Barriers to providing low-intensity cognitive behavioural therapy to individuals with schizophrenia by home-visiting nurses in Japan: a qualitative descriptive study of nurses’ experiences

Abstract

Background: Although cognitive behavioural therapy (CBT) is recommended for managing individuals with schizophrenia, it has been underutilised in clinical practice. Low-intensity CBT (fewer sessions provided by non-specialists) is expected to offer a partial solution; however, its implementation within community-based care settings remains limited. Aims: To explore the difficulties and barriers faced by home-visiting nurses when providing low-intensity CBT to individuals with schizophrenia. Methods: A qualitative descriptive study was conducted through semi-structured interviews with six nurses in Japan who had experience in delivering low-intensity CBT, including CBTs for psychosis (CBt-p) and individualised metacognitive training for psychosis (MCT+). Data were analysed using a qualitative descriptive method. Results: Three main categories of difficulties/barriers were identified: ‘Difficulties in learning low-intensity CBT’, ‘Difficulties in applying low-intensity CBT to individual clients’ and ‘Difficulties in providing low-intensity CBT due to the unique structures and functions of home-visiting nursing’. Conclusions: The findings suggest the need for refining the implementation manuals with simplified terminology and familiar examples; creating a work environment that allows continuous consultation with supervisors and mutual learning; revising reimbursement systems under the national health insurance scheme to allow for longer visit times; and training non-specialist nurses as co-therapists to ensure the continuity of care.