A pilot study of the goal attainment program for in-patients with schizophrenia in Hong Kong

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A pilot study of the goal attainment program for in-patients with schizophrenia in Hong Kong

 

Author: Ng, Fung-leung Bacon
Title: A pilot study of the goal attainment program for in-patients with schizophrenia in Hong Kong
Degree: M.Sc.
Year: 1999
Subject: Schizophrenics -- China -- Hong Kong -- Rehabilitation
Hong Kong Polytechnic University -- Dissertations
Department: Multi-disciplinary Studies
Dept. of Rehabilitation Sciences
Pages: xvi, 151 leaves ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1477357
URI: http://theses.lib.polyu.edu.hk/handle/200/1190
Abstract: The purpose of this research is to develop a clinical protocol for a 'Goal Attainment Program' to assist psychiatric in-patients in Hong Kong to formulate realistic life goals with a view to shortening their length of stay in the hospital and motivating them to join in home and work rehabilitation programs. The framework of the program follows a four-stage cyclical model which is based on Mezirow's Adult Learning Theory, and Rantz and Miller's Change Theory. Twenty-three strategies and appropriate attitudes to facilitate program effectiveness were abstracted from the literature. The four-stage individualized Goal Attainment Program was structured in a logical development sequence from (1) affirming personal worth, (2) imaging the future, (3) establishing a sense of control to (4) setting goals for the future. The Goal Attainment Scale for Psychiatric In-patients and the Cultural-free Self-esteem Inventory were validated and used to evaluate the change in life goals and self-esteem after attending the four-session Goal Attainment Program. The validated 10-item version of the Goal Attainment Scale for Psychiatric In-patients (GASPI-10) was found to have good inter-rater reliability (ρI ranged from .64 to .88, p < .01; N = 26) and internal consistency (α of rater 1 = .92, rater 2 = .87, N = 26). The validated Chinese version of the Culture Free Self-esteem Inventory (CFSEI-HK) was found to have good internal consistency (α = .88, N = 65) and test-retest reliability (r = .83, p < .01, N = 31). One of the Clinical Management Teams of Castle Peak Hospital in Hong Kong was selected conveniently and a random sampling of thirty-eight chronic psychiatric in-patients with schizophrenia and no discharge plan were invited to participate. Twenty-five (66%) participants consented and completed the goal attainment program. The participants were assessed using the pre and post-test quasi-experimental design. The T-score computation of GASPI-10 showed that 92% of cases showed improvement in Goal Attainment. The participants showed improvement in nine items of the GASPI-10, namely Goal formulation, Insight, Decisiveness, Self-confidence, Assertiveness, Direction-following, Attention-concentration, Dependence-independence and Participation. Furthermore, significant increase in CFSEI-HK scores after treatment intervention were found. Some 92% of cases said out they were willing to leave the hospital, and 72% of participants planned to seek paid employment upon discharge after completion of the program. It was interesting to find that the females had higher T-scores on the GASPI-10 than the males. Participants with 'Priority Follow-up Status' had higher Self-confidence but lower motivation in following direction. The suicidal group showed significantly higher Insight. Younger patients showed better performance in Direction-following and Independence after the treatment. The length of stay of patients correlated negatively with Responsibility of GASPI-10. The higher the education level of the patient, the higher the Defensiveness. Research results supported the force field relationship of Goal-attainment and Self-esteem. A significant positive correlation between the GASPI-10 and the CFSEI-HK was found (r = .80, p = .000). Significant correlations between Goal Formulation, Decisiveness and Self-confidence of GASPI-10 with self-esteem of CFSEI-HK were also indicated. The overall results of this study justified the effectiveness of the Goal Attainment Program in instilling hope in chronic patients with schizophrenia and the use of the Goal Attainment Scale in documenting patients' progress. Further studies using path analysis and predictive correlation studies as well as clinical replication were suggested.

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