The Effect of Psychoeducation Based on Motivational Interview Techniques on Medication Adherence, Hope, and Psychological Well-Being in Schizophrenia Patients

Mediators of functioning and quality of life among people living with schizophrenia participating in the culturally adapted family psychoeducation (KUPAA) trial in Tanzania

PURPOSE

KUPAA is a culturally adapted version of Family Psychoeducation (FPE) that has shown to be beneficial to people living with schizophrenia-spectrum disorders (PLWS), who may experience limitations across multiple functional domains. Family Psychoeducation can lead to improvement in functional outcomes that align with recovery goals; however, the mechanisms of action are unclear. The current study objective is to identify mechanisms by which the KUPAA intervention reduces disability and improves quality of life among care-seeking PLWS in Tanzania.

METHODS

This clinical trial was conducted at Muhimbili National Hospital and Mbeya Zonal Referral Hospital and included a total of 66 dyads composed of PLWS ages 18-50 years and their caregivers. A causal mediation framework employing the g-formula was used to estimate the indirect effects of the KUPAA intervention on disability and quality of life, through the mediated pathways of hopefulness, self-stigma and generalized self-efficacy.

RESULT

A greater decrease in mean disability score and increase in quality of life score was observed among KUPAA participants, compared to controls. We found that generalized self-efficacy mediates 33% of the effect of KUPAA on quality of life and generalized self-efficacy and hope each mediate 36% of the effect of KUPAA on disability.

CONCLUSION

Results provide preliminary support for the hypothesis that KUPAA can reduce disability and improve quality life by reducing stigma, increasing hope and strengthening self-efficacy. Future psychosocial programs for PLWS should consider tailoring their interventions to focus on reducing stigma, increasing hope and fostering self-efficacy.

The Effect of Cognitive Behavioural Therapy-Based Psychoeducation on Medication Adherence and Aggression in Individuals Diagnosed With Schizophrenia: An Experimental Study

INTRODUCTION

It is known that treatment compliance is low and aggression is higher in individuals diagnosed with schizophrenia compared to the normal population. Cognitive behavioural therapy (CBT) is known to reduce relapse and hospitalisation and increase well-being in individuals diagnosed with schizophrenia. However, there are almost no studies on increasing treatment compliance and decreasing aggression.

AIMS

This study was conducted to determine how CBT-based psychoeducation affects medication adherence and aggression in individuals diagnosed with schizophrenia.

METHODS

The study was conducted as a quasi-experimental model with the pre-test-post-test control group with 73 schizophrenic patients (33 experimental, 40 control) between June 2022 and July 2023. Data were collected using the Descriptive Characteristics Form, Morisky Medication Adherence Scale (MMAS) and Buss-Perry Aggression Questionnaire (BPSQ). The schizophrenic patients in the experimental group were given eight sessions of CBT-based psychoeducation, while the schizophrenic patients in the control group were not given any training. The data were analysed using mean, standard deviation, chi-squared test, dependent samples t-test and independent samples t-test.

RESULTS

It was determined that the aggression level of the experimental group before the training was 80.51 ± 19.38, and after the CBT-based psychoeducation, it was 73.12 ± 15.28. It was determined that the aggression level of the control group before the training was 84.22 ± 12.13, and after the post-test, it was 85.60 ± 11.72. It was determined that the medication adherence level of the experimental group before the training was 2.75 ± 1.25, and after the CBT-based psychoeducation, it was 3.57 ± 0.67. It was determined that the medication adherence level of the control group before the training was 2.05 ± 1.33, and after the post-test, it was 2.17 ± 1.36. The psychoeducation based on CBT caused a statistically significant difference (p = 0.001) in medication adherence and aggression levels in the experimental group.

DISCUSSION

It was determined that CBT applied to individuals diagnosed with schizophrenia was effective on increasing their medication adherence and reducing their aggression. It is recommended for psychiatric nurses to include CBT-based psychoeducation in their nursing practices in order to increase medication adherence and reduce aggression in individuals with schizophrenia.

IMPLICATIONS FOR PRACTICE

The findings emphasise that CBT-based psychoeducation increases treatment adherence and significantly decreases the level of aggression in individuals diagnosed with schizophrenia. Psychiatric nurses should include CBT-based psychoeducation in their treatments.

Effects of psychosocial interventions on wellbeing in individuals with severe mental illness: a systematic review

Introduction

Wellbeing, encompassing hedonic and/or eudaimonic components, provides a two-dimensional framework for evaluating the effects of psychosocial interventions for individuals with severe mental illness (SMI). This study investigates how this conceptualization of wellbeing is reflected in existing research on psychosocial interventions for people with SMI. This is the first systematic review to assess the effects of psychosocial interventions on wellbeing as a purely positive phenomenon in this population. The study was registered in PROSPERO (CRD42024598954).

Method

A systematic review was conducted on intervention studies involving adults with SMI receiving psychosocial interventions in an out-patient setting, with a control condition and a wellbeing outcome aligned with a wellbeing framework. Five databases were searched, supplemented by manual searches, yielding 2,842 potential studies. Due to considerable heterogeneity (I 2 = 94%), interventions were analyzed independently, with results summarized based on the proportion of studies reporting significant effects. The study followed PRISMA guidelines.

Results

Seventeen studies met the inclusion criteria. Only one study (6%) provided a full rationale for using a wellbeing measure as the primary outcome. Over 70% reported a significant positive effect on wellbeing. In 13 studies effect size could be calculated, 29% in reference to all 17 studies demonstrated a positive effect (ranging from small to large). Clinical implications of the wellbeing construct were discussed in 47% of the studies, including an increased emphasis on positive functioning. Fewer than 50% received a high-quality rating, and only three studies reporting significant effects used Intention-To-Treat (ITT) data.

Conclusion

Research on two-dimensional wellbeing is a promising yet underprioritized field, providing a renewed focus on abilities and generating significant clinical implications. Wellbeing ought to be a prioritized outcome in out-patient treatment policies, but today no recommendation as to which interventions are most effective are possible due to insufficient data. The implications of detecting changes in wellbeing in individuals with SMI, along with recommendations for future research, are discussed.

Marital concerns of long-term hospitalised patients with diagnosed schizophrenia: A descriptive phenomenological study

Marital concerns can trigger emotional stress, especially among long-term hospitalised individuals diagnosed with schizophrenia, significantly affecting their treatment and recovery. Unfortunately, rehabilitation programs tend to overlook the marital needs of individuals with diagnosed schizophrenia. This research aimed to investigate the content related to marital concerns of Chinese individuals diagnosed with schizophrenia who were undergoing extended hospitalisation. Fifteen participants diagnosed with schizophrenia were recruited through purposive sampling for face-to-face semi-structured interviews. The gathered data were analysed using Colaizzi's method, revealing three themes: (1) manifestations of marriage-related concerns, (2) effects of marriage on disease progression, and (3) the need for support from family and the hospital. This study offers new insights into marital concerns among long-term schizophrenia inpatients and underscores the significance of screening and intervention for such concerns. Healthcare professionals and family members should extend support to patients to foster confidence within their marital relationships.

The Effect of Motivational Interview-Based Counseling in Individuals With Amputation: A Randomized Controlled Trial in Turkey

AIM

This randomized controlled experimental study determined the effect of motivational interview-based counseling on the coping strategies and perceived social support levels in individuals with amputations due to chronic disease.

DESIGN

A randomized controlled trial was conducted.

METHOD

The study was completed in the orthopedics and traumatology department with 48 patients. Data were collected using a descriptive information form, the Coping Strategies Scale, and the Multidimensional Scale of Perceived Social Support. Independent samples t test, paired t test, and chi-square test were used for data analysis.

RESULTS

The scores of the Coping Strategies Scale and the Perceived Social Support Scale of individuals in the intervention group significantly increased in the posttest after motivational interview-based counseling compared to their pretest scores. It was determined that the Coping Strategies Scale and Perceived Social Support Scale subdimension scores and total mean scores for individuals in the intervention group in the posttest were higher than the mean scores for individuals in the control group. The difference between the groups was significant.

CONCLUSION

The motivational interview-based counseling given to individuals with amputation because of chronic disease increased their coping strategies and perceived social support levels.

Prevalence and associated factors of medication adherence among infertile women undergoing frozen-thawed embryo transfer cycle: A cross-sectional study

Objective: This study aimed to explore the prevalence and associated factors of medication adherence among infertile women undergoing frozen-thawed embryo transfer (FET) cycle.

Methods: A cross-sectional study was conducted with 556 infertile women undergoing FET cycle in total. The Self-efficacy for Appropriate Medication Use Scale (SEAMS), Herth Hope Index (HHI) scale, and Social Support Rating Scale (SSRS) were used to evaluate the patients. Data were described by univariate and multivariate analyses. Logistic regression method was performed to analyse the factors potentially associated with medication adherence.

Results: The average score of Self-efficacy for Appropriate Medication Use Scale (SEAMS) was 30.38 ± 6.65, and 65.3% of participants showed non-adherence. Multiple regression analysis indicated that first-time FET cycle, treatment stage, methods of daily medication, social support and hope level were the main associated factors of the medication adherence among infertile women undergoing FET cycle (p < 0.001).

Conclusion: This study revealed the medication adherence is at medium level among infertile women undergoing FET cycle, especially in patients with repeated FET cycles. The study also suggested that improving the hope level and social support of infertile women undergoing FET cycle may increase medication adherence.

Effects of empowerment-based illness management on the medication adherence and recovery of persons with schizophrenia: A systematic review and meta-analysis

Medication adherence and recovery rates are <50% among persons with schizophrenia; therefore, this health concern needs attention. Empowerment is a vital element for behavioural change, but previous studies have presented different results and lack specific connotations about empowerment. Therefore, this study systematically reviewed and meta-analysed the effects of empowerment-based illness management on the medication adherence and recovery of persons with schizophrenia. The databases searched included the PROSPERO registration network, Cochrane Library, PubMed, Embase, CINAHL, PsycAricle, and Airiti Library. The research steps were based on PRISMA. RoB 2.0 was used for article quality evaluation, the effect size was calculated using RevMan software, and the random-effect model and standardized mean differences (SMD) were established. Eight randomized controlled trials (RCTs) involving 859 participants were used to investigate the effect of empowerment on medication adherence. The trials involved the use of effective strategies as inducing medication motivation, promoting self-medication management, and providing support resources. A moderate effect was observed (SMD = 0.58, 95% CI 0.18-0.99). Ten RCTs involving 1473 participants were used to investigate the effect of empowerment on recovery. These trials involved the use of such effective strategies as using self-strength, connecting external forces, understanding personal needs, and overcoming self-stigma. A moderate effect was observed (SMD = 0.55, 95% CI 0.10-0.99). Empowerment in illness management can effectively promote the medication adherence and recovery of persons with schizophrenia. In the future, nurses can use self-strength care to promote medication motivation and connect internal and external forces to assist a person's medication adherence and recovery.

Application of Diversified Health Education Combined with Psychological Nursing in the Treatment of Patients with Infectious Bone Defects by Induction Membrane Surgery

Objective

To explore the application value of diversified health education combined with psychological nursing in the treatment of patients with infectious bone defects by induction membrane surgery.

Methods

A total of 52 patients with infectious bone defects treated by induction membrane surgery from May 2018 to January 2022 were selected as the research subjects and divided into an observation group (with diversified health education combined with psychological care) and a control group according to the random number table method (routine nursing care). There were 26 patients in each group, and the Hospital Anxiety and Depression Scale (HADS) and Self-Care Ability Scale (ESCA) were compared.

Results

At admission, there was no significant difference in anxiety dimension, depression dimension, and total score of anxiety and depression between the two groups (P > 0.05). At admission, there was no significant difference in self-care responsibility, self-concept, self-care skills, health knowledge level, and total score between the two groups (P > 0.05). Skills, health knowledge level, and total score were higher than those in the control group (P < 0.05). The total incidence of complications in the observation group was lower than that in the control group (P < 0.05).

Conclusion

Diversified health education combined with psychological nursing is beneficial to reduce negative emotions, improve self-care ability, and reduce the incidence of complications in the treatment of patients with infectious bone defects by induction membrane surgery.