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.