Reducing Relapse for People with Schizophrenia in Jakarta, Indonesia: Developing a culturally-relevant, evidence-based Family Intervention

精神疾病是全世界与健康有关的经济负担的最大来源。精神分裂症是在这些低资源环境中最致残的疾病之一，需要治疗的人中有90%没有得到治疗。因此，大部分护理负担都转移到了没有资源支持他们照顾亲人的家庭。通常情况下，照顾者缺乏知识和专业知识，如何管理和照顾的责任显着影响自己的生活质量。在高资源设置家庭干预（FIp）提供作为一个“谈话疗法”的亲属和照顾者。这些类型的干预措施侧重于帮助家庭科普疾病，学习如何沟通，解决问题和制定治疗目标。家庭也发现这些干预措施是支持和安慰，有助于他们自己的应对和情绪。这些干预措施被认为是非常有效的，但它们可能不会直接从一种文化转化为另一种文化，因为人们看待精神疾病的方式，他们如何看待和相互沟通以及如何组织治疗存在差异。这项研究的目的是看看我们是否能够量身定制一种我们知道在英国有效的干预措施，以满足生活在印度尼西亚的人们的需求。为了做到这一点，我们将询问人们对干预的看法，关于他们获得帮助的经历以及精神分裂症如何影响他们的生活。我们将询问他们将来希望如何接受干预，哪些方面是重要的，他们更喜欢什么类型的治疗师，以及他们希望如何以及何时接受干预。然后，我们将召集一个专家小组，就干预措施做出最终决定，并询问他们认为什么样的资源有助于培训人员。我们将制定一份手册，帮助提供干预措施的人很好地提供这些干预措施，我们将准备教学资源，以便将来他们可以教别人提供干预措施。这项工作的最后一部分是培训人们在初级保健环境中提供干预措施。这种干预的大型试验将使用大量宝贵的资源来完成，如果我们不知道我们可以完成试验，那么就不会很好地利用资源。例如，我们可能无法招募人员，所以在我们进入这个阶段之前，我们将进行一个小型试验，看看所有的部分是否能协同工作，我们可以招募我们需要的每个人，并收集我们需要的所有信息。我们还需要确保提供干预的医疗保健专业人员可以按照手册中的描述进行干预。然后，我们将需要与接受干预的人核实他们是否喜欢它，我们是否可以改变部分以使其更好，以及提供它的人是否也喜欢它。同时，我们将考虑如何在初级保健中发挥作用，我们将与将使用或受我们新干预影响的合适的人进行对话，我们将告诉他们我们正在做什么。

Mental illnesses comprise the single largest source of health-related economic burden worldwide. Schizophrenia is among the most disabling conditions in these low-resource settings and 90% of those who need treatment do not receive it. Consequently, much of the burden of care is transferred to families who have few resources to support them in caring for their loved one. Often, carers lack knowledge and expertise about how to manage and having caring responsibilities significantly affects their own quality of life.In high-resource settings family interventions (FIp) are provided as a 'talking therapy' for relatives and carers. These types of interventions focus on helping families to cope with illness, learn how to communicate, solve problems and set goals for treatment. Families also find these interventions supportive and reassuring which helps with their own coping and emotions. These interventions are known to be highly effective but they may not translate directly from one culture to another because there are differences in the way people view mental illnesses, how they see and communicate with each other and how treatment is organised. The aim of this study is to see whether we will be able to tailor an intervention we know is effective in the UK to the needs of people living in Indonesia. To do this, we will ask people in groups what they think of the intervention, about their experiences with getting help and how schizophrenia has affected their lives. We will ask them how they would like to receive the intervention in the future, what aspects are important to include, what type of therapist they would prefer and how and when they would like to receive the intervention. We will then gather a panel of experts to make a final decision about the intervention and ask them what kind of resources they think would help to train people. We will develop a manual to help people who deliver the intervention to deliver these interventions well and we will prepare teaching resources so that in the future, they can teach others to deliver the intervention.The final part of this work is to train people to deliver the intervention in a primary care setting. A large trial of this intervention would use lots of valuable resources to complete and would not be a good use of resources if we don't know that we can complete the trial. For example, we might not be able to recruit people so before we get to that stage we will do a small trial and see if all the pieces work together, we can recruit everyone we need and collect all the information we need. We also need to make sure that healthcare professionals delivering the intervention can do this with the manual as it is described. We will then need to check with the people who receive the intervention that they like it, whether we could change parts to make it better and whether people delivering it also like it. At the same time, we will be thinking about how this will work in primary care, we will be having conversations with the right people who will use or be affected by our new intervention and we will tell them about what we are doing.