|Year : 2018 | Volume
| Issue : 2 | Page : 46-52
Effectiveness of standardized psycho-education for primary caregivers of patients in Tertiary Care Hospital
Yumnam Surbala Devi1, Rajesh Konnur2
1 Lecturer, College Of Nursing, AIIMS, New Delhi, India
2 Associate Professor, Kurji Holy Family Hospital, Patna, India
|Date of Web Publication||9-Jul-2019|
Source of Support: None, Conflict of Interest: None
Background: Many people are still unaware that there are effective treatments for schizophrenia. A combination of regular medication, family education and support can reduce the relapse rate from 50% to10%.
Aim: To assess effectiveness of standardized psycho-education for primary caregivers on care of chronic mentally ill patients. Method: One group pre-test post-test design with pre-experimental approach was used. 50 primary caregivers of patient with schizophrenia were selected using purposive sampling technique. Data was collected using structured knowledge questionnaire from two selected hospitals of Mangalore. A 45 minutes standardized psycho education was given to primary caregivers in small group of three.Results: Mean knowledge score at pre-test was 25.82±5.35 and 36.28±3.607 at post-test. There was significant difference in knowledge scores of pre-test and post-test (t= 21.676, p<0.01). In area wise analysis, 29.35% gain in knowledge score in drug treatment and its side effect, followed by27.6% increase in relapse prevention, 25% in mental illness and its causes, 17.86% was increased in communication, and social interaction and minimizing psychosis. There was no association between knowledge score and selected demographic variables. Conclusion: There was significant gain in knowledge score of primary caregivers. The study concluded that standardized psycho education was effective in increasing the knowledge of primary caregivers of care of chronic mentally ill patients. Psycho education of the family members is the key to understand about the illness and provide better care to the patient.
Keywords: effectiveness, primary caregivers, psycho education, chronic mental illness, schizophrenia
|How to cite this article:|
Devi YS, Konnur R. Effectiveness of standardized psycho-education for primary caregivers of patients in Tertiary Care Hospital. Indian J Psy Nsg 2018;15:46-52
|How to cite this URL:|
Devi YS, Konnur R. Effectiveness of standardized psycho-education for primary caregivers of patients in Tertiary Care Hospital. Indian J Psy Nsg [serial online] 2018 [cited 2019 Aug 20];15:46-52. Available from: http://www.ijpn.in/text.asp?2018/15/2/46/262451
| Introduction|| |
Mental illness is a psychological or behavioural pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture. A chronic mental illness such as schizophrenia is a challenging task for caregivers especially in the current era of de-institutionalization. After the de-institutionalization of psychiatric hospitals, many families have become primary caregivers for seriously mentally ill individuals.
WHO (9 April 2018) reported that Schizophrenia is a severe mental disorder affecting more than 21 million people worldwide. Worldwide, schizophrenia is associated with considerable disability and may affect educational and occupational performance. People with schizophrenia are 22.5 times more likely to die early than the general population. Schizophrenia is treatable. Treatment with medicines and psychosocial support is effective.
More than 50% of people with schizophrenia are not receiving appropriate care. Ninety per cent of people with untreated schizophrenia live in low- and middle-income countries. People with schizophrenia are less likely to seek care. The engagement of family members and the wider community in providing support is very important. Treatment with medicines and psychosocial support is effective. With appropriate treatment and social support, affected people can lead a productive life, be integrated in society.
WHO 2002 report shows that globally 450 million people suffer from mental disorder. Out of these 450 million people, 154 million suffer from depressive disorder and 25 million people from schizophrenia. Schizophrenia affects about seven per thousand of the adult population, mostly in the age group of 15-35 years. The prevalence rate for schizophrenia is approximately 1.1% of the population over the age of 18 or at any one time as many as 51 million people worldwide suffer from schizophrenia. Based on the population, 6 to 12 million people in China, 4.3 to 8.7 million people in India 2.2 million people in USA .5% to 6% people live in hospital and 25% of the populations live with family member.
Though the incidence is low (3/10,000), the prevalence is high due to chronicity. Ganguli (2007), reported overall incidence of schizophrenia was 0.35/1000 population. The prevalence was 2.5/1000 in both urban and rural parts of Chandigarh . A community-based cross-sectional study in Mangalore reported that the prevalence of mental disability was found to be 2.3%. The prevalence was higher among female (3.1%) than males (1.5%), higher among the elderly age group and illiterates. Kamath et al.2007 reported that providing an educational intervention for family members of patients with schizophrenia led to significant knowledge gain of schizophrenic patients’ relatives and to increase in the psychological well being of the relatives.
In India family members have been a vital resource in the care of the mentally ill. Attempts at formal family interventions have been to augment the already existing coping within the families. Psycho education of the family members is the key to understand about the illness and provide better care to the patient.
Need for the study
Many people are still unaware that there are effective treatments for many mental disorders. With schizophrenia a combination of regular medication, family education and support can reduce the relapse rate from 50% to10%.5 In developing countries like India, 90% of people with schizophrenia are untreated. More than 50% persons with schizophrenia are not receiving appropriate care. The global burden of the disease study has shown that by the year 2020, mental disorders are projected to increase and major depression will be the first leading cause of disease burden. Mathew Samuel.et al(2002) NIMHANS, Bangalore reported that educating patients and their family members about identifying symptoms, drug effects and side effects can improve compliance among patient with schizophrenia. Kulhara P,2000 reported that 74% (23 patients) schizophrenic patients had undergone magico-religious treatment. 
An interventional study conducted at Chulalongkorn Memorial Hospital, Bangkok, Thailand, to assess the effectiveness of a psycho-educational programme on knowledge and attitude of schizophrenia on caregivers of 91 schizophrenic patients. The result showed that the scores of knowledge and attitude before the programme were 6.06% and 37.57 and the after the programme were 6.91and 29.31 i.e. the psycho-educational programme was effective. The author concluded that the psycho-educational programme on schizophrenia increased the knowledge and shaped the attitude of caregivers.10An experimental study (Hong Kong) to evaluate the effectiveness of psycho-education programmes for Chinese family members with schizophrenia among 64 patients showed that experimental group had more improvement on their perception of burden of care, self-efficacy and social support.
This study supported psycho-education as an effective nursing intervention for Chinese family carers
Psycho education of the primary caregivers is one of the effective means of imparting knowledge regarding care of chronic mentally ill patients.
Objectives of the Study
- To assess the level of knowledge of primary caregivers on care of chronic mentally ill patients
- To evaluate the effectiveness of standardised psycho education on knowledge of primary caregivers regarding care of chronic mentally ill patients
- To findout the association between the pre-test knowledge score and selected demographic variables.
The primary caregivers possess some knowledge regarding care of chronic mentally ill patients. Psycho education will help to increase the knowledge regarding care of chronic mentally ill patients.
H1: The mean post-test knowledge scores of primary caregivers regarding care of chronic mentally ill patients will be significantly higher than that of their mean pre-test knowledge scores at 0.05 level of significance.
H2: There will be a significant association of pre-test knowledge scores of primary caregivers with selected demographic variables.
Pre-experimental one group pre-test post-test design was used for the study. The study design is schematically represented as follows:
O1: Pre-test Assessment of knowledge of primary caregivers regarding care of chronic mentally ill patients before administration of standardised psycho education program.
X : Administration ofstandardised psycho education program to primary caregivers of patients who was diagnosed with Scizophrenia for at least two years.
O2: Post-test Assessment of knowledge of primary caregivers regarding care of chronic mentally ill patients after administration of standardised psycho education program
Sample and Sampling: Purposive sampling method was used for enrolling primary caregivers in the study.
Inclusion criteria: Primary care givers:
- of a patient diagnosed with chronic schizophrenia since two years.
- who stay and involve actively in day to day care activities of patient for minimum of six month.
- who is willing to provide written informed consent to participate in the study.
- available at the time of data collection.
- staying with and taking care of patient who has diagnosed as schizophrenia for a minimum of six months.
• Primary care givers of patients who are diagnosed with any mental disorders.
Size of the Sample
Investigator approached the primary caregiver who attend psychiatry OPD and inpatient ward of two tertiary hospitals, 35 primary caregivers (8 Inpatients and 27 outpatients) were selected from first hospital and 15 (5 inpatients and 10 outpatients) primary caregivers from second hospital.
| Material and Methods|| |
Tools: The data was collected using a structured tool which include demographic Performa and knowledge questionnaire with four different sections i.e., i) mental illness and its causes, ii) treatment, drug side effects and management, iii) communication, social interaction and ways to manage psychotic symptoms and iv) regarding prevention of relapse and empowerment.
Intervention: Standardised Psycho-education for primary caregivers on care of chronic mentally ill patients
Steps were followed while developing a blue print of psycho-education based on review of literature and given to twelve experts from the field of psychiatric nursing (8), (2) psychiatrist, (2) psychiatric social worker and standardised. Aim was to enhance knowledge of primary caregivers of patient diagnosed with chronic schizophrenia related to care of chronic mentally ill patients. Eligible primary caregivers were called in separate room available in OPD and Inpatient. Informed written consent was taken from primary caregiver. Subject information was collected with the help of subject data sheet. Teaching was to be given using lecture method which included topics related to mental illness and its causes, schizophrenia, sign and symptoms, management, treatment modalities, side effects, ways to improve communication, socialisation, relapse prevention, prevention of self-harm, psychosocial rehabilitation. Psycho education was validated by experts from different discipline like psychiatrist, psychiatric nurse, psychologist. Psychoeducation was given through lecture cum discussion, power point and charts. Psycho-education was designed for one hour and each session included minimum group of three primary caregivers. Teaching was given using lecture method which included topics related to mental illness and its causes, schizophrenia, sign and symptoms, management, treatment modalities, side effects, ways to improve communication, socialisation, relapse prevention, prevention of self-harm, psychosocial rehabilitation for the duration of 45minutes followed by 15 minutes discussion.
Procedure for Data Collection
Formal permission to conduct the study was obtained from the concerned authority. Data was collected from psychiatric O.P.D and in-patient ward of two selected tertiary hospitals at Mangalore. Informed written consent was taken from primary caregiver.
The primary caregivers were assured of anonymity and confidentiality of the information provided by them. Fifty primary caregivers of chronic schizophrenic patients (diagnosed with ICD -10 in the last two years) who are staying with patient with minimum of 6 months were selected using purposive sampling.
Pre-experimental one group pre-test post-test design with evaluative approached was used on primary caregivers in small group.
Pre-test was done using knowledge questionnaire on day one. Psycho-education was designed for one hour and each session included minimum group of three primary caregivers. Teaching was given using lecture method which included topics related to mental illness and its causes to be given for the duration of 45minutes followed by 15 minutes discussion. Doubts were clarified during discussion. Post test was conducted on 7th day using same questionnairen to evaluate the effectiveness of psycho education.
Data Analysis: The data obtained was analyzed using descriptive and inferential statistics. Frequencies, percentage, mean, SD, median to describe the data. Paired “t” test was used for testing effectiveness of standardised psycho education and Chi-square test was used to find association.
| Results|| |
Section A: Description of primary caregivers.
The data presented in [Table 1] shows that the majority13 (26%) of the respondents were in the age group of 40-49 years and 7(14%) were aged >60 years. 34(68%) of participants were male and 16(32%) were female. Majority 17(34%) of the respondents had studied up to lower primary group and only 2(4%) had completed graduation and 3 (6%) of them were post graduates and professionals. Where as 11(22%) were housewives and agriculture as occupation. 10(20%) were businessmen and any other occupation, and 8(16%) were professionals. 22 (44%) were siblings, 9 (18%) were father and mothers, 6(12%) were spouse and 4(8%) were patient’s children. 38(76%) of the respondents lived in nuclear family and 12(24%) lived in joint family.11(22%) of the participants had monthly income between Rs. 4000 to Rs. 6999. Out of 60 participants 12(24%) had monthly income of Rupees <2000 and 7000 and above 15(30%) of had between Rs. 2000 to Rs.3999.
|Table 1: Distribution of frequency and percentage of primary caregivers according to socio-demographic variables|
Click here to view
Section B: Knowledge Scores of Primary caregivers on care of chronic mentally ill patients
As given in [Table 2] it reveals that in pre-test highest percentage (90%) of caregivers had moderate knowledge regarding the care of chronic mentally ill patients, 2% of the caregivers had poor knowledge and 8% had good knowledge. In post-test 94 % primary caregivers had good knowledge and only 6% had average knowledge.
|Table 2: Distribution of Primary caregivers according to Knowledge Scores on care of chronic mentally ill patients (n=30+30=60)|
Click here to view
Section C: Knowledge scores of primary caregivers regarding care of chronic mentally ill patients.
As given in [Table 3] that there was significant increase in post test scores of primary caregivers. The mean post test knowledge score 36.26 (SD=2.068) of primary caregivers was significantly higher than their pre-test knowledge score 25.86(SD=2.886). The computed t’ test statistic value is 21.676, p<0.01. Since, the p value for the test is less than 0.05, the null hypothesis is rejected at the 95% confidence level it shows that the ‘psycho education was effective method for improving the knowledge of primary caregivers on care of chronic mentally ill patients.
|Table 3: Knowledge score of primary caregivers regarding care of chronic mentally ill patients. (n=30)|
Click here to view
|Table 4: Area wise effectiveness of psycho education on care of chronic mentally ill patients|
Click here to view
In area wise analysis, 29.35% gain in knowledge score in drug treatment and its side effect, followed by 27.6% increased in relapse prevention, 25% in mental illness and its causes, 17.86% was increased in communication, and social interaction and minimising psychosis. Pre-test mean percentage was 61.57% and 86.33% at post test which shows effectiveness of psycho education.
Section D: Association of knowledge scores and selected demographic variables of caregivers.
There was no significant association between the pre-test knowledge scores of caregivers and selected demographic variables.
Testing of Hypothesis
In the light of the findings null hypothesis H01: The mean posttest knowledge scores of primary caregivers regarding care of chronic mentally ill patients will not be higher than that of their mean pre-test knowledge scores at 0.05 level of significance, was rejected therefore research hypothesis 1 was accepted .
In the light of the findings null hypothesis H02: There will be no association between pre-test knowledge scores of primary caregivers with their selected demographic variables at 0.05 level of significance was accepted therefore hypothesis 2 was rejected .
| Discussion|| |
Present study shows that the relationship of primary caregiver with patient were siblings, father and mothers, spouse, patient’s children as 22(44%), 9(18%), 6(12%), and 4(8%). P.J. Selten.et at conducted a population-based cohort study of 1.75 million person in Denmark also reported that relative risk of schizophrenia for person with a mother, father or sibling who had schizophrenia were 9.31, 7.20 and 6.99 as compared to persons with no affected parents and siblings.12
Present study finding shows that the mean post test knowledge score 36.26 (SD=2.068) of primary caregivers was significantly higher than their pre-test knowledge score 25.86(SD=2.886), which shows that the psycho education was effective for primary caregivers on care of chronic mentally ill patients. Similar study by P.G Walz, Pitschel et al. conducted at Ireland that a brief psycho educational intervention for relative is effective in improving relative’s knowledge about schizophrenia and reducing rehospitalisation.13
Study finding is supported with finding of WP Hornung et al. which revealed that the psycho education led to significant knowledge gains and to an increase in the psychological well-being of the participant.14
Another study which support the present study finding is by W T Chien, F K Wong, which reported that participants in the psycho-education group reported greater improvement in family and patient functioning, family’s burden of care, and the number and length of patient rehospitalisation over the 12-month follow-up. The findings of the study support the effectiveness of family psycho-education group programme in improving the psychosocial health and functioning of Chinese patients with schizophrenia and their families.15
The findings of the present study shows that 29.35% gain in knowledge score in drug treatment and its side effect, followed by 27.6% increased in relapse prevention, 25% in mental illness and its causes, 17.86% was increased in communication and social interaction and minimising psychosis. Similar finding was reported by E Cassidy et al. that there is significantly reduction in hospitalization rate after 12 and 24 months and better compliance among the patient who attended psycho educational group. The author concluded that psycho education should be routinely offered to all patients with schizophrenia and their families.16
Limitation Small sample size restricted generalisation of the findings. Didn’t use a control group. Psycho education was developed only on some selected areas which has time limit.
Nursing Practice Psycho education can be planned and given to primary caregivers of chronic mentally ill patients at inpatient, outpatients and community setting as it helps to improve the knowledge, medication adherence and compliance to treatment and reduce relapse. It can be given along with the regular treatment to the primary caregivers.
Nursing Research: Further research can be carried out to explore about what is the minimum requirement of psycho education for primary caregivers of acute and chronic mentally ill patients.
Nursing Administration Should organise in-service educational programmes on how to provide Psycho education to the family members of mentally ill patients.
Nursing education The students’ learning experience must emphasise on the care of chronic mentally ill patients and promotion of knowledge on mental illness of various community groups. Psycho education can be given more can be included in curriculum of nursing students.
| Recommendation|| |
- Future studies can be done on the questions of how to adapt programs for stable outpatients and their families
- Study can be replicated on larger sample with control group
- Comparative study between the urban and rural caregivers can be done.
- Follow up study can be conducted
- Self Instructional module can be developed for future learning needs of the caregivers
| Conclusion|| |
Standardised psycho education was effective in increasing the knowledge of the primary caregiver on care of chronic mentally ill patients. It is very important to teach the caregivers about the mental illness so that they can provide better care to the patient having chronic mental illness.
| References|| |
Neeraja KP, Essential of mental health and psychiatric nursing, volume-one, Jaypee Brothers Medical Publishers (P) Ltd first edition 2008.
Dr Lalitha K, “Mental health and psychiatric Nursing; An Indian Perspectives”, first edition VMG Book House Bangalore 2007; 16.
WHO: Facts of schizophrenia www who.int/mental health management / schizophrenia accessed on 27.11.18.
Das Acharya et al. “Prevalence and pattern of mental disability using Indian disability evaluation assessment scale in a rural community of Karnataka”. Indian Journal of Psychiatry 50(1), Jan-March; 2008.
E Stengård,” Educational intervention for the relatives of schizophrenia patients in Finland” Nord Journal of Psychiatry. 2003; 57(4):271-7.
Mathew Samuel, Murali Thyloth, “Care givers roles in India”, Psychiatric Services 53:346-347, March 2002.
Kamath Ravindra,Parkar Shubhangi, Creado Dean A, “A comparison of the level of functioning in chronic schizophrenia with coping and burden in care givers”, Journal of psychiatric and mental health nursing, vol- 14,issue -7; October 2007; 679687.
P worakul, N Thavichachart, P Lueboonthavatchi, “Effects of psycho educational programme on knowledge and attitude upon schizophrenia of schizophrenic patient’s caregivers”, J Med Assoc Thai. 2007; Jun; 90(6):1199-2041.
Kulhara P, Avasthi A, Sharma A, “Magico-religious beliefs in schizophrenia: a study from north India”, Psychopathology; Mar-Apr; 2000; 33(2):62-68.
P J Selten, Cantor-Graae E, SR Kahn. “Schizophrenia and migration: a meta-analysis and review” American Journal of Psychiatry 2005.
P G Walz Pitschel et al, “Psycho education and compliance in the treatment of schizophrenia: results of the Munich Psychosis Information Project Study”. Journal of Clinical Psychiatry. 2006; Mar; 67(3):443-52.
WP Hornung ,U Franzen ,R Lemke ,C Wiesemann , G Buchkremer, “ Can psycho-education of chronic schizophrenic patients have a short-term effect on drug-related attitude and behavior?”. Psychiatric Prax. 1993 Jul; 20(4):152-4.
W T Chien,F K Wong, “A family psycho education group program for Chinese people with schizophrenia in Hong Kong”. Psychiatric Services. 2007; Jul; 58(7):1003-6.
E Cassidy ,S Hill ,E O’Callaghan,” Efficacy of a psycho educational intervention in improving relatives’ knowledge about
[Table 1], [Table 2], [Table 3], [Table 4]