Peer-led recovery groups for people with psychosis in South Africa (PRIZE): results of a randomized controlled feasibility trial

Abstract

Abstract Aims The aims of this feasibility trial were to assess the acceptability and feasibility of peer-led recovery groups for people with psychosis in a low-resource South African setting, to assess the feasibility of trial methods, and to determine key parameters in preparation for a definitive trial. Methods The design was an individually randomised parallel group feasibility trial comparing recovery groups in addition to treatment as usual (TAU) with TAU alone. Ninety-two isiXhosa-speaking people with psychosis, and 47 linked caregivers, were recruited from primary care clinics and randomly allocated to trial arms in a 1:1 allocation ratio. TAU comprised anti-psychotic medication delivered in primary care. The intervention arm comprised six recovery groups including both service users and caregivers. Two-hour recovery group sessions were delivered weekly in a 2-month auxiliary social worker-facilitated phase, then a 3-month supported peer-led phase. To explore acceptability and feasibility, a mixed methods process evaluation included 25 in-depth interviews and two focus group discussions at 5 months with service users, caregivers and implementers, and quantitative data collection including attendance and facilitator competence. To explore potential effectiveness, quantitative outcome data (functioning, relapse, unmet needs, personal recovery, stigma, health service use, medication adherence and caregiver burden) were collected at baseline, 2 months and 5 months post randomisation. Trial registration: PACTR202202482587686. Results Recovery groups were broadly acceptable with most participants finding groups to be an enjoyable opportunity for social interaction, sharing experiences and joint problem-solving. Peer facilitation was a positive self-development experience, however a minority of participants did not value expertise by lived experience to the same degree as professional facilitators. Attendance was moderate in the ASW-led phase (participants attended 59% sessions on average) and decreased in the peer-led phase (41% on average). Participants desired a greater focus on productive activities and financial security. Recovery groups appeared to positively impact on relapse. Relapse occurred in 1/46 (2.2%) in the recovery group arm compared to 8/46 (17.4%) in the control arm (risk difference − 0.15 (95% CI -0.26; -0.05)). Recovery groups also impacted on one marker of functioning, but had no detectable effect on other quantitative outcomes. Conclusion We have demonstrated encouraging findings relating to the acceptability, feasibility and potential effectiveness of peer-led recovery groups for people with psychosis in South Africa. A larger trial, incorporating key amendments such as increased support for peer facilitators and an economic empowerment component, is needed to demonstrate intervention effectiveness definitively.