The “active ingredients” of enhancing contact model on reducing affiliate stigma among family caregivers of persons with schizophrenia in rural China: A qualitative study

Abstract

Enhancing contact model (ECM) has been proven effectiveness in reducing affiliate stigma among family caregivers of persons with schizophrenia (FCPWS). However, the underlying “active ingredients” that contribute to its effectiveness remain unidentified. This study aims to explore the perceived active ingredients of ECM from the participants’ perspectives and to understand its role in reducing affiliate stigma in rural China. Semi-structured interviews were conducted with FCPWS who completed the ECM randomized control trial. These interviews were recorded and transcribed verbatim. Thematic analysis approach was used for data analysis. Three active ingredients were identified from 15 participants: (1) soft skills of positive contact including empathy, appreciation, and role diversification; (2) culture uniqueness of the positive contact, leveraging filial piety and parental affection to enhance positive contact and reduce affiliate stigma among FCPWS; (3) hard skills of positive contact encompassing nonverbal positive contact skills, avoiding negative contact, problem-solving skills, and interpersonal skills; and (4) positive attitudes on the peer support group, which involved gaining new knowledge and skills and expanding social networks. Lastly, challenges were identified when employing ECM, including FCPWS’ frustration or discomfort, unwillingness to share, and lack of recognition and appreciation. This is the first qualitative study to explore the active ingredients of ECM. Our findings suggest that these active ingredients should be strengthened in future intervention design and clinical practice. Furthermore, the challenges identified should be fully considered and addressed when planning and implementation ECM to better serve the target population.