An Assets-Based Approach to Co-Producing a Culturally Adapted Family Intervention (CaFI) with African Caribbeans Diagnosed with Schizophrenia and Their Families

Abstract

Objective: To determine how to improve the cultural appropriateness and acceptability of an extant evidence-based model of family intervention (FI), a form of 'talking treatment,' for use with African Caribbean service users diagnosed with schizophrenia and their families.

Design: Community partnered participatory research (CPPR) using four focus groups comprising 31 key stakeholders.

Setting: Community locations and National Health Service (NHS) mental health care settings in northwest England, UK.

Participants: African Caribbean service users (n=10), family members, caregivers and advocates (n=14) and health care professionals (n=7).

Results: According to participants, components of the extant model of FI were valid but required additional items (such as racism and discrimination and different models of mental health and illness) to improve cultural appropriateness. Additionally, emphasis was placed on developing a new ethos of delivery, which participants called 'shared learning.' This approach explicitly acknowledges that power imbalances are likely to be magnified where delivery of interventions involves White therapists and Black clients. In this context, therapists' cultural competence was regarded as fundamental for successful therapeutic engagement and outcomes.

Conclusions: Despite being labelled 'hard-to-reach' by mainstream mental health services and under-represented in research, our experience suggests that, given the opportunity, members of the African Caribbean community were highly motivated to engage in all aspects of research. Participating in research related to schizophrenia, a highly stigmatized condition, suggests CPPR approaches might prove fruitful in developing interventions to address other health conditions that disproportionately affect members of this community.

Keywords: African Caribbean; Community Partnered Participatory Research (CPPR); Ethnicity; Health Disparities; Minority Mental Health; Psychosis; Schizophrenia.

Figure 1.. Working example of problem solving and goal planning.