Promoting Adherence to Treatment in Schizophrenia

描述（由申请人提供）：本R01拨款提案是对PA-00-016“精神障碍干预依从性研究”的回应的修订版本。本项目(a)在公共精神卫生环境中采用随机对照设计，评估旨在促进墨西哥裔美国精神分裂症患者治疗依从性的文化适应性、基于家庭的干预措施，并(b)检验关于Ajzen计划行为理论（TPB）适用性的假设，该理论是干预措施关键结构的概念基础，适用于治疗依从性研究。之所以选择这个概念模型进行研究，是因为它强调主观规范和感知行为控制的重要作用，这与研究人群和拟议的干预措施高度相关。患有精神分裂症的墨西哥裔美国人及其家人将在精神病住院期间进入研究，并在出院后随访两年。受试者将被随机分配到：1)为期一年的多个家庭小组，强调对依从性的态度，主观规范，以及维持依从性的自我认知和实际依从性技能的重要性，并增加正在进行的常规门诊护理；2)在常规门诊的基础上增加一年的标准多家庭组；或者3)常规的门诊治疗（每月的药物治疗和临床需要的额外服务）。评估将在基线和每四个月进行一次，为期两年的实际遵守行为（使用多维方法，将行为测量与多个信息提供者相结合），并基于假设的中介因素。论项目的理论模式：用心坚持治疗；达到这一目的的决策过程；感知到的主观规范(即，对其亲属对治疗依从性的偏好的感知；获得、维持和利用治疗依从性技能的真实和感知能力；对疾病及其治疗的态度；精神病理水平，以及其他重要结果（例如，社会功能、生活质量、复发和再住院率）。在同一时间段内，将对主要亲属进行评估，以确定他们对如何以及为何影响患者行为的理解；他们对精神病患者的态度；他们对精神分裂症的认识和看法；他们在治疗过程中作为合作参与者的角色；以及他们对亲人的治疗和康复的期望。研究结果将促进对影响墨西哥和美国精神分裂症患者坚持治疗的因素的理解，如果治疗有效，将为提高这一人群的治疗依从性提供新的工具。

DESCRIPTION (provided by applicant): This R01 grant proposal is a revised version of a response to PA-00-016 "Research on Adherence to Interventions for Mental Disorders." The project (a) evaluates a culturally adapted, family-based intervention designed to promote treatment adherence among Mexican-Americans with schizophrenia using a randomized, controlled design in a public mental health setting, and (b) tests hypotheses about the applicability of Ajzen's theory of planned behavior (TPB), the conceptual foundation for the intervention's key constructs, to the study of treatment adherence. This conceptual model was selected for study because its emphases on the important roles of subjective norms and perceived behavior control are highly germane to the study population and to the proposed intervention. Mexican-Americans with schizophrenia and their families will be entered into the study during a psychiatric hospitalization and followed after discharge for two years. Subjects will be randomly assigned to either: 1) one year of multiple family groups that emphasize the importance of attitudes towards adherence, subjective norms, and self-perceived and actual adherence skills in maintaining adherence, added to ongoing customary outpatient care; 2) one year of standard multiple family groups added to customary outpatient care; or 3) customary outpatient care only (monthly pharmacotherapy sessions and additional services as clinically needed). Evaluations will be made at baseline and every four months for two years of actual adherence behaviors (using a multi-dimensional approach that integrates behavioral measures with multiple informants), and of the postulated mediating factors based .on the project's theoretical model: intentions to adhere to treatment; decision-making processes used to arrive at this intention; perceived subjective norms (i.e., perceptions regarding their relatives' preferences regarding treatment adherence; real and perceived ability to acquire, maintain, and utilize treatment adherence skills; attitudes towards the illness and its treatment; levels of psychopathology, and other important outcomes (e.g., social functioning, quality of life, relapse and rehospitalization rates). Key relatives will be assessed during those same time frames to determine their understanding of how and why they influence the patient's actions; their attitudes towards their mentally ill relative; their knowledge and views of schizophrenia; their roles as collaborating participants in the treatment process; and their expectations with regard to their relative's treatment and recovery. The results will advance the understanding of the factors that affect adherence to treatment for Mexican, Americans with schizophrenia, and, if the treatment were effective, would add a new tool for improving treatment adherence in this population.