Effectiveness of a Program on the Participatory Behaviors in Schizophrenic Patient Rehabilitation by Health Volunteers: A Mixed Methods Approach

Background: The rate of Thai patients receiving psychiatric services had increased between 2015 and 2017 from 1.5 to 2.7 million. Thus, communities are important for reducing the disability of schizophrenic patients. Objective: To design a community-based rehabilitation program (CBRP) for schizophrenic patient rehabilitation and assess the effectiveness of CBRP on participatory behavior among village health volunteers (VHVs). Materials and Methods: The present study was a mixed-methods research done between August 2021 and January 2023. In Phase 1, the study was conducted using in-depth interviews with open-ended questions, covering health belief areas with key informants that included schizophrenia patients, caregivers, community leaders, health personnel, and experts. The content validity with the item-objective congruence (IOC) was evaluated by five experts yielding a high level of congruence with scores ranging from.60 to 1.00. In Phase 2, experimental research was conducted on 40 VHVs in a randomized controlled trial divided into experimental and control groups, with 20 volunteers in each group. The instrument included health belief patterns, incentives, and participation behaviors in schizophrenic patient rehabilitation. The questionnaire used a 5-rating scale with a Cronbach’s alpha of 0.83 to 0.91. The CBRP consisted of four activity sessions over four weeks, measured at three intervals, pre, post, and follow-up. Content analysis and MANOVA were used for data analyses. Results: In Phase 1, the findings indicated that the perceived risk/severity of schizophrenia was due to lack of treatment and non-adherence to medication. Lack of knowledge about the disease and community stigma were significant barriers. The perceived benefits of treatment included continuous medication adherence. Motivational perception included community support for psychiatric patients, community involvement, and self-efficacy involving access to support resources, patient readiness, and genuine acceptance from family and community. These perceptions were used in the design of the CBRP. In Phase 2, the experimental results showed that the average scores for health belief patterns, incentives, and participation behaviors in schizophrenic patient rehabilitation were significantly higher in the experimental group compared to the control group and the pre-experimental period (p<0.001). Conclusion: The CBRP can aid VHVs in dealing with schizophrenic patients. It improved health beliefs, incentives, and participation in rehabilitation, and can be implemented with health personnel in communities, offering a promising application for various communities.