The Effect of Psychoeducation on Healthy Lifestyle Behaviors in Individuals With Schizophrenia
Condition: Schizophrenia
MeSH terms: Schizophrenia
Study type: Interventional

Summary: 
      Definition: Schizophrenia is a chronic mental disorder that causes drastic changes in life
      quality and life functions, characterized by behavioural, cognitive and affective state
      deterioration. Therefore, it is regarded as one of the most important health problems causing
      both personal and economic problems around the world. Unhealthy lifestyle behaviours in
      individuals with chronic mental disorders, like schizophrenia, are emphasized to play a big
      part in physical health problems. For individuals to develop a healthy lifestyle behaviour,
      it is necessary to primarily determine the lifestyle behaviours and then prevent the
      illnesses caused by the lifestyle and deaths linked to these illnesses. Current theory or
      models used to benefit from health programmes, prepared for the development of healthy
      lifestyle behaviours, should be deep-scaled. Theories and models are guides for systematic
      planning and decision-making. A well-defined model could contribute to the process of
      effective health improvement programmes for directive and content creation. One of the models
      mainly used to develop a behavioural change in health and explain how to obtain the most
      effective health behavioural change is the "Transtheoretical Model". Objective: The study was
      conducted with the pretest-posttest randomized controlled trial design to detect the effect
      of psychoeducation on a healthy lifestyle, based on the Transtheoretical Model in an
      individual with schizophrenia.

      The Hypotheses of the Study Hypothesis 1: When the individuals with schizophrenia who
      received psychoeducation based on the Transtheoretical Model are compared to the ones that
      did not, they will show progress in behavioural change steps.

      Hypothesis 2: When the individuals with schizophrenia who received psychoeducation based on
      the Transtheoretical Model are compared to the ones that did not, they will have higher final
      test results in the healthy lifestyle scale.

      Methods: The data were collected from 82 participants, as 41 intervention and 41 control. The
      data were collected via personal information form, behavioural change stage diagnosis form
      and healthy lifestyle scale II. 6-week psychoeducation, consisting of 6 modules, based on the
      Transtheoretical model, was applied to the intervention group. No interventions were applied
      to the control group. Pretests and posttests were applied to both groups.
    

Detailed description: 
      This study is conducted in pretest-posttest randomized controlled experimental research type
      in a Community Mental Health Center in the south of Turkey. The population of the study are
      the individuals with schizophrenia who registered in a Community Mental Health Center and are
      under observation (N=230). The sample number is determined based on another similar study
      with power analysis. In the evaluation completed according to the healthy lifestyle
      behaviours score, the sample number needed to participate in the study was determined to be
      at least 42 (intervention group=21 - control group=21) in order for research results to have
      a meaningful effect.In order to reduce the selection bias in the determination of
      intervention and control groups, intervention and control groups were formed with a third
      person who did not have a direct role in the research from 1 to 82 using simple random
      sampling method. The data were collected from 82 individuals with schizophrenia, as 41
      intervention and 41 control groups. The individuals with schizophrenia in the study and their
      families were informed according to the Helsinki Declaration and written and verbal approval
      were collected. The behavioural change identification form was applied to individuals with
      schizophrenia, who agreed to participate in the study, and their stage of the
      Transtheoretical Model was detected. The participants meeting the criteria in the
      participation stage (contemplation, preparation, action) were assigned to the intervention
      and control groups with the randomization. Pretests (personal information form, behavioural
      change identification form, Healthy Lifestyle Behaviours Scale II) were applied to the
      intervention and control groups before the psychoeducation. In addition to the rehabilitation
      activities conducted in the Community Mental Health Center, healthy lifestyle behaviours
      psychoeducation programme, based on the Transtheoretical Model, with 6 sessions (healthcare
      responsibility, nutrition, physical activity, spiritual development, interpersonal
      relationships, stress management) was applied to the intervention group for 6 weeks as three
      days in the weekdays and two sessions in a day. Psychoeducation was carried out by the
      researcher on the same day but within different time zones. Each psychoeducation session took
      90-120 minutes with the breaks taken considering the participants' mood. After completing six
      sessions, the behavioural change identification form and Healthy Lifestyle Behaviours Scale
      II were applied to the intervention group again. On the other hand, the control group
      continued their rehabilitation practices prepared for themselves in the Community Mental
      Health Center. It was contacted with the control group three times, two face to face and one
      via phone. In the third and final meeting, when the intervention group's sessions are
      completed, the behavioural change identification form and Healthy Lifestyle Behaviours Scale
      II were applied again to the control group. All the participants remained in the study at the
      end of it. The study was completed with 41 individuals in the intervention group and 41
      individuals in the control group. Statistical Package for the Social Sciences v23.0, which is
      a statistical analysis programme, was used to evaluate the findings of the study. It was
      benefited from descriptive statistics such as frequency, percentage, arithmetic average,
      standard deviation, minimum and maximum during data analysis. Parametric tests were used for
      the data analysis. The chi-squared test was used for relation analysis of two different
      categorized variables whereas the t-test was used while comparing averages of two independent
      groups. To determine the alteration of individuals' behavioural change stages before and
      after receiving psychoeducation, the McNemar test was used. Analysis of covariance (ANCOVA)
      while detecting the effect of the intervention study in the researches designed in the
      entrepreneurial pattern. In ANCOVA, to detect how big the effect of the independent variable
      on the dependent variable the eta squared (effect size) was calculated and the eta squared
      value (η2) was interpreted that it presents which parts of the change explain the total
      variant that the independent variable has on the dependent variable and it received a value.
      Eta squared is interpreted as 0,01 as the minor effect, 0,06 as medium effect and 0,14 as
      large effect. All test results were evaluated in terms of p<0.05 meaningfulness level
    

Intervention name(s): Psychoeducation Based on the Transtheoretical Model on Healthy Lifestyle Behaviors
Intervention type(s): Behavioral
Intervention description(s): Healthy lifestyle behaviours psychoeducation programme, based on the Transtheoretical Model, with 6 sessions (healthcare responsibility, nutrition, physical activity, spiritual development, interpersonal relationships, stress management) was applied to the intervention group for 6 weeks as three days in the weekdays and two sessions in a day. Psychoeducation was carried out by the researcher on the same day but within different time zones. Each psychoeducation session took 90-120 minutes with the breaks taken considering the participants' mood. After completing six sessions, the behavioural change identification form and Healthy Lifestyle Behaviors Scale II were applied to the intervention group again.
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: This study is conducted in pretest-posttest randomized controlled experimental research type.
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: Schizophrenia; Transtheoretical Model; Healthy Lifestyle; Behavioral Change; Mental Health and Psychiatric Nurse