26.2 FORMATIVE RESEARCH TO INFORM A CULTURALLY TAILORED FAMILY PSYCHOEDUCATION INTERVENTION FOR ADULTS WITH PSYCHOTIC DISORDERS IN TANZANIA

Abstract

Background Family Psychoeducation (FPE) is an evidence-based practice developed in high-income countries to support and improve recovery among adults living with psychotic disorders. FPE aims to educate affected individuals and their families about psychosis so that they may better understand and manage it. The evidence base is strong for FPE's impact on reducing relapse and re-hospitalization compared to standard services in high-income countries. The multiple family group FPE format in particular, could be highly appropriate for cultural contexts such as Tanzania where the vast majority of affected individuals live with families, independent living is rare, and problem-solving often involves the larger community. Multifamily groups are a specific format that can help address social isolation, stigmatization, and psychological burden by strengthening the social support network, providing a forum for mutual aid and problem-solving, and increasing hope through mutual example and experience. Methods In anticipation of a pilot clinical trial of FPE in Tanzania, formative qualitative research was conducted to culturally tailor the SAMHSA FPE package as is appropriate for global mental health interventions. In Dar es Salaam and Mbeya, Tanzania, a total of 81 in-depth key informant interviews were conducted on a range of topics including pathways to psychiatric care and treatment, beliefs on the cause and course of psychotic disorders, and barriers and facilitators to recovery-oriented goals. Individuals living with a psychotic disorder (n=20), their relatives (n=20), clinic-based health providers (n=15), alternative providers such as traditional practitioners and religious leaders (n=11), and healthcare managers and policymakers (n=15) were interviewed. Overall, the interviews were roughly split between women and men and between study sites. Results Preliminary analyses indicate high levels of family involvement in care and treatment, general hypothetical acceptability of a multiple family group format (vs. individual family sessions), and openness to a structured psychosocial treatment to complement monthly medication management clinic visits. Results also highlight that patients' and families' traditional beliefs about cause of psychosis (e.g. witchcraft) may delay entry into clinic-based services but does not necessarily negate willingness to use prescribed psychotropic medications. Likewise, non-biological understandings regarding contributing factors for mental illness (e.g. God's will or family conflict) often lead to dual treatment (clinic-based plus traditional and/or religious-based). The role of faith was particularly salient for a many patients. Conclusions Adaptations have been made to the FPE model including directly addressing issues of dual treatment (biological and alternative).