Culturally adapted family intervention for schizophrenia in Pakistan: a feasibility study

Abstract

Objectives

To establish feasibility and acceptability of a Culturally adapted Family Intervention (CulFI) that was developed using an empirically derived conceptual framework in Pakistan.

Methods

A rater-blind, randomised trial to evaluate the feasibility and acceptability of delivering CulFI compared to treatment as usual in Karachi, Pakistan. Indicators of feasibility included evaluation of recruitment rates, retention and randomisation. We also evaluated the acceptability of the intervention and trial procedures.

Results

Excellent recruitment and retention rates informed the feasibility of the intervention. CulFI had more than a 90% participant attendance of 8–10 sessions and retained more than 90% who commenced in the intervention. Eighty percent of those who initially provided consent were willing to be randomised and the quality of CulFI was rated as good to excellent by 85.7% of participants.

Conclusions

Importantly, this study determines that pathways into a psychosocial intervention can be established in Pakistan. A combination of factors contribute to low levels of access to psychiatric care including different explanatory models of illness, small numbers of trained staff, limited resources and reliance on traditional healers. These results support the feasibility, acceptability and merit of conducting a full-scale trial of CulFI in comparison with standard care.

ClinicalTrials.gov Identifier: NCT02167347

KEY POINTS

• The significant treatment gap in LMICs leaves families providing much of the care for people with schizophrenia.

• There is limited evidence from LMICs supporting the effectiveness and feasibility of psychosocial interventions more broadly, and family interventions specifically.

• This study adds to the scarce literature and demonstrates that pathways into delivering psychosocial interventions can be established in Pakistan.

• The results of this trial support the feasibility and acceptability of a Culturally adapted Family Intervention (CulFI) for schizophrenia patients and their families in Pakistan

• A full-scale trial of CulFI in comparison with standard care is warranted to determine clinical and cost-effectiveness.

Keywords:

• CulFI
• family intervention
• psychosis
• schizophrenia
• lower middle-income country

Acknowledgements

We are thankful to all the participants. This study was partly funded by The UK International Health Links Funding Scheme (IHLFS) and partly by the Pakistan Institute of Living and Learning (PILL).

Consent for publication

Not applicable.

Data availability and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Disclosure statement

IBC and NH have given lectures and advice to Eli Lilly, Bristol Myers Squibb, Lundbeck, Astra Zeneca and Janssen Pharmaceuticals, for which they or their employing institution have been reimbursed. IBC. and NH were previously trustees of the Pakistan Institute of Learning and Living. NH is Chair of the board of trustees of the Manchester Global Foundation. The other authors have no interests to declare.

Author contributions

MOH shared responsibility of the training and supervision of RAs, contributed to the interpretation of results and drafted the manuscript. The idea of the study was conceived by NH and IBC, as well as contribution to the design and its coordination. NH and IBC also shared responsibility for the training and supervision of RAs. TK, AB and SS contributed to the design of the study, recruitment of participants and carrying out assessments. SL contributed to statistical analysis and contributed to writing the manuscript. LR contributed to the interpretation of results and writing of the manuscript. FN was involved in the training and supervision of RA’s and contributed to the preparation of the manuscript. All authors read and approved the final manuscript.

Additional information

Funding

This study was partly funded by The UK International Health Links Funding Scheme (IHLFS) and partly by the Pakistan Institute of Living and Learning (PILL). The design, conduct and analysis of the study were completely independent of the funders. The content is solely the responsibility of the authors and does not necessarily represent those of the funders.