Qualitative process evaluation of a problem-solving guided self-help manual for family carers of young people with first-episode psychosis

BMC Psychiatry

Dan I Lubman¹  Terence V McCann² 

[1] Turning Point, Eastern Health and Monash University, Melbourne, Australia;Centre for Chronic Disease Prevention and Management, Discipline of Mental Health Nursing and Aged Care, College of Health and Biomedicine, Victoria University, PO Box 1428, Melbourne 8001, VIC, Australia

关键词: Self-help manual;    Randomised controlled trial;    Qualitative research;    Process evaluation;    Problem-solving;    Primary carers;    Nurses;    Guided self-help;    First-episode psychosis;    Clinicians;    Bibliotherapy;   

Others  :  1123526
DOI  :  10.1186/1471-244X-14-168

 received in 2014-03-01, accepted in 2014-06-03,  发布年份 2014

【 摘 要 】

Background

Caring for a young person experiencing first-episode psychosis is challenging and can affect carers’ well-being adversely. While some face-to-face approaches have achieved promising outcomes, they are costly and resource-intensive to provide, restricting their reach and penetration. Guided self-help in book-form (or bibliotherapy) is an alternative but untested approach in these circumstances. In this study, we aimed to evaluate carers’ beliefs about the usefulness of problem-solving guided self-help manual for primary carers of young people with first-episode psychosis.

Methods

A qualitative process evaluation nested in a randomised controlled trial, conducted across two early intervention psychosis services in Melbourne, Australia. 124 carers were randomised to problem-solving guided self-help intervention or treatment as usual. We also undertook a qualitative process evaluation, using individual interviews, with a random sample of 24 of the intervention group. A thematic analysis of the qualitative data was undertaken, which is the subject of this paper. Interviews were conducted between January 2009 and September 2010.

Results

Three themes were abstracted from the data, reflecting carers’ beliefs about the usefulness of the manual: promoting carers’ well-being, increasing carers’ understanding of and support for the young person with first-episode psychosis, and accessibility and delivery modes of the programme.

Conclusion

This process evaluation highlights that guided self-help is useful in informing and supporting carers of affected young people. While there is scope for broadening the delivery modes, the approach is easy to use and accessible, and can be used as a cost-effective adjunct to standard support provided to carers, by community mental health nurses and other clinicians.

Trial registration

ACTRN12609000064202

【 授权许可】

   
2014 McCann and Lubman; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Berglund N, Vahlne JO, Edman A: Family intervention in schizophrenia - impact on family burden and attitude. Soc Psychiatry Psychiatr Epidemiol 2003, 38(3):116-121.
• [2]McCann TV, Lubman DI, Clark E: First-time primary caregivers’ experience of caring for young adults with first-episode psychosis. Schizophr Bull 2011, 37(2):381-388.
• [3]Gerson R, Wong C, Davidson L, Malaspina D, McGlashan T, Corcoran C: Self-reported coping strategies in families of patients in early stages of psychotic disorder: an exploratory study. Early Interv Psychiatry 2011, 5(1):76-80.
• [4]Onwumere J, Kuipers E, Bebbington P, Dunn G, Freeman D, Fowler D, Garety P: Coping styles in carers of people with recent and long-term psychosis. J Nerv Ment Dis 2011, 199(6):423-424.
• [5]Butzlaff RL, Hooley JM: Expressed emotion and psychiatric relapse: a meta-analysis. Arch Gen Psychiatry 1998, 55(6):547-552.
• [6]Tompson MC, Pierre CB, Boger KD, McKowen JW, Chan PT, Freed RD: Maternal depression, maternal expression, and youth psychopathology. J Abnorm Child Psychol 2010, 38(1):105-117.
• [7]Bebbington P, Kuipers L: The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychol Med 1994, 24(3):707-718.
• [8]Kuipers E, Onwumere J, Beddington P: Cognitive model of caregiving in psychosis. Br J Psychiatry 2010, 196(4):259-265.
• [9]McCann TV, Lubman DI, Clark E: Primary caregivers’ satisfaction with clinicians’ response to them as informal carers of young people with first-episode psychosis: a qualitative study. J Clin Nurs 2011, 21(1–2):224-231.
• [10]Onwumere J, Bebbington P, Kuipers E: Family interventions in early psychosis: specificity and effectiveness. Epidemiol Psychiatr Sci 2011, 20(2):113-119.
• [11]Gleeson J, Cotton SM, Alvarez-Jimenez M, Wade D, Crisp K, Newman B, Spiliotacopoulos D, McGorry PD: Family outcomes from a randomized controlled trial of relapse prevention therapy in first-episode psychosis. J Clin Psychiatr 2010, 71(4):475-483.
• [12]Addington J, McCleery A, Addington D: Three-year outcome of family work in an early psychosis program. Schizophr Res 2005, 79(1):107-116.
• [13]Campbell LF, Smith TP: Integrating self-help books into psychotherapy. J Clin Psychol 2003, 59(2):177-186.
• [14]Cuijpers P, Donker T, van Straten A, Li J, Andersson G: Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative studies. Psychol Med 2010, 40:1943-1957.
• [15]Jorm AF, Griffiths KM, Christensen H, Rodgers B: Effectiveness of complementary and self-help treatments for depression. Med J Aust 2002, 176:84-95.
• [16]Bilich LL, Deane FP, Phipps AB, Barisic M, Gould G: Effectiveness of bibliotherapy self-help for depression with varying levels of telephone helpline support. Clin Psychol Psychother 2008, 15:61-74.
• [17]Songprakun W, McCann TV: Evaluation of a bibliotherapy manual for reducing psychological distress in people with depression: a randomized controlled trial. J Adv Nurs 2012, 68(12):2674-2684.
• [18]Songprakun W, McCann TV: Effectiveness of a self-help manual on the promotion of resilience in individuals with depression in Thailand: a randomised controlled trial. BMC Psychiatry 2012, 12:12. BioMed Central Full Text
• [19]Oxford University Press: Concise Oxford English Dictionary. 12th edition. Oxford: Author; 2011.
• [20]D’Zurilla TJ, Nezru AM: Problem-solving therapy: a positive approach to clinical intervention. 3rd edition. New York: Springer; 2007.
• [21]Cotton SM, McCann TV, Gleeson JF, Crisp K, Murphy BP, Lubman DI: Coping strategies in carers of young people with a first episode of psychosis. Schizophr Res 2013, 146(1–3):118-124.
• [22]McCann TV, Lubman DI, Cotton SM, Murphy B, Crisp K, Catania L, Marck C, Gleeson JFM: A randomized controlled trial of bibliotherapy for carers of young people with first-episode psychosis. Schizophr Bull 2013, 39(6):1307-1317.
• [23]Matthews JHS: Introduction to randomized controlled clinical trials. 2nd edition. Chapman & Hall/CRC: Boca Raton, Florida; 2006.
• [24]Hackshaw A: A Concise Guide To Clinical Trials. Chichester, West Sussex, UK: Wiley-blackwell/BMJ Books; 2009.
• [25]Grant A, Treweek S, Dreischulte T, Foy R, Guthrie B: Process evaluations for cluster-randomised trials of complex interventions: a proposed framework for design and reporting. Trials 2013, 14:15. BioMed Central Full Text
• [26]Oakley A, Strange V, Bonell C, Allen E, Stephenson J: Process evaluation in randomised controlled trials of complex interventions. BMJ 2006, 332(7538):413-416.
• [27]Bleijenberg N, Ten Dam VH, Steunenberg B, Drubbel I, Numans ME, De Wit NJ, Schuurmans MJ: Exploring the expectations, needs and experiences of general practitioners and nurses towards a proactive and structured care programme for frail older patients: a mixed-methods study. J Adv Nurs 2013, 69(10):2262-2273.
• [28]Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new medical research council guidance. BMJ 2008, 337:a1655.
• [29]Lewin S, Glenton C, Oxman AD: Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study. BMJ 2009, 339:b3496.
• [30]Lichstein KL, Riedel BW, Grieve R: Fair tests of clinical trials: a treatment implementation model. Adv Behav Res Ther 1994, 16:1-29.
• [31]Patton MQ: Qualitative research and evaluation methods. 3rd edition. Thousand Oaks, California: Sage; 2002.
• [32]Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol 2006, 3:77-101.
• [33]Holloway I, Wheeler S: Qualitative research in nursing and healthcare. 3rd edition. Oxford: Wiley-Blackwell; 2010.
• [34]Hill CE, Thompson BJ, Nutt Williams E: A guide to conducting consensual qualitative research. Counsel Psychol 1997, 25(4):517-572.
• [35]Denzin NK: The research act: a theoretical introduction to sociological methods. 3rd edition. Prentice Hall: Englewood Cliffs, New Jersey; 1989.
• [36]Morse J: The significance of saturation [Editorial]. Qual Health Res 1995, 5(2):147-149.
• [37]Morse JM: “Cherry picking:” Writing from thin data. Qual Health Res 2010, 20(1):3.
• [38]Mays N, Pope C: Rigour and qualitative research. BMJ 1995, 311:109-112.
• [39]Lincoln YS, Guba EG: Naturalistic inquiry. Newbury Park, California: Sage; 1985.
• [40]McCann TV, Lubman DI, Clark E: Responding to stigma: first-time caregivers of young people with first-episode psychosis. Psychiatr Serv 2011, 62(5):548-550.
• [41]Gerson R, Davidson L, Booty A, Wong C, McGlashan T, Malespina D, Pincus HA, Corcoran C: Families’ experience with seeking treatment for recent-onset psychosis. Psychiatr Serv 2009, 60(6):812-816.
• [42]McCann TV, Lubman DI, Clark E: First-time primary caregivers' experience accessing first-episode psychosis services. Early Interv Psychiatry 2011, 5(2):156-162.
• [43]Czuchta DM, McCay E: Help-seeking for parents of individuals experiencing a first episode of schizophrenia. Arch Psychiatr Nurs 2001, 15(4):159-170.
• [44]Australian Bureau of Statistics: Programme For The International Assessment Of Adult Competencies, Australia, 2011–12. Canberra: ABS; 2013. [http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4228.0Main+Features702011-12 webcite]
• [45]Sepulveda AR, Lopez C, Macdonald P, Treasure J: Feasibility and acceptability of DVD and telephone coaching-based skills training for carers of people with an eating disorder. Int J Eat Disord 2008, 41(4):318-325.
• [46]Dyer EA, Kansagara D, McInnes DK, Freeman M, Woods S: Mobile Applications And Internet-Based Approaches For Supporting Non-Professional Caregivers: A Systematic Review. Washington, DC: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service; 2012.
• [47]Blom MM, Bosmans JE, Cuijpers P, Zarit SH, Pot AM: Effectiveness and cost-effectiveness of an internet intervention for family caregivers of people with dementia: design of a randomized controlled trial. BMC Psychiatry 2013., 13(17) doi:10.1186/1471-244X-13-17
• [48]Beauchamp N, Irvine AB, Seeley J, Johnson B: Worksite-based internet multimedia program for family caregivers of persons with dementia. Gerontologist 2005, 45(6):793-801.
• [49]Lewis ML, Hobday JV, Hepburn KW: Internet-based program for dementia caregivers. Am J Alzheimer’s Dis Demen 2010, 25(8):674-679.
• [50]Green J: Generalisability and validity in qualitative research. BMJ 1999, 319:421.
• [51]Garbett R, McCormack B: The experience of practice development: an exploratory telephone interview study. J Clin Nurs 2001, 10(1):94-102.
• [52]Smith EM: Telephone interviewing in healthcare research: a summary of the evidence. Nurse Res 2005, 12(3):32-41.
• [53]Novick G: Is there a bias against telephone interviews in qualitative research? Res Nurs Health 2008, 31(4):391-398.
• [54]Sturges JE, Hanrahan KJ: Comparing telephone and face-to-face qualitative interviewing: a research note. Qual Res 2004, 4:107-118.
• [55]Chapple A: The use of telephone interviewing for qualitiative research. Nurse Res 1999, 6(3):85-93.
• [56]Sweet L: Telephone interviewing: is it compatible with interpretive phenomenological research? Contemp Nurse 2002, 12(1):58-63.