Effects of Virtual Life Skills Training on the Performance of the Families of Patients with Chronic Mental Disorders: A Quasi-experimental Study

An efficient family cannot be defined as one that is free of mental stress, conflicts, and problems, but rather, it is defined based on the extent to which the family is capable of fulfilling its duties and functions. Poorly functioning families have difficulty dealing with emotional issues. In these families, communication is neglected or unqualified, the range of emotional reactions is limited, and the quantity and quality of these reactions is abnormal depending on the context and environment. These issues highlight the need to provide psychological training to the families of patients with chronic mental disorders. The variety and intensity of caring roles may lead to mental disorders in family members. If these individuals receive no intervention, their mental health will decline, thereby rendering them as ‘hidden patients’. Family interventions could reduce the recurrence and frequent hospitalization of patients with mental disorders. Therefore, the involvement of the families of patients with chronic mental disorders is paramount. The families who live with these patients are exposed to the challenges associated with their illness and are often responsible for their care and wellbeing. Life skills training is an effective psychological intervention that helps families promote adaptive and positive behaviors to manage the challenges of daily life. Life skills training for the families of patients with chronic mental disorders could also reduce the stigma associated with the disease, improve familial relations, and decrease the burden or stress of the caregivers. The present study aimed to evaluate the effect of life skills training on the performance of the families of patients with chronic mental disorders.

This single-group quasi-experimental study was conducted with a pretest-posttest design on 37 family members of patients with chronic mental disorders admitted to Iran Psychiatric Center in 2020. The sample size was calculated to be 32 considering the error rate of 0.05 and test power of 0.80, which was almost equal to 37 participants with 10% attrition. The participants were selected via convenience sampling from the family members of the patients. After obtaining the required permit to conduct the research, the researcher began the sampling process. Due to the simultaneity of the intervention with the Covid-19 pandemic, it was not possible to hold meetings in person, and the intervention was performed virtually. For this purpose, the researcher referred to the research environment, and after coordination with the educational supervisor, obtained the contact number recorded in the patientschr('39') files, and the families were contacted. While explaining the objectives of the research, the researcher convinced the families to participate in the study. To have access to all the subjects, the researcher formed a group in WhatsApp, which was called Life Skills, where all the subjects had direct access to the researcher. After completing the informed consent form and to perform the pretest, demographic forms were distributed among the families to measure the variables of age, gender, marital status, education level, relationship with the client, economic status, type of mental disorder, and family performance tools. One month after the pretest and at the end of the training course, the posttest was conducted electronically via WhatsApp by the researcher. The research samples were taught online in six 60-minute sessions for three weeks using recorded audio, PowerPoint, PDF files, and clips, which could be uploaded to WhatsApp. Initially, the demographic form and McMaster family assessment questionnaire were completed, and the life skills training was provided afterwards. The posttest was performed one month after the intervention. Data analysis was performed in SPSS version 16 using descriptive and analytical statistics. The study protocol was approved by the Ethics Committee of Iran University of Medical Sciences, and written informed consent was obtained from the participants electronically. Participation was voluntary, and the subjects were assured of the confidentiality and anonymity of the data. 

 The majority of the participants were aged less than 30 years (51.4%), female (75.7%), and married (56.8%). In addition, most of the subjects had academic education (73%) and a moderate economic status (75.7%), and the client-parent relationship was most frequent (40.5%). According to the posttest results, the mean scores of overall family performance (P<0.001) and its dimensions, including problem-solving (P<0.001), communication (P<0.001), roles (P<0.001), emotional response (P<0.001), emotional mixing (P=0.045), and behavior control (P=0.006) significantly decreased compared to the pretest, indicating the positive effect of the training intervention on family performance and its dimensions. Based on the calculated effect size, the maximum effect of the intervention was on the problem-solving dimension (0.93), and the minimum effect size was observed in the emotional response dimension (0.34).

 According to the results, life skills training for the families of patients with chronic mental disorders had a significant impact on all the aspects of family performance and could be used as an effective method in psychiatric centers to improve the performance of these families. Furthermore, it is suggested that psychiatric ward nurses become familiar with the educational content of life skills and family performance to implement these interventions for patientschr('39') families if necessary. Our findings could also help nursing managers and head nurses of psychiatric wards for the better management of care provision to patients with chronic mental disorders and supporting the families of these patients after discharge. The life skills educational content provided to our participants could also be provided to clinical professors, so that students would become familiar with these outlines and incorporate the content into their care plans. Since the implementation of an intervention based on life skills training improved family performance of clients with chronic mental disorders, it is suggested that a similar intervention be evaluated to improve variables affecting life skills areas such as communication skills, problem solving skills, and Behavior control.