title: Culturally-adapted Family Intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: a feasibility study protocol of implementation and acceptability.
abstract: BACKGROUND
  African-Caribbeans in the UK have the highest schizophrenia incidence and greatest inequity in access to mental health services of all ethnic groups. The National Institute for Health and Care Excellence (NICE) highlights this crisis in care and urgent need to improve evidence-based mental healthcare, experiences of services and outcomes for this group. Family intervention (FI) is clinically and cost-effective for the management of schizophrenia but it is rarely offered. Evidence for FI with minority ethnic groups generally, and African-Caribbeans in particular, is lacking. This study aims to test the feasibility and acceptability of delivering Culturally-adapted Family Intervention (CaFI) to African-Caribbean service users diagnosed with schizophrenia.
  
  
  METHODS
  This is a feasibility cohort design study. Over a 12-month intervention period, 30 service users and their families, recruited from hospital and community settings, will receive ten one-hourly sessions of CaFI. Where biological families are absent, access to the intervention will be optimised through 'family support members'; trusted individuals nominated by service users or study volunteers. We shall collect data on eligibility, uptake, retention and attrition and assess the utility and feasibility of collecting various outcome measures including readmission, service engagement, working alliance, clinical symptoms and functioning, perceived criticism, psychosis knowledge, familial stress and economic costs. Measures will be collected at baseline, post-intervention and at 3-month follow-up using validated questionnaires and standardised interviews. Admission rates and change in care management will be rated by independent case note examination. Variability in the measures will inform sample size estimates for a future trial. Independent raters will assess fidelity to the intervention in 10 % of sessions. Feedback at the end of each session along with thematically-analysed qualitative interviews will examine CaFI's acceptability to service users, families and healthcare professionals.
  
  
  CONCLUSIONS
  This innovative response to inequalities in mental healthcare experienced by African-Caribbeans diagnosed with schizophrenia might improve engagement in services, access to evidence-based interventions and clinical outcomes. Successful implementation of CaFI in this group could pave the way for better engagement and provision across marginalised groups and therefore has potentially important implications for commissioning and service delivery in ethnically diverse populations. This study will demonstrate whether the approach is feasible and acceptable and can be implemented with fidelity in different settings.
authors.affiliation: Centre for Women's Mental Health, Institute of Brain, Behaviour and Mental Health and School of Psychological Sciences, University of Manchester, G6 Coupland Building, Manchester, M13 9PL UK.
authors.forename: Dawn
authors.initials: D
authors.lastname: Edge
authors.affiliation: Centre for Women's Mental Health, Institute of Brain, Behaviour and Mental Health and School of Psychological Sciences, University of Manchester, Third Floor Jean McFarlane Building, Manchester, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Degnan
authors.affiliation: Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cotterill
authors.affiliation: School of Psychological Sciences, University of Manchester, Second Floor Zochonis Building, Manchester, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Berry
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, Third Floor Jean McFarlane Building, Manchester, UK ; Manchester Mental Health & Social Care Trust, 70 Manchester Rd, Manchester, M21 9UN UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Drake
authors.affiliation: Faculty of Medicine and Health, University of Leeds, Baines Wing, Leeds, LS2 9JT UK.
authors.forename: John
authors.initials: J
authors.lastname: Baker
authors.affiliation: School of Psychological Sciences, University of Manchester, Second Floor Zochonis Building, Manchester, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Barrowclough
authors.affiliation: MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Manchester, UK ; York Trials Unit, Department of Health Sciences, University of York, York, UK.
authors.forename: Adwoa
authors.initials: A
authors.lastname: Hughes-Morley
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, Third Floor Jean McFarlane Building, Manchester, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Grey
authors.affiliation: Institute of Psychiatry, Kings College London, London, WC2R 2LS UK.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Bhugra
authors.affiliation: Manchester Mental Health and Social Care NHS Trust, Chorlton House, Chorlton, Manchester, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Cahoon
authors.affiliation: Institute of Psychiatry, Kings College London, London, WC2R 2LS UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tarrier
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, Third Floor Jean McFarlane Building, Manchester, UK.
authors.forename: Shôn
authors.initials: S
authors.lastname: Lewis
authors.affiliation: Centre for Women's Mental Health, Institute of Brain, Behaviour and Mental Health, University of Manchester, Third Floor Jean McFarlane Building, Manchester, UK ; Manchester Mental Health & Social Care Trust, 70 Manchester Rd, Manchester, M21 9UN UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Abel
keywords: African-Caribbean; Black British; Black and minority ethnic (BME); Cultural adaptation; Family intervention; Feasibility trial; Psychological therapy; Psychosis; Schizophrenia; Severe mental illness (SMI)