Background
Method
Group-based intervention
Sample
Patients characteristics N = 15 | |
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Gender | |
Male | 4 |
Female | 11 |
Age | |
Range | 18–51 |
Mean | 34 |
Education | |
Middle school | 3 |
High school | 4 |
College and above | 8 |
Times of Episode | |
Mean | 3.7 |
Data collection
Analysis
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familiarizing with data;
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generating the initial codes;
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searching themes from text;
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reviewing themes;
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defining and naming the themes;
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producing the report.
Ethics
Results
Theme 1: Perception of participating in the program
Sub-theme 1: Engagement
“I have a better understanding of the illness, why not? It’s cost-free” (Participant 10).
Sub-theme 2: Recommending the program to others
“I feel so lucky that I was selected to attend this program, I would definitely recommend the program to others I know suffering from a bipolar disorder.” (Participant 6)
Sub-theme 3: Suggestions for the program
“Can you print the handout for me before I am discharged from the hospital? I need it. I can review it when I am at home.” (Participant 6)
“I would like to have access to more up-to-date information about my illness and treatments from the doctor.” (Participant 11)
Theme 2: Perceptions of the setting
Sub-theme 1: Learning environment
“This ambiance with light music enhanced my mood and allowed me to focus on the class.” (Participant 7)
“A big table can fit all of the people (group members) and I felt it’s a teamwork and our heart tights junctions.” (Participant 10)
“um….the light was too dim, I felt sleepy and a bit depressed....it was hard to concentrate on the class. What I suggested is a change to a brighter light.” (Participant 2)
“You know, I would wonder sometimes if I was hearing the noise from outside. I hope it’s quiet.” (Participant 3)
“The session was long, and we should have had five minutes to rest in between.” (Participant 1)
Sub-theme 2: Facilitators
“The class was very organized; the devices, such as the laptop, projector and practice booklet, were well arranged by those doctors and every time they came to pick us up from the ward to the classroom, they were always on time; I appreciated that.” (Participant 8)
“There are too many texts in some slides, I found the class quite boring.” (Participant 9)
“I had many questions on the medication section; I wanted to ask more questions to the teacher but the time was ending.” (Participant 9)
“Sometimes the class was in a little bit of chaos and I felt irritable towards the group members who were speaking loudly and dominating the group.” (Participant 1)
“However, some contents are easy to forget, I wish the facilitator had repeated things again at the beginning of the class.” (Participant 8)
Sub-theme 3: Time
“You know, we have to wake up at 6 am during the routine hospitalization. In the following 3 hours, I have to eat breakfast, read some books and play table tennis. Whenever the class started at 10 am, I felt tired and sleepy. So, I prefer to attend the 3pm class in the afternoon as I felt more energized then after my 2pm nap.” (Participant 5)
“Sometimes the class took longer than 40 minutes and I felt restless.” (Participant 6)
Theme 3: Perception of participating in a group
Sub-theme 1: Group-versus individual-based intervention
“I am not only the one who has bipolar disorder; many people around me have the same problems. Within the group, we can discuss bipolar disorder.” (Participant 8)
“When I see what others are doing, I can push myself harder.” (Participant 5)
“I was sharing my own experiences at the period of manic onset; I told everyone I earned salary of 10000 RMB in a month, my husband only earned 8000 RMB. I wanted to change my husband at that time….but then everyone in the group was laughing at me and I felt very embarrassed.”
“I didn’t know what to expect from the course and I felt very anxious initially…many strangers were siting around me.” (Participant 3)
Sub-theme 2: Class-taught versus discussion
“If I only listened to the teaching talking, I would lose my interest in the class.” (Participant 5)
“She kept talking, talking and talking in the class, I felt restless and annoyed at her.”
Sub-theme 3: Family involvement
“If my mom could come to the class that would be helpful, she could listen more about bipolar disorder, the medication I am taking and this would help her understand more about me….maybe she will change her attitude towards me, that I am not lazy.” (Participant4)
“Yes, especially in the psychological session, the doctor taught us how to identify, understand, express and manage our emotion; if my husband was here, it would definitely improve our relationship.”
“That’s too far, my dad is living in the Shandong province, I don’t want him to come here everyday, you know traveling is difficult for him”.
“No, I don’t. I don’t want my mom to participate in the class because we argue very often at home”. (Participant 2)
Sub-theme 4: Real stories sharing
“It’s better to listen to some real stories from real people who have been cured, such as how they recovered from the bipolar disorder, what they did during the treatment and recovery period… which medication they think is the best….this information could help me feel more authentic”. (Participant 15)
Theme 4: Perception of learning content
Sub-theme 1: Concept of BD
“No one has ever told me what is bipolar disorder, and now I know what has happened to me.” (Participant 10)
Sub-theme 2: Treatment of BD
“I don’t like to take medication, I always hide the medication under my pillow and then the nurse found out and forced me to take it. But now I understand why I should take the medication.” (Participant 13)
Sub-theme 3: Psychological approach
“The imagery relaxation made me feel comfortable; I could imagine that I was in the ocean with my lover. I also practiced it before going to sleep every night and it enabled me to really calm down.” (Participant 9)
“In the past, I was always thinking that I was going to die, but I understand now this type of thought is called catastrophizing; catastrophizing means only expecting the worst outcome in everything, so actually I was not going to die.” (Participant 7)
Sub-theme 4: Self-management
“I feel that I can actually recognize the dangerous triggers in the different environment settings as a result of an increased awareness of my mood.” (Participant 5)
Sub-theme 5: Lifestyle management
“I always reversed my bio-clock, I used to work at night until 5 to 6 am and go to bed at daytime. I understand if I do not want to come back to hospital again, I should have a regular life.” (Participant 7)
“I will keep doing sports every day because my mood becomes more stable after playing badminton with my neighbor every time.” (Participant 6)
Sub-theme 6: Relapse prevention
“The mood diary was the most useful thing I have learned from the class, it can help me monitor my mood, if the score is higher than 4 or 4.5, I should definitely see my doctor as soon as possible.”(Participant 8)
Sub-theme 7: Suggestion for improving the learning content
“I am still not very sure of electroconvulsive therapy, what’s that for? Will I die after injecting something in my body by the doctor?” (Participant 8)
“The doctor gave me the sheet but I totally had no idea how to do that.”(Participant 13)
“The side effects of the medication are common to everyone, not only me, but I still fear weight gain as result of taking long-term medication, I want to know how to reduce this side effect.” (Participant 8)
“I understand how important medication is to me, but the side effects….You know I am a girl and I am not married yet.” (Participant 7)
“I have bipolar disorder and want to get pregnant but I want to know the risks and benefits of medications and forms of birth control.” (Participant 13)
Theme 5: Outcome of participating in program
Sub-theme 1: Self-acceptance
“I understand that my illness is not my fault.” (Participant 11)
“This is something I can’t change by myself, but I should accept it.” (Participant 15)
Sub-theme 2: Self-confidence
“I was struggling to speak up about my illness, but when someone was speaking up about their illness in the group discussions, that would give me the confidence to do the same.” (Participant 8)
“Since I started to share my own experiences in the group, I felt stronger within myself.” (Participant 6)
Sub-theme 3: Self-awareness
“Once I recognized the trigger and in the future I will know when my mood is becoming low or high.” (Participate 15)
Sub-theme 4: Self-motivation
“My mom sent me to the hospital because I would always go on a shopping sprees... If I receive enough treatment, I won’t waste the money again.” (Participant 4)
“I feel so sorry and regret towards my husband, I won’t try to change my husband again despite my salary being higher than him, I will try my best to recover from the illness.” (Participant 13)
Sub-theme 5: Social support
“I am not only getting support from my family, but also from the group members.” (Participant 8)
“She said I am her good friend, we did everything together during the hospitalization, we would wake up at the same time, go to the washroom, watch TV, sit together when eating breakfast and lunch.” (Participant 6)
Sub-theme 6: Relationship with the doctor
“I was reluctant to talk to my resident doctor before attending this program, because I thought he had lied to me about my condition and that he just wouldn’t let me go home but I found out I was wrong….we did have a pleasant conversation yesterday in the ward and I believed him.” (Participant 12)
“If I keep up taking the medication that my doctor prescribes me then everything will be okay for me.” (Participant 5)