الفهرس 
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Abstract
Family caregivers of patients with schizophrenia often experience a high level of burden and stress. They often experience feelings such as guilt, depression, anxiety, fear, anger, and hopelessness during the caregiving process. Hence, the level of hope is crucial in determining the caregiver’s burden. With the advent of deinstitutionalization, family caregivers are required to take full responsibility for caring for their patients even though they are not equipped with the knowledge and skills to care for them. The family’s specific needs for information, skills, and support can be addressed through psychoeducation.
Virtual social network-based psychoeducation (VSN) is a web-based online environment that offers information, skills, training, and support to caregivers quickly and conveniently, without the need for face-to-face meetings, which gives them the opportunities to ask and discuss freely.
The current study aimed to determine the effect of virtual social network-based psychoeducation intervention on the level of hope and burden among family caregivers of patients with schizophrenia.
This study followed a quasi-experimental research design (pretest-posttest).
It was conductedatEl-Maamoura Hospital outpatient clinic for Psychiatric Medicine affiliated with the Ministry of Health and Population.
The study subjects included41 family caregivers of patients with schizophrenia.
The data for this study were obtained using the following tools:
Tool I: Patients with schizophrenia and Family Caregivers Socio-Demographic and Clinical Data Questionnaire:
The researcher developed this questionnaire and covered two parts: The patient’s family caregiver’s socio-demographic characteristics as age, gender, marital status, educational level, occupation, economic status, kinship to the patient, and duration of caregiving roles. The patient’s socio-demographic and clinical data, such as age, gender, marital status, educational level, duration of illness, number of admissions to psychiatric hospitals, and compliance with medications.
Tool II: The Adult Hope Scale (AHS) was used to assess the level of hope. The scale consists of 12 items and uses a 4-point Likert-type scale. The scale is divided into two subscales: (1) Agency (i.e., goal-directed energy) and (2) Pathways (i.e., planning to accomplish goals).
Tool III: Caregiver Burden Inventory (CBI)explores caregiver burden. It has five different dimensions: time-dependent burden (5 items), developmental burden (5 items), physical burden (4 items), social burden (5 items), and emotional burden (5 items).
Tool IV: Knowledge and Skills of Caregiving Scale (KSCS):This five-item questionnaire measures the caregiver’s perception of their understanding of the following aspects: symptoms of patients with schizophrenia, medication for the treatment of schizophrenia, side effects of the medicines, how to care for the patients, and how to control the patient’s symptoms.
Method of the actual study:
Official approvals were taken from related authorities. The researcher completed an online ”How to Create a Virtual Classroom using Google Slides” training program. A Pilot study and internal consistency were done on five family caregivers of patients with schizophrenia to assess the clarity and applicability of the tools. Reliabilities of the translated tools (II and III) were tested using Cronbach’s Alpha, and both proved reliable (0.809, 0.878), respectively. The researcher translated the psychoeducational intervention package Sharif et al. (2012) developed into Arabic. The study subjects were subdivided into 6 subgroups; each subgroup received 12 sessions of online group psychoeducation. After the termination of all sessions for each subset, a posttest was done for each caregiver individually and then repeated after one month.
The following are the main results of the present study:
I. Patients’ socio-demographic and clinical characteristics:
Patients’ ages ranged between 21 and 57 years, majority of patients (70.7%) were single, only 21.9% had a university level of education.The majority (68.3%) were not working, and 9.7% were housewives. Most of patients 92.7% had a history of previous hospitalization.
II. Caregivers’ socio-demographic characteristics:
Caregiversage ranged between 27 and 64 years with 43.9% aged more than 50, and majority of caregivers were females (78.0%). More than one-third (39.1%) of caregivers were parents of the patients. About two-thirds (63.4%) of caregivers were either housewives or not working, and 75.6% of the caregivers considered their income as insufficient. Among the caregivers reported providing care alone, and 36.6% received assistance. The duration of being a caregiver ranged between 1 and 12 years.
III. Caregivers’ hope:
- The overall total mean percent score of hope has increased steadily from pre to post and one month after the intervention (30.18±13.72, 60.37±11.57, and 68.50±9.46), respectively.
- There was a statistically significant difference between pre-post and one month after intervention regarding agency and pathway sub-scale of hope, P (<0.001*).
- A positive correlation was found between the overall hope score pre-post and one month after intervention P (<0.001*).
IV. Caregivers’ burden results:
- A statistically significant difference between mean scores of caregiver’s burdens regarding time-dependent, developmental, physical, social, and emotional burdens was foundpre-, post and one month after intervention P= (0.034, 0.001, 0.031, 0.001, 0.001) respectively.
- The overall total percentage mean score of caregivers’ burden in the post and one month after intervention (46.58±11.71, 40.44±10.82 respectively) was significantly decreased than that pre-intervention (59.24±13.78).
- A statistically significant difference was found between the overall burden score pre-post and one month after intervention P (<0.001*).
- Before the application of the VSN psychoeducation intervention, the level of burden was high; however, after implementing the intervention, the results showed a significant decrease in the level of burden among family caregivers of patients with schizophrenia.
V. Caregivers’ knowledge and skills results:
- Statistically significant difference was found between the mean scores of knowledge and skills of caregiving pre-post and one month after intervention regarding symptoms of patients with schizophrenia, medication for treatment, side effects of the drug, caring for the patient, controlling symptoms were (p<0.001* for all items).
VI. The correlation between overall score of hope, burden, and knowledge skills pre-post and one month after intervention:
- There is a strong negative correlation between burden and hope scores pre-post and one month after the intervention (r= -0.422*, p=0.006, r= -0.360*, p=0.021*, r= -0.282, p=0.074 respectively).
- A negative correlation was found between the overall knowledge and skills perception and burden score pre-post intervention but not one month after. (r= -0.337*, p=0.031*, r= -0.312*, p=0.047*, r= -0.191, p=0.233 respectively).
- A positive correlation between overall knowledge and skills of caregiving and hope pre-intervention (r= 0.420*, p=0.006*) was found, but there is no such correlation post or one month after the intervention (r= 0.238, p=0.133, r= 0.167, p=0.298 respectively).
- Caregivers with more knowledge and skills have increased level of hope and lower level of burden indicating that the virtual social network-based psychoeducation intervention effectively reduced the caregiver burden and increased their level of hope.
The following are the main recommendations:
• Integrate VSN psychoeducation intervention in long-term guidance and ongoing follow-up of caregivers of patients with schizophrenia to reduce patients’ relapses and enhance their adjustment to society.
• VSN psychoeducation platforms should be structured or designed based on caregivers’ needs to ensure that the interventions are family-centered and effective.
• Include VSN psychoeducational intervention in the discharge plan for family caregiversof patients with schizophrenia as part of activities of daily living.
• Integrating the VSN psychoeducation protocol as an adjunct to the traditional system of psychiatric hospitals’ routine of care to increase the accessibility of psychiatric interventions throughout the country.
• Conducting In-service educational training programs about the importance of VSN psychoeducation and how to motivate patients and their family caregivers to participate and share their experiences regularly.
• Implementing regular workshops for psychiatric nursing staff and health care providers about incorporating web-based psychoeducation skills in the treatment and rehabilitation process.
• Creating a variety of resources as part of the Egyptian mental health care system to support the needs of family caregivers of patients with schizophrenia, including various social and recreational services for caregivers and encouraging them to participate in these activities to enhance their well-being, reduce their burdens, and enhance their hope.
• Healthcare educators need to update their traditional pedagogical methods to be more compatible with the current era of technology by introducing innovative teaching and learning methods to deliver virtual network-based psychological education in different fields.
• Future studies are needed to determine the sustainability of the virtual social network-based intervention’s effect and the feasibility of its applications in the community, as well as to investigate its impact on patients’ recovery after they have been discharged from the hospital.
• More research is required to find other variables that might affect the family’s virtual social network-based psychoeducational needs, level of burden, and hope.
• More studies are needed to compare the virtual model with other psychoeducation models, such as the traditional face-to-face model.