Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
PLoS One. 2024 Aug 22;19(8):e0309238. doi: 10.1371/journal.pone.0309238. eCollection 2024.
Relapse among individuals with serious mental illnesses in resource-limited contexts, including South Africa, is a significant concern. To date, the risks for relapse among this population is well documented, but little is known about prevention strategies to reduce its occurrence in these resource-limited settings. Therefore, this qualitative study explores the risk factors and strategies for relapse prevention from the patients' and caregivers' perspectives.
We conducted audio-recorded face-to-face in-depth interviews to capture the lived experience of relapse of inpatient study participants with serious mental illness (N = 24) at a public specialized psychiatry hospital in South Africa and their caregivers (N = 6). We conducted an inductive thematic analysis with two pre-specified themes (risk factors for relapse and strategies for prevention), with the codes devised from the data.
Six sub-themes were identified from the analysis within the two pre-specified themes(Risk factors and strategies for relapse prevention): personal-related, family-related, and health system-related risk factors and strategies for preventing relapse, respectively. To highlight some essential findings, the importance of motivation for drug adherence, family involvement, and availability of anti-psychotic drugs in public health care were noted. More importantly, this study identified important cultural complexities where traditional healers play a significant role in some cultural understanding and treatment of mental illness, affecting medication adherence.
This study calls for people-centered mental health care delivery in a public health system that listens to the voice of concern, including cultural challenges, and implements meaningful support that matters most to the patient and their family/caregivers.
在资源有限的环境中，包括南非在内，严重精神疾病患者的复发是一个重大问题。迄今为止，该人群的复发风险已有充分记录，但对于减少资源有限环境中复发的预防策略知之甚少。因此，这项定性研究从患者和照顾者的角度探讨了复发的风险因素和预防策略。
我们对南非一家公立精神科专科医院的 24 名住院严重精神疾病患者（研究参与者）及其 6 名照顾者进行了录音的面对面深入访谈，以了解他们的复发经历。我们采用了一种归纳主题分析方法，有两个预先设定的主题（复发的风险因素和预防策略），代码是从数据中设计的。
在这两个预先设定的主题（复发的风险因素和预防策略）中，从分析中确定了六个子主题：个人相关、家庭相关和卫生系统相关的复发风险因素和预防策略。为了突出一些重要的发现，强调了药物依从性的动机、家庭参与和公共卫生保健中抗精神病药物的可获得性的重要性。更重要的是，这项研究发现了一些重要的文化复杂性，在这些文化中，传统治疗师在一些文化理解和精神疾病治疗中扮演着重要的角色，这影响了药物的依从性。
这项研究呼吁在公共卫生系统中提供以患者为中心的精神保健服务，倾听关注的声音，包括文化挑战，并实施对患者及其家庭/照顾者最重要的有意义的支持。
