Exploring views of relatives and mental health professionals to inform the cultural adaptation of a family intervention for schizophrenia in Oman: A qualitative study

Abstract

Background: Family interventions (FI) for schizophrenia were primarily developed and practised in the West. It has been proven that cultural adaptation for FI facilitates its uptake and improves therapy outcomes; however, the majority of literature on the development of FI focussed on outpatient or community settings, and little attention has been paid to in-patient units. There is an opportunity to engage with the family during admission, particularly in Asia. Aims: To explore relatives’ and mental health professionals’ views and opinions to inform the cultural adaptation of FI for hospitalised patients with schizophrenia in Oman. It also aimed to gain consensus on items that need adaptation. Methods: We conducted semi-structured interviews with the caregivers ( n = 20) and two separate focus groups with psychiatrists ( n = 7) and nurses ( n = 5). Another consensus group was a mix of both ( n = 6) to develop agreement and solve discrepant issues. The data were analysed using framework analysis to identify the intervention components and delivery system. Results: Modifications to existing components indicated that the cultural adaption of the intervention focussed more on themes such as religious and spiritual causes of mental illness, simplified language, format of delivery as individual sessions and culturally relevant and acceptable problem solving and coping skills. The components of the intervention identified as psychoeducation, problem-solving and emotional support. The consensus group finalised the intervention’s content and delivery system concerning training needs and issues and barriers to implementation. The proposed culturally adapted FI for hospitalised patients requires a flexible approach to meet the family’s needs. Conclusions: The findings of the study indicated that FI is an acceptable and feasible approach to be delivered during hospitalisation. The intervention will be accompanied with an intervention manual, which will be tested in a future feasibility study.

The psychosocial stressors of siblings of people with experiences of psychosis (SOPEP): A systematic narrative review across cultures

“…In addition, three groups reuse their data to publish multiple papers (Al-Sawafi et al, 2021;Al Sawafi et al, 2022;Amaresha et al, 2015Amaresha et al, , 2019Graves et al, 2020Graves et al, , 2021. The weight of these papers has been taken into consideration in the result and discussion.…”

“…Social issues such as public stigma towards people with experiences of psychosis may result in negative stereotypes (e.g., aggressive and violent) (Liegghio, 2017;Napa et al, 2017) and discrimination (e.g., unable to own property) (Liegghio, 2017;Paul & Nadkarni, 2017). Negative perceptions of psychosis impacted on SOPEP feeling embarrassed, uncomfortable (Al Sawafi et al, 2022;Amaresha et al, 2015Amaresha et al, , 2019Liegghio, 2017;Young & Flannigan, 2021) and isolated from others (Amaresha et al, 2019;Graves et al, 2021;Liegghio, 2017).…”

“…In some cultures, psychosis was described as 'bizarre' (Graves et al, 2021) or 'picchi', 'hucchu', 'madness' (Amaresha et al, 2015(Amaresha et al, , 2019Young & Flannigan, 2021) and the result of 'vamachara' (black magic) or a 'Jinn' (Al- Sawafi et al, 2021;Al Sawafi et al, 2022;Amaresha et al, 2015Amaresha et al, , 2019Young & Flannigan, 2021) or a message from God (Park & Lee, 2017). Help-seeking behaviours included accessing traditional healers prior to mental health services (Al-Sawafi et al, 2021;Al Sawafi et al, 2022;Amaresha et al, 2015Amaresha et al, , 2019Young & Flannigan, 2021).…”

“…When my parents die … I think (caregiving) would fall to me. (Dodge & Smith, 2019) 3.3.4 | Personality traits SOPEP expressed compassion, empathy and patience towards their sibling and wanting to provide a calming presence when socialising together (Al-Sawafi et al, 2021;Al Sawafi et al, 2022;Amaresha et al, 2019;Bishop & Greeff, 2015;Day & Petalas, 2020;Graves et al, 2020;Liu & Zhang, 2019;Park & Lee, 2017;Young & Flannigan, 2021). SOPEP desired patience when communicating with their siblings, mostly when they felt exhausted or frustrated by the sibling's behaviours (Amaresha et al, 2015;Kovacs et al, 2019).…”

“…How long will it take to cure? (Udgiri et al, 2017) Five studies (Al Sawafi et al, 2022;Amaresha et al, 2015;Dodge & Smith, 2019;Graves et al, 2020;Paul & Nadkarni, 2017) discuss practical skills and techniques for SOPEP in managing symptoms.…”