Caregiver Views on Medication Treatment for Persons with Schizophrenia in a Cultural Context
ABSTRACT CAREGIVER VIEWS ON MEDICATION TREATMENT FOR PERSONS WITH SCHIZOPHRENIA IN A CULTURAL CONTEXT Tracy Griffith Roberta Sands Ph.D Schizophrenia is a disabling, often persistent psychiatric disorder that poses numerous challenges in its management and consequences. The burden of care for persons with schizophrenia has shifted from hospitals to families, resulting in a significant cost for the caregiver as well as for the person with schizophrenia (Jungbauer, Wittmund, Dietrich & Angermeyer, 2004). Although there is no agreement on whether a specific cluster of psychotic symptoms has the most impact on a caregiver’s burden of care, there is agreement that the severity of symptoms affects the caregiver. The more severe the symptoms, the larger the burden felt by the caregiver (Muhlbauer, 2008). The cause of schizophrenia remains elusive and there is no known cure. The best practice model for treating the symptoms of schizophrenia is treatment with anti-psychotic medications and psychosocial supports for the person with schizophrenia and his or her caregiver (McDonald, Short, Berry & Dyck, 2003). Strong social supports, including family and community supports and a good relationship with the care team, reportedly exert a positive influence on medication adherence (Bentley & Walsh, 2006). A study by Drapalski, Leith and Dixon (2009) also has noted that when a family member acts as a caregiver, this has a positive effect on patient outcomes. This qualitative study explored the views of African American caregivers on medication treatment for schizophrenia. It was guided by the following research questions: What are the views of African American caregivers toward the taking of medication for schizophrenia? How do the caregivers describe their role in relation to medication adherence? What kinds of strategies do the caregivers use to promote medication adherence? How do the caregivers describe their caregiving role in relation to activities outside medication adherence? How do African American caregivers incorporate cultural values into their caregiving role? How do caregivers view support, or lack thereof, provided by community mental health services? The research used a modified grounded theory methodology. Semi-structured interviews were conducted with ten African American caregivers and two key informants. The major study findings were: (1) Monitoring of medication was a significant activity for caregivers. (2) Strategies to promote medication adherence varied among caregivers. (3) Non-medication adherence caregiver activities were around maintaining their loved one in the community. (4) The importance of family and church was a strong cultural value for the caregivers. ( 5) Supports and coping methods for the caregivers centered around a strong faith system and close family, friends and the relationship with the psychiatrist. Two theories of explanation were used to interpret the findings, symbolic interactionism and a family life course developmental framework. Recommendations for social work intervention with caregivers were made.
Lina Hartocollis Ph.D.
Christian Kohler M.D.