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ORIGINAL ARTICLE
Year : 2022 | Volume
: 66
| Issue : 4 | Page : 439-442
Effectiveness of psychoeducative intervention on quality of life among caregivers of patients with schizophrenia: A randomized control trial
GJ Sara Sapharina1, Ganapathy Neelakshi2
1 Lecturer, Department of Psychiatric Nursing, Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, Tamil Nadu, India
2 Professor, Department of Psychiatric Nursing, Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, Tamil Nadu, India
Correspondence Address:
G J Sara Sapharina
Lecturer, Department of Psychiatric Nursing, Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai - 600 116, Tamil Nadu
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijph.ijph_2094_21
Abstract
Background: The caregiver, who is taking care of a patient with schizophrenia, needs to spend an extensive amount of time, energy, and money during the process of caregiving, which is the major root cause for the psychological strain and physical exhaustion. Objectives: The objectives were to evaluate the effectiveness of psychoeducative intervention on quality of life (QOL) and associate QOL with selected background variables among caregivers of patients with schizophrenia. Methods: A quantitative research with evaluative approach was used. The research design adopted was randomized controlled trial. The study had two groups, a study group and a control group. A sample size of 150 (75 in each group) caregivers of patients with schizophrenia equally distributed to study and control groups were included. The World Health Organization QOL – BREF scale is used to assess the QOL among caregivers, in this study. Data were analyzed using descriptive and inferential statistics. Results: The repeated measures of analysis of variance computed for QOL scores for within the study group (F = 15.82, P = 0.001), control group (F = 5.06, P = 0.004), and between the study and control groups (F = 1.42, P = 0.02) were significant. The changes observed from pretest to posttest 1 were statistically significant. There was a significant association between QOL scores and selected background variables such as social support and medical expenses among caregivers in the control group. Conclusion: The present study concludes that psychoeducative intervention was found to be very effective in improving QOL among caregivers of patients with schizophrenia.
Keywords: Caregiver, psychoeducation, quality of life, schizophrenia
Introduction 
Patient's family members and their neighbors face a lot of discomfort and trouble. People, who are very close to the patients in terms of assisting them in their day-to-day activities, undergo a considerable amount of distress, experiencing a poor quality of life (QOL) that become a major burden to them. The constant relationship with the patient may get exhausted by the caregivers and experiences a chronic stress due to the disruptive and progressive nature of the disease condition of their affected patient. The caring performance of them may affect due to physical, psychological distress, social activities, financial strain, and family relationship that leads to poor coping ability.[1] Caregivers of a patient with schizophrenia need to be empowered with disease-specific knowledge for them to understand the patient condition and how to manage the symptoms, since caregivers are designated as the tolerator, preventer, and concerner.[2] Caregivers are important representatives to bring a better outcome in the patient recovery; they need to practice a structured user-friendly approach to work through independently within home and community environment at their own pace and time to reduce their stress, cope adequately and will help in improving their QOL and will be able to meet the demands and challenges encountered in the caregiving process. In the field of health, QOL is one of the most vital constituents, which is associated with delivering an integral service to an ill person and their family, emphasizing the individual perspective held by the patient and the family.[3] Caregivers of patients with schizophrenia gain a better understanding about the schizophrenia, its prognosis, relapse, and the importance of adherence to medication through psychoeducative intervention program. There by, the investigator focused on teaching and practice through an interactive session to help them improve QoL in caring process.
Materials and Methods Quantitative research with evaluative approach was used. The research design adopted was randomized controlled trial. The study had two groups, a study group and a control group. The study was conducted at both psychiatric ward and OPD of Sri Ramachandra hospital, Porur, Chennai. The sample consisted of caregivers of patients with schizophrenia, who fulfilled the sampling criteria during the study. The investigator adopted randomization in assigning the samples to study and control groups, respectively, until the determined sample size was obtained. The sample size was determined by the following formula, n = 2(Zα + Z1–β)/Δ2. Sample size was determined using power analysis and effect size. The study involved the comparison of two means. With α=5% and power (1–β) =80%, the sample size needed was 170. Finally, 150 (75 in each group) caregivers of patients with schizophrenia equally distributed to study and control groups were included. The sampling technique adopted for this study was simple random sampling technique. Participants were randomly assigned to the study or the control group; all the participants who fulfilled the selection criteria were included in the study.
Sample selection criteria
Inclusion criteria
Caregivers of patients with schizophrenia, who are
At the age group from 21 yearsAvailable during data collection periodAble to read and write in English or TamilWilling to participate in this studyMale or femaleNot on medical treatment for chronic/acute diseasesStaying with the patient for more than 6 months.Exclusion criteria
Caregivers
Who are not a family member of patients with schizophreniaOf patients with dual diagnosisWho are practicing yoga/meditationHaving hearing impairment.The World Health Organization (WHO) QOL – BREF scale[4] was used to assess the QOL among caregivers in this study. The tool was developed by the WHO in 1996. Reliability of the WHO QOL – BREF scale was r = 0.86, which was established by split-half technique. Score interpretation: The WHO QOL – BREF scale is composed of self-assessment items, which can be grouped into four domains: physical domain – seven items, psychological domain – six items, social domain – three items, and environment domain – eight items. Remaining two questions should have self-perceived QOL and satisfaction with health. The total items were 26, and it was based on a four-point Likert scale. The maximum score indicated a higher QOL.
Ethical considerations
Approval was obtained from the Institutional Ethics Committee of Sri Ramachandra University for the conduct of the study. Permission was obtained from the Head of the Department of Psychiatry of Sri Ramachandra Hospital to carry out the study.
Informed written consent was obtained from the caregivers of the study. The participation was completely voluntary. Participants were given the freedom to withdraw from the study at any time. Confidentiality of the collected data was maintained. The investigator prepared 150 chits (75 for the study group and 75 for the control group) which were kept in a ballot box. The caregivers, accompanying the patients with schizophrenia on their 1st day of admission with the consideration of inclusion and exclusion criteria, were approached and clearly explained about the study, and verbal consent was obtained from them. The caregivers were asked to pick up the chit, and according to the chit picked up from the ballot box, either the study or the control group was allotted through simple random technique, and thereby randomization was done. On the 1st day of the intervention, caregivers of the study group were given the briefing regarding the session by greeting the caregivers and explaining the purpose of the study to the caregivers (session 1). It is a group approach, and group consists of 3–5 caregivers. The entire session was programmed for 60 min. At the end of the group, interactive session doubts were clarified. On the 2nd day of intervention, the investigator facilitated the group about their emotional concerns about the patient and caregiving by applying therapeutic communication techniques (session 2). At the end of the group, interactive session doubts were clarified. The entire session was programmed for 60 min. On the 3rd day, psychoeducative intervention included meaning, causes types, clinical features, importance of medication adherence, and follow-up care and home care management of patient with schizophrenia through power point presentation. The duration of teaching was about 45 min and remaining 30 min for the discussion and clarification of doubts.
Results Majority of the caregivers of patients with schizophrenia, 24 (32%), in the study group and 30 (40%) in the control group were in the age group of 31–40 years. Similarly, females constitute most in the both groups, 61 (81.2%) in the study group and 46 (61.3%) in the control group. Majority of them, 31 (41.3%), in the study group and 30 (40%) in the control group were residing in the urban areas. Majority of them had educational qualification of secondary education, 35 (46.7%), in the study group and 34 (45.3%) in the control group. Most of them were belonged to Hindu religion, 36 (48%), in the study group and 40 (53.3%) in the control group.
Majority of them, 40 (53.3%), in the study group and in the control group were homemakers, respectively. Most of them, 50 (66.7%), in the study group and 55 (73.3%) in the control group were belonged to nuclear family, i.e., majority of them were married, i.e., 73.7% in the study group and 48% in the control group. Most of them getting a social support from the husbands, i.e., 36% in the study group and 37.3% in the control group. Majority of them had a family income of Rupees 20001–40000/month, i.e., 46.7% in the study group and 52% in the control group. Most of them were spending medical expenses by themselves, i.e., 76% in the study group and 85.3% in the control group. Majority of them were parents to the caregivers, i.e., 46.7% in the study group and 68% in the control group. Majority of the patients had 6 months to 1 year duration of illness, i.e., 57.3% in the study group and 57.3% in the control group. Both groups were similar in their baseline characteristics (P > 0.05).
Data presented in [Table 1] show that the mean pretest QOL-physical health scores of caregivers of patients with schizophrenia in the study group and control group were 48.88 ± 14.32 and 45.81 ± 11.52, respectively, the mean pretest QoL-psychological scores in the experimental group and control group were 48.84 ± 14.02 and 44.65 ± 13.44, respectively, the mean pretest QoL-social relationship scores in the study and control groups were 59.05 ± 23.09 and 53.83 ± 23.05, respectively, and the mean pretest QoL-environment scores in the study and control groups were 53.79 ± 15.53.09 and 49.63 ± 15.30, respectively. There is a statistically significant difference in the mean scores of QOL (psychological-Domain-2) between pretest and posttest I among caregivers of patients with schizophrenia in control group (P = 0.001), in QOL (social relationship-Domain-3) between pretest and posttest I (P = 0.001).
Table 1: The mean and standard of quality of life among caregivers of patients with schizophrenia in the study and control groups (n=150)The data presented in the [Table 2] show that the repeated measures of analysis of variance computed for QOL scores for within the study group (F = 15.82, P = 0.001), control group (F = 5.06, P = 0.004), and between the study and control groups (F = 1.42, P = 0.02) were significant. The changes observed from pretest to posttest I were statistically significant. The findings indicated that QOL among the caregivers gradually improved after the intervention. This shows that psychoeducative intervention improve QOL. There was a significant association between QOL scores and selected background variables such as social support and medical expenses among caregivers in the control group.
Table 2: Repeated measures of ANOVA on quality of life among caregivers of patients with schizophrenia between study and control groups (n=150) Discussion Majority of the caregivers of patients with schizophrenia, 24 (32%), in the study group and 30 (40%) in the control group were in the age group of 31–40 years. Similarly, females constitute most in the both groups, 61 (81.2%), in the study group and 46 (61.3%) in the control group. Majority of them, 31 (41.3%), in the study group and 30 (40%) in the control group were residing in the urban areas, and this has been reported by some other studies as well. Soliman et al.[5] have conducted a study impact of psychoeducation program on QOL of schizophrenic patients and their caregivers. The findings highlighted that most of our patients are male (60%), with a mean age of 35.43 ± 10.50 years. Around half of our sample live in rural areas, and statistically significant difference between patients who received psychoeducation and those treated as usual regarding question 1, question 2, domain 1 (physical), domain 2 (psychological), domain 3 (social relation), and domain 4 (environment) measured by the WHOQoL scale with higher score in received psychoeducation patients.
The findings indicated that QOL among the caregivers improved after the intervention. This shows that the psychoeducative intervention is an effective method to improve QOL among caregivers of patients with schizophrenia. The findings from another study conducted by Verma, et al.,[6] following an psychoeducation and interactive sessions, demonstrate that patients of both the group were reassessed on the QOL scale, which revealed significant improvements in terms of perceived QOL in experimental group caregivers compared to control group caregivers. The study reveals that the psychoeducative intervention has a definite impact in reducing stress, helps in adapting effective coping strategy, and improves QOL among caregivers of patients with schizophrenia. To spread this message, it is essential for the psychiatric nurses to create awareness and conduct psychoeducation program for caregivers of patients with schizophrenia for a better care and prevention of relapse. Nurses are key personnel of health team, who play a vital role in the health promotion and maintenance.
Conclusion The present study concludes that the psychoeducative intervention was found to be very effective in improving QOL among caregivers of patients with schizophrenia. With psychoeducative intervention, reinforcement and proper follow-up help in prevention of relapse and better disease management.
Acknowledgment
The authors are highly thankful to all the respondents who took part in this study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References 
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