The effectiveness of enhancing contact model to reduce affiliate stigma among family caregivers of persons with schizophrenia in rural China : a mixed methods study

Abstract

This dissertation examines the effectiveness of Enhancing Contact Model (ECM) on reducing affiliate stigma among family caregivers of persons with schizophrenia (FCPWS) in rural China. By implying mixed methods, this research comprises two studies. Both studies used first-hand data collected in Xinjin County, Chengdu City, China, from March 2019 to September 2021. By using quantitative approaches, Study I involved 253 FCPWS and mainly responded to three inter-related inquiries: (1) the severity of affiliate stigma and associations among FCPWS in rural China; (2) the effectiveness of ECM on reducing affiliate stigma; (3) the effectiveness of ECM on reducing caregiving burden and improving the mental well-being of FCPWS. We found that 78.66% and 95.26% of FCPWS reported experiencing a high and severe level of affiliate stigma and burden due to caregiving for a relative with schizophrenia. Family caregivers who are middle-aged, unemployed, with high caregiving burden and low quality of life, showed severer affiliate stigma. Compared with participants in the Treat As Usual (TAU) arm, participants in the ECM arm had significantly lower ASSS scores at 9-month follow-up (T3). Compared with Psychoeducation Family Intervention (PFI), the ECM intervention yielded more steady reduction affiliate stigma. Compared with participants in the TAU arm, participants in the ECM arm had significantly lower caregiving burden scores both at T1 and T2 (post-intervention and 3-month follow-up). Compared with participants in the TAU arm, participants in the PFI arm had significantly higher Quality of Life scores in T1, while participants in the ECM arm had significantly higher QOL scores in T3 (9-month follow-up). To better understand the mechanism behind ECM, Study II employed a pilot thematic analysis and further identified three main “active ingredients”. They are (1) soft skills of the positive contact model; (2) hard skills of the positive contact model; and (3) positive feedback on the peer support group. Meanwhile, four “adverse ingredients” were also recognized. They are (1) negative attitudes to contact; (2) negative contact behaviors; (3) negative feedback on the peer support group; and (4) difficulties in maintaining good relationships with PWS. This thesis extended the contact theory by emphasizing enhancing positive contact instead of general contact. Moreover, this research has also addressed that contact theory could be used in a broad context, not only mental illness related stigma, but also caregiving burden, hope, and QOL in a non-western context. Three “active ingredients” and four “adverse ingredients” identified in the research should be considered when future research design and conduct contact-based anti-stigma interventions. (409 words)