Caregiver Burden for People with Schizophrenia in Medan, Indonesia

Experiences of the family caregivers of persons with schizophrenia in north Indian region: A qualitative inquiry

INTRODUCTION

Family caregivers with schizophrenia struggle with psychological, social, and other challenges due to stigma, lack of adequate information, and maladaptive coping strategies. We aimed to explore the experiences of caregivers of persons with schizophrenia (PwS) to comprehend the emotional challenges and other burdens and coping strategies utilized.

METHODS

We subscribed to a phenomenological approach and interviewed nine caregivers in-depth. Audio-recorded interviews were transcribed and translated from Hindi to English. Thematic analysis was performed using the seven-step Colaizzi's method. ATLAS.ti.22 was used for the analysis of the data.

RESULTS

Five themes emerged from the data: 1) general understanding of schizophrenia, 2) emotional burden, 3) Disruption in personal and socio-occupational life, 4) challenges in caregiving, and 5) coping strategies. Caregiving adversely affected the quality of life socially and financially. Schizophrenia stigmatized families, trapped them in their homes, and left them no choice but to get support from informal networks. Also, caregivers experienced a lack of healthcare facilities in the vicinity and reported a substandard level of formal care.

CONCLUSION

Giving care to PwS entails financial, social, emotional, and physical burden. Feelings of frustration, helplessness, uncertainty, and loss are common. Transformation of personal, professional, and social life are usual consequence of caregiving. Generally, caregivers cope through addictions or spiritual means. Significant perceived requirements include a lack of knowledge about the condition and how to manage it as well as inadequate support services. Emotional and financial support and community support services near home may ease the burden of caregiving for PwS.

Stakeholder perspectives of family interventions for schizophrenia in Indonesia: a qualitative study

Mental illnesses comprise the single largest source of health-related economic burden globally and low-and middle-income countries (LMICs) are disproportionately affected. Many individuals with schizophrenia do not receive evidence-based, psychosocial interventions as these are largely unavailable, undeveloped, and under-researched in LMICs. Involving service-users and carers in the design of interventions is crucial to ensure stakeholder needs are adequately addressed by the intervention and to aid successful implementation. We aimed to explore the views and perspectives of different stakeholder groups about the delivery, format, and content of family interventions for people living with schizophrenia in Indonesia as a first step towards developing evidence-based, acceptable family interventions. This study used a qualitative design comprising single stakeholder focus groups. Data were analysed separately using the framework approach incorporating deductive and inductive coding within an existing heuristic framework. 51 participants consented to take part in this study comprising six stakeholder consultation groups including service-users (n = 15), caregivers (n = 15) and healthcare professionals (n = 21). Service users were diagnosed with schizophrenia. Caregivers comprised parents (n = 10, 67%), brothers (n = 2, 13%), sister (n = 1, 7%) and husbands (n = 2, 13%). Healthcare professionals were working as nurses (n = 6, 29%), doctors (n = 5, 23%) or cadre's (n = 10, 48%). Caregiver and service-user respondents had limited knowledge or experience of structured family interventions. There was strong support for such interventions, however, for effective delivery a number of challenges exist in terms of widespread stigmatised views, low expectations for involvement in sharing decisions about care and treatment, views that healthcare professionals are expert and have the authority to delegate tasks to families such as responsibility for ensuring medication adherence and understanding the need to balance the needs of both service-users and families when there are conflicting agendas for treatment. These findings can support the development of evidence-based family interventions for families of those with schizophrenia in Indonesia, as user-informed interventions enhance engagement, satisfaction, and adherence to family interventions.

Culturally adapted family intervention for people with schizophrenia in Indonesia (FUSION): a development and feasibility study protocol

Background

Mental illnesses comprise the single largest source of health-related economic burden globally, and low- and middle-income countries are disproportionately affected. The majority of people with schizophrenia who need treatment do not receive it and are often wholly reliant on family caregivers for daily care and support. Family interventions have an exceptionally robust evidence base for their efficacy in high-resource settings, but it is unknown whether they can produce equivalent effects in some low-resource settings where cultural beliefs, explanatory models of illness and contextual socio-economic issues differ.

Methods

This protocol describes the methods for a randomised controlled trial to determine the feasibility of testing culturally adapt and refine an evidence-based, family intervention for relatives and caregivers of people with schizophrenia in Indonesia. The feasibility and acceptability of implementing our adapted, co-produced intervention via task shifting in primary care settings will be evaluated using the Medical Research Council framework for complex interventions. We will recruit 60 carer-service-user dyads and randomise them in a 1:1 ratio either to receive our manualised intervention or continue to receive treatment as usual. Healthcare workers in primary care settings will be trained to deliver family interventions using our manualised intervention by a family intervention specialist. Participants will complete the ECI, IEQ, KAST and GHQ. Service-user symptom level and relapse status will be measured using the PANSS at baseline, post-intervention and 3 months later by trained researchers. Fidelity to the intervention model will be measured using the FIPAS. Qualitative evaluation will further assist with refining the intervention, evaluating trial processes and evaluating acceptability.

Discussion

National healthcare policy in Indonesia supports the delivery of mental health services in a complex network of primary care centres. This study will provide important information on the feasibility of delivering family interventions for people with schizophrenia via task shifting in primary care settings in Indonesia and allow further refinement of the intervention and trial processes.

The effect of a physical activity intervention on burden and healthy lifestyle behavior in family caregivers of patients with schizophrenia: A randomized controlled trial

AIM

The aim of this study is to investigate the efficacy of a physical activity intervention on burden and healthy lifestyle behavior in family caregivers of schizophrenia.

METHOD

A randomized, controlled trial was conducted to evaluate the effect of physical activity program on burden and healthy lifestyle behavior in family caregivers of patients with schizophrenia. The "Physical Activity Program" consisted of 5 min of warm-up activities as the initial segment, 20 min of rhythmic exercises as the activity segment, 5 min of cool down exercises as the final segment and 30 min of free walking. The program consisted of 8 sessions. The Zarit Caregiver Burden Scale and the Healthy Lifestyle Behavior Scale were applied to the physical activity and control groups ahead of the program's implementation. A total of 60 caregivers were randomly distributed to the intervention (n = 30) and control groups (n = 30). Post-intervention measurement was completed by 60 caregivers and all the caregivers completed the intervention.

RESULTS

Significant differences were found on the Zarit Caregiver Burden Scale score and Healthy Lifestyle Behavior score between the groups.

CONCLUSION

Future research should examine with larger sample groups, carry out interventions, and apply the physical activity intervention by targeting caregivers, along with different interventions.

Positive Mental Health and Mental Health Literacy of Informal Caregivers: A Scoping Review

Positive mental health and mental health literacy are two main concepts to ensure an individual and social state of mental health and well-being. A scoping review of the scientific literature published in the field of health sciences was conducted to identify the relationship between mental health literacy and the positive mental health of family caregivers. A research expression was used to search for articles in health databases, respecting the main topics of the Participants/Concept/Context (PCC) framework. A total of eight articles were included from the 2830 initially identified using the PRISMA Extension for Scoping Reviews (PRISMA-ScR) process. It was noticeable that none of the studies related positive mental health and mental health literacy of caregivers. Nevertheless, it was possible to identify predictors of mental health and self-efficacy, such as burden and a lack of information about and support in the process of care. Caregivers' quality of life, self-esteem and confidence are also important positive mental health predictors that are closely related to health literacy. The knowledge of these factors can contribute to the reduction in negative determinants of mental health of caregivers and the resolution of strategies to meet caregivers' needs.

Caregiver burden experiences of caregivers of patients with schizophrenia: A qualitative inquiry

BACKGROUND

Parents of children with schizophrenia struggle with emotional, social, and economic burdens because they do not receive adequate support and experience difficulties.

AIM

To determine the caregiver burden experiences of parents who care for schizophrenic patients and to provide in-depth data on their feelings, thoughts, and opinions on this issue.

METHODS

In this study, the phenomenological method was used. In-depth interviews were conducted with 13 parents. Maxqda 2020 was used for the analysis of the research data.

RESULTS

In our qualitative study, it was concluded that caregivers were stigmatized by their environment, exposed to social isolation, and stigmatized themselves. It has been determined that the social isolation experienced by the parents negatively affects them economically, socially, and emotionally.

CONCLUSION

The results of this study were discussed within the framework of three themes: emotional burden, social burden, and economic burden experienced by caregivers.

The Effect of Coffee Aromatherapy on Reducing Fatigue and Stress Levels of Female Caregivers Caring for the Elderly in Hospitals

Background. The exploration of coffee as an aromatherapy in the health service has not been widely carried out. In many cases, aromatherapy has been shown to reduce stress and fatigue. Purpose.   To analyzes the effect of coffee aromatherapy on the fatigue and stress levels of female caregivers caring for the elderly at the University of Sumatera Utara Hospital (USU Hospital), in Medan. Methods. This is a quasi-experiment one group pretest posttest design.  The research involved 16 caregivers were given a treatment of coffee oil by inhalation for 15 minutes for three consecutive days, without coffee oil inhalation and 10% of coffee oil concentration on the first day, 20% on the second day, and 30% on the third day. Each sample received a pretest and posttest in the form of stress and fatigue instruments.  The data analysis performed was univariate in order to describe the properties of each variable examined and analyze the mean score. Similarly, bivariate analysis with the Analysis of Variance (ANOVA) statistical test was used to determine the effect of coffee aromatherapy on reducing the fatigue and stress level. Results. The result showed that most caregivers were elderly children with an average age of 38 years, 81.3% assisted in caring for the elderly, and actively working outside the home. Based on the ANOVA test, the data showed that the administration of coffee aromatherapy for three consecutive days has no effect on female caregivers’ fatigue and stress level.  However, the mean score showed a decrease in fatique and stress level before and after coffee oil inhalation in three days.  Conclusion. It is necessary to provide coffee oil aromatherapy intervention with a longer duration to have an effect on reducing caregiver fatique and stress in the future, so the results are expected to form the basic data for the design of nursing interventions based on complementary therapies in order to reduce the fatigue and stress of caregivers while providing care to the hospitalized elderly.