Culturally Adapted Family Intervention for People With Schizophrenia in Indonesia (FUSION): A Development and Feasibility Study Protocol

Background Mental illnesses comprise the single largest source of health-related economic burden globally and low-and middle-income countries are disproportionately affected. The majority of people with schizophrenia who need treatment do not receive it and are often wholly reliant on family caregivers for daily care and support. Family interventions have an exceptionally robust evidence base for their efficacy in high resource settings, but it is unknown whether they can produce equivalent effects in some low resource settings where cultural beliefs, explanatory models of illness and contextual socio-economic issues differ. Methods This protocol describes methods to culturally adapt and refine an evidence-based, family intervention for relatives and caregivers of people with schizophrenia in Indonesia. The feasibility and acceptability of implementing an adapted, co-produced intervention via task-shifting in primary care settings will be evaluated using the Medical Research Council framework for complex interventions. The development and preliminary testing of the adapted intervention will occur in three phases utilising mixed methods; stakeholder and key informant interviews will inform consensus workshops using nominal group techniques to develop a testable intervention. The feasibility of testing the intervention in a larger trial and the acceptability of the intervention will be explored in a feasibility trial of adapted family interventions compared to standard treatment. Participants in Phase 1 consultation groups will comprise service-users (n = 10-15), carers (n=10-15) and key stakeholders including lay and healthcare workers (n=10-15) and semi-structured interviews with key informants to identify implementation challenges and facilitators (n= 10). Phase 2 participants will include expert stakeholders including experts by experience to achieve consensus on the essential elements of the intervention (n = 20) and a separate group to develop training methods and materials for our task-shifted intervention. Phase 3 will comprise 60 carer-service-user dyads participating in a randomised feasibility trial. Discussion National healthcare policy in Indonesia supports the delivery of mental health services in a complex network of primary care centres. This study will provide important information on the feasibility of delivering family interventions for people with schizophrenia via task-shifting in primary care settings in Indonesia.