The present study is a quasi-experimental study with control and intervention groups. The population consisted of all family caregivers of clients with bipolar disorder who referred to Ghods Psychiatric Hospital in Sanandaj in 2019-2020. The inclusion criteria for the caregivers included 18 to 65 years old, spending the most caring time for the client, lack of mental retardation, lack of drug and alcohol consumption, lack of vision and hearing impairment. The exclusion criteria were withdrawal from further research and non-participation in at least two sessions of the training program.
The sample size was measured according to the study of Shamsaei et al. (19), with the reliability level of 95% and statistical power of 80% using the following equation, and taking into account the 10% drop-out in the samples size, 32 people was considered in each group (total sample size was 64).
After receiving the code of ethics (IR.MUK.REC 1398.151), obtaining the executive license and coordination with the officials of Ghods Psychiatric Hospital, the sampling procedure was performed on all wards of the hospital and the outpatient clinic based on inclusion criteria. In order to prevent any major intervening variable, the sampling was performed first for the control group and then for the intervention group. After recruitment of subjects of the control group as well as the intervention group, psycho-education presented to the intervention group.
Because the selection of the control and intervention groups was done simultaneously from one medical center, first the control group and then the intervention group were examined, so that the data collection would not be biased. Both groups completed the demographic questionnaires and the Affiliate Stigma Scale in two intervals. The pre-test was administered at the beginning of the study and the post-test was administered four weeks after the pre-test.
The psycho-education program for the intervention group was performed for 4 weeks, one session per week for 60 to 90 minutes. The training sessions were held in groups of 4 to 5 participants, several times a week, according to the request and conditions of the caregiver through group discussion. At the end of the psycho-education program, the post-test was administered for the intervention group.
The implementation of the psycho-education program, the number of sessions, and the general framework of the educational content were as follows:
The first session started with the introduction of the individuals and the researcher stated the purpose of the study. Then the researcher discussed about the disease and its treatments, and the way of caring the ill member.
The second session started by reviewing the previous session. Then, continuing by the explaining of the concept of stigma and the strategies to cope with it for the caregivers. Also the participants shared their experiences of being labeled by those around them because of their client’s disorder and mentioned how they coped with the situation.
At the beginning of the third session the concept of stigma and its coping strategies reviewed. Then, the session continued with a discussion of life skills and how they can use that skills in their life in order to live better.
The fourth session was a continuation of practice on life skills. Then the educational content of previous session reviewed. At the end, the whole necessary educational content was presented to the participants as booklet and pamphlet. Table 1 shows the headings of the educational content for each session.
The demographic questionnaire: This questionnaire consist of information about the caregivers, including age, gender, marital status, education, job, economic status, the number of family members, caregiver-client relationship, the history of patient’s disease, the family history of the disease and the number of times of the previous hospitalization.
Affiliate stigma scale: This scale designed by Shamsaei et al. in 2016 has 30 items on 5-point Likert scale (always (4), most of the time (3), sometimes (2), rarely (1), and never (0)). The affiliate stigma score was ranged between 0 and 120. A score between (0-30) indicates no stigma, (30-60) indicates mild stigma, (60-90) indicates moderate stigma, and (90-120) indicates high stigma. The validity and reliability of the Affiliate Stigma Scale designed by Shamsaei et al. in 2016 were determined and confirmed through content validity. The validity of the questionnaire was 0.8 and its reliability was determined through Cronbach's alpha coefficient at 0.94 (19).
To ensure the reliability of the questionnaire, it was administered to fifteen caregivers of clients who were not part of the research community. They had similar characteristics to this population. Employing the internal consistency method, the calculated Cronbach's alpha coefficient for this questionnaire was 0.85, which indicates the optimal reliability for this tool. The data were analyzed through SPSS-22 using descriptive statistics and inferential statistics.