Peer-to-peer psychoeducation in schizophrenia: a new approach.

Objective: To evaluate the feasibility of the first peer-to-peer psychoeducation program in schizophrenia. Method: We developed a 5-step curriculum for structured training of peer moderators. In step I, peer moderators participate in regular psychoeducation, and in step 2, they participate in work-shops on knowledge about schizophrenia and moderation techniques. In step 3, peer moderators conduct peer-to-peer groups in the presence of a mental health professional, and in step 4, they conduct the groups independently with regular supervision. Further peer moderators are recruited in step 5. Psychoeducation by trained peer moderators comprises 8 60-minute group sessions (warm-up, symptoms, diagnosis, causes, medication, psychosocial therapy, warning signs, coping with schizophrenia) with 6 to 10 patients per group. The feasibility of the 5-step curriculum was evaluated by conducting a pilot study of 7 peer groups with 2 peer moderators. Evaluation of peer-moderated groups was done from January 2003 to July 2004 using inpatients of a university hospital who had schizophrenia or schizoaffective disorder according to ICD-10. The primary outcomes of interest were change in knowledge and concept of illness from baseline to endpoint. Results: Two peer moderators conducted psychoeducational groups with a total of 49 patients in the presence of a physician (step 3). On the whole, conduction of peer-moderated groups worked well. Knowledge of illness increased significantly (N = 44, p <.001), and concept of illness changed significantly in 3 subscales: trust in physician (N = 40, p =.002) and trust in medication (N = 40, p =.001) increased, and negative treatment expectations decreased (N = 40, p =.001). Subjective assessments of peer moderators by participating patients were positive. Conclusion: First results suggest that peer-to-peer psychoeducation in schizophrenia according to the 5-step curriculum is feasible and may be comparable to professional psychoeducation in regard to short-term outcomes.