Evaluation of the Impact of a Psycho-Educational Intervention for People Diagnosed With

EVALUATION OF THE IMPACT OF A PSYCHO-EDUCATIONAL INTERVENTION FOR PEOPLE DIAGNOSED WITH SCHIZOPHRENIA AND THEIR PRIMARY CAREGIVERS IN JORDAN: FINDINGS FROM A SEQUENTIAL EXPLANATORY MIXED METHODS STUDY

Abstract

Background:Psycho-educational interventions (PEIs) for people diagnosed with schizophrenia (PDwS) and their primary caregivers (PCs) appear promising; however, the majority of studies have significant methodological shortcomings. Little is known about the effects of these interventions, delivered in a booklet format in resource-poor countries, and little is known about people's experiences of receiving such interventions.

Aim:The aims of this study were to evaluate the effectiveness of a PEI designed for Jordanian PDwS and their PCs to improve their knowledge of schizophrenia, reducing psychiatric symptom severity and relapse rate among PDwS, and reducing the burden of care and improving quality of life (QoL) for PCs. The study also explored PDwS and PCs' experiences of the intervention.

Methods:A randomised, controlled trial was conducted with 121 dyads of PDwS and their PCs. Participants aged 18 years or older with DSM-IV schizophrenia or schizoaffective disorder and their PCs from four outpatient mental health clinics in Jordan, were randomly assigned to receive 12-week of a booklet form of PEI with follow-up phone calls and treatment as usual [TAU] (intervention, n = 58) or TAU (control, n = 63). A variety of outcomes were assessed for participants at baseline immediately post-intervention (post-test 1) and at three-month follow-up (post-test 2). The primary outcome measure was the baseline to endpoint change in knowledge of schizophrenia for PDwS and PCs. Secondary outcomes (psychological) for PDwS were psychiatric symptoms and relapse rate with hospitalisation or medication. Secondary outcomes for PCs were burden of care and QoL. A subsequent qualitative evaluation was carried out with 17 participants from the intervention group following its completion.

Results:PDwS in the intervention group experienced greater improvement in knowledge scores at post-test 1 and at the post-test 2 and greater reduction in psychiatric symptom severity at follow-up. Relapse rate with hospitalisation was reduced significantly at post-test 1 and at post-test 2 in the intervention group, while relapse with medication increased in the intervention group at both follow-up times. Similarly, there was a significant improvement in the PCs' knowledge score at post-test 1 and at post-test 2. PCs' burden of care was significantly reduced in the intervention group and their QoL improved at post-test 1 and post-test 2. Three themes emerged from the qualitative data: ‘Awareness of schizophrenia’, ‘Positive impact on health and wellbeing’ and ‘Empowerment and enhanced confidence’, which indicated the variety of experiences with the intervention, although most reported that the intervention was acceptable and valued.

Conclusions:PEI supported with TAU improves the knowledge levels of schizophrenia for PDwS and PCs, psychiatric symptoms and relapse rate, as well as PCs' burden of care and QoL. The intervention is acceptable to PDwS and their PCs, user-friendly and easy to design. Implications for the findings for mental health care practice, education and research are discussed and recommendations are made for future research in this area.

My Name: Abd Alhadi Ibrahim Ahmad Hasan

Email:

Host institution: Nottingham University, Queen Medical Centre, NG2 2UH, UK

Home institution: Zarqa University