Family psychoeducation for adults with psychotic disorders in Tanzania Global health officials have called for treatment of psychotic disorders to be prioritized in low- and middle- income countries where they have been severely neglected. A major obstacle to care for those living with psychotic disorders such as schizophrenia globally is an absence of evidence-based practices appropriate for cultural contexts where resources are scarce, families are fundamental for treatment, and where many affected individuals and their families hold traditional (i.e. non-biomedical) ideas about the cause of psychosis and seek treatment from traditional practitioners. Family psychoeducation (FPE) is an evidence-based practice used in high-income countries to help individuals with psychotic disorders and their relatives to cope more effectively with the illness; however, FPE has never been tested in a low-resource country nor have the mechanisms of action for this psychosocial intervention been fully identified in any context. This project posits that FPE has great potential for improving the reach, quality, and effectiveness of mental health services for those with psychotic disorders in Tanzania and other similar contexts worldwide?namely, by using family members as co-facilitators for the intervention and by explicitly addressing the traditional beliefs and practices of affected individuals and their caregivers. The goal of this R34 proposal (RFA-MH-16-410) is to pilot test a tailored Family Psychoeducation model (FamPE) for adults with psychotic disorders and their relatives that is appropriate for cultural settings inclusive of both traditional and biomedical ideas about mental illness and that incorporates relatives as co-facilitators of the intervention. We will utilize formative research [70 qualitative interviews], an expert review panel, and a small randomized controlled trial (RCT) [72 patient/relative dyads] to meet these specific aims: 1) Assess how family psychoeducation can improve client outcomes, engage families and address gaps in mental health services in Tanzania from various stakeholder perspectives; 2) Develop the FamPE intervention for use in Tanzania by building upon and tailoring the SAMHSA Family Psychoeducation Evidence-Based Practice Kit; 3) Elucidate the mechanisms of action and refine the mediation and study outcome measures for the future R01; and 4) Pilot test the FamPE intervention to a) assess the feasibility and acceptability of an adapted FPE intervention for 12 weeks, and b) explore its impact on patient relapse, quality of life and disability. This pilot effectiveness trial of FamPE will adequately prepare us for a subsequent R01 submission for a fully powered RCT of FamPE against the standard of care in Tanzania. This project supports NIMH's strategic priority of effectiveness research on therapeutic interventions with previously demonstrated efficacy for use with broader target populations and it also supports NIMH's priority for clinical trials to explicitly address whether the intervention engages the hypothesized mechanisms of action.
Family psychoeducation for adults with psychotic disorders in Tanzania The proposed research is relevant to public health because the mental health needs of individuals with psychotic disorders in low-resource countries have been severely neglected, due in part to a lack of culturally tailored and evidence-based interventions. Family psychoeducation (FPE) is an evidence-based practice from high-income countries that could have a significant impact in settings such as Africa and other regions worldwide where resources are limited, families are largely responsible for care and support, and traditional beliefs and treatments are common. This R34 will pilot test a newly adapted and culturally tailored FPE intervention called FamPE for adults living with psychotic disorders in Tanzania and also examine the mechanisms of action for FamPE in order to inform a subsequent larger trial that is consistent with NIMH's priority for ?effectiveness research on preventive and therapeutic interventions with previously demonstrated efficacy for use with broader target populations? (RFA-MH-16-410).
