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Title: Developing culturally adapted cognitive remediation for South Asian first episode psychosis sufferers
Author: Press, Claire
ISNI:       0000 0004 2719 911X
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2012
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Introduction: An increased incidence of schizophrenia among migrant and ethnic minority groups has been established. Ethnic minorities have poorer access to and outcomes from evidence based psychosocial interventions compared to the majority population. The overall aims of this thesis was to explore culturally adapted psychosocial interventions for migrant and ethnic minority schizophrenia sufferers, and use the results of these investigations to develop culturally adapted cognitive remediation (CR) to meet the needs of South Asian first episode sufferers. Methods: A systematic review and meta-analysis of previous randomised controlled trials (RCTs) investigated the quality, methods and effectiveness of culturally adapted psychosocial interventions for schizophrenia. Interviews, analysed using framework analysis, explored the acceptability, and perceived accessibility, of CR to the target population. CR for first episode psychosis was then adapted to target South Asian sufferers' needs and participants' satisfaction and engagement measured in a feasibility study. Results: The systematic review identified 17 RCTs of culturally adapted psychosocial interventions for schizophrenia. Meta-analysis of culturally adapted Family Intervention (caFI) compared to Treatment As Usual (TAU) showed no reduction in relapse risk. There were non-significant reductions in risk and number of hospitalisations during the intervention and significant shortening of total time in hospital. Meta-analysis of culturally adapted Social Skills Training (caSST), compared to TAU showed improvements in medication and symptom management but no effects when compared to a time-matched psychosocial intervention. Results must be interpreted with caution due to the small number of trials included and limitations in their analyses. Cultural adaptations made to the interventions were similar across trials. This allowed for the development of a measure systematically recording the methods used in culturally adapting interventions. Scale items included: language, therapeutic alliance, teaching style, manual content, family, treatment goals, explanatory models of illness, help seeking behaviour, delivery, stigma, societal context and cultural tenets. Emergent themes from qualitative interviews with ten South Asian first episode schizophrenia sufferers included: help seeking for psychosis, sociocultural influences on help seeking, experience of cognitive deficits, and recommended cultural adaptations to CR. CR was well received by all respondents. Level of acculturation and the influence of family and illness beliefs were associated with distinct pathways to care. A feasibility study of culturally adapted cognitive remediation (caCR) for first episode South Asian psychosis patients resulted in high levels of service user satisfaction, therapeutic alliance and participant retention rates. The majority (87.5%) reported cognitive benefits and a boost in self-esteem. Conclusions: The scale of cultural adaptations for psychosocial interventions for schizophrenia will provide a framework for those developing culturally adapted interventions for migrant or ethnic minority communities and a means to record the degree and type of adaptation. CaCR was acceptable to first episode South Asian psychosis sufferers. A larger trial is required to investigate this intervention's efficacy in terms of cognitive and global functioning.
Supervisor: Husain, Nusrat; Drake, Richard Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: psychosis ; psychosocial interventions ; cognitive remediation ; cultural adaptation ; schizophrenia