Psychosocial Rehabilitation and peer support for people with schIZophrEnia in South Africa (PRIZE): a pilot cluster-randomised trial

南非精神分裂症患者的心理社会康复和同伴支持（奖品）：一项试点整群随机试验

• 批准号: MC_PC_MR/S007814/1
• 负责人: Laura Asher
• 金额: $ 10.8万
• 依托单位: University of Nottingham
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MC_PC_MR%2FS007814%2F1
• 关键词: Psychosocial; Rehabilitation; peer; support; people

Schizophrenia is a mental illness that can lead to problems in family life and in keeping a job. Experts agree that a combination of medication and psychosocial rehabilitation (PSR) gives people with schizophrenia the best chance of recovery. PSR involves a support worker giving information, advice and support on topics such as understanding schizophrenia, taking medication, getting back to work and building relationships. Whilst the South African government supports this approach, in reality such programmes are rarely implemented because of a shortage of mental health professionals in South Africa. In a previous project, we developed group-based PSR for South Africa delivered by auxiliary social workers, who are not mental health specialists. Having non-specialists deliver the programme makes it more feasible to deliver widely, to reach the people with schizophrenia who need this support across the country. The people with schizophrenia who received PSR felt it was beneficial, but their family members were difficult to engage with and there was no ongoing support in place once the 4 month PSR programme had finished. We also found that we don't have accurate ways of measuring disability, unmet needs and recovery in people with schizophrenia in South Africa. This project aims to improve on the previous PSR programme by finding better ways to involve caregivers and by adding a peer support component. Peer support groups involve service users sharing their experiences and jointly solving problems. Groups are led by service users on a voluntary basis. Peer support groups are a promising way to provide long-term psychosocial support in the community. It is hoped this new combined PSR and peer support programme could be implemented across South Africa and that it will be beneficial for service users. We will use the information from this study to plan a future larger study, which will give us better information on whether PSR and peer support works to improve outcomes of people with schizophrenia and whether it provides value for money.The current study will last three years and is set in Nelson Mandela Bay District, Eastern Cape, South Africa. There are four objectives.Objective 1 is to develop a combined PSR and peer support programme for people with schizophrenia that is suitable for the setting and addresses the problems in the previous PSR programme, including the lack of on-going support. We will achieve Objective 1 by seeking the views of service users, caregivers, and health workers in participatory workshops and in-depth interviews and using the findings to design a new programme.Objective 2 is to compare the combined PSR and peer support programme to stand-alone PSR in terms of how useful they are thought to be, and how practical they will be to implement into existing health services. We will achieve Objective 2 by conducting a pilot study involving 100 service users with schizophrenia in 10 clinics. We will randomly allocate 5 of these clinics to receive PSR and peer support, whilst 5 clinics will receive only PSR. After 4 and 10 months we will ask service users their views on the services and assess whether their needs are being met.Objective 3 is to improve assessments, in the form of short interviews, to more accurately measure disability, unmet needs and recovery. We hope these assessments can be used in future evaluations of PSR and peer support groups. We will achieve Objective 3 by holding focus groups with service users and caregivers to understand how well the assessments capture their problems. We will then test the assessments to check they are easy to understand and use.Objective 4 is to determine how practical it is to conduct a larger study of PSR and peer support in the future, and how many participants we would need to make the study worthwhile. We will achieve Objective 4 by testing various procedures, such as recruitment of participants, in the pilot study.

精神分裂症是一种精神疾病，会导致家庭生活和工作出现问题。专家们一致认为，药物治疗和社会心理康复（PSR）相结合给精神分裂症患者带来了最好的康复机会。PSR包括一名支持工作者就理解精神分裂症、服药、重返工作岗位和建立人际关系等问题提供信息、建议和支持。虽然南非政府支持这种做法，但实际上由于南非缺乏精神卫生专业人员，这种方案很少得到实施。在之前的一个项目中，我们为南非开发了基于小组的PSR，由辅助社会工作者提供，他们不是心理健康专家。由非专业人员实施该规划，更有可能广泛实施，惠及全国需要这种支持的精神分裂症患者。接受PSR的精神分裂症患者认为这是有益的，但他们的家庭成员很难参与，而且一旦4个月的PSR项目结束，就没有持续的支持。我们还发现，我们没有准确的方法来衡量南非精神分裂症患者的残疾、未满足的需求和康复情况。该项目旨在通过寻找更好的方法让护理人员参与进来，并增加同伴支持的组成部分，从而改进以前的PSR方案。同侪互助小组让服务使用者分享经验，共同解决问题。小组由服务使用者在自愿的基础上领导。同伴支持小组是在社区中提供长期社会心理支持的一种有希望的方式。希望这一新的PSR和同伴支持联合方案能够在南非各地实施，并对服务使用者有益。我们将利用这项研究的信息来计划未来更大规模的研究，这将为我们提供更好的信息，了解PSR和同伴支持是否能改善精神分裂症患者的预后，以及它是否物有所值。目前的研究将持续三年，地点设在南非东开普省纳尔逊曼德拉湾地区。有四个目标。目标1是为精神分裂症患者制定一个适合环境的PSR和同伴支持联合计划，并解决以前的PSR计划中的问题，包括缺乏持续支持。为了实现目标1，我们将在参与性讲习班和深度访谈中征求服务使用者、护理人员和卫生工作者的意见，并利用调查结果设计一项新方案。目标2是比较PSR和同伴支持联合方案与单独的PSR方案的有用程度，以及在现有保健服务中实施这些方案的实际程度。我们将通过在10个诊所开展一项涉及100名精神分裂症服务使用者的试点研究来实现目标2。我们将随机分配其中5个诊所接受PSR和同伴支持，而5个诊所只接受PSR。在4个月和10个月后，我们将询问服务用户对服务的看法，并评估他们的需求是否得到满足。目标3是以简短访谈的形式改进评估，以便更准确地衡量残疾、未满足的需求和恢复情况。我们希望这些评估可以用于未来对PSR和同伴支持小组的评估。为了实现目标3，我们将与服务使用者和护理人员举行焦点小组讨论，以了解评估在多大程度上反映了他们的问题。然后，我们将测试评估，以检查它们是否易于理解和使用。目标4是确定在未来进行更大规模的PSR和同伴支持研究的可行性，以及我们需要多少参与者才能使研究有价值。我们将通过在试点研究中测试各种程序（如招募参与者）来实现目标4。