Exploring caregiver representations that could be obstacles or elements favouring the implementation of therapeutic patient education programmes for people with schizophrenia: a qualitative study of mental health professionals’ perceptions

Background: In France, there are two main types of psychosocial educational therapies for people with mental disorders: 1) therapeutic patient education (TPE) or "training" and 2) psychoeducation. Both types of educational therapy aim to improve disease morbidity, treatment compliance and patient quality of life, but they have very different modes of application. The aim this study was to interview mental health professionals in order to explore and identify the determinants (barriers and enablers) underlying their acceptance of therapeutic patient education (TPE) in order to facilitate the implementation of these programmes among people with severe mental illness such as schizophrenia.MethodsIn this multicentre cross-sectional study, we opted for a qualitative approach based on individual semi-structured interviews with 21 mental health professionals trained in TPE, regardless of whether they had practiced it before or not. In accordance with the "Jardé" law. (Decree n°2016 − 1537 dated 16 November 2016 published on 17 November 2016 in the Official Journal of the French Republic). No regulatory approval was required for this study.ResultsThe major themes that emerged from the analysis were grouped into the following conceptual framework: 1) mental health professionals (MHPs) highlight important organizational and institutional challenges that they feel are beyond their scope; 2) MHPs mention in parallel their own perceptions and representations of TPE in the context of mental health care, 3) MHPs’ representations could hide a lack of knowledge or awareness that would prevent them from appropriating TPE programmes. For each major theme, the sub-themes identified are presented.ConclusionsAlthough TPE is of interest in the process of patient empowerment, we found that caregivers were reluctant to appropriate this approach to care. Efforts must be made in the initial and ongoing training of MHPs to move from a paternalistic model to a patient partnership model, which is made possible by TPE. These efforts must also be firmly supported by health care facilities, and proactive governance is required for the successful implementation of TPE.Trial registrationretrospectively registered