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Joung and Kim: Effects of a Relapse Prevention Program on Insight, Empowerment and Treatment Adherence in Patients with Schizophrenia
Original Article

Journal of Korean Academy of Nursing 2017; 47(2): 188-198.

Published online: 28 April 2017

DOI: https://doi.org/10.4040/jkan.2017.47.2.188

Effects of a Relapse Prevention Program on Insight, Empowerment and Treatment Adherence in Patients with Schizophrenia

Jaewon Joung1, Sungjae Kim2

1College of Nursing, Seoul National University, Seoul, Korea.

2College of Nursing · The Research Institute of Nursing Science, Seoul National University, Seoul, Korea.

Address reprint requests to: Kim, Sungjae. College of Nursing · The Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8814, Fax: +82-2-765-4103, sungjae@snu.ac.kr

Received 27 February 2016       Revised 19 September 2016       Accepted 4 November 2016

© 2017 Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to develop a relapse prevention program (RPP) and examine the effects of the RPP on insight, empowerment, and treatment adherence in patients with schizophrenia.

Methods

A non-equivalent control group pretest-posttest design was used. Participants were 54 inpatients who had a diagnosis of schizophrenia (experimental group: 26, control group: 28). The study was carried out from February 7, 2012 to February 6, 2013. Over a 10-day period prior to discharge each participant in the experimental group received three one-hour sessions of RPP a one-to-one patient-nurse interaction. Data were collected using Assess Unawareness of Mental Disorder (SUMD), Empowerment Scale, and Insight and Treatment Attitude Questionnaire (ITAQ) and analyzed using PASW 18.0 with chi-square test, independent t-test, Mann-Whitney U test, and ANCOVA.

Results

The experimental group had a significant increase in insight and treatment adherence compared to the control group. However, there was no significant difference in empowerment between the two groups.

Conclusion

Findings indicate that the RPP for patients with schizophrenia was effective in improving insight and treatment adherence. A longitudinal study is needed to confirm the persistence of these effects of RPP in patients with schizophrenia.

Keywords: Schizophrenia, Relapse, Prevention, Treatment, Empowerment

Figures and Tables

Figure 1

Conceptual framework for this study.

jkan-47-188-g001
Table 1

Session & Contents of Relapse Prevention Program for Patients with Schizophrenia

jkan-47-188-i001
Session Contents Expected effects
1 · Pre-test Improving insight
· Retrospection of the relapse or psychotic episode
· Education
 -Understanding the individual's attitude toward his or her illness
 -Perception of the risk and controllability of relapse
 -Beliefs that may exacerbate the relapse process
2 · Identification of the early warning sign (relapse signature or psychotic symptom) Improving insight
 -Timeline exercise
 -Card sort exercise
3 · Exploring coping strategies Enhancing empowerment
· Development of a relapse drill
 -Relapse prevention sheet
 -Role play
· Post test
Table 2

Homogeneity Test of Socio-Demographic and Psychiatric Characteristics

jkan-47-188-i002
Characteristics Exp. (n=26) Cont. (n=28) χt p
n (%) or mean±SD n (%) or mean±SD
Gender Male 8 (30.8) 13 (46.4) 1.39 .238
Female 18 (69.2) 15 (53.6)
Age (year) 20~29 11 (42.3) 11 (39.3) −.60 .550
30~39 6 (23.1) 6 (21.4)
40~49 7 (26.9) 6 (21.4)
50~60 2 (7.7) 5 (17.9)
Mean±SD 34.61±9.69 36.39±11.81
Marital status Yes 6 (23.1) 6 (21.4) 1.37 .713
No 20 (76.9) 22 (78.6)
Educational level High school or less 9 (34.6) 9 (32.1) 2.50 .475
College or more 17 (65.4) 19 (67.9)
Religion Yes 20 (76.9) 20 (71.4) .21 .645
No 6 (23.1) 8 (28.6)
Job Yes 10 (38.5) 13 (46.4) .35 .554
No 16 (61.5) 15 (53.6)
Economic status Low 8 (30.8) 13 (46.4) 7.62 .179
Middle 11 (42.3) 4 (14.3)
High 7 (26.9) 11 (39.3)
Duration of illness (year) 0~4 12 (46.2) 18 (64.3) 2.30 .599
5 and over 14 (53.8) 10 (35.7)
Mean±SD 8.08±9.06 5.07±8.35

SD=standard deviation.

Table 3

Homogeneity of Dependent Variables

jkan-47-188-i003
Dependent variables Exp. (n=26) Cont. (n=28) t/Z p
mean±SD mean±SD
Insight 15.23±3.07 16.11±3.57 −0.75* .454
Empowerment 74.73±11.14 80.75±9.91 −2.09 .042
Treatment adherence 25.19±5.32 21.46±6.70 −2.47* .014
Core treatment adherence 14.92±3.61 12.89±4.35 −2.12* .034

*Mann Whitney U-test.

Exp.=Experimental group, Cont.=Control Group.

Table 4

Comparison of Dependent Variables between Experimental and Control Groups

jkan-47-188-i004
Variables Groups Pretest Posttest Z or F p
M±SD M±SD
Insight Exp. 15.23±3.07 10.54±3.53 −4.17 <.001
Cont. 16.11±3.57 17.07±4.78
Empowerment Exp. 74.73±11.14 77.04±8.39 0.59 .446*
Cont. 80.75±9.91 81.46±10.98
Treatment adherence Exp. 25.19±5.32 28.00±4.03 11.77 .001*
Cont. 21.46±6.70 22.71±5.01
Core treatment adherence Exp. 14.92±3.61 16.65±2.34 4.73 .034*
Cont. 12.89±4.35 14.21±3.60

*ANCOVA conducted with covariate of pre-test value.

Exp.=Experimental group, Cont.=Control Group.

Notes

This manuscript is a revision of the first author's master's thesis from Seoul National University.

CONFLICTS OF INTEREST The authors declared no conflict of interest.

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