Family intervention for Schizophrenia in Egypt

1
Family intervention for Schizophrenia in Egypt

• Rasha Wahid
• University of Manchester

2
What ?

• Develop a Culturally sensitive family
  intervention for people with schizophrenia and
  their carers in Egypt.

3
Background

• Schizophrenia
• Family intervention
• Culturally sensitive intervention
• In Egypt (Arab Muslim Community)

4
Why Schizophrenia?

• It is the most commonly diagnosed major mental
  health problem which has disabling effects on the
  person, family and community and it was
  identified as one of the ten most debilitating
  diseases affecting human beings (WHO 1999).

5
Schizophrenia In Egypt

• It is the most common chronic psychosis in Egypt
  and accounts for the majority of in-patients in
  our mental hospitals (Okasha, 2004).
• New policy of de-institutionalisation in 1990.
• Limited mental health and social community
  services for follow up.

6
Treatment of Schizophrenia

• Antipsychotic medications are the first line of
  pharmacological therapy.
• Despite advances in the use of anti-psychotics
  and adherence to medication, many people remain
  symptomatic and continue to experience disabling
  residual symptoms.
• Various psychological methods were developed for
  dealing with these residual symptoms and other
  consequences with schizophrenia.

7
Family Intervention (FI)

• FI emerged when research began taking interest in
  the family and the effects of the home
  environment on schizophrenia sufferers after
  discharge from the psychiatric institutions .
• FI reflects a shift from viewing families as the
  cause of illness to a source of support for the
  ill relative.

8
What is FI??

• It is any strategy or programme, clinical or
  non-clinical, designed to help and empower
  families to cope with the mental illness through
  provision of support, education, skills training,
  family consultation, family support and advocacy
  groups and other forms of assistance to families
  (Solomon 2000).

9
Effects of Family Intervention

• Evidence-Based Medicine confirms that Family
  interventions reduce relapse rates,
  rehospitalisation, and costs of treatment and
  also increase compliance with medication (Tarrier
  et al 1988, Leff et al 1990, Falloon, 1993 ).
• Furthermore, it decreases family burden,
  family stress, high expressed emotion (EE) and
  improve families coping skills (Leff Vaughn
  1985, Fadden et al 1987).

10
However !!

• Although It is clear that FI is an effective
  intervention for schizophrenia through the
  replicated studies, the aspects of what
  constitutes FI and the theoretical approaches
  underpinning it differ, thus the specific and
  effective ingredients of the intervention are
  unknown (Fadden 1989 Dixon Lehman, 1995).
• There are various models of the intervention that
  have been developed, however these treatments
  were adapted from Western models by Western
  experts which present difficulties in delivering
  the intervention in different cultures.

11
Cultural review (1)

• Studies in different cultures found that the
  Western or standard model of family intervention
  was not suitable to their cultures and may be
  intrusive also, it failed to show positive
  treatment outcomes (Weisman 2006).
• Culturally sensitive FI studies reported
  significant reduction in relapse rates and
  increase in patients and carers satisfaction
  with the service (WHO, 1998).

12
Cultural review (2)

• Researches revealed that one of the most
  important explanations for the high drop-out
  rates and premature termination of the family
  work for ethnic minorities was the service
  inability to provide culturally responsive forms
  of treatment, and thus clients found the service
  strange, foreign and unhelpful (Castro, 2004).

13
Challenges of delivering FI model in Egyptian
community

• Individualistic culture versus Collectivistic
  (extended families, decision making, family
  involvement..).
• Spirituality role in the peoples mental health.
• Traditional Healers.
• Lack of health services recourses (Community
• based versus Hospital-based).
• Belief system and attributions to mental illness.

14
Model of self

• In Egypt (Islamic model)

• Family intervention model

Spiritual dimension
Body
Mind
Body
Family
Heart
Culture
Society
Emotion
15
Model of self (cont.)

• The Islamic model of self illustrates the
  external and internal influences (family,
  culture, heart, spirituality) on personality
  which have an impact on the individual mental
  health and that has not been explicated in the
  Western psychology (Yaqoob 2001).

16
Cultural factors to be considered

• Stigma of mental illness
• Traditional healers
• Family structure (extended families).
• Conceptualisation of mental illness (spirit, evil
  eye, gift..).
• Different language of stress and help seeking
  behaviour
• Coping strategies (religious leaders, prayers,
  Imam,..)

17
Aim of the study

• To develop a culturally acceptable and
  feasible Family Intervention for schizophrenia in
  the Egyptian context.

18
Objectives

• Identify the critical components of the
  intervention.
• Conduct focus groups to identify feasible and
  acceptable ways of delivering the intervention.
• Pre and post intervention study to evaluate the
  impact of the intervention on reducing family
  burden.
• In-depth interviews to test the acceptability of
  the FI.

19
Methodology

• Phase 1 Literature review (family intervention
  and culture review)
• Phase 2 Focus groups
• Phase 3 pre and post intervention study and
  in-depth interviews

20
Stage (1)Identify the critical components (a)

• Phase one started with updating the recent FI
  systematic review completed by Cochrane (2003)
  through systematically reviewing (using the same
  terms) other randomised control trials to date.
• Components were identified and picked up on the
  basis of their frequency.
• Twenty eight studies were found, which used 14
  different components with a frequency of 1-8
  (except for the psychoeducational component which
  had been included in 25 studies).
• Component was included if it has been used for at
  least 4 times.

21
Identify the critical components (b)

• Theoretical identification of the significance
  behind each component will be studied through the
  literature. This will be done to provide a strong
  rational for including the component and to give
  the researcher the flexibility to modify -if
  needed- after evaluating its acceptability.
• SWOT analyses will be performed for each of the
  identified components to assess its strength,
  weakness, opportunities and threats. Also,
  through which the questions for the focus groups
  will be identified.

22
SWOT analysis (family support group)
23
Stage 2 (a) Focus groups

• To explore in depth a range of views from
  relevant stakeholders about the most relevant and
  feasible ways of delivering the Intervention.
• To explore and examine the content of the
  intervention to ensure it is culturally
  acceptable.
• It will be conducted by including, Nurses and
  Social workers, Academics, Head nurses, Managers,
  Carers and Patients in Egypt.

24
Stage 2 (b) Written manual

• After analysing the focus groups data, a
  written manual will be developed to be used by
  carers / patients (containing the aim,
  components, structure of the intervention,
  homework sheets) and the research nurse
  (framework of delivering the intervention).

25
Finally, Stage (3)

• Pre and post intervention study will be conducted
  to evaluate the effectiveness of the intervention
  on reducing family burden.
• In-depth interviews will be performed with
  carers and patients after delivering the
  intervention to test its acceptability.

26
Thank You rasha.wahid_at_postgrad.man.ac.uk