TABLE 2.

Recommended elements of a contextually appropriate group psychosocial intervention for service users with schizophrenia and caregivers in the North West Province, South Africa.

Type of intervention	Need identified	Recommended strategy for addressing need
Service user intervention	a. Orientation of facilitators to experiences and perspectives of service users	Training on the impact of poverty, stigma and discrimination and stress on service users. Highlight importance of traditional and religious explanatory models of illness (EMI) and related coping strategies. Highlight role of traditional healers and religious organisations in providing psychosocial support but emphasise adherence to medication.
	b. Psycho-education on causes, symptoms, course	Dedicate significant time in meetings for psycho-education adapted from evidence-based approaches. Increase insight into individual nature of recovery and address expectations regarding cure. Increase insight into coping strategies for symptoms. Emphasise self-management and involvement in care.
	c. Medication literacy and adherence support	Dedicate time in meetings for sharing accurate information on medication. Involve a nurse or specialist if possible. Address different types of medication, side effects and the fact that medication may change based on availability.
	d. Reduce stress associated with family conflict and improve emotional well-being	Provide information on role of family conflict in stress and relapse. Skills building for managing anger and stress and dealing with conflict, coping skills for stress and anxiety. Improve money management skills and communication around disability grants.
	e. Tools for dealing with social isolation, experiences of stigma and discrimination	Skills building on problem management and healthy thinking. Prioritise time for sharing of experiences on stigma/discrimination in meetings, encouraging peer support Encourage group members to support each other outside of facilitated meetings. Organise social activities in addition to group meetings.
	f. Productive activities to help to reduce poverty and stress and improve role functioning	Include information on importance of productive activity for recovery. Link to skills development and employment opportunities. Enable service users to contribute more effectively to household tasks.
Caregiver intervention	g. Orientation of facilitators to experiences of caregivers	Training on impact of stress, burden, poverty, missed opportunities, lack of hope for future.
	h. Psycho-education on causes, symptoms, treatment, course, role of conflict	Increase empathy for service users, reduce fear.
	i. Improve caregiver ability to create an environment supportive to recovery	Share strategies for coping with conflict. Ensure opportunities for sharing of experiences and coping strategies.
	j. Reduce caregiver burden, improve emotional well-being	Share information on accessing resources in community, caring for the caregiver. Encourage environment of peer support Incorporate sharing of information with extended family. Build coping skills for dealing with stress and anxiety Encourage participation of male caregivers.