Background The available care for people with psychosis in South Africa is inadequate to support personal recovery. Group peer support interventions are a promising approach to foster recovery, but little is known about the preferences of service users, or the practical application of this care model, in low- and middle-income countries (LMIC). This study aims to assess the acceptability and feasibility of integrating peer-led recovery groups for people with psychosis and their caregivers in South Africa into existing systems of care, and to determine key parameters in preparation for a definitive trial. Methods The study is set in Nelson Mandela Bay Metropolitan district of the Eastern Cape Province, South Africa. The design is an individually randomised parallel group feasibility trial comparing recovery groups in addition to treatment as usual (TAU) with TAU alone in a 1:1 allocation ratio. We aim to recruit 100 isiXhosa-speaking people with psychosis and 100 linked caregivers. TAU comprises anti-psychotic medication-focused outpatient care. The intervention arm will comprise seven recovery groups, including service users and caregiver participants. Recovery groups will be delivered in two phases: a 2-month phase facilitated by an auxiliary social worker, then a 3-month peer-led phase. We will use mixed methods to evaluate the process and outcomes of the study. Intervention acceptability and feasibility (primary outcomes) will be assessed at 5 months post-intervention start using qualitative data collected from service users, caregivers, and auxiliary social workers, along with quantitative process indicators. Facilitator competence will be assessed with the GroupACT observational rating tool. Trial procedures will be assessed, including recruitment and retention rates, contamination, and validity of quantitative outcome measures. To explore potential effectiveness, quantitative outcome data (functioning, unmet needs, personal recovery, internalised stigma, health service use, medication adherence, and caregiver burden) will be collected at baseline, 2 months, and 5 months post-intervention start. Discussion This study will contribute to the sparse evidence on the acceptability and feasibility of peer-led and recovery-oriented interventions for people with psychosis in LMIC when integrated into existing care systems. Results from this feasibility trial will inform preparations for a definitive trial and subsequent larger-scale implementation. Trial registration Pan-African Clinical Trials Register PACTR202202482587686. Registered on 28 February 2022. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=21496.
Background People with severe mental health conditions such as schizophrenia are an underserved and under-researched group in low and middle income countries, requiring evidence to promote development of services for their needs. This study investigated the experiences and coping strategies of people with lived experience of this condition, and their family caregivers, in South Africa during the initial stages of the COVID-19 pandemic. Methods Telephonic qualitative interviews were conducted with people with schizophrenia (n = 14) and caregivers (n = 15) from the Nelson Mandela Bay District in the Eastern Cape, South Africa between April and June 2020, the most restrictive period of the COVID-19 lockdown in South Africa. Audio recordings were transcribed and translated to English from isiXhosa. Thematic analysis was conducted with NVivo12. Results Participants described several negative impacts including increased material hardship, intensified social isolation and heightened anxiety, particularly among caregivers who had multiple caregiving responsibilities. Coping strategies included finding ways to get and give social support from others, engaging in productive activities and taking care of physical health. Main limitations of the study are inclusion only of people with access to a telephone, and the use of telephonic interviews, which may have limited richness of data. Conclusions These findings highlight that support needs for people with mental health conditions and their families should include opportunities for social interaction and sharing coping strategies. Current support is likely to be inadequate with the ripple effects of the COVID-19 pandemic. Based on these findings, implementation of additional community-based recovery-focused services for families must be prioritized.
BackgroundThe available care for people with psychosis in South Africa is inadequate to support personal recovery. Group peer support interventions are a promising approach to foster recovery, but little is known about the preferences of service users, or the practical application of this care model, in low and middle-income countries (LMIC). This study aims to assess the acceptability and feasibility of integrating peer-led recovery groups for people with psychosis and their caregivers in South Africa into existing systems of care, and to determine key parameters in preparation for a definitive trial.MethodsThe study is set in Nelson Mandela Bay Metropolitan district of the Eastern Cape Province, South Africa. The design is an individually randomised parallel group feasibility trial comparing recovery groups in addition to treatment as usual (TAU) with TAU alone in a 1:1 allocation ratio. We aim to recruit 100 isiXhosa-speaking people with psychosis and 100 linked caregivers. TAU comprises anti-psychotic medication-focused outpatient care. The intervention arm will comprise seven recovery groups, including service users and caregiver participants. Recovery groups will be delivered in two phases: a 2-month phase facilitated by an auxiliary social worker, then a 3-month peer led phase. We will use mixed methods to evaluate the process and outcomes of the study. Intervention acceptability and feasibility (primary outcomes) will be assessed at 5 months post-intervention start using qualitative data collected from service users, caregivers and auxiliary social workers, along with quantitative process indicators. Facilitator competence will be assessed with the GroupACT observational rating tool. To explore potential effectiveness, quantitative outcome data (functioning, unmet needs, personal recovery, internalised stigma, health service use, medication adherence and caregiver burden) will be collected at baseline, 2 months and 5 months post-intervention start. Trial procedures will be assessed, including recruitment and retention rates, contamination, and validity of quantitative outcome measures.DiscussionThis study will contribute to the sparse evidence on the acceptability and feasibility of peer-led and recovery-oriented interventions for people with psychosis in LMIC when integrated into existing care systems. Results from this feasibility trial will inform preparations for a definitive trial and subsequent larger scale implementation.Trial registrationRegistered at Pan-African Clinical Trials Register on 28th February 2022. PACTR202202482587686. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=21496
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