Developing culturally sensitive cognitive behaviour therapy for psychosis for ethnic minority patients by exploration and incorporation of service users' and health professionals' views and opinions.
BACKGROUND
Studies of cognitive behaviour therapy (CBT) for schizophrenia demonstrate that African-Caribbean and Black African patients have higher dropout rates and poor outcomes from treatment.


OBJECTIVE
The main aim of the study was to produce a culturally sensitive adaption of an existing CBT manual for therapists working with patients with psychosis from specified ethinic minority communities (African-Caribbean, Black-African/Black British, and South Asian Muslims). This will be based on gaining meaningful understanding of the way members (lay and service users) of these minority communities typically view psychosis, its origin and management including their cultural influences, values and attitudes.


METHODS
This two-centre (Hampshire and West London) qualitative study consisted of individual semi-structured interviews with patients with schizophrenia (n = 15); focus groups with lay members from selected ethnic communities (n = 52); focus groups or semi-structured interviews with CBT therapists (n = 22); and mental health practitioners who work with patients from the ethnic communities (n = 25). Data were analyzed thematically using evolving themes and content analysis. NVivo 8 was used to manage and explore data.


RESULTS
There was consensus from the respondent groups that CBT would be an acceptable treatment if culturally adapted. This would incorporate culturally-based patient health beliefs, attributions concerning psychosis, attention to help seeking pathways, and technical adjustments.


CONCLUSIONS
While individualization of therapy is generally accepted as a principle, in practice therapists require an understanding of patient-related factors that are culturally bound and influence the way the patient perceives or responds to therapy. The findings of this study have practical implications for therapists and mental health practitioners using CBT with people with psychosis from BME communities.
Rathod
Shanaya
S
Hampshire Partnership NHS Foundation Trust, Winchester, UK. shanayarathod@nhs.net
Kingdon
David
D
Phiri
Peter
P
Gobbi
Mary
M
D000069:Acculturation; D000328:Adult; D001291:Attitude of Health Personnel; D001521:Behavior Therapy / Q000458:organization & administration*; D044383:Black People / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000458:organization & administration*; D003256:Community Participation; D003431:Cross-Cultural Comparison; D054521:Cultural Competency; D005260:Female; D017144:Focus Groups; D006801:Humans; D007318:Inservice Training; D007514:Islam / Q000523:psychology*; D008297:Male; D008370:Manuals as Topic / Q000592:standards; D008875:Middle Aged; D019303:Multilingualism; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology; D017060:Patient Satisfaction; D011287:Prejudice; D011618:Psychotic Disorders / Q000208:ethnology* / Q000628:therapy*; D012069:Religion and Psychology; D012559:Schizophrenia / Q000208:ethnology* / Q000628:therapy*; D006113:United Kingdom