Effects of an online program about intimate and romantic relationships for people with mental disorders (AIRIKI): a study protocol for a randomized controlled trial

Effects of an online program about intimate and romantic relationships for people with mental disorders (AIRIKI): a study protocol for a randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol Effects of an online program about intimate and romantic relationships for people with mental disorders (AIRIKI): a study protocol for a randomized controlled trial Momoko Kusaka, Masako Kageyama, Keiko Yokoyama, Kayo Ichihashi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4322634/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Oct, 2024 Read the published version in BMC Psychiatry → Version 1 posted 4 You are reading this latest preprint version Abstract Background The concept of recovery has become internationally widespread. To promote personal recovery of individuals with mental disorders, it is important that they live life on their own terms. Many people with mental disorders wish to build intimate relationships and marry. However, people with mental disorders face obstacles in building such relationships and communicating with their partners. The program AIRIKI, which means “power to love,” was developed to help people with mental disorders gain confidence in building intimate relationships. The AIRIKI pilot study with one-group pre post test showed positive effects on self-esteem, hope, and communication. Therefore, the purpose of the proposed randomized controlled trial (RCT) is to determine the effects of the videoconferencing program on self-esteem, hope, and self-confidence in communication among un-married people with mental disorders. Methods The proposed randomized controlled trial has two arms (intervention group and control group). After baseline questionnaire assessment, participants will be allocated randomly. Within two months of allocation, the intervention group will participate in videoconferences about intimate relationships and marriage with 2–5 participants and 3 facilitators, which will last 3 h, for two days. Three facilitators will support participants in each session. The intervention group will complete a questionnaire for outcome assessment at termination and one month after the program. The control group will complete the outcome questionnaire at one month after baseline and two months after baseline. The questionnaire will include the Rosenberg Self-Esteem Scale (RSES), Herth Hope Index (HHI), and Self-confidence in Communication Scale (SCS). Control group members can participate in a videoconference program, which will be held separately from the intervention group, after completing their outcome assessments. Discussion This trial is the first randomized controlled trial of which we are aware to test the effects of an online program for un-married people with mental disorders to consider and discuss their romantic relationship and marriage. The results will provide information on the effectiveness of an online program for people with mental disorders to imagine their romantic relationships and marriages. Trial registration This trial has been registered with the UNIN Clinical Trials Registry (UMIN000052027; 2023/08/28). intervention intimate relationships mental disorders peer support personal recovery romantic relationships Figures Figure 1 Background The concept of recovery has become internationally widespread among individuals with mental disorders and healthcare professionals. 1 To promote personal recovery of individuals with mental disorders, it is important that they live life their own way. In a survey conducted in Japan, the rate of unmarried people with mental disorders is 75%. 2 In contrast, the unmarried rates of those 50 years of age in Japan are 28.3% and 17.8% in men and women, respectively. 3 Moreover, the prevalence of having an intimate partner is 14% among unmarried individuals with mental disorders. Further, 68% of individuals with mental disorders who do not have intimate partners want to have one. In sum, although many Japanese people with mental disorders want to build intimate relationships, the marriage rate and the number of people with intimate partners are low. Everyone can love one another. An intimate relationship is “an interpersonal process in which two partners express and share their feelings, thoughts, and experiences, both verbally and non-verbally, in order to learn more about themselves and each other.”. 4 However, people with mental disorders face several barriers in establishing intimate relationships: 1) symptoms of mental illness and side effects of medication, 2) poor communication and social skills, 3) self-stigma and societal prejudice, and 4) lack of financial resources and, 5) unconducive living environments. 5 , 6 Support programs to help people with mental disorders overcome these barriers are scarce. A study by Cloutier et al. 7 tested the effectiveness of a group therapy program called “ power of two ,” focusing on the theme of “dating,” “sex and intimacy,” and “communication,” in Canada and France. This study showed the effects of a repeated single-case experimental design on romantic functioning, mentalizing skills, and symptomatology among 27 male participants with mental disorders. Although the study results are important to support people with mental disorders in establishing and maintaining intimate relationships, it is necessary to have men and women learn together and reflect on the cultural differences between Japan and Western countries. Based on the co-creation concept, Kageyama et al. 8 developed the AIRIKI program for individuals with mental disorders and healthcare professionals in Japan. AIRIKI means “power to love” in Japanese, the program’s aim is to provide an opportunity for people with mental disorders to think about love and intimate relationships. The AIRIKI program involves group work and role-play, which are intended to help people with mental disorders communicate with others. A pilot study of AIRIKI showed the feasibility and psychological effects on self-esteem, recovery, and hope by employing a one-group pre-post-test design. Details of the program, development process, and preliminary assessment of feasibility and outcomes were reported by Kageyama, and colleagues 8 . The subsequent phase of AIRIKI project is to test the effectiveness and the spread of the program. Therefore, we developed a videoconferencing AIRIKI program using ZOOM application to increase availability and accessibility to more people and geographical locations. This study aims to evaluate the effectiveness of AIRIKI program on self-esteem, hope, and confidence in communications using a randomized controlled trial (RCT) design. Methods Study aim This study aims to test the effect of a videoconferencing program of AIRIKI on self-esteem, hope, and confidence in communication among people with mental disorders. Study design: An RCT with two arms (intervention and control) will be conducted. Random allocation will be performed after collecting baseline assessment. The control group will receive no intervention and will answer assessment questionnaires three times: at baseline (T1), one (T2), and two (T3) months after random allocation. The intervention group will participate in a videoconferencing program focused on romantic relationships for two days (3-hours per day) within two months of completing the baseline questionnaire. Moreover, they will answer the assessment questionnaires at intervention termination and one month after the intervention. The control group members can voluntarily participate in videoconferencing which will be held separate from the intervention group after completing their outcome assessments. Random allocation and blinding KY will prepare two random numbers sequences, one for men and one for women. A will stand for the intervention group and B for the control group. The block size will be four, with computer randomizer automatically arranging A’s and B’s for two set of blocks. The random sequences will consist of 20 blocks, one for males and one for females. M. Kusaka will ask KY to allocate study participants after collecting their doctors’ forms, participants’ written consent, and completion of baseline questionnaires by mail. KY will assign each participant according to the random numbers sequence for their sex and will inform M. Kusaka about the person’s assigned group via an E-mail. M. Kusaka will manage the correspondence and list regarding participants group assignment. Researchers other than M. Kusaka will not be aware of the assignment. M. Kusaka and M Kageyama will enter the data using study ID. Statistical analyses will be conducted by M. Kageyama and KN. Participants: Study participants will be comprised of unmarried people with mental disorders interested in participating in the videoconferencing program for romantic relationships and marriage. The following inclusion criteria will be applied: 1) adults (≥ 18 years of age) diagnosed with at least one mental disorder and currently undergoing psychiatric outpatient treatment; 2) the patient decides on their own as to whether to voluntarily join the study (their psychiatrist provides a determination as to whether the patient has decision-making capacity); 3) currently unmarried; 4) able to participate in group discussion activities without difficulty using Japanese; 5) never participated in-person AIRIKI program; 6) availability of a personal computer, smartphone, or tablet-type device to access videoconference: and ability and willingness to show their face on a web camera during videoconferencing activities. Individuals who do not meet the inclusion criteria will be excluded. Sample Size Considering the effect size of the pilot study 8 and feasibility, we will enter 100 participants, 50 in the intervention group and 50 in the control group. The statistical considerations for the primary analysis with a sample size of 100 participants are discussed below. In the pilot study, the dropout rate was 6.6%. In this study, we assume a slightly higher dropout rate, estimating it to be 10%. Therefore, it is anticipated that complete data at T3 will be obtained from 90 participants. In the Mixed-effect Model for Repeated Measures (MMRM) to be used for the primary analysis, we assume parameter values based on the pilot study. Using Monte Carlo simulation with 1000 iterations, we found the confidence interval width of the intervention effect at T3, to be approximately 5.4, suggesting that a certain precision in interval estimation can be achieved. Procedure The flow diagram of participants is shown in Fig. 1 . The procedures for recruitment, eligibility determination and enrollment will be as follows: Potential candidates will learn about the AIRIKI RCT study via study announcements on AIRIKI homepage, Social Network Service (SNS), several self-help groups, and mental health events. People interested in the study will send an E-mail to M. Kusaka. M. Kusaka will contact them and schedule individual online appointment with them using ZOOM. During the online appointment, M. Kusaka will explain the study design, what researchers will ask participants, the voluntariness of their study participation, and the privacy policy. Additionally, M. Kusaka will request them to provide doctor’s written opinion form and the study description document to their psychiatrist. M. Kusaka will send doctors’ written opinion forms and study documents by mail to those who participated in the ZOOM interview and expressed interest in proceeding to join the study. People who are interested in participating in the study will be informed to ask their psychiatric doctors to fill out the doctors’ opinion form. The doctor will send the completed doctor’s opinion form to M. Kusaka by mail. M. Kusaka will confirm the doctors’ opinions of each potential participant. Subsequently, M. Kusaka will send informed consent form and the baseline questionnaire to the participants by mail. Participants complete a written informed consent form and baseline questionnaire (T1). After receiving the participants’ written informed consent and the baseline questionnaire, M. Kusaka will ask KY to allocate participants using a computerized randomizer. After random allocation, M Kusaka will inform participants by E-mail of the allocated group and the following schedule. The intervention group will participate in the AIRIKI program within 2 months of allocation and will complete the questionnaire at termination (T2) and one month (T3) after program participation. The control group will receive questionnaires one month (T2) and two months (T3) after allocation. After completing T3 questionnaire, the control group can participate in the AIRIKI program which will be conducted separately from the intervention group. At the end of the study, participants will receive a coupon of 3,000 yen (approximately 20 USD) as a gesture of gratitude. Intervention: The videoconferencing AIRIKI program will be held during two consecutive weeks (Saturday or Sunday) on ZOOM. Each session of the day will last 3 hours. Three facilitators will support 2–5 participants together in each session. Thus, the group in each session will be comprised of 5–8 people. The facilitators will consist of two individuals diagnosed with mental disorders and one healthcare professional (either a Mental Health Nurse, Psychiatrist, or Mental Health Social Worker). Only facilitators who receive training can provide the program. Practice sessions will be held for facilitators to offer smooth teleconferencing programing on ZOOM before starting participants’ enrollment. In AIRIKI program, the facilitators will work together and talk about their own experiences of loving people. The facilitators' talk will help to bring awareness and evoke ideas to other participants. Details of the AIRIKI program have been previously described. 8 The program is slightly modified to be compatible with videoconferencing, which is shown in Table 1. The program will begin with the announcement by facilitators of precautions for participating in videoconferencing programs (e.g., showing their face using web camera, keeping themselves hydrated). The warm-up session will last for 20 min (e.g., introductions and discuss aims of participation). On Day 1, the participants and facilitators will share their thoughts and talk about Module 1 - What is love for you? (60 min) and Module 2 - Understand your loved one (80 min), using a textbook that was originally developed for the AIRIKI program. In Module- 1, participants will be given time to think and then express their thoughts about what love is for them, and reflect on their experience of being loved by someone who is not only a lover but also by friends and family. In Module- 2, participants will be asked to think about and discuss how they know another person. In addition, a role-playing exercise, in which participants are asked to invite their role play partner on a first date, will be conducted. At the end of Day 1, short reflections and positive feedback will be offered to each other. On Day 2, which will be held the following week from Day 1, participants will consider Module 3 - Meeting and dating (80 min) and Module 4 - Maintaining a long-term relationship (70 min). In Module- 3, participants will be asked to think and then discuss how to find a partner and initiate an intimate relationship. Additionally, a role-playing exercise, in which participants will disclose their mental illness to their role play partner, will be practiced. In Module- 4, participants will share their thoughts and images of marriage. Finally, the program will end with participants’ reflection and positive feedback to each other. During discussion of their reflections, participants will tell their impression of the program and how they think they will act in the future and everyone will tell the other participants what they see as their strengths and positive features. Assessment plan 1. Demographic variables Demographic variables will be collected using baseline questionnaire. These variables will include: age, sex, cohabitation status, experience of marriage, experience with romance, having a partner or not, age at onset of mental illness, diagnosis of mental illness, treatment of mental illness, prescribed medication or not, experience of hospitalization, disability classification, and degree of social participation. 2. Outcome variables Self-esteem The main outcome is self-esteem, which will be measured using the Rosenberg Self-Esteem Scale (RSES). The RSES is a self-rated scale with 10 items. The validity and reliability of the Japanese version of the scale have been confirmed. 9 , 10 Participants will rate each item using a four-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). The total score ranges from 10 to 40 points. Higher scores indicate greater self-esteem. Hope Hope is a secondary outcome, which will be measured using the Herth Hope Index (HHI) 11 . Yamaki et al. developed the Japanese version of the HHI. 12 HHI is a four-point Likert scale ranging from 1 (completely disagree) to 4 (completely agree), with 12 items and total scores range from 12 to 48 points. HHI contains three subscales, which are “inner sense of temporary and future (4 items),” “inner positive readiness and expectancy (4 items),” and “interconnectedness with self and others (4 items).” The validity and reliability of the Japanese version of the scale have been confirmed 12 . Self-confidence in communication Self-confidence in communication is also a secondary outcome. The Self-Confidence in Communication scale (SCS) has been developed for the general Japanese population. 13 The SCS is a seven-point Likert scale ranging from 1 (not applied at all) to 7 (definitely applied), with 30 items. SCS has three subscales, as follows: “intention communication (9 items),” “intention restraints (9 items),” and “intention comprehension (9 items).” The contents of “I can rightly tell what I want to say to my partner (item 1)” and “I can successfully express my emotions to my partner (item 10)” are contained in “intention communication” subscale. For this study, the subscale “intention communication” will be the only portion of scale used; since it is important for the couple to communicate their own thoughts and opinion to each other, which is a target of AIRIKI program participation. The total range of this subscale is 9–63 points with higher scores being greater self-confidence in communicating. Cronbach alpha coefficients will be calculated for all scales employed. 3. Feasibility assessment Participants will participate in a feasibility assessment using a self-rated original questionnaire after completion of the program. The contents are as follows: any difficulties in program participation, any thoughts regarding program, accessibility, thoughts about program length, about the number of participants, and about the textbook. Demographic variables will be collected at the baseline assessment (T1). Outcome variables will be collected at the baseline assessment (T1), following assessment 1(T2), and following assessment 2 (T3). A feasibility assessment will be conducted after the program’s completion. Table 2 shows the contents of the questionnaire. Study hypothesis Hypothesis 1 The main hypothesis is that the self-esteem scores at T3 will be greater for the intervention group than in the control group. Hypothesis 2 The secondary hypothesis is that the changes in self-esteem scores from T1 to T2, and T3 will be greater in the intervention group than in the control group. Hypothesis 3 The main hypothesis is that hope scores at T3 will be higher in the intervention group than in the control group. The secondary hypothesis is that the changes in hope scores from T1 to T2, and T3 will be greater in the intervention group than in the control group Hypothesis 4 The main hypothesis is that self-confidence in communication scores at T3 will be greater in the intervention group than in the control group. The secondary hypothesis is that changes in self-confidence in communication scores from T1 to T2, and T3 will be higher in the intervention group than in the control group Statistical analysis We will conduct an intention-to-treat analysis (ITT), in which we will use all available data. The population for which the ITT takes place is the full analysis set (FAS). In addition, per protocol set (PPS) will be defined as the population of study subjects who do not fall under any of the following categories in the FAS; 1) if the patient received a procedure different from the original allocation; 2) failure to participate in the AIRIKI program within 2 months of allocation; and 3) if the patient withdraws from the study in the intervention group. Baseline data for continuous variables will be summarized as mean and standard deviations, whereas categorical variables will be summarized as frequencies and percentages. For the main hypothesis, using the total score on the self-esteem scale at T3, we will calculate summary statistics for each group and compute the 95% confidence interval (CI) for the mean. Furthermore, we will fit an MMRM, including sex, intervention, time point, and interaction between intervention and time point as a fixed effect, and group as a random effect. We will calculate the group differences in least squares means, their standard errors, 95% confidence intervals, and p-values at T3. The variance-covariance structure of the error terms in the MMRM will be conducted in the following order: unstructured, compound symmetry, and auto-regression. The estimation results based on the first successful convergence of the specified structure will be adopted. MMRM estimation will be conducted using the restricted maximum likelihood method. Similarly, we will undertake an analysis targeting the Per-Protocol Set as a sensitivity analysis. For the secondary hypothesis, the change over time in the self-esteem scale and summary statistics will be calculated for T1 and T2 in the same manner as above, and the same model will be used to calculate the group differences in least squares means, their standard errors, 95% confidence intervals, and p-values at T1 and T2. The other hypothesis, the HHI and SCS, will be analyzed in the same manner as the self-esteem scale. All statistical analyses will be performed using SAS software, version 9.4 (SAS Institute). Ethics and dissemination Documents on the ethical issues of the study have been developed, including the study protocol, voluntariness of participation, privacy policy, data management, participants’ safety, and the absence of conflicts of interest. The study protocol was evaluated and approved by the Research Ethics Committee of the Shonan University of Medical Sciences on July 18, 2023 (No. 23 − 014). M Kusaka, who has a nurse-license, will be carefully monitoring the health conditions of the participants via e-mail. If a participant has an unscheduled doctor's visit or a medical condition that worsens, M Kusaka will speak with the participant over the phone and make a preliminary assessment regarding need for further assessment and/or treatment. After completing this study, we will publish the results in an international peer-reviewed medical or nursing journal and present the results at national and international conferences. Information on publication will be announced on the AIRIKI homepage according to the journal’s publication policies. Discussion In Maslow’s hierarchy of needs, every human needs love and belonging, which include friendships, family, and intimate partner. 14 People with mental disorders may find it difficult to initiate and develop intimate relationships with others because of their mental symptoms, adverse effects of medicine, or lack of communication skills. The AIRIKI program is a group work program for thinking about and discussing intimate relationships and marriage among people with mental illness with their peers and with professionals. In this study, we developed the videoconferencing version of AIRIKI for people with mental disorders to reach participants from different regions of Japan. Other merits of videoconferencing include COVID-19 and flu infection prevention, cost-effectiveness (saving venue and transportation expenses), and participation from home which may relieve the anxiety of participants. The program offers different components that enable talking about partnerships, communication skills (both verbal and non-verbal) with their dating partners and imagining married life. In this study, the participants are limited to un-married individuals. The problem of partnerships may differ between unmarried and married individuals. Married people generally have a fixed and stable relationship with their partner due to living together which is not the situation with unmarried people. Therefore, this study focuses on unmarried people who may have trouble initiating and developing new, intimate relationships with their dating partners. Programs focusing on intimate relationships, and marriage among people with mental disorders are limited. This study’s results may suggest the potential use of videoconferencing programs that focus on intimate relationships and marriage among people with mental disorders. Additionally, if our hypotheses are confirmed, the AIRIKI videoconferencing program may help improve self-esteem, hope, and self-confidence in communication with potential partners for a successful marriage. In summary, this study may significantly contribute to promoting the use of videoconferencing group work programs for intimate relationships and marriage among people with mental disorders. List Of Abbreviations CI confidence interval FAS Full Analysis Set HHI Herth Hope Index ITT Intention-to-treat MMRM Mixed-effect Model for Repeated Measures PPS Per Protocol Set RCT randomized controlled trial RSES Rosenberg Self-esteem Scale. SCS Self-Confidence in Communication Scale SNS Social Network Service USD United States Dollars Declarations Ethics approval and consent to participate This study protocol was approved by the Research Ethics Committee of the Shonan University of Medical Sciences on July 18, 2023 (Approval no. 23-014). Written informed consent will be obtained from all participants. Consent for publication Not applicable Availability of data and materials Not applicable Competing interests The authors declare that they have no competing interests. Funding This study is supported by JSPS KAKENHI Grant Number 23H03226 and research funding of Shonan University of Medical Sciences. Authors’ contribution Conceptualizations: Masako Kageyama, Keiko Yokoyama, Kayo Ichihashi Design, methodology, writing, review, and editing: Momoko Kusaka, Masako Kageyama, Keiko Yokoyama, Kayo Ichihashi, Ryota Hashimoto, Kazutaka Nishio, Phyllis Solomon Supervision: Masako Kageyama, Phyllis Solomon All authors have read and approved the final manuscript. Acknowledgement We would like to thank all facilitators of the AIRIKI program for providing us with useful advice for the creation of this videoconferencing program. Authors’ information Momoko Kusaka: Department of Nursing, Shonan University of Medical Sciences, Yokohama, Japan Masako Kageyama: Institute of Advanced Co-Creation Studies, Osaka University, Osaka, Japan Keiko Yokoyama: Department of Nursing, Faculty of Nursing, Yokohama Soei University, Yokohama, Japan Kayo Ichihashi: Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan Ryota Hashimoto: Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan Kazutaka Nishio: Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan Phyllis Solomon: School of Social Policy & Practice, University of Pennsylvania Philadelphia, USA References Anthony WA. Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation J. 1993;16(4):11–23. 10.1037/h0095655 . Certified NPOCOMHBO. Renai-anketo, mental health magazine. Kokoro-no genki plus. 2017;11(4):6–7. National Institute of Population and Social Security Research, Table 6–23 seibetsu 50-sai ji no mikon wariai shibetsu wariai oyobi ribetsu wariai: 1920–2020. 2020. https://www.ipss.go.jp/syoushika/tohkei/Popular/P_Detail2022.asp?fname=T06-23.htm . Reis HT, Shaver P. Intimacy as an interpersonal process. In: Duck SW, editor. Handbook of personal relationships. Chichester, UK:Wiley; 1988. pp. 367–389. Boucher M, Groleau D, Whitley R. Recovery and severe mental illness: The role of romantic relationships, intimacy, and sexuality. Psychiatr Rehabil J. 2016;39(2):180–2. 10.1037/prj0000193 . de Jager J, Cirakoglu B, Nugter A, van Os J. Intimacy and its barriers: A qualitative exploration of intimacy and related struggles among people diagnosed with psychosis. Psychosis. 2017;9(4):301–9. 10.1080/17522439.2017.1330895 . Cloutier B, Lecomte T, Diotte F, Lamontagne J, Abdel-Baki A, Daneault J, Rabbath MEG, de Connor A, Perrine C. Improving Romantic Relationship Functioning Among Young Men With First-Episode Psychosis: Impact of a Novel Group Intervention. Behav Modif. 2023;47(5):1170–92. https://doi.org/10.1177/01454455231186586 . Kageyama M, Yokoyama K, Ichihashi K, Noma S, Hashimoto R, Nishitani M, Okamoto R, Solomon P. A peer-led learning program about intimate and romantic relationships for persons with mental disorders (AIRIKI): co-creation pilot feasibility study. BMC Psychiatry. 2023;23(1):767. 10.1186/s12888-023-05254-1 . Mimura C, Griffiths P. A Japanese version of the Rosenberg Self-Esteem Scale: Translation and equivalence assessment. J Psychosom Res. 2007;62(5):589–94. 10.1016/j.jpsychores.2006.11.004 . Uchida T, Ueno T. Rosenberg jison kanjo syakudo no shinraisei oyobi datosei no kento[Reliability and Validity of the Rosenberg Self Esteem Scale]. Annual Bulletin, Graduate School of Education, Tohoku University. 2010;58:257–66. Herth K. Abbreviated instrument to measure hope: Development and psychometric evaluation. J Adv Nurs. 1992;17(10):1251–59. Yamaki C, Yamazaki Y. Herth Hope Index (HHI) nihongoban sakuseino torikumi [Development of Herth Hope Index (HHI) Japanese version]. In: KAKENHI Report 14201021. Tokyo; 2003. pp. 147–9. Hatano K. Seinenkikouki ni oketu komyunikeshon ni taisuru jishin to aidenthithi tono kanrensei [Self-confidence in communication and identity in Late adolescents]. Kyoiku Shinrigaku kenkyu. 2010;58:404–13. Maslow AH. A theory of human motivation. Psychol Rev. 1943;50(4):370–96. 10.1037/h0054346 . Tables Table 1. Components of the AIRIKI online program Structure The program focuses on intimate relationships Small group of less than 9 people Groups are led by peer facilitators and healthcare professionals Sharing own thoughts and experiences about loving people Modules min Lesson Purposes Contents Day 1 Warming-up 20 Ice break Self-introduction, motivation for participation, favorite type of person, mood of participants Chapter 1 The love that you think about 8 Introduction Introduction of the program and sharing the rules Introduction of AIRIKI program Basic rules of the program 7 What is love for you? Sharing thoughts about loving people Introduction of theories and quotations about love. Sharing their thoughts and experiences. Contents include not only loving their partner but also being loved by parents or friends. 10 What is the difference between love and romance? 5 Whom do you love? 20 Important people and events for your recovery Sharing the experience of being loved by someone Participants introduce how people and events have affected their process of recovery. 10 Reflection Summarize own thoughts Participants share their awareness and impressions about Chapter 1. Chapter 2 Understand your partner 15 What do you need to do for love? Clarify what is important to love others The ability of love includes comprehension, caring, respect, and responsibility. Personal boundaries are briefly described. 7 Basic communication skills Learn communication skills Learning about basic communication skills such as listening carefully. Participants share what they are careful about their communication. 28 Skill training in inviting date As a communication exercise, participants simulate in a role play with each other where they invite and are invited for the first date. 5 Reflection Summarize own thoughts Participants share their awareness and impressions about role play. 25 Reflection and positive feedback Reflect on what they were impressed with and share their thoughts Participants present what impressed on Day 1 program. All participants and facilitators share their thoughts and offer messages of support to each other. Day 2 Chapter 3 Meeting and dating 7 Warming-up Ice break Beginning of second day; Sharing their mood and basic rules of the program. 10 How do we find a partner? Aware of own thoughts regarding meeting partner Participants share what they think important in choosing and finding a partner. 13 Dating manners Caring about a partner Participants share what dating manners they know. 40 Conversation and skill training in confiding their illness Practice ways to confide their illness to dating partner Important to know how to confide their illness to dating partner Participants practice in their own way. 10 Reflection Summarize own thoughts Participants share their insights and impressions. Chapter 4 Maintaining a long-term relationship 8 Factors to be careful of in an intimate relationship Reduce risks in romantic relationships Mental health condition impacted by loving people, sexually transmitted diseases, unexpected pregnancies, and intimate partner violence are briefly explained. 12 Marriage Think of whether to get married and coping with problems in marriage Changes associated with marriage (e.g., sharing household finances, rhythm of daily living) are explained. Side effects of medications on sexual difficulties and child care are also explained. 40 Reflection and positive feedback Reflect on what impressed them and share their thoughts of program. Participants present what impressed them about program and their own future plans. All participants and facilitators share their thoughts and send messages of support to each other. 10 Overall comments Program completion Participants share their overall thoughts of two-day program. Table 2. The contents of questionnaire Demographic variables Outcomes T1 (baseline assessment) ✓ ✓ T2 (following assessment 1) ✓ T3 (following assessment 2) ✓ Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Oct, 2024 Read the published version in BMC Psychiatry → Version 1 posted Editorial decision: Revision requested 27 Aug, 2024 Editor assigned by journal 20 May, 2024 Submission checks completed at journal 20 May, 2024 First submitted to journal 25 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4322634","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":307620945,"identity":"43809604-cb09-4062-b09a-2a864c533dc1","order_by":0,"name":"Momoko Kusaka","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYJACxgYGBgMgzczAUAGimBtI0XIGRDGSooWxDcbHA3TbuxMfzqhgMDY4f/ixwc95tdH87UAtPyq24dRidubsZsMNZxjMDG6kGSf2bjueO+MwYwNjz5nbuLXcyN0m+bCNwcbgBoPxAd5tx3IbgFqYGduI0XL++OeDf+ccy51PlJaNbUCHHcgxTuZtqMndQFALyC8zzkgYS97IKTaWOXYgdyNQy0G8fjneu/FhT4WNYd/545sl39TU5c47f/jggx8VuLVAgQSMcRhMHiCkHhnUkaJ4FIyCUTAKRggAAAQuYQLH7QZkAAAAAElFTkSuQmCC","orcid":"","institution":"Shonan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Momoko","middleName":"","lastName":"Kusaka","suffix":""},{"id":307620946,"identity":"bf8c794c-8117-4fad-ba75-24db9e5fd854","order_by":1,"name":"Masako Kageyama","email":"","orcid":"","institution":"Osaka University","correspondingAuthor":false,"prefix":"","firstName":"Masako","middleName":"","lastName":"Kageyama","suffix":""},{"id":307620947,"identity":"e20caefd-2170-4060-932d-27eedea64c39","order_by":2,"name":"Keiko Yokoyama","email":"","orcid":"","institution":"Yokohama Soei University","correspondingAuthor":false,"prefix":"","firstName":"Keiko","middleName":"","lastName":"Yokoyama","suffix":""},{"id":307620948,"identity":"adc2db5b-9352-4096-9913-864ce4b131d8","order_by":3,"name":"Kayo Ichihashi","email":"","orcid":"","institution":"University of Tokyo Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kayo","middleName":"","lastName":"Ichihashi","suffix":""},{"id":307620949,"identity":"2aae1d55-d7c0-4e5e-a911-90c25c890f17","order_by":4,"name":"Ryota Hashimoto","email":"","orcid":"","institution":"National Institute of Mental Health","correspondingAuthor":false,"prefix":"","firstName":"Ryota","middleName":"","lastName":"Hashimoto","suffix":""},{"id":307620950,"identity":"1b9fe82e-fc0b-478d-853d-e5f8ab4c957a","order_by":5,"name":"Kazutaka Nishio","email":"","orcid":"","institution":"Osaka University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kazutaka","middleName":"","lastName":"Nishio","suffix":""},{"id":307620951,"identity":"9c5bba70-d372-4f59-828f-068d6b6d94f2","order_by":6,"name":"Phyllis Solomon","email":"","orcid":"","institution":"University of Pennsylvania","correspondingAuthor":false,"prefix":"","firstName":"Phyllis","middleName":"","lastName":"Solomon","suffix":""}],"badges":[],"createdAt":"2024-04-25 08:26:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4322634/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4322634/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-024-06063-w","type":"published","date":"2024-10-25T15:56:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57723057,"identity":"c36f6803-78e7-4e17-a3e8-d0a778f1fdd9","added_by":"auto","created_at":"2024-06-04 19:13:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59698,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of participants\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4322634/v1/366ed3295e558c73c578a0b5.png"},{"id":67681620,"identity":"9c61e798-fa8e-4f58-a8ba-e505a5efa61c","added_by":"auto","created_at":"2024-10-28 16:06:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":591930,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4322634/v1/aefc2be0-1289-4b87-ac03-ec2d2856a6f0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of an online program about intimate and romantic relationships for people with mental disorders (AIRIKI): a study protocol for a randomized controlled trial","fulltext":[{"header":"Background","content":"\u003cp\u003eThe concept of \u003cem\u003erecovery\u003c/em\u003e has become internationally widespread among individuals with mental disorders and healthcare professionals.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e To promote personal recovery of individuals with mental disorders, it is important that they live life their own way.\u003c/p\u003e \u003cp\u003eIn a survey conducted in Japan, the rate of unmarried people with mental disorders is 75%.\u003csup\u003e2\u003c/sup\u003e In contrast, the unmarried rates of those 50 years of age in Japan are 28.3% and 17.8% in men and women, respectively. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Moreover, the prevalence of having an intimate partner is 14% among unmarried individuals with mental disorders. Further, 68% of individuals with mental disorders who do not have intimate partners want to have one. In sum, although many Japanese people with mental disorders want to build intimate relationships, the marriage rate and the number of people with intimate partners are low.\u003c/p\u003e \u003cp\u003eEveryone can love one another. An intimate relationship is \u0026ldquo;an interpersonal process in which two partners express and share their feelings, thoughts, and experiences, both verbally and non-verbally, in order to learn more about themselves and each other.\u0026rdquo;.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e However, people with mental disorders face several barriers in establishing intimate relationships: 1) symptoms of mental illness and side effects of medication, 2) poor communication and social skills, 3) self-stigma and societal prejudice, and 4) lack of financial resources and, 5) unconducive living environments.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSupport programs to help people with mental disorders overcome these barriers are scarce. A study by Cloutier et al.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e tested the effectiveness of a group therapy program called \u0026ldquo;\u003cem\u003epower of two\u003c/em\u003e,\u0026rdquo; focusing on the theme of \u0026ldquo;dating,\u0026rdquo; \u0026ldquo;sex and intimacy,\u0026rdquo; and \u0026ldquo;communication,\u0026rdquo; in Canada and France. This study showed the effects of a repeated single-case experimental design on romantic functioning, mentalizing skills, and symptomatology among 27 male participants with mental disorders. Although the study results are important to support people with mental disorders in establishing and maintaining intimate relationships, it is necessary to have men and women learn together and reflect on the cultural differences between Japan and Western countries.\u003c/p\u003e \u003cp\u003eBased on the co-creation concept, Kageyama et al.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e developed the AIRIKI program for individuals with mental disorders and healthcare professionals in Japan. AIRIKI means \u0026ldquo;power to love\u0026rdquo; in Japanese, the program\u0026rsquo;s aim is to provide an opportunity for people with mental disorders to think about love and intimate relationships. The AIRIKI program involves group work and role-play, which are intended to help people with mental disorders communicate with others. A pilot study of AIRIKI showed the feasibility and psychological effects on self-esteem, recovery, and hope by employing a one-group pre-post-test design. Details of the program, development process, and preliminary assessment of feasibility and outcomes were reported by Kageyama, and colleagues\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe subsequent phase of AIRIKI project is to test the effectiveness and the spread of the program. Therefore, we developed a videoconferencing AIRIKI program using ZOOM application to increase availability and accessibility to more people and geographical locations. This study aims to evaluate the effectiveness of AIRIKI program on self-esteem, hope, and confidence in communications using a randomized controlled trial (RCT) design.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy aim\u003c/h2\u003e \u003cp\u003eThis study aims to test the effect of a videoconferencing program of AIRIKI on self-esteem, hope, and confidence in communication among people with mental disorders.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy design:\u003c/h2\u003e \u003cp\u003eAn RCT with two arms (intervention and control) will be conducted. Random allocation will be performed after collecting baseline assessment. The control group will receive no intervention and will answer assessment questionnaires three times: at baseline (T1), one (T2), and two (T3) months after random allocation. The intervention group will participate in a videoconferencing program focused on romantic relationships for two days (3-hours per day) within two months of completing the baseline questionnaire. Moreover, they will answer the assessment questionnaires at intervention termination and one month after the intervention. The control group members can voluntarily participate in videoconferencing which will be held separate from the intervention group after completing their outcome assessments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eRandom allocation and blinding\u003c/h2\u003e \u003cp\u003eKY will prepare two random numbers sequences, one for men and one for women. A will stand for the intervention group and B for the control group. The block size will be four, with computer randomizer automatically arranging A\u0026rsquo;s and B\u0026rsquo;s for two set of blocks. The random sequences will consist of 20 blocks, one for males and one for females. M. Kusaka will ask KY to allocate study participants after collecting their doctors\u0026rsquo; forms, participants\u0026rsquo; written consent, and completion of baseline questionnaires by mail. KY will assign each participant according to the random numbers sequence for their sex and will inform M. Kusaka about the person\u0026rsquo;s assigned group via an E-mail.\u003c/p\u003e \u003cp\u003eM. Kusaka will manage the correspondence and list regarding participants group assignment. Researchers other than M. Kusaka will not be aware of the assignment. M. Kusaka and M Kageyama will enter the data using study ID. Statistical analyses will be conducted by M. Kageyama and KN.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eParticipants:\u003c/h2\u003e \u003cp\u003eStudy participants will be comprised of unmarried people with mental disorders interested in participating in the videoconferencing program for romantic relationships and marriage. The following inclusion criteria will be applied: 1) adults (\u0026ge;\u0026thinsp;18 years of age) diagnosed with at least one mental disorder and currently undergoing psychiatric outpatient treatment; 2) the patient decides on their own as to whether to voluntarily join the study (their psychiatrist provides a determination as to whether the patient has decision-making capacity); 3) currently unmarried; 4) able to participate in group discussion activities without difficulty using Japanese; 5) never participated in-person AIRIKI program; 6) availability of a personal computer, smartphone, or tablet-type device to access videoconference: and ability and willingness to show their face on a web camera during videoconferencing activities. Individuals who do not meet the inclusion criteria will be excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSample Size\u003c/h2\u003e \u003cp\u003eConsidering the effect size of the pilot study\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e and feasibility, we will enter 100 participants, 50 in the intervention group and 50 in the control group. The statistical considerations for the primary analysis with a sample size of 100 participants are discussed below.\u003c/p\u003e \u003cp\u003eIn the pilot study, the dropout rate was 6.6%. In this study, we assume a slightly higher dropout rate, estimating it to be 10%. Therefore, it is anticipated that complete data at T3 will be obtained from 90 participants. In the Mixed-effect Model for Repeated Measures (MMRM) to be used for the primary analysis, we assume parameter values based on the pilot study. Using Monte Carlo simulation with 1000 iterations, we found the confidence interval width of the intervention effect at T3, to be approximately 5.4, suggesting that a certain precision in interval estimation can be achieved.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003eThe flow diagram of participants is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The procedures for recruitment, eligibility determination and enrollment will be as follows:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePotential candidates will learn about the AIRIKI RCT study via study announcements on AIRIKI homepage, Social Network Service (SNS), several self-help groups, and mental health events.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePeople interested in the study will send an E-mail to M. Kusaka.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eM. Kusaka will contact them and schedule individual online appointment with them using ZOOM.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDuring the online appointment, M. Kusaka will explain the study design, what researchers will ask participants, the voluntariness of their study participation, and the privacy policy. Additionally, M. Kusaka will request them to provide doctor\u0026rsquo;s written opinion form and the study description document to their psychiatrist.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eM. Kusaka will send doctors\u0026rsquo; written opinion forms and study documents by mail to those who participated in the ZOOM interview and expressed interest in proceeding to join the study.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePeople who are interested in participating in the study will be informed to ask their psychiatric doctors to fill out the doctors\u0026rsquo; opinion form.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe doctor will send the completed doctor\u0026rsquo;s opinion form to M. Kusaka by mail.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eM. Kusaka will confirm the doctors\u0026rsquo; opinions of each potential participant. Subsequently, M. Kusaka will send informed consent form and the baseline questionnaire to the participants by mail.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eParticipants complete a written informed consent form and baseline questionnaire (T1).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAfter receiving the participants\u0026rsquo; written informed consent and the baseline questionnaire, M. Kusaka will ask KY to allocate participants using a computerized randomizer.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAfter random allocation, M Kusaka will inform participants by E-mail of the allocated group and the following schedule.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe intervention group will participate in the AIRIKI program within 2 months of allocation and will complete the questionnaire at termination (T2) and one month (T3) after program participation. The control group will receive questionnaires one month (T2) and two months (T3) after allocation.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAfter completing T3 questionnaire, the control group can participate in the AIRIKI program which will be conducted separately from the intervention group.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAt the end of the study, participants will receive a coupon of 3,000 yen (approximately 20 USD) as a gesture of gratitude.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eIntervention:\u003c/h2\u003e \u003cp\u003eThe videoconferencing AIRIKI program will be held during two consecutive weeks (Saturday or Sunday) on ZOOM. Each session of the day will last 3 hours. Three facilitators will support 2\u0026ndash;5 participants together in each session. Thus, the group in each session will be comprised of 5\u0026ndash;8 people. The facilitators will consist of two individuals diagnosed with mental disorders and one healthcare professional (either a Mental Health Nurse, Psychiatrist, or Mental Health Social Worker). Only facilitators who receive training can provide the program. Practice sessions will be held for facilitators to offer smooth teleconferencing programing on ZOOM before starting participants\u0026rsquo; enrollment. In AIRIKI program, the facilitators will work together and talk about their own experiences of loving people. The facilitators' talk will help to bring awareness and evoke ideas to other participants.\u003c/p\u003e \u003cp\u003eDetails of the AIRIKI program have been previously described.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e The program is slightly modified to be compatible with videoconferencing, which is shown in Table\u0026nbsp;1. The program will begin with the announcement by facilitators of precautions for participating in videoconferencing programs (e.g., showing their face using web camera, keeping themselves hydrated). The warm-up session will last for 20 min (e.g., introductions and discuss aims of participation). On Day 1, the participants and facilitators will share their thoughts and talk about Module 1 - What is love for you? (60 min) and Module 2 - Understand your loved one (80 min), using a textbook that was originally developed for the AIRIKI program. In Module- 1, participants will be given time to think and then express their thoughts about what love is for them, and reflect on their experience of being loved by someone who is not only a lover but also by friends and family. In Module- 2, participants will be asked to think about and discuss how they know another person. In addition, a role-playing exercise, in which participants are asked to invite their role play partner on a first date, will be conducted. At the end of Day 1, short reflections and positive feedback will be offered to each other.\u003c/p\u003e \u003cp\u003eOn Day 2, which will be held the following week from Day 1, participants will consider Module 3 - Meeting and dating (80 min) and Module 4 - Maintaining a long-term relationship (70 min). In Module- 3, participants will be asked to think and then discuss how to find a partner and initiate an intimate relationship. Additionally, a role-playing exercise, in which participants will disclose their mental illness to their role play partner, will be practiced. In Module- 4, participants will share their thoughts and images of marriage. Finally, the program will end with participants\u0026rsquo; reflection and positive feedback to each other. During discussion of their reflections, participants will tell their impression of the program and how they think they will act in the future and everyone will tell the other participants what they see as their strengths and positive features.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAssessment plan\u003c/b\u003e \u003c/p\u003e \u003cp\u003e1. Demographic variables\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eDemographic variables will be collected using baseline questionnaire. These variables will include: age, sex, cohabitation status, experience of marriage, experience with romance, having a partner or not, age at onset of mental illness, diagnosis of mental illness, treatment of mental illness, prescribed medication or not, experience of hospitalization, disability classification, and degree of social participation.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e2. Outcome variables\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eSelf-esteem\u003c/h2\u003e \u003cp\u003eThe main outcome is self-esteem, which will be measured using the Rosenberg Self-Esteem Scale (RSES). The RSES is a self-rated scale with 10 items. The validity and reliability of the Japanese version of the scale have been confirmed.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Participants will rate each item using a four-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). The total score ranges from 10 to 40 points. Higher scores indicate greater self-esteem.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eHope\u003c/h2\u003e \u003cp\u003eHope is a secondary outcome, which will be measured using the Herth Hope Index (HHI)\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Yamaki et al. developed the Japanese version of the HHI.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e HHI is a four-point Likert scale ranging from 1 (completely disagree) to 4 (completely agree), with 12 items and total scores range from 12 to 48 points. HHI contains three subscales, which are \u0026ldquo;inner sense of temporary and future (4 items),\u0026rdquo; \u0026ldquo;inner positive readiness and expectancy (4 items),\u0026rdquo; and \u0026ldquo;interconnectedness with self and others (4 items).\u0026rdquo; The validity and reliability of the Japanese version of the scale have been confirmed\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSelf-confidence in communication\u003c/h2\u003e \u003cp\u003eSelf-confidence in communication is also a secondary outcome. The Self-Confidence in Communication scale (SCS) has been developed for the general Japanese population.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e The SCS is a seven-point Likert scale ranging from 1 (not applied at all) to 7 (definitely applied), with 30 items. SCS has three subscales, as follows: \u0026ldquo;intention communication (9 items),\u0026rdquo; \u0026ldquo;intention restraints (9 items),\u0026rdquo; and \u0026ldquo;intention comprehension (9 items).\u0026rdquo; The contents of \u0026ldquo;I can rightly tell what I want to say to my partner (item 1)\u0026rdquo; and \u0026ldquo;I can successfully express my emotions to my partner (item 10)\u0026rdquo; are contained in \u0026ldquo;intention communication\u0026rdquo; subscale. For this study, the subscale \u0026ldquo;intention communication\u0026rdquo; will be the only portion of scale used; since it is important for the couple to communicate their own thoughts and opinion to each other, which is a target of AIRIKI program participation. The total range of this subscale is 9\u0026ndash;63 points with higher scores being greater self-confidence in communicating.\u003c/p\u003e \u003cp\u003eCronbach alpha coefficients will be calculated for all scales employed.\u003c/p\u003e\u003cp\u003e3. Feasibility assessment\u003c/p\u003e\u003cp\u003eParticipants will participate in a feasibility assessment using a self-rated original questionnaire after completion of the program. The contents are as follows: any difficulties in program participation, any thoughts regarding program, accessibility, thoughts about program length, about the number of participants, and about the textbook.\u003c/p\u003e \u003cp\u003eDemographic variables will be collected at the baseline assessment (T1). Outcome variables will be collected at the baseline assessment (T1), following assessment 1(T2), and following assessment 2 (T3). A feasibility assessment will be conducted after the program\u0026rsquo;s completion. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the contents of the questionnaire.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStudy hypothesis\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 1\u003c/strong\u003e \u003cp\u003eThe main hypothesis is that the self-esteem scores at T3 will be greater for the intervention group than in the control group.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 2\u003c/strong\u003e \u003cp\u003eThe secondary hypothesis is that the changes in self-esteem scores from T1 to T2, and T3 will be greater in the intervention group than in the control group.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 3\u003c/strong\u003e \u003cp\u003eThe main hypothesis is that hope scores at T3 will be higher in the intervention group than in the control group.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe secondary hypothesis is that the changes in hope scores from T1 to T2, and T3 will be greater in the intervention group than in the control group\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 4\u003c/strong\u003e \u003cp\u003eThe main hypothesis is that self-confidence in communication scores at T3 will be greater in the intervention group than in the control group.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe secondary hypothesis is that changes in self-confidence in communication scores from T1 to T2, and T3 will be higher in the intervention group than in the control group\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eWe will conduct an intention-to-treat analysis (ITT), in which we will use all available data. The population for which the ITT takes place is the full analysis set (FAS). In addition, per protocol set (PPS) will be defined as the population of study subjects who do not fall under any of the following categories in the FAS; 1) if the patient received a procedure different from the original allocation; 2) failure to participate in the AIRIKI program within 2 months of allocation; and 3) if the patient withdraws from the study in the intervention group.\u003c/p\u003e \u003cp\u003eBaseline data for continuous variables will be summarized as mean and standard deviations, whereas categorical variables will be summarized as frequencies and percentages.\u003c/p\u003e \u003cp\u003eFor the main hypothesis, using the total score on the self-esteem scale at T3, we will calculate summary statistics for each group and compute the 95% confidence interval (CI) for the mean. Furthermore, we will fit an MMRM, including sex, intervention, time point, and interaction between intervention and time point as a fixed effect, and group as a random effect. We will calculate the group differences in least squares means, their standard errors, 95% confidence intervals, and p-values at T3. The variance-covariance structure of the error terms in the MMRM will be conducted in the following order: unstructured, compound symmetry, and auto-regression. The estimation results based on the first successful convergence of the specified structure will be adopted. MMRM estimation will be conducted using the restricted maximum likelihood method. Similarly, we will undertake an analysis targeting the Per-Protocol Set as a sensitivity analysis.\u003c/p\u003e \u003cp\u003eFor the secondary hypothesis, the change over time in the self-esteem scale and summary statistics will be calculated for T1 and T2 in the same manner as above, and the same model will be used to calculate the group differences in least squares means, their standard errors, 95% confidence intervals, and p-values at T1 and T2. The other hypothesis, the HHI and SCS, will be analyzed in the same manner as the self-esteem scale.\u003c/p\u003e \u003cp\u003eAll statistical analyses will be performed using SAS software, version 9.4 (SAS Institute).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eEthics and dissemination\u003c/h2\u003e \u003cp\u003eDocuments on the ethical issues of the study have been developed, including the study protocol, voluntariness of participation, privacy policy, data management, participants\u0026rsquo; safety, and the absence of conflicts of interest. The study protocol was evaluated and approved by the Research Ethics Committee of the Shonan University of Medical Sciences on July 18, 2023 (No. 23\u0026thinsp;\u0026minus;\u0026thinsp;014).\u003c/p\u003e \u003cp\u003eM Kusaka, who has a nurse-license, will be carefully monitoring the health conditions of the participants via e-mail. If a participant has an unscheduled doctor's visit or a medical condition that worsens, M Kusaka will speak with the participant over the phone and make a preliminary assessment regarding need for further assessment and/or treatment.\u003c/p\u003e \u003cp\u003eAfter completing this study, we will publish the results in an international peer-reviewed medical or nursing journal and present the results at national and international conferences. Information on publication will be announced on the AIRIKI homepage according to the journal\u0026rsquo;s publication policies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn Maslow\u0026rsquo;s hierarchy of needs, every human needs love and belonging, which include friendships, family, and intimate partner.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e People with mental disorders may find it difficult to initiate and develop intimate relationships with others because of their mental symptoms, adverse effects of medicine, or lack of communication skills.\u003c/p\u003e \u003cp\u003eThe AIRIKI program is a group work program for thinking about and discussing intimate relationships and marriage among people with mental illness with their peers and with professionals. In this study, we developed the videoconferencing version of AIRIKI for people with mental disorders to reach participants from different regions of Japan. Other merits of videoconferencing include COVID-19 and flu infection prevention, cost-effectiveness (saving venue and transportation expenses), and participation from home which may relieve the anxiety of participants. The program offers different components that enable talking about partnerships, communication skills (both verbal and non-verbal) with their dating partners and imagining married life. In this study, the participants are limited to un-married individuals. The problem of partnerships may differ between unmarried and married individuals. Married people generally have a fixed and stable relationship with their partner due to living together which is not the situation with unmarried people. Therefore, this study focuses on unmarried people who may have trouble initiating and developing new, intimate relationships with their dating partners.\u003c/p\u003e \u003cp\u003ePrograms focusing on intimate relationships, and marriage among people with mental disorders are limited. This study\u0026rsquo;s results may suggest the potential use of videoconferencing programs that focus on intimate relationships and marriage among people with mental disorders. Additionally, if our hypotheses are confirmed, the AIRIKI videoconferencing program may help improve self-esteem, hope, and self-confidence in communication with potential partners for a successful marriage. In summary, this study may significantly contribute to promoting the use of videoconferencing group work programs for intimate relationships and marriage among people with mental disorders.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cp\u003eCI confidence interval\u003c/p\u003e \u003cp\u003eFAS Full Analysis Set\u003c/p\u003e \u003cp\u003eHHI Herth Hope Index\u003c/p\u003e \u003cp\u003eITT Intention-to-treat\u003c/p\u003e \u003cp\u003eMMRM Mixed-effect Model for Repeated Measures\u003c/p\u003e \u003cp\u003ePPS Per Protocol Set\u003c/p\u003e \u003cp\u003eRCT randomized controlled trial\u003c/p\u003e \u003cp\u003eRSES Rosenberg Self-esteem Scale.\u003c/p\u003e \u003cp\u003eSCS Self-Confidence in Communication Scale\u003c/p\u003e \u003cp\u003eSNS Social Network Service\u003c/p\u003e \u003cp\u003eUSD United States Dollars\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study protocol was approved by the Research Ethics Committee of the Shonan University of Medical Sciences on July 18, 2023 (Approval no. 23-014). Written informed consent will be obtained from all participants. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is supported by JSPS KAKENHI Grant Number 23H03226 and research funding of Shonan University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualizations: Masako Kageyama, Keiko Yokoyama, Kayo Ichihashi\u003c/p\u003e\n\u003cp\u003eDesign, methodology, writing, review, and editing: Momoko Kusaka, Masako Kageyama, Keiko Yokoyama, Kayo Ichihashi, Ryota Hashimoto, Kazutaka Nishio, Phyllis Solomon\u003c/p\u003e\n\u003cp\u003eSupervision: Masako Kageyama, Phyllis Solomon\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all facilitators of the AIRIKI program for providing us with useful advice for the creation of this videoconferencing program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMomoko Kusaka: Department of Nursing, Shonan University of Medical Sciences, Yokohama, Japan\u003c/p\u003e\n\u003cp\u003eMasako Kageyama: Institute of Advanced Co-Creation Studies, Osaka University, Osaka, Japan\u003c/p\u003e\n\u003cp\u003eKeiko Yokoyama: Department of Nursing, Faculty of Nursing, Yokohama Soei University, Yokohama, Japan\u003c/p\u003e\n\u003cp\u003eKayo Ichihashi: Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan\u003c/p\u003e\n\u003cp\u003eRyota Hashimoto: Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan\u003c/p\u003e\n\u003cp\u003eKazutaka Nishio: Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan\u003c/p\u003e\n\u003cp\u003ePhyllis Solomon: School of Social Policy \u0026amp; Practice, University of Pennsylvania Philadelphia, USA\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAnthony WA. Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation J. 1993;16(4):11\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/h0095655\u003c/span\u003e\u003cspan address=\"10.1037/h0095655\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCertified NPOCOMHBO. Renai-anketo, mental health magazine. Kokoro-no genki plus. 2017;11(4):6\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Institute of Population and Social Security Research, Table 6\u0026ndash;23 seibetsu 50-sai ji no mikon wariai shibetsu wariai oyobi ribetsu wariai: 1920\u0026ndash;2020. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ipss.go.jp/syoushika/tohkei/Popular/P_Detail2022.asp?fname=T06-23.htm\u003c/span\u003e\u003cspan address=\"https://www.ipss.go.jp/syoushika/tohkei/Popular/P_Detail2022.asp?fname=T06-23.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReis HT, Shaver P. Intimacy as an interpersonal process. In: Duck SW, editor. Handbook of personal relationships. Chichester, UK:Wiley; 1988. pp. 367\u0026ndash;389.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoucher M, Groleau D, Whitley R. 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Psychosis. 2017;9(4):301\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/17522439.2017.1330895\u003c/span\u003e\u003cspan address=\"10.1080/17522439.2017.1330895\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCloutier B, Lecomte T, Diotte F, Lamontagne J, Abdel-Baki A, Daneault J, Rabbath MEG, de Connor A, Perrine C. Improving Romantic Relationship Functioning Among Young Men With First-Episode Psychosis: Impact of a Novel Group Intervention. Behav Modif. 2023;47(5):1170\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/01454455231186586\u003c/span\u003e\u003cspan address=\"10.1177/01454455231186586\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKageyama M, Yokoyama K, Ichihashi K, Noma S, Hashimoto R, Nishitani M, Okamoto R, Solomon P. A peer-led learning program about intimate and romantic relationships for persons with mental disorders (AIRIKI): co-creation pilot feasibility study. BMC Psychiatry. 2023;23(1):767. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12888-023-05254-1\u003c/span\u003e\u003cspan address=\"10.1186/s12888-023-05254-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMimura C, Griffiths P. A Japanese version of the Rosenberg Self-Esteem Scale: Translation and equivalence assessment. J Psychosom Res. 2007;62(5):589\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpsychores.2006.11.004\u003c/span\u003e\u003cspan address=\"10.1016/j.jpsychores.2006.11.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUchida T, Ueno T. Rosenberg jison kanjo syakudo no shinraisei oyobi datosei no kento[Reliability and Validity of the Rosenberg Self Esteem Scale]. Annual Bulletin, Graduate School of Education, Tohoku University. 2010;58:257\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHerth K. Abbreviated instrument to measure hope: Development and psychometric evaluation. J Adv Nurs. 1992;17(10):1251\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamaki C, Yamazaki Y. Herth Hope Index (HHI) nihongoban sakuseino torikumi [Development of Herth Hope Index (HHI) Japanese version]. In: KAKENHI Report 14201021. Tokyo; 2003. pp. 147\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHatano K. Seinenkikouki ni oketu komyunikeshon ni taisuru jishin to aidenthithi tono kanrensei [Self-confidence in communication and identity in Late adolescents]. Kyoiku Shinrigaku kenkyu. 2010;58:404\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaslow AH. A theory of human motivation. Psychol Rev. 1943;50(4):370\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/h0054346\u003c/span\u003e\u003cspan address=\"10.1037/h0054346\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Components of the AIRIKI online program\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"662\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eStructure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eThe program focuses on intimate relationships\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eSmall group of less than 9 people\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eGroups are led by peer facilitators and healthcare professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eSharing own thoughts and experiences about loving people\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\n \u003cp\u003eModules\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003emin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eLesson\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003ePurposes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eContents\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDay 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\n \u003cp\u003eWarming-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eIce break\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eSelf-introduction, motivation for participation, favorite type of person, mood of participants\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChapter 1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe love that you think about\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eIntroduction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eIntroduction of the program and sharing the rules\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eIntroduction of AIRIKI program\u003c/p\u003e\n \u003cp\u003eBasic rules of the program\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eWhat is love for you?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eSharing thoughts about loving people\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eIntroduction of theories and quotations about love.\u003c/p\u003e\n \u003cp\u003eSharing their thoughts and experiences.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eContents include not only loving their partner but also being loved by parents or friends.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.61971830985915%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"13.380281690140846%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eWhat is the difference between love and romance?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.61971830985915%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"13.380281690140846%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eWhom do you love?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eImportant people and events for your recovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eSharing the experience of being loved by someone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eParticipants introduce how people and events have affected their process of recovery.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eReflection\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eSummarize own thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eParticipants share their awareness and impressions about Chapter 1.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChapter 2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUnderstand your partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eWhat do you need to do for love?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eClarify what is important to love others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eThe ability of love includes comprehension, caring, respect, and responsibility.\u003c/p\u003e\n \u003cp\u003ePersonal boundaries are briefly described.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eBasic communication skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eLearn communication skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eLearning about basic communication skills such as listening carefully. Participants share what they are careful about their communication.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.94353369763206%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.9216757741347905%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.86520947176685%\" valign=\"top\"\u003e\n \u003cp\u003eSkill training in inviting date\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48.2695810564663%\" valign=\"top\"\u003e\n \u003cp\u003eAs a communication exercise, participants simulate in a role play with each other where they invite and are invited for the first date.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eReflection\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eSummarize own thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eParticipants share their awareness and impressions about role play.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eReflection and positive feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eReflect on what they were impressed with and share their thoughts\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eParticipants present what impressed on Day 1 program. All participants and facilitators share their thoughts and offer messages of support to each other.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDay 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChapter 3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMeeting and dating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eWarming-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eIce break\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eBeginning of second day; Sharing their mood and basic rules of the program.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eHow do we find a partner?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eAware of own thoughts regarding meeting partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eParticipants share what they think important in choosing and finding a partner.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eDating manners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eCaring about a partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eParticipants share what dating manners they know.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eConversation and skill training in confiding their illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003ePractice ways to confide their illness to dating partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eImportant to know how to confide their illness to dating partner Participants practice in their own way.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eReflection\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eSummarize own thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eParticipants share their insights and impressions.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChapter 4\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMaintaining a long-term relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eFactors to be careful of in an intimate relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eReduce risks in romantic relationships\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eMental health condition impacted by loving people, sexually transmitted diseases, unexpected pregnancies, and intimate partner violence are briefly explained.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eMarriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eThink of whether to get married and coping with problems in marriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eChanges associated with marriage (e.g., sharing household finances, rhythm of daily living) are explained. Side effects of medications on sexual difficulties and child care are also explained.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eReflection and positive feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eReflect on what impressed them and share their thoughts of program.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eParticipants present what impressed them about program and their own future plans. All participants and facilitators share their thoughts and send messages of support to each other.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.709969788519638%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.740181268882175%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.45015105740181%\" valign=\"top\"\u003e\n \u003cp\u003eOverall comments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.069486404833835%\" valign=\"top\"\u003e\n \u003cp\u003eProgram completion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.03021148036254%\" valign=\"top\"\u003e\n \u003cp\u003eParticipants share their overall thoughts of two-day program.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2. The contents of questionnaire\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"501\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.85657370517928%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.07171314741036%\" valign=\"top\"\u003e\n \u003cp\u003eDemographic variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.07171314741036%\" valign=\"top\"\u003e\n \u003cp\u003eOutcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.85657370517928%\" valign=\"top\"\u003e\n \u003cp\u003eT1 (baseline assessment)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.07171314741036%\" valign=\"top\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.07171314741036%\" valign=\"top\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.85657370517928%\" valign=\"top\"\u003e\n \u003cp\u003eT2 (following assessment 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.07171314741036%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.07171314741036%\" valign=\"top\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.85657370517928%\" valign=\"top\"\u003e\n \u003cp\u003eT3 (following assessment 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.07171314741036%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.07171314741036%\" valign=\"top\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"intervention, intimate relationships, mental disorders, peer support, personal recovery, romantic relationships","lastPublishedDoi":"10.21203/rs.3.rs-4322634/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4322634/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe concept of \u003cem\u003erecovery\u003c/em\u003e has become internationally widespread. To promote personal recovery of individuals with mental disorders, it is important that they live life on their own terms. Many people with mental disorders wish to build intimate relationships and marry. However, people with mental disorders face obstacles in building such relationships and communicating with their partners. The program AIRIKI, which means “power to love,” was developed to help people with mental disorders gain confidence in building intimate relationships. The AIRIKI pilot study with one-group pre post test showed positive effects on self-esteem, hope, and communication. Therefore, the purpose of the proposed randomized controlled trial (RCT) is to determine the effects of the videoconferencing program on self-esteem, hope, and self-confidence in communication among un-married people with mental disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe proposed randomized controlled trial has two arms (intervention group and control group). After baseline questionnaire assessment, participants will be allocated randomly. Within two months of allocation, the intervention group will participate in videoconferences about intimate relationships and marriage with 2–5 participants and 3 facilitators, which will last 3 h, for two days. Three facilitators will support participants in each session. The intervention group will complete a questionnaire for outcome assessment at termination and one month after the program. The control group will complete the outcome questionnaire at one month after baseline and two months after baseline. The questionnaire will include the Rosenberg Self-Esteem Scale (RSES), Herth Hope Index (HHI), and Self-confidence in Communication Scale (SCS). Control group members can participate in a videoconference program, which will be held separately from the intervention group, after completing their outcome assessments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis trial is the first randomized controlled trial of which we are aware to test the effects of an online program for un-married people with mental disorders to consider and discuss their romantic relationship and marriage. The results will provide information on the effectiveness of an online program for people with mental disorders to imagine their romantic relationships and marriages.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis trial has been registered with the UNIN Clinical Trials Registry (UMIN000052027; 2023/08/28).\u003c/p\u003e","manuscriptTitle":"Effects of an online program about intimate and romantic relationships for people with mental disorders (AIRIKI): a study protocol for a randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-04 19:13:19","doi":"10.21203/rs.3.rs-4322634/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-28T03:07:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-20T09:06:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-20T09:06:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2024-04-25T08:16:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b6ddae0d-32ad-4128-8269-de3d55b9d97f","owner":[],"postedDate":"June 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T15:58:48+00:00","versionOfRecord":{"articleIdentity":"rs-4322634","link":"https://doi.org/10.1186/s12888-024-06063-w","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2024-10-25 15:56:59","publishedOnDateReadable":"October 25th, 2024"},"versionCreatedAt":"2024-06-04 19:13:19","video":"","vorDoi":"10.1186/s12888-024-06063-w","vorDoiUrl":"https://doi.org/10.1186/s12888-024-06063-w","workflowStages":[]},"version":"v1","identity":"rs-4322634","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4322634","identity":"rs-4322634","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}