
11.
go back to reference Giron M, Fernandez-Yanez A, Mana-Alvarenga S, Molina-Habas A, Nolasco A, Gomez-Beneyto M. Efficacy and effectiveness of individual family intervention on social and clinical functioning and family burden in severe schizophrenia: a 2-year randomized controlled study. Psychol Med. 2010;40(1):73–84.CrossRefPubMed Giron M, Fernandez-Yanez A, Mana-Alvarenga S, Molina-Habas A, Nolasco A, Gomez-Beneyto M. Efficacy and effectiveness of individual family intervention on social and clinical functioning and family burden in severe schizophrenia: a 2-year randomized controlled study. Psychol Med. 2010;40(1):73–84.CrossRefPubMed
12.
go back to reference Hasan AA, Callaghan P, Lymn JS. Evaluation of the impact of a psycho-educational intervention for people diagnosed with schizophrenia and their primary caregivers in Jordan: a randomized controlled trial. BMC Psychiatry. 2015;15(1):1–10.CrossRef Hasan AA, Callaghan P, Lymn JS. Evaluation of the impact of a psycho-educational intervention for people diagnosed with schizophrenia and their primary caregivers in Jordan: a randomized controlled trial. BMC Psychiatry. 2015;15(1):1–10.CrossRef
13.
go back to reference Zoladl MS F, et al. Common lived experiences of Iranian families with mental illness. Saudi Ger Hosp Med J. 2007;2(1):443–52. Zoladl MS F, et al. Common lived experiences of Iranian families with mental illness. Saudi Ger Hosp Med J. 2007;2(1):443–52.
14.
go back to reference Creswell JW. Research design: Qualitative, quantitative, and mixed methods approaches. USA: Sage publications; 2013. Creswell JW. Research design: Qualitative, quantitative, and mixed methods approaches. USA: Sage publications; 2013.
15.
go back to reference Avis M. Do we need methodological theory to do qualitative research? Qual Health Res. 2003;13(7):995–1004.CrossRefPubMed Avis M. Do we need methodological theory to do qualitative research? Qual Health Res. 2003;13(7):995–1004.CrossRefPubMed
16.
go back to reference Patton MQ. Qualitative evaluation and research methods. SAGE Publications, inc; 1990. Patton MQ. Qualitative evaluation and research methods. SAGE Publications, inc; 1990.
17.
18.
go back to reference Braun V, Clarke V. Successful qualitative research: A practical guide for beginners. Sage; 2013. Braun V, Clarke V. Successful qualitative research: A practical guide for beginners. Sage; 2013.
19.
go back to reference Al-Krenawi A, Graham JR, Kandah J. Gendered utilization differences of mental health services in Jordan. Commun Ment Health J. 2000c, 36(5):501–511. Al-Krenawi A, Graham JR, Kandah J. Gendered utilization differences of mental health services in Jordan. Commun Ment Health J. 2000c, 36(5):501–511.
20.
go back to reference Oakley A, Strange V, Bonell C, Allen E, Stephenson J, Team RS. Health services research: process evaluation in randomised controlled trials of complex interventions. BMJ: Br Med J. 2006;332(7538):413.CrossRef Oakley A, Strange V, Bonell C, Allen E, Stephenson J, Team RS. Health services research: process evaluation in randomised controlled trials of complex interventions. BMJ: Br Med J. 2006;332(7538):413.CrossRef
21.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
22.
go back to reference Green J, Thorogood N. Qualitative methods for health research. Sage; 2013. Green J, Thorogood N. Qualitative methods for health research. Sage; 2013.
23.
go back to reference Denzin NK. The research act: A theoretical introduction to sociological methods. Transaction publishers; 1970. Denzin NK. The research act: A theoretical introduction to sociological methods. Transaction publishers; 1970.
24.
go back to reference Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International J Qual Health Care. 2007;19(6):349–57.CrossRef Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International J Qual Health Care. 2007;19(6):349–57.CrossRef
25.
go back to reference McCauley CO, McKenna H, Keeney S, McLaughlin DF. Concept analysis of recovery in mental illness in young adulthood. J Psychiatr Ment Health Nurs. 2015;22(8):579–89.CrossRefPubMed McCauley CO, McKenna H, Keeney S, McLaughlin DF. Concept analysis of recovery in mental illness in young adulthood. J Psychiatr Ment Health Nurs. 2015;22(8):579–89.CrossRefPubMed
26.
go back to reference Hasan AA, Callaghan P, Lymn JS. Evaluation of the impact of a psycho-educational intervention for people diagnosed with schizophrenia and their primary caregivers in Jordan: a randomized controlled trial. BMC Psychiatry. 2015;15(1):72.CrossRefPubMedPubMedCentral Hasan AA, Callaghan P, Lymn JS. Evaluation of the impact of a psycho-educational intervention for people diagnosed with schizophrenia and their primary caregivers in Jordan: a randomized controlled trial. BMC Psychiatry. 2015;15(1):72.CrossRefPubMedPubMedCentral
27.
go back to reference Ran MS, Xiang MZ, Chan CLW, Leff J, Simpson P, Huang MS, Shan YH, Li SG. Effectiveness of psychoeducational intervention for rural Chinese families experiencing schizophrenia - A randomised controlled trial. Soc Psychiatry Psychiatr Epidemiol. 2003;38(2):69–75.CrossRefPubMed Ran MS, Xiang MZ, Chan CLW, Leff J, Simpson P, Huang MS, Shan YH, Li SG. Effectiveness of psychoeducational intervention for rural Chinese families experiencing schizophrenia - A randomised controlled trial. Soc Psychiatry Psychiatr Epidemiol. 2003;38(2):69–75.CrossRefPubMed
28.
go back to reference Chan SWC, Yip B, Tso S, Cheng BS, Tam W. Evaluation of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers. Patient Educ Couns. 2009;75(1):67–76.CrossRefPubMed Chan SWC, Yip B, Tso S, Cheng BS, Tam W. Evaluation of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers. Patient Educ Couns. 2009;75(1):67–76.CrossRefPubMed
29.
go back to reference Merinder LB, Viuff AG, Laugesen HD, Clemmensen K, Misfelt S, Espensen B. Patient and relative education in community psychiatry: a randomized controlled trial regarding its effectiveness. Soc Psychiatry Psychiatr Epidemiol. 1999;34(6):287–94.CrossRefPubMed Merinder LB, Viuff AG, Laugesen HD, Clemmensen K, Misfelt S, Espensen B. Patient and relative education in community psychiatry: a randomized controlled trial regarding its effectiveness. Soc Psychiatry Psychiatr Epidemiol. 1999;34(6):287–94.CrossRefPubMed
30.
go back to reference Vogel DL, Wade NG, Haake S. Measuring the self-stigma associated with seeking psychological help. J Couns Psychol. 2006;53(3):325.CrossRef Vogel DL, Wade NG, Haake S. Measuring the self-stigma associated with seeking psychological help. J Couns Psychol. 2006;53(3):325.CrossRef
31.
go back to reference El-Badri S, Mellsop G. Stigma and quality of life as experienced by people with mental illness. Australas Psychiatry. 2007;15(3):195–200.CrossRefPubMed El-Badri S, Mellsop G. Stigma and quality of life as experienced by people with mental illness. Australas Psychiatry. 2007;15(3):195–200.CrossRefPubMed
32.
go back to reference Kleim B, Vauth R, Adam G, Stieglitz R-D, Hayward P, Corrigan P. Perceived stigma predicts low self-efficacy and poor coping in schizophrenia. J Ment Health. 2008;17(5):482–91.CrossRef Kleim B, Vauth R, Adam G, Stieglitz R-D, Hayward P, Corrigan P. Perceived stigma predicts low self-efficacy and poor coping in schizophrenia. J Ment Health. 2008;17(5):482–91.CrossRef
33.
go back to reference Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res. 2003;121(1):31–49.CrossRefPubMed Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res. 2003;121(1):31–49.CrossRefPubMed
34.
go back to reference Vauth R, Kleim B, Wirtz M, Corrigan PW. Self-efficacy and empowerment as outcomes of self-stigmatizing and coping in schizophrenia. Psychiatry Res. 2007;150(1):71–80.CrossRefPubMed Vauth R, Kleim B, Wirtz M, Corrigan PW. Self-efficacy and empowerment as outcomes of self-stigmatizing and coping in schizophrenia. Psychiatry Res. 2007;150(1):71–80.CrossRefPubMed
35.
go back to reference Roe D. Progressing from patienthood to personhood across the multidimensional outcomes in schizophrenia and related disorders. J Nerv Ment Dis. 2001;189(10):691–9.CrossRefPubMed Roe D. Progressing from patienthood to personhood across the multidimensional outcomes in schizophrenia and related disorders. J Nerv Ment Dis. 2001;189(10):691–9.CrossRefPubMed
36.
go back to reference Lysaker PH, Roe D, Yanos PT. Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bull. 2007;33(1):192–9.CrossRefPubMed Lysaker PH, Roe D, Yanos PT. Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bull. 2007;33(1):192–9.CrossRefPubMed
38.
go back to reference Glanville DN, Dixon L. Caregiver burden, family treatment approaches and service use in families of patients with schizophrenia. Isr J Psychiatry Relat Sci. 2005;42(1):15–22.PubMed Glanville DN, Dixon L. Caregiver burden, family treatment approaches and service use in families of patients with schizophrenia. Isr J Psychiatry Relat Sci. 2005;42(1):15–22.PubMed
39.
go back to reference Solomon et al. The impact of individualized consultation and group workshop family education interventions on ill relative outcomes. J Nerv Ment Dis. 2000;23(2):27–37. Solomon et al. The impact of individualized consultation and group workshop family education interventions on ill relative outcomes. J Nerv Ment Dis. 2000;23(2):27–37.
40.
go back to reference Degmečić D, Požgain I, Filaković P. Psychoeducation and compliance in the treatment of patients with schizophrenia. Coll Antropol. 2007;31(4):1111–5.PubMed Degmečić D, Požgain I, Filaković P. Psychoeducation and compliance in the treatment of patients with schizophrenia. Coll Antropol. 2007;31(4):1111–5.PubMed
41.
go back to reference Herz MI, Lamberti JS, Mintz J, Scott R, O'Dell SP, McCartan L, Nix G. A program for relapse prevention in schizophrenia - A controlled study. Arch Gen Psychiatry. 2000;57(3):277–83.CrossRefPubMed Herz MI, Lamberti JS, Mintz J, Scott R, O'Dell SP, McCartan L, Nix G. A program for relapse prevention in schizophrenia - A controlled study. Arch Gen Psychiatry. 2000;57(3):277–83.CrossRefPubMed
42.
go back to reference Carpenter WT, Buchanan RW, Kirkpatrick B, Breier AF. Diazepam treatment of early signs of exacerbation in schizophrenia. 2014. Carpenter WT, Buchanan RW, Kirkpatrick B, Breier AF. Diazepam treatment of early signs of exacerbation in schizophrenia. 2014.
43.
go back to reference Lamberti JS. Seven keys to relapse prevention in schizophrenia. J Psychiatr Pract®. 2001;7(4):253–9.CrossRef Lamberti JS. Seven keys to relapse prevention in schizophrenia. J Psychiatr Pract®. 2001;7(4):253–9.CrossRef
44.
go back to reference Bond GR, Drake RE, Mueser KT, Latimer E. Assertive community treatment for people with severe mental illness. Dis Manag Health Out. 2001;9(3):141–59.CrossRef Bond GR, Drake RE, Mueser KT, Latimer E. Assertive community treatment for people with severe mental illness. Dis Manag Health Out. 2001;9(3):141–59.CrossRef
45.
go back to reference Turkington D, Kingdon D, Turner T. Effectiveness of a brief cognitive—behavioural therapy intervention in the treatment of schizophrenia. Br J Psychiatry. 2002;180(6):523–7.CrossRefPubMed Turkington D, Kingdon D, Turner T. Effectiveness of a brief cognitive—behavioural therapy intervention in the treatment of schizophrenia. Br J Psychiatry. 2002;180(6):523–7.CrossRefPubMed
46.
go back to reference Tsai Y-F, Ku Y-C. Self-care symptom management strategies for auditory hallucinations among inpatients with schizophrenia at a veterans' hospital in Taiwan. Arch Psychiatr Nurs. 2005;19(4):194–9.CrossRefPubMed Tsai Y-F, Ku Y-C. Self-care symptom management strategies for auditory hallucinations among inpatients with schizophrenia at a veterans' hospital in Taiwan. Arch Psychiatr Nurs. 2005;19(4):194–9.CrossRefPubMed
47.
go back to reference Barrio C, Yamada A-M. Culturally based intervention development: the case of Latino families dealing with schizophrenia. Res Soc Work Pract. 2010;20(5):483–92.CrossRefPubMedPubMedCentral Barrio C, Yamada A-M. Culturally based intervention development: the case of Latino families dealing with schizophrenia. Res Soc Work Pract. 2010;20(5):483–92.CrossRefPubMedPubMedCentral
48.
go back to reference Cheng LY, Chan S. Psychoeducation program for Chinese family carers of members with schizophrenia. West J Nurs Res. 2005;27(5):583–99.CrossRefPubMed Cheng LY, Chan S. Psychoeducation program for Chinese family carers of members with schizophrenia. West J Nurs Res. 2005;27(5):583–99.CrossRefPubMed
49.
go back to reference McWilliams S, Hill S, Mannion N, Kinsella A, O'Callaghan E. Caregiver psychoeducation for schizophrenia: is gender important? Eur Psychiatry. 2007;22(5):323–7.CrossRefPubMed McWilliams S, Hill S, Mannion N, Kinsella A, O'Callaghan E. Caregiver psychoeducation for schizophrenia: is gender important? Eur Psychiatry. 2007;22(5):323–7.CrossRefPubMed
50.
go back to reference Huffman MH. Compliance, health outcomes, and partnering in PPS: acknowledging the patient’s agenda. Home Healthc Nurse. 2005;23(1):23–8.PubMed Huffman MH. Compliance, health outcomes, and partnering in PPS: acknowledging the patient’s agenda. Home Healthc Nurse. 2005;23(1):23–8.PubMed
51.
go back to reference Rofail D, Heelis R, Gournay K. Results of a thematic analysis to explore the experiences of patients with schizophrenia taking antipsychotic medication. Clin Ther. 2009;31:1488–96.CrossRefPubMed Rofail D, Heelis R, Gournay K. Results of a thematic analysis to explore the experiences of patients with schizophrenia taking antipsychotic medication. Clin Ther. 2009;31:1488–96.CrossRefPubMed
Metadata
Title
Qualitative process evaluation of a psycho-educational intervention targeted at people diagnosed with schizophrenia and their primary caregivers in Jordan
Authors
Abd Al-HadiHasan
Patrick Callaghan
Joanne S. Lymn
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1225-2

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