Developing a culturally adapted family intervention for relatives living with schizophrenia in Oman

  • Aziza Al Sawafi

Student thesis: Phd


Introduction: The evidence for family interventions (FI) in schizophrenia is robust, and these interventions have been adapted to other cultures to improve effectiveness and acceptability. In Oman, we do not know much about the experiences, needs or resources of families living with schizophrenia. Understanding family members' and mental health professionals' preferences, perceptions and experiences is a fundamental element in the process of intervention development. This study aims to develop a culturally sensitive and acceptable FI for relatives of hospitalised patients diagnosed with schizophrenia in Oman. Method: The Medical Research Council's framework provided the conceptual structure for the study, involving four separate but interrelated stages: 1) Systematically reviewing the available literature from five electronic databases regarding culturally adapted FI in the Arab world to identify the content and characteristics of these interventions, determine the strategies used to culturally adapt them, assess the feasibility and acceptability and evaluate their effectiveness for service users and their families. 2) Qualitative semi-structured interviews with 20 relatives of hospitalised patients diagnosed with schizophrenia to explore their experience and perceived needs and preferences regarding intervention. 3) Two separate focus groups with psychiatrists (n=7) and nurses (n=5) involving health professionals to explore their views and opinions to inform the cultural adaptation process and discuss the feasibility of delivering the FI in the Omani context. 4) Consensus group with a mix of both nurses (n=2) and psychiatrists (n=4) to synthesise the data from the previous three stages, maximise exploration and final thoughts about the planned intervention and its delivery system and resolve any discrepancies Results: Stage one: Six studies (4 from Egypt, 2 from Jordan) were retrieved from the search indicating limited evidence of culturally adapted FI in the Arab region. However, the cultural adaptation process reported in the reviewed studies was comprehensive, and the implementation appears to be feasible and acceptable. The review identified the content and characteristics of culturally adapted FIs in the Arab world and confirmed their feasibility and acceptability in the Arab culture. Stage two: The experience of family members illuminated four themes: burden, stigma, violence, and family needs. Parents, spouses, and siblings were confronted with a burden specific to the demand of different life situations, and their needs differed accordingly. The caregiving experience appears negative, but some positive aspects were prominent among siblings. Relatives gave their opinion about the content and preference of the intervention from their personal experiences. Stage three: Mental health professionals discussed the delivery system of the intervention from a clinical standpoint concerning issues and barriers to implementation. They recommended modifications to the existing intervention components focusing on themes such as religious and spiritual causes of mental illness, simplified language, the format of delivery, and culturally relevant and acceptable problem solving and coping skills to enhance the acceptability and feasibility of the intervention in the local setting. Stage four: The consensus focus group finalised the intervention's content and delivery system concerning training needs and issues and barriers to implementation. They proposed a flexible approach to meet the needs of hospitalised patients and their relatives. Conclusion: The findings of the four stages indicated that FI is acceptable and feasible to be delivered during hospitalisation in Oman. The intervention components and characteristics have been defined, and the content will be refined in a further focus group, which will develop the intervention manual that will be tested in a feasibility study.
Date of Award1 Aug 2023
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorKarina Lovell (Supervisor), Nusrat Husain (Supervisor) & Laoise Renwick (Supervisor)


  • schizophrenia
  • family intervention
  • cultural-adaptation
  • Oman

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