Developing peer-led recovery groups (PRIZE) for people with psychosis and their caregivers in a low resource South African setting

Aim

In South Africa and other low- and middle-income countries (LMIC), personal recovery for people with a severe mental health condition (SMHC) is hampered by lack of community-based support. This paper describes the development of a non-specialist and peer-facilitated recovery intervention (PRIZE) intended as an adjunct to psychiatric care.

Methods

Intervention development was guided by the MRC framework for complex interventions. Evidence review was followed by 43 in-depth interviews exploring desired recovery outcomes of people with lived experience and caregivers, and 15 interviews with service providers. Thematic analysis guided development of a theory of change and evaluation framework. District stakeholder mapping, engagement and feedback was undertaken to explore acceptability and feasibility of recovery groups facilitated by trained peers (people with lived experience of SMHC or carers).

Results

Intervention components are described in line with the GUIDED framework. Formative work identified expressed recovery needs and led to a theory of change based on building self-esteem, reducing social isolation, and improving responses to financial instability, substance use and medication difficulties. The intervention was based on sharing experiences and coping strategies. It incorporated two phases of mutual support groups comprising people with SMHC and caregivers. An auxiliary social worker-led phase (9 weekly sessions) was followed by a supported peer-led phase (12 weekly sessions). The planned didactic psychosocial rehabilitation intervention evolved into an intervention designed to support individuals’ recovery journeys, grounded in values of building hope, opportunity and control, and harnessing strengths. This required training to realign the practice of auxiliary social workers accustomed to a traditional helping role towards an empowering role. Particular attention was given to processes for supportive supervision and mentorship.

Conclusion

The involvement of district stakeholders and potential participants resulted in a tailored, context-specific intervention with potential to contribute to evidence for community-based, task-shared, peer-led and recovery-focused interventions in LMIC.