Schizophrenia and its Associated Factors

Schizophrenia refers to a mental disorder that is usually manifested in early adulthood or late adolescence and is characterised by hallucinations, delusions, and other cognitive problems (Meehl, 2017). This mental disorder is commonly exhibited in the form of an abnormal social behaviour and loss of contact with the reality. The signs and symptoms are directly responsible for a reduction in social engagement, lack of emotional expressions, and reduced motivation. Individuals suffering from this mental illness have also been found to report other psychological problems such as, depression, substance abuse and anxiety (Hallak et al., 2013). Some of the most common causes of the disorder are genetic and environmental. The symptoms faced by schizophrenia affected people are categorised into four groups namely, positive, negative, cognitive or emotional problems (Modinos et al., 2013). Although treatment helps in relieving majority of the symptoms that are associated with the condition, most of the patients have to take efforts to cope with their distress. Common interventions that are applied for the disorder include psychological counselling, medication, and self-help resources. The report will critically analyse three qualitative research studies on schizophrenia and assess their rigour, strength and weaknesses.

The aim of the research was to gain an understanding of the treatment outcomes, perceived as important by informal carers who deliver care services to people affected with schizophrenia. They based their study on the finding that an improvement of the treatment outcomes and the overall wellbeing and quality of life among people suffering from mental illness is one crucial aspect of care giving (Cruwys & Gunaseelan, 2016). The authors employed a strategic sample recruitment procedure. They conducted a qualitative analysis by selecting 34 person and 8 couples, from the total 50 people who were made to attend interviews. Sample frame forms an essential aspect of research and describes the group or number of individuals who can be recruited from a target population. Moreover, evidences have supported the fact that qualitative research requires smaller sample, when compared to the quantitative counterparts. It has been suggested by Creswell that an estimated 20-30 participants are good enough for a qualitative study (Marshall, Cardon, Poddar & Fontenot, 2013). Thus, the sample size for this research was adequate. Following receiving a positive response for an email, confirmation was obtained via telephonic conversations with carers. The primary inclusion criteria included people who had cared patients diagnosed with schizophrenia for not less than 2 years. Thus, it can be suggested that the authors had followed convenience sampling strategy. This is a non-probability sampling method where participants are selected based on their proximity and accessibility to the researcher (Emerson, 2015). The sampling method was useful in the convenience with which the research could be carried out. Moreover, it allowed the research to be conducted in a short time span and was a cost-effective option.

Qualitative Research on Schizophrenia

The method of assessment was conduction of interviews at home. Focus groups and interviews have been recognised as the most effective methods of data collection for qualitative purpose. Interviews have particularly proved useful in collecting personalised data and probing into the underlying factors responsible for a problem. One major advantage of employing this data collection method can be attributed to its role in offering a descriptive and complete analysis of the research subject, regardless of the nature of responses. Furthermore, conduction of face-to-face interviews either in the university or at homes provided the key advantage of capturing essential non-verbal and verbal cues, by creating the provision of observing the expressions and body language of the carers. However, one major limitation was associated with gender bias among the respondents (Irvine, Drew & Sainsbury, 2013). This faulty methodology might have resulted in incorrect results. Furthermore, the convenience sampling technique had high possibilities of sampling errors, and probability of a bias. Bias might have occurred because some of the groups were over-represented.

Ho et al., (2016) conducted a qualitative study for determining the roles and meanings of spirituality from the perspective of schizophrenic individuals and other mental health workers. The researchers were accurate in developing the foundation of their research on the need of spiritual and psychosocial care for mental disorders. Most psychologists hold the view that mental disorders are intricately related to spirituality and religion in the life of all patients (Pargament & Lomax, 2013). Hence, the study addressed a well-focused issue. A grounded theory approach was employed by the researchers in this regard. One major advantage of this research design is the fact that it provides a detailed methodology for the development of an understanding of the social phenomenon, without the influence of any pre-determined paradigms or theories. However, this grounded theory fails to identify the embeddedness of the researchers, thereby concealing their agency in data collection and interpretation (Cho & Lee, 2014). A method of purposeful sampling was adopted for sample recruitment. The pros of this sampling technique are its role in reaching the target sample rapidly, and involving multiple stages in the research design. However, this sampling process was prone to bias of the researcher since it was based on the researcher’s judgment (Barratt, Ferris & Lenton,2015).

Furthermore, defending the representativeness of the sample would also be difficult. Data collection was performed by individual interviews at outpatient clinics. Some of the primary advantages of selecting interviews as the data collection procedure were that they help in the easy correction of speech, thus preventing any miscommunication. Furthermore, face-to-face interviews are also effective in increasing mutual understanding and collecting primary information. Cost-effectiveness and gaining an in-depth understanding of the phenomenon being investigated are other benefits. However, semi-structured responses often fails to guarantee the honesty of the respondents and do not help in interpretation of the cause and effect. Rigour in qualitative studies are often defined by opposite set of criteria and are related to openness of the data that adheres to a perspective.

Methodology of the Three Qualitative Studies

Rigour of the study being analysed was established by formulation of an interview guide, and conducting interviews till a point of saturation was reached. Using triangulation approach was another effective strategy that established validity (Hussein, 2015). This usually encompasses analysis of a research question from different perspectives to get consistent results.  However, presence of a selection criteria might have resulted in bias while generalising the results. Another limitation was related to recruitment of Chinese participants. This was directly responsible for selection bias.

This research aimed to assess the impacts of exercise as perceived by people present in their early psychosis stages. The research was based on a clearly focused question due to the association between schizophrenia and poor physical fitness, as established by other findings (McNamee, Mead, MacGillivray & Lawrie, 2013). Recruitment of the participants was conducted from the EIP Services in Greater Manchester. Participants were recruited amongst those aged 14-35 years, experiencing full threshold psychotic symptoms. This might have resulted in selection bias that was caused due to failure to achieve proper randomisation of the participants (Stanley & Doucouliagos, 2014). Thus, the sample recruited was not completely randomised, thereby causing some members of the target population to be less likely included, when compared to others. Furthermore, majority of the sample was comprised of male participants, who had displayed a willingness for participation in the study. This was another potential source of sampling bias. Following administration of the intervention (individualised exercise programs), a one-to-one interview was conducted either immediately or post 6 months of the intervention. Advantage of interviewing face-to-face helps in identifying the personality and expression of the person being interviewed with the help of body language and gestures. Furthermore, interviews are also effective in establishing clarity and relativity between the questions and their responses. In focus groups, it usually becomes difficult for the researcher to judge responses. This drawback is adequately addressed in individual interviews. However, major drawbacks with the process were related to its time consuming nature, and associated costs (Farrelly, 2013).

Furthermore, selection of the candidates were according to the interviewer’s perceptions. Rigour of the study was established by the categorisation of the findings into different themes and sub-themes, and validation by first hand quotes of the respondents. Another limitation of the study could be attributed to the use of six patients during both the original and the follow-up interviews. This was another potential source of response bias in the study since the phenomenon involves a tendency of the person to provide misleading and/or untruthful answers that are socially acceptable (Studer et al., 2013).

Analysis of the Three Qualitative Studies

Conclusion

Thus, it can be concluded that all the articles focused on research questions that were clearly focused on different aspects of schizophrenia. Although most of the researchers attempted to maintain rigour of the studies, some of the major limitations were related to the sampling techniques and data collection procedures. Sampling procedure generally forms an essential component in research studies that involve taking a predetermined number of participants or individuals from a larger population. Thus, the types of sampling used for a research depends on the analysis that the researches intend to perform. Thus, problems might have been faced in relation to generalizability of the study results to a larger representative population. Sampling bias could be prevented in the aforementioned three articles by namely, (1) using simple random sampling, (2) using stratified random sampling, (3) avoiding convenience sampling. Another limitation related to adopting interviews as the data collection procedure could be eliminated by conducting non-directive or unstructured interviews where the researchers would not pre-arrange the interview questions from beforehand. These would help in probing complex issues related to schizophrenia, and focus on an egalitarian relationship between the interviewee and the researcher.

References

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