Effects of a Peer-facilitated, Acceptance-based Self-learning for Illness Management (PASIM) Program

August 11, 2025 updated by: Prof. Wai Tong CHIEN, Chinese University of Hong Kong

Evaluating the Effects of a Peer-facilitated, Acceptance-based Self-learning for Illness Management (PASIM) Program for Adults With Recent-onset Psychosis: A Randomized Controlled Trial

Psychosis is a very disabling mental illness with a wide range of dysregulations and disruptions in cognition, emotions, and behaviors, resulting in poor functioning and frequent relapses, especially in the first five years of the illness. There is a knowledge gap about whether Peer-facilitated, Acceptance-based Self-learning for Illness Management (PASIM) can have longer-term and more significant benefits than current professional-led psychoeducation in diverse health outcomes of these psychotic patients such as functioning, problem-solving, and recovery. This multi-center randomized controlled trial with repeated measures, 3-arm design is proposed to test and compare the effects between two alternative interventions (PASIM and Psychoeducation Group program) and a usual-care-only group over an 18-month follow-up.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Objectives:

To test the primary hypothesis that the PASIM program can produce significantly greater improvements than psychoeducation and/or usual-care only groups at 1-week, 9-month, and/or 18-month follow-ups on patients' functioning; To test the hypothesis that the PASIM program will produce significantly greater improvements than psychoeducation and usual-care-only over the 18-month follow-ups in patients' psychotic symptoms, problem-solving, illness insight, rehospitalization rates, and/or service satisfaction (secondary outcomes); To explore the strengths, weaknesses and areas for improvements of and satisfaction with the PASIM program, from participants' and peer facilitators' perspectives, using individual semi-structured interviews.

Design: A multi-center randomized controlled trial with repeated measures, 3-arm design will be conducted with both outcome and process evaluation.

Subjects: 186 adults with recent-onset psychosis and randomly assigned into three study groups.

Data collection procedure: After explaining the study and ethical issues to participants, written consent and then baseline measurement will be obtained. During interventions, participants' attendance, workbook completion and attritions will be monitored. At 1-week (Posttest-1), and 9- (Posttest-2) and 18-month (Posttest-3) post-intervention, outcome measurements will be evaluated. In addition, individual semi-structured interviews will be conducted after Posttest-1.

Data analysis: Generalized Estimating Equation test will be used to compare mean-value changes in individual outcomes, and Kaplan-Meier survival-analysis used to analyze the relative risks of re-hospitalizations, between groups over follow-ups. Content analysis will be conducted for qualitative interview data.

Expected results: The PASIM is the first peer-supported self-help for illness management intervention for early-stage psychosis, particularly in Chinese population. It can be a useful and potential cost-saving intervention in community mental healthcare service, providing accessible, self-learned illness self-management training facilitated by peer-support workers (persons recovered from psychosis) in views of limited healthcare resources and mental health professionals in locally and internationally.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
186

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Contact Backup

Study Locations

  • China
    • Hong Kong
      • Hong Kong, Hong Kong, China
        • Integrated Community Centers for Mental Wellness
        • Contact:
      • Hong Kong, Hong Kong, China
        • Psychiatric outpatient clinics in one hospital cluster of Hospital Authority
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Primarily diagnosed with psychosis (or ROP with <5 years of illness as defined in recent literature), including brief, first-episode and other psychotic disorders according to the criteria of the DSM-5 [American Psychiatric Association 2013];
  • H.K. Chinese residents, aged 18-64 years;
  • Global Assessment of Functioning scores ≥51, indicating mild to moderate symptoms and difficulties in psychosocial/occupational functioning [American Psychiatric Association 2013], being mentally stable to comprehend APSI or psychoeducation and outcome measures;
  • Able to read and understand Cantonese/ Mandarin.

Exclusion Criteria:

  • Have received or are receiving other psychotherapies;
  • Comorbidity with other mental (learning disability, cognitive, or personality disorder) or significant medical disease(s);
  • And/or communication, visual or hearing difficulty.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: PASIM group
Participants in the PASIM program will study and complete the self-learning manual (printed and online versions available) with 5 modules for ROP patients (translated, refined and validated by research team) and participate in 4 group sessions facilitated by a peer-support worker over 5 months.
Behavioral: PASIM program
The program consists of 5 modules for ROP patients (translated, refined and validated by research team) and 4 group sessions (1.5 hours per session; 8-10 members/group; in-between completion of the 5 modules) facilitated by a peer-support worker over 5 months. The 5 modules include: Module 1-Patient's well-being; Module 2-Getting the best out of support services; Module 3-Acceptance and insight toward psychosis and long-term self-care; Module 4-Dealing with psychosocial effects of the illness- I; and Module 5-Dealing with physical/mental health effects of the illness- II. The 4 group sessions will be conducted at the orientation and after reading the 1st, 3rd and 5th module to introduce the program, encourage to complete the module per month, performing value clarifying and acceptance (psychological flexibility) exercises, and clarify and discuss self-care learning and and challenges.
Behavioral: Usual-Care-only
Participants receive usual community mental healthcare services provided by POPCs and ICCMWs.
Experimental: Psychoeducation group
The psychoeducation group (12 two-hour sessions, 5 subgroups with 12-14 patients per group) will be led by one trained psychiatric nurse experienced in psychiatric rehabilitation and psychoeducation group.
Behavioral: Usual-Care-only
Participants receive usual community mental healthcare services provided by POPCs and ICCMWs.
Behavioral: Psychoeducation
The psychoeducation group (5 subgroups with 12-14 patients per group) will be led by one trained psychiatric nurse experienced in psychiatric rehabilitation and psychoeducation group. The program consists of 12 two-hour sessions held weekly or biweekly (similar to the PASIM) over 5 months with four key components, including introduction and goal setting; an education workshop on psychosis care and community service; learning effective coping and self-care skills with rehearsals/reviews; and skills practices and preparing for future life.
Other: Usual-care-only group
This control group (and 2 intervention groups) will receive usual community mental healthcare services provided by POPCs and ICCMWs. Patients in ICCMWs and POPCs may receive services in commons, including occupational/living skills training, education on psychosis care, recreational services, and individual and/or family counseling and referrals to social and health care services as needed. The control group will also receive an information booklet about illness self-care to minimize the Hawthorne effect from the PASIM manual reading.
Behavioral: Usual-Care-only
Participants receive usual community mental healthcare services provided by POPCs and ICCMWs.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Patient functioning
Time Frame: Baseline
The 43-item Specific Level of Functioning Scale is used to measure patient functioning across four domains: self-maintenance, social functioning, activities, and community-living skills. Each item is evaluated using a 5-point Likert scale (1=highly dependent/typical/always to 5=fully self-sufficient/never; total score range= 43-215). A higher total score indicates a higher level of functioning.
Baseline
Patient functioning
Time Frame: Change from baseline to 1-week post-intervention
The 43-item Specific Level of Functioning Scale is used to measure patient functioning across four domains: self-maintenance, social functioning, activities, and community-living skills. Each item is evaluated using a 5-point Likert scale (1=highly dependent/typical/always to 5=fully self-sufficient/never; total score range= 43-215). A higher total score indicates a higher level of functioning.
Change from baseline to 1-week post-intervention
Patient functioning
Time Frame: Change from baseline to 9-month follow-up after the intervention
The 43-item Specific Level of Functioning Scale is used to measure patient functioning across four domains: self-maintenance, social functioning, activities, and community-living skills. Each item is evaluated using a 5-point Likert scale (1=highly dependent/typical/always to 5=fully self-sufficient/never; total score range= 43-215). A higher total score indicates a higher level of functioning.
Change from baseline to 9-month follow-up after the intervention
Patient functioning
Time Frame: Change from baseline to 18-month follow-up after the intervention
The 43-item Specific Level of Functioning Scale is used to measure patient functioning across four domains: self-maintenance, social functioning, activities, and community-living skills. Each item is evaluated using a 5-point Likert scale (1=highly dependent/typical/always to 5=fully self-sufficient/never; total score range= 43-215). A higher total score indicates a higher level of functioning.
Change from baseline to 18-month follow-up after the intervention

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Problem-solving ability
Time Frame: Baseline
Problem-solving ability will be measured a 25-item Chinese version of Revised (Short) Social Problem-Solving Inventory. It comprises 2 domains: problem-solving style (rational, impulsive/careless and avoidance) and orientation (positive/negative). Items are rated on a 5-point Likert scale (0=not at all true to 4=extremely true; total score range= 0-100). A higher total score indicates better problem solving ability.
Baseline
Problem-solving ability
Time Frame: Change from baseline to 1-week post-intervention
Problem-solving ability will be measured a 25-item Chinese version of Revised (Short) Social Problem-Solving Inventory. It comprises 2 domains: problem-solving style (rational, impulsive/careless and avoidance) and orientation (positive/negative). Items are rated on a 5-point Likert scale (0=not at all true to 4=extremely true; total score range= 0-100). A higher total score indicates better problem solving ability.
Change from baseline to 1-week post-intervention
Problem-solving ability
Time Frame: Change from baseline to the 9-month follow-up after the intervention
Problem-solving ability will be measured a 25-item Chinese version of Revised (Short) Social Problem-Solving Inventory. It comprises 2 domains: problem-solving style (rational, impulsive/careless and avoidance) and orientation (positive/negative). Items are rated on a 5-point Likert scale (0=not at all true to 4=extremely true; total score range= 0-100). A higher total score indicates better problem solving ability.
Change from baseline to the 9-month follow-up after the intervention
Problem-solving ability
Time Frame: Change from baseline to 18-month follow-up after the intervention
Problem-solving ability will be measured a 25-item Chinese version of Revised (Short) Social Problem-Solving Inventory. It comprises 2 domains: problem-solving style (rational, impulsive/careless and avoidance) and orientation (positive/negative). Items are rated on a 5-point Likert scale (0=not at all true to 4=extremely true; total score range= 0-100). A higher total score indicates better problem solving ability.
Change from baseline to 18-month follow-up after the intervention
Psychotic symptoms
Time Frame: Baseline
Psychotic symptoms will be assessed by a trained researcher using the 30-item Positive and Negative Syndrome Scale. It contains three subscales: positive symptoms, negative symptoms, and general psychopathology. Items will be rated on an 8-point scale (1= absent to 7= extreme; total score range= 30-210). A higher total score indicates more severe psychotic symptoms.
Baseline
Psychotic symptoms
Time Frame: Change from baseline to 1-week post-intervention
Psychotic symptoms will be assessed by a trained researcher using the 30-item Positive and Negative Syndrome Scale. It contains three subscales: positive symptoms, negative symptoms, and general psychopathology. Items will be rated on an 8-point scale (1= absent to 7= extreme; total score range= 30-210). A higher total score indicates more severe psychotic symptoms.
Change from baseline to 1-week post-intervention
Psychotic symptoms
Time Frame: Change from baseline to 9-month follow-up after the intervention
Psychotic symptoms will be assessed by a trained researcher using the 30-item Positive and Negative Syndrome Scale. It contains three subscales: positive symptoms, negative symptoms, and general psychopathology. Items will be rated on an 8-point scale (1= absent to 7= extreme; total score range= 30-210). A higher total score indicates more severe psychotic symptoms.
Change from baseline to 9-month follow-up after the intervention
Psychotic symptoms
Time Frame: Change from baseline to 18-month follow-up after the intervention
Psychotic symptoms will be assessed by a trained researcher using the 30-item Positive and Negative Syndrome Scale. It contains three subscales: positive symptoms, negative symptoms, and general psychopathology. Items will be rated on an 8-point scale (1= absent to 7= extreme; total score range= 30-210). A higher total score indicates more severe psychotic symptoms.
Change from baseline to 18-month follow-up after the intervention
Insight into illness/treatment
Time Frame: Baseline
Insight into illness/treatment will be assessed with the 11-item Insight and Treatment Attitude Questionnaire. Items are rated on a 3-point Likert scale (0=not necessary to receive treatment to 2=treatment should be required/continued regularly; total score range= 0-22). A higher total score indicates better insight into the illness/treatment.
Baseline
Insight into illness/treatment
Time Frame: Change from baseline to 1-week post-intervention
Insight into illness/treatment will be assessed with the 11-item Insight and Treatment Attitude Questionnaire. Items are rated on a 3-point Likert scale (0=not necessary to receive treatment to 2=treatment should be required/continued regularly; total score range= 0-22). A higher total score indicates better insight into the illness/treatment.
Change from baseline to 1-week post-intervention
Insight into illness/treatment
Time Frame: Change from baseline to 9-month follow-up after the intervention
Insight into illness/treatment will be assessed with the 11-item Insight and Treatment Attitude Questionnaire. Items are rated on a 3-point Likert scale (0=not necessary to receive treatment to 2=treatment should be required/continued regularly; total score range= 0-22). A higher total score indicates better insight into the illness/treatment.
Change from baseline to 9-month follow-up after the intervention
Insight into illness/treatment
Time Frame: Change from baseline to 18-month follow-up after the intervention
Insight into illness/treatment will be assessed with the 11-item Insight and Treatment Attitude Questionnaire. Items are rated on a 3-point Likert scale (0=not necessary to receive treatment to 2=treatment should be required/continued regularly; total score range= 0-22). A higher total score indicates better insight into the illness/treatment.
Change from baseline to 18-month follow-up after the intervention
Rehospitalization rate
Time Frame: Baseline
Rehospitalization rate will be calculated using the frequency and duration of and time to rehospitalizations over the past 5-6 months.
Baseline
Rehospitalization rate
Time Frame: At 1-week post-intervention
Rehospitalization rate will be calculated using the frequency and duration of and time to rehospitalizations over the past 5-6 months.
At 1-week post-intervention
Rehospitalization rate
Time Frame: At 9-month follow-up after the intervention
Rehospitalization rate will be calculated using the frequency and duration of and time to rehospitalizations over the past 5-6 months.
At 9-month follow-up after the intervention
Rehospitalization rate
Time Frame: At 18-month follow-up after the intervention
Rehospitalization rate will be calculated using the frequency and duration of and time to rehospitalizations over the past 5-6 months.
At 18-month follow-up after the intervention
Service satisfaction
Time Frame: Baseline
Service satisfaction will be assessed with the 8-item Client Satisfaction Questionnaire. Items are rated on a 4-point Likert scale (1= very dissatisfied to 4= very satisfied; total score range= 8-32). A higher total score indicates a better satisfaction with the services received/receiving.
Baseline
Service satisfaction
Time Frame: Change from baseline to 1-week post-intervention
Service satisfaction will be assessed with the 8-item Client Satisfaction Questionnaire. Items are rated on a 4-point Likert scale (1= very dissatisfied to 4= very satisfied; total score range= 8-32). A higher total score indicates a better satisfaction with the services received/receiving.
Change from baseline to 1-week post-intervention
Service satisfaction
Time Frame: Change from baseline to 9- month follow-up after the intervention
Service satisfaction will be assessed with the 8-item Client Satisfaction Questionnaire. Items are rated on a 4-point Likert scale (1= very dissatisfied to 4= very satisfied; total score range= 8-32). A higher total score indicates a better satisfaction with the services received/receiving.
Change from baseline to 9- month follow-up after the intervention
Service satisfaction
Time Frame: Change from baseline to the 18-month follow-up after the intervention
Service satisfaction will be assessed with the 8-item Client Satisfaction Questionnaire. Items are rated on a 4-point Likert scale (1= very dissatisfied to 4= very satisfied; total score range= 8-32). A higher total score indicates a better satisfaction with the services received/receiving.
Change from baseline to the 18-month follow-up after the intervention

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Chinese University of Hong Kong

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Integrated Community Centers for Mental Wellness
Psychiatric outpatient clinics

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Wai Tong Chien, PhD, Chinese University of Hong Kong

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
January 2, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
August 31, 2028

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
October 31, 2028

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
August 6, 2025

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 11, 2025

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
August 19, 2025

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 19, 2025

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 11, 2025

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
August 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 14608525

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

The name and email of the researchers can be shared openly for communication and collaboration.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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