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单一来源。在这些资源匮乏的环境中，精神分裂症是致残最严重的疾病之一，90%需要治疗的人没有得到治疗。因此，大部分照顾的负担被转移到那些没有多少资源来支持他们照顾亲人的家庭。通常，护理人员缺乏关于如何管理和承担护理责任的知识和专业知识，这对他们自己的生活质量产生了重大影响。在高资源环境中，家庭干预（FIp）作为一种“谈话疗法”提供给亲属和照顾者。这些类型的干预措施侧重于帮助家庭应对疾病、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性的和令人放心的，有助于他们自己的应对和情绪。众所周知，这些干预措施非常有效，但它们可能无法直接从一种文化翻译到另一种文化，因为人们看待精神疾病的方式、他们如何看待和相互交流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根据生活在印度尼西亚的人们的需求，量身定制我们知道在英国有效的干预措施。为此，我们将分组询问人们对干预的看法，询问他们获得帮助的经历以及精神分裂症是如何影响他们的生活的。我们会问他们希望将来如何接受干预，哪些方面是重要的，他们更喜欢哪种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，对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。我们会制定一份手册来帮助实施干预措施的人更好地实施这些干预措施我们会准备教学资源以便将来，他们可以教其他人实施干预措施。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，就不会很好地利用资源。例如，我们可能招不到人，所以在我们进入这个阶段之前，我们会做一个小试验，看看所有的部分是否能一起工作，我们可以招募到我们需要的所有人，收集我们需要的所有信息。我们还需要确保提供干预措施的医疗保健专业人员能够按照手册的描述进行操作。然后我们需要检查接受干预的人是否喜欢它，我们是否可以改变部分使它更好，以及提供它的人是否也喜欢它。与此同时，我们将考虑这将如何在初级保健中发挥作用，我们将与合适的人进行对话，他们将使用或受到我们新的干预措施的影响，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.