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

精神分裂症是一种精神疾病，会导致家庭生活和保住工作的问题。专家们一致认为，药物治疗和心理社会康复（PSR）的结合为精神分裂症患者提供了最好的康复机会。PSR涉及支持工作者提供信息，建议和支持的主题，如了解精神分裂症，服用药物，回到工作岗位和建立关系。虽然南非政府支持这种做法，但实际上，由于南非缺乏心理健康专业人员，这种方案很少实施。在以前的一个项目中，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。让非专家提供该方案使其更可行地广泛提供，以达到全国各地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接触，一旦4个月的PSR计划结束，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式让照顾者参与进来并增加同伴支持的内容来改进以前的PSR方案。同侪支援小组让服务使用者分享经验，共同解决问题。小组由服务使用者自愿领导。同侪支助小组是在社区提供长期心理社会支助的一个有希望的办法。希望这一新的私营部门改革和同侪支助相结合的方案能够在南非各地实施，并使服务用户受益。我们将利用这项研究的信息来计划未来更大的研究，这将为我们提供更好的信息，无论是PSR和同伴支持工作，以改善精神分裂症患者的结果，以及它是否提供物有所值。目前的研究将持续三年，并设置在纳尔逊曼德拉湾区，东开普省，南非。目标一是为精神分裂症患者发展一个适合当地情况的精神分裂症患者自我检讨及朋辈支援计划，并解决以往精神分裂症患者自我检讨计划所存在的问题，包括缺乏持续支援的问题。我们将通过参与性工作坊和深入访谈，征求服务使用者、照顾者和卫生工作者的意见，并利用调查结果设计一个新的方案，以实现目标1。目标2是比较合并的PSR和同伴支持方案与单独的PSR，以了解它们的有用程度，以及它们在现有卫生服务中实施的实用性。为达致目的2，我们会在10间诊所进行试验研究，对象为100名精神分裂症服务使用者。我们将随机分配其中5家诊所接受PSR和同伴支持，而5家诊所将只接受PSR。在4个月和10个月后，我们将询问服务使用者对服务的意见，并评估他们的需求是否得到满足。目标3是改进评估，以简短的访谈形式，更准确地衡量残疾、未满足的需求和康复情况。我们希望这些评估可以用于未来的PSR和同伴支持小组的评估。为达致目标3，我们会与服务使用者和照顾者举行焦点小组讨论会，以了解评估能否准确反映他们的问题。然后我们将测试这些评估，以检查它们是否易于理解和使用。目标4是确定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。我们会在试验研究中测试各项程序，例如招募参加者，以达致目的4。

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.