| Author: | Chen, Xi |
| Title: | A Chinese-culture-specific intervention to decrease the stigmatisation of schizophrenia by nursing students : a pilot randomised controlled trial |
| Advisors: | Leung, Sau Fong (SN) Bressington, Daniel (SN) |
| Degree: | Ph.D. |
| Year: | 2024 |
| Subject: | Nursing students -- Attitudes Discrimination against the mentally ill Mental illness -- Public opinion Stigma (Social psychology) Hong Kong Polytechnic University -- Dissertations |
| Department: | School of Nursing |
| Pages: | xxii, 343 pages : color illustrations |
| Language: | English |
| Abstract: | Background The stigmatisation of mental illness is affected by culture, beliefs, and empathy; however, researchers rarely take these factors into consideration when developing interventions to reduce stigma. Nursing professionals represent the largest group of healthcare workers globally and are responsible for the care and recovery of individuals with schizophrenia. However, people with schizophrenia face serious stigmatisation. Research findings indicate that nursing students express unfavourable attitudes towards people with schizophrenia, indeed more severely than medical students express such attitudes. As nursing students are future healthcare providers for individuals with schizophrenia, addressing their existing stigma is essential for providing high-quality care for people with schizophrenia. Aim The purpose of this study was to assess the feasibility, acceptability, and preliminary efficacy of a Chinese-culture-specific intervention aimed at reducing schizophrenia stigma among fourth-year nursing students in mainland China. Methods This study consisted of three phases. During the initial phase, a descriptive qualitative study was undertaken to develop a Chinese-culture-specific intervention to decrease the stigmatisation of schizophrenia by nursing students. Thirty nursing students involved in the initial phase of the study were recruited by purposive snowball sampling. Data were collected through online focus group interviews using the Tencent video conference platform. Concurrently, content analysis with NVivo 12 was used to analyse the data, and the findings helped to develop the content of the second-phase intervention. Phase 2 involved a single-centre, two-arm, open-label pilot randomised controlled trial (RCT) in which 60 fourth-year nursing students were recruited by convenience sampling from the Xiangya Hospital and randomly distributed to the experimental or control arms. The intervention design was rooted in transformation learning theory and the knowledge–attitude–practice paradigm. Participants in the experimental arm attended a 4-week intervention programme, while those in the control arm were asked to read a book during the same period. The intervention programme had been validated by three experts from mainland China, comprising two psychiatric nursing professors from a university and a head nurse from a clinical psychiatric department. The feasibility of the intervention was assessed in terms of subject recruitment rate, the consent rate, the eligibility rate, and the feasibility of the measurement tools. The acceptability of the intervention was assessed based on prospective acceptability, the recruitment rate, concurrent acceptability, the dropout rate, the intervention attendance rate, the retention rate, the intervention completion rate, and the acceptability of randomisation. The preliminary efficacy of the intervention was examined by calculating the differences in schizophrenia-related knowledge, attitudes, intended behaviour, and empathy between the experimental and the control group at three time points using the Chinese versions of the Knowledge about Schizophrenia Test (KAST), the Mental Illness Clinicians’ Attitudes Scale (MICA), the Reported and Intended Behaviour Scale (RIBS), and the Jefferson Scale of Empathy – Nursing Students’ version R (JSE-NSR). Paired T-test and Wilcoxon signed-rank tests were used to identify within-group differences. Generalised estimating equations were used to calculate the differences between the experimental group and the control groups at three time points: baseline (T1), post-intervention (T2), and 3-month follow-up (T3). A P-value less than 0.05 was used to establish statistical significance in a two-tailed test. Phase 3 included a process evaluation that aimed to assess the second-phase pilot RCT. This evaluation used self-report questionnaires and focus group interviews with 30 participants to gather feedback on the participants’ experiences with the intervention and to collect their suggestions for its future improvement and application. The data from the questionnaires are presented as means and standard deviations, and content analysis was employed to analyse the data collected from the focus group interviews. Results In the first phase of the focus group interviews, the following four themes emerged: 1) recognition status of schizophrenia, 2) attitudes towards schizophrenia, 3) nursing students’ coping strategies for schizophrenia, and 4) perspectives of individuals with schizophrenia. These themes were influenced to some extent by Chinese culture. In the second phase, the Paired T-test or Wilcoxon signed rank test showed that the pilot RCT showed good feasibility and acceptability. The experimental group exhibited significant improvements in KAST scores (knowledge of schizophrenia) at both T2 and T3, and noteworthy improvements in the RIBS score (intended behaviour) at T2, with a simultaneous significant decrease in the MICA score (negative attitudes) at T2 and T3 time point. Furthermore, the JSE-NSR score (empathy) displayed a significant increase at T3. Nevertheless, although the pilot RCT showed significant improvements in the KAST score compared with the baseline of the control group, the control group did not show any notable alterations in the MICA, RIBS, or JSE-NSR scores at T2 and T3 timepoints. The GEE test showed that the interplay of group and time demonstrated that the experimental arm experienced a notably more significant decrease in MICA scores than the control group at T2 (Wald χ2 = 4.907, P = 0.027) and T3 (Wald χ2 = 10.848, P = 0.001). Moreover, the interplay of group and time in the experimental group displayed a substantial enhancement in JSE-NSR scores (Wald χ2 = 6.466, P = 0.011) in comparison with the control group at T3. The RIBS score significantly decreased at T2 compared with the baseline score at T1 (Wald χ2 = 4.197, P = 0.040). In the third phase of process evaluation, 30 nursing students from the experimental group participated, and the participants reported high satisfaction scores for the pilot RCT, with a mean score of 9.83 ± 1.09 out of 10. The evaluation revealed the following four key themes concerning the participants’ experience of the study: 1) the feasibility of the intervention, 2) the acceptability of the intervention, 3) the efficacy of the intervention, and 4) suggestions for future interventions. These four themes indicate that the second-phase pilot RCT had good feasibility and acceptability. Implications As this constitutes a pilot RCT, the sample size and effectiveness were limited. A full RCT should be conducted in the future to take cultural considerations into account, address nursing students’ misconceptions and knowledge gaps regarding schizophrenia, and focus on mitigating their negative attitudes while fostering their positive attitudes and empathy towards people with schizophrenia. By addressing these implications in future research, we can work towards reducing mental-illness stigma among nursing students and enhancing the nursing and support provided to individuals with schizophrenia. Conclusions This study successfully demonstrated the feasibility and acceptability of an online training programme to reduce schizophrenia stigma among fourth-year nursing students in mainland China. The study’s findings offer promising and high-quality preliminary evidence regarding the feasibility, acceptability, and preliminary efficacy of the intervention. |
| Rights: | All rights reserved |
| Access: | open access |
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