Determinants of family independence in caring for hebephrenic schizophrenia patients.

Background: Schizophrenic patients are very susceptible to recurrent incidences, therefore the family plays a key role in providing care as a part of the recovery team. This study aimed to determine the relationship between knowledge, perceptions, attitudes and support with family independence in caring for hebephrenic schizophrenic patients. Design and
Methods: It was used a correlational analytic design with cross sectional approach, and consecutive sampling technique was used, which attained 57 respondents. The independent variables were knowledge, perceptions, attitudes, and support, while independence was the dependent variable, and both were measured using questionnaires, and Spearman rank test was used for data analysis.
Results: The results indicate the presence of a relationship between knowledge, perceptions, attitudes, as well as support and family independence in caring for hebephrenic schizophrenia. In addition, the spearman rank test showed P-values of 0.008, 0.011, 0.032, and 0.027 in family knowledge, perception, attitudes and support, respectively, at <0.05. Conclusions: This study indicates the importance of family support in attempts to improve the self-esteem of schizophrenic patients. Based on this data, the hospital is expected to improve the family-based patient recovery program. ©Copyright: the Author(s).

Introduction

Schizophrenia is a type of psychosis which ranks highly amongst all mental disorders,[1] at an incidence of 1 per 1,000, although recurrence is experienced in about 80% of cases.[2] In addition, many patients at the Menur Mental Hospital, Surabaya, that were declared cured and sent home often experience relapse. This is due to the ignorance on the part of the family regarding how to care for and deal with the behaviors exhibited by patients, characterized by avoidance of medication and regular check-ups with the doctor. Furthermore, patients also tend to personally stop the medication without authorized approval, while some families even attempt reducing the drug dosage. The withdrawal of support from the family and community is also a problem. However, patients in the hospital have been properly trained and coached on how to optimize treatments through regular medication.[3,4]

A preliminary study showed 127 heberfrenic schizophrenia patients, which was characterized by 60 old cases, and 67 new ones, comprising of 35 (52%) male and 32 (48%) female patients.[5] Furthermore, an interview with 10 and 6 families indicated a deficiency in the understanding of how to teach independence to patients leading to the poor desire to regularly take medication and subsequent relapse.[6]

The factors attributed to the recurrence of Schizophrenia are both internal, encompassing age, sex, education, occupation, economic situation, onset, and type of schizophrenia,[5-7] and external, including family knowledge, the role of the family and health workers, physical factors, medication dosage regularity, and the type of treatment.[7,8] Moreover, the practice of intensive positive behavior in the family is one of the efforts adopted to reduce patient recurrence rate, because family is a part of the treatment and recovery team.[9,10] This supportive role is performed both during hospital treatment and at home.[10] Also, there is need for families to accept the experience as well as possible means to maintain the condition after psychologists, psychiatrists, neurologists, doctors, nutritionists, and therapists have declared a good state of health. This practice is essential, in order to accelerate the patients return to normal living with the family and the community.[11,12] In addition, a stigma has been attributed to sufferers, including the assumption that mental illness is a difficult disease to cure, which brings disgrace to the family.[13] This tends to cause undesirable consequences to patients, as well as negative perceptions regarding the affected family, which raises the attitudes of rejection, denial, exclusion and isolation.[13,14]

Some factors influencing family independence in the delivery of patient care include knowledge, perception, attitude, and support factors.[15] In addition, the level of knowledge in this area is very important for the formation of an individual’s action, while the reduction of negative and discriminatory perceptions of family members possibly supports recovery.[16] The attribution of warm and caring attitude to the patient assist the treatment process and also minimizes the likelihood of recurrence. Being the closest unit, the family serves as a “primary nurse” for patients to provide the support needed.[15-17] This study, therefore, aims to determine the relationship between knowledge, perceptions, attitudes and support on family independence in caring for hebephrenic schizophrenia patients of Menur Mental Hospital.

Design and Methods

This study uses correlational analytic design with cross sectional approach, and consecutive sampling technique, where about 57 respondents were selected. In addition, the inclusion criteria comprise of families living with patients at home, where relatives delivers care to hebephrenic schizophrenia patients, aged between 18 and 60 years, characterized by the willingness to fill the informed consent form and questionnaire provided. The exclusion criteria include families that are not willing to participate in an interview, as well as those having more than one family member with hebephrenics schizophrenia. The independent variables include knowledge, perceptions, attitudes, and support, while independence was dependent. The data were collected through a questionnaire using closed questions, and Spearman rank test was used for analysis.

Results and Discussion

Table 1 shows the association between knowledge, perceptions, attitudes, support and family independence in caring for hebephrenic schizophrenic patients. The results of Spearman show a P<0.05, which concluded the presence of a relationship between knowledge, perceptions, attitudes, support, and family independence.

Table 1.

Knowledge, perceptions, attitudes, support and family independence (n=57).

Variables	Family independence										P-Value
	1		2		3		4		Total
	(n)	%	(n)	%	(n)	%	(n)	%	(n)	%
Knowledge
Good	4	10.5	5	13.2	11	28.9	18	47.4	38	100	0.008
Medium	1	9.1	4	36.4	4	36.4	2	18.2	11	100
Less	3	37.5	2	25.0	2	25.0	1	12.5	8	100
Perceptions
Positive	3	6.5	9	19.6	15	32.6	19	41.3	46	100	0.011
Negative	5	45.5	2	18.2	2	18.2	2	18.2	11	100
Attitudes
Positive	4	8.3	9	18.8	16	33.3	19	39.6	48	100	0.032
Negative	4	44.4	2	22.2	1	11.1	2	22.2	9	100
Support
Good	1	4.0	6	24.0	7	28.0	11	44.0	25	100	0.027
Medium	2	9.1	3	13.6	8	36.4	9	40.9	22	100
Less	5	50.0	2	20.0	2	20.0	1	10.0	10	100

This study showed the presence of an association between knowledge and respondents’ independence in caring for a hebephrenic schizophrenic family member. Knowledge of mental disorders was identified as the most important determining factor for attitudes and actions exhibited during the helping healing process. The family’s understanding of symptoms and signs of mental disorders also determines the preventive actions to be taken while making treatment decisions.[17,18] Also the level of independence for less knowledge was one, as families lacked the ability to handle the existing problems, although the health workers and care were accepted accordingly. Another factor affecting the treatment was lack of information and less active participation in hospital counseling activities.

Individual perceptions and respondents independence in caring for hebephrenic schizophrenic patients are other factors related to recovery,[17] hence it is necessary for families to reduce negative perceptions and discrimination against mentally ill individuals, and provide social support, empathy, acceptance, and encouragement to start social interaction and also to not give up.[18] Most families tend to demonstrate positive perception, which proves the capacity for adequate control and acceptance of the mental condition. In addition, there is a high tendency to provide love and meet daily needs, as families try to restore health to the individual suffering mental disorders.[18,19] A good attitude towards the necessity to care independently for patients was needed to support the patients in terms of actions and acceptance. Therefore, family members are perceived as an inseparable part of the environment,[19] characterized by the role played in providing supports in conducting treatment because of the feeling of responsibility to optimize healing efforts.[18,19] Patients are requested to socialize with other relatives and the environment, in order to facilitate proper socialization and subsequently increase self-esteem. There is a significant relationship between support and family independence in caring for hebephrenic schizophrenic patients. This refers to the attitude, actions and acceptance towards the affected individual. Friedman reported on the assumption that family members are people who are always ready to provide the needed help and assistance.[20] In addition, the provision of emotional support to a sick individual is very important in the healing process, which is achieved by enhancing the feeling of safety and love at home. Also, the family tends to continuously assist with daily activities, and tender praises on occasions where the patient conducts specific tasks.[20,21] Moreover, social support is also provided in terms of increased empathy, acceptance, and encouragement to initiate interactions and to not give up, in order for the clients not experience a relapse, which demand hospitalization.

Conclusions

Based on the result and discussion, it is concluded that knowledge and support have a good correlation with family independence in caring for hebephrenic schizophrenia patients, while perceptions and attitudes have positive correlation. This study also recommends the improvement of family-based patient treatment programs by hospitals management, through the creation of health promotion programs to reduce the negative perceptions of families and the community.