Development and validation of a self-reported questionnaire on users' opinions about schizophrenia: a participatory research

Development and validation of home-based psychosocial self-management interventions in schizophrenia and related disorders in low-resource settings: A mixed methods approach

Background

Psychosocial interventions, crucial for recovery in patients with schizophrenia, have often been developed and tested in high income countries. We aimed at developing and validating home-based a booklet based psycho-social intervention with inputs from stakeholders: patients, families, and mental health professionals (MHP) for patients with schizophrenia and related disorders in low resource settings.

Methods

We developed a preliminary version of psychosocial intervention booklets based on six themes derived from focus group discussions conducted with patients, families, and MHP. Initially, quantitative assessment of content validity was done by MHP on overall and Content Validity Index of individual items of the specific booklets, followed by in-depth interviews about their views. The booklets were modified based on their inputs. Further, pilot testing of manuals was done on the users - nine pairs of patients and caregivers followed by development of a final version of psycho-social intervention.

Results

The percentage content validity of individual modules and overall booklets was ≥78.5% indicating good validity. Most MHP reported that the manuals were relevant and easy to use but were text-heavy, and lengthy. On pilot testing of modified manuals with patients and their family caregivers, majority (77.8%) of them found booklets useful and suggested that there should be separate booklets for both patients and caregivers for providing information and entering separate response for the activities, integrating helpful tips. Language should be simple. Finally, two sets of booklets ("info book" and "workbook") named 'Saksham' (meaning empowered) were created with specific modules (viz., 'Medicine adherence', 'Daily routine', 'Eating right', 'Physical activity', 'Physical health monitoring', 'Self-reliance', and 'Psychoeducation') for patients and caregivers each, in two languages (Hindi and English).

Conclusion

Booklets with modules for psychosocial interventions for patients with schizophrenia and their caregivers were developed after establishing content validity and pilot testing.

Participatory Action Research Among People With Serious Mental Illness: A Scoping Review

Participatory action research (PAR) is a research approach that creates spaces for marginalized individuals and communities to be co-researchers to guide relevant social change. While working toward social transformation, all members of the PAR team often experience personal transformation. Engaging people with serious mental illness (PSMI) in PAR helps them to develop skills and build relationships with stakeholders in their communities. It supports positive changes that persist after the completion of the formal research project. With the increasing recognition of PAR's value in PSMI, it is helpful to consider the challenges and advantages of this approach to research with this population. This review aimed at determining how PAR has been conducted with PSMI and at summarizing strategies used to empower PSMI as co-researchers by engaging them in research. This scoping review followed five steps Arkesy and O'Malley (2005) outlined. We charted, collated, and summarized relevant information from 87 studies that met the inclusion criteria. We identified five strategies to empower PSMI through PAR. These are to build capacity, balance power distribution, create collaborative environments, promote peer support, and enhance their engagement as co-researchers. In conclusion, PAR is an efficient research approach to engage PSMI. Further, PSMI who engage in PAR may benefit from strategies for empowerment that meet their unique needs as co-researchers.

Conceptualizing and Measuring Mental Illness Stigma: The Mental Illness Stigma Framework and Critical Review of Measures

Although the last decade has seen a proliferation of research on mental illness stigma, lack of consistency and clarity in both the conceptualization and measurement of mental illness stigma has limited the accumulation of scientific knowledge about mental illness stigma and its consequences. In the present article, we bring together the different foci of mental illness stigma research with the Mental Illness Stigma Framework (MISF). The MISF provides a common framework and set of terminology for understanding mechanisms of mental illness stigma that are relevant to the study of both the stigmatized and the stigmatizer. We then apply this framework to systematically review and classify stigma measures used in the past decade according to their corresponding stigma mechanisms. We identified more than 400 measures of mental illness stigma, two thirds of which had not undergone any systematic psychometric evaluation. Stereotypes and discrimination received the most research attention, while mechanisms that focus on the perspective of individuals with mental illness (e.g., experienced, anticipated, or internalized stigma) have been the least studied. Finally, we use the MISF to discuss the strengths and weaknesses of mental illness stigma measurement, identify gaps in the literature, and provide recommendations for future research.

Effects of the diagnostic label 'schizophrenia', actively used or passively accepted, on general practitioners' views of this disorder

BACKGROUND

General practitioners (GPs) play a key role in the care of somatic and psychiatric problems in people diagnosed with schizophrenia (PWS). It is probable that, like other health professionals, GPs are not all free of prejudices toward PWS. In clinical practice, GPs sometimes interact with clients diagnosed with schizophrenia by specialists, passively accepting this diagnosis. Other times, GPs interact with clients having symptoms of schizophrenia but who have not been diagnosed. In this case, GPs are expected to actively make a diagnosis. Giving the key role of GPs in the process of care, it is worthwhile examining whether passive acceptance and active usage of the diagnosis schizophrenia have differential effects on GPs' attitudes toward people with this disorder.

AIMS

To investigate GPs' views of schizophrenia and whether they were influenced by a 'schizophrenia' label, passively accepted or actively used.

METHODS

A total of 430 randomly selected GPs were invited to complete a questionnaire about their views of schizophrenia, either after reading a description of this disorder and making a diagnosis, or without being provided with a description but passively accepting the label 'schizophrenia' given in the questionnaire.

RESULTS

The GPs who passively accepted the label schizophrenia ( n = 195) and those who actively identified schizophrenia from the description ( n = 127) had similar views. Compared to the GPs who did not identify schizophrenia in the description ( n = 65), those who used the diagnosis, actively or passively: more frequently reported heredity and less frequently psychosocial factors as causes of the disorder; were more skeptical about recovery; were more convinced of the need for long-term pharmacotherapies; believed more strongly that PWS should be discriminated against when in medical hospital; and perceived PWS as more dangerous and as kept at greater social distance.

CONCLUSION

The diagnosis 'schizophrenia', however used, is associated with pessimistic views. Stigma education should be provided to GPs.

Development and validation of the Family Coping Questionnaire for Eating Disorders

OBJECTIVE

To develop and validate a new instrument, the Family Coping Questionnaire for Eating Disorders (FCQ-ED), specifically designed to assess the coping strategies of relatives of patients with eating disorders (EDs).

METHOD

The study was articulated in the following seven stages: (1) in-depth analysis of scientific literature; (2) focus groups with expert researchers and clinicians in the fields of EDs and family assessment; (3) development of a pre-final version of the questionnaire; (4) recruitment of relatives and patients with EDs; (5) data collection; (6) statistical analysis; (7) finalization of the questionnaire.

RESULTS

The final version of the questionnaire consists of 32 items, grouped in five subscales ("avoidance," "coercion," "collusion," "information," and "positive communication with the patient"), with a Cronbach's alpha ranging between 0.820 and 0.625. All Items with a Cohen's Kappa > 0.60 were included in the final version of the questionnaire. Factor analysis led to the identifications of two factors, the problem-oriented and the emotion-focused coping strategies.

DISCUSSION

The final version of the questionnaire shows good psychometric properties, and it requires a short time to be completed. The five subscales correspond to those adopted by relatives of patients with schizophrenia, confirming that relatives of patients with EDs need to be supported and informed on how to cope with patient's disturbing behaviours. This questionnaire may be particularly useful for the development of psychoeducational packages for relatives of patients with EDs and the evaluation of the impact of family functioning on the course of the disease.

What to do about depression? Self-help recommendations of the public

BACKGROUND

While help-seeking and treatment preferences for depression have been assessed in a number of population studies, little is known about the public's self-help beliefs.

AIMS

To explore public beliefs about self-help actions to be taken in case of depression.

METHODS

In spring 2009, a population-based survey was conducted by telephone in the city of Vienna. A fully structured interview was carried out, which began with the presentation of a vignette describing a case of depression. Subsequently, respondents were asked to indicate to what extent they would recommend various self-help actions.

RESULTS

Among the self-help options proposed, confiding in a close friend or someone in the family were most frequently recommended. Apart from that, a variety of interpersonal actions (socializing with others, joining a self-help group), psychological methods (thinking positively), lifestyle changes (engaging in sport, listening to music, going on vacation, reading a good book) and dietary methods (eating healthy food) were endorsed by over half of respondents. While women were more ready to recommend self-help actions, the better educated were less enthusiastic about them.

CONCLUSIONS

As only some of the self-help measures endorsed by the public are evidence based, more research is needed before promulgating their use.