The Effects of an Online Family Psychoeducation Program on Expressed Emotion of Family Members and Medication Adherence of Patients With First-Episode Schizophrenia

April 22, 2026 updated by: Areerat Yongprasert, Mahidol University
This study examined the effects of family psychoeducation program via line application on expressed emotion of family members and medication adherence in patients with first-episode schizophrenia.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

The investigators examined if LINE family Psychoeducation Program plus routine treatment is effective for reducing Expressed Emotion and improving Medication Adherence in real practice. Family members and patients with first-episode schizophrenia received a 7-week online family psychoeducation program via the LINE application, while the control group received routine care. Family caregivers completed the Thai Expressed Emotion Scale (TEES) and the Medication Adherence Report Scale (MARS). Baseline assessments were conducted prior to group allocation. Post-intervention assessments were conducted at week 8. Intervention fidelity was monitored through weekly quizzes and researcher oversight.

Study Type

Interventional

Enrollment (Actual)

53

Phase

  • 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 Locations

  • Thailand
    • Bangkok
      • Bangkok Noi, Bangkok, Thailand, 10700
        • Faculty of Nursing, Mahidol University

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

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion criteria for patients were:

  • a diagnosis of schizophrenia according to the International Classification of Diseases, 10th Revision ICD-10 (F20.00 to F20.09), with a duration of illness not exceeding five years from the date of initial diagnosis
  • received oral antipsychotic treatment for at least 6 months but no longer than five years
  • aged between 18 to 35 years.
  • mild psychotic symptoms severity, defined as a total score of 18 to 36 on the Brief Psychiatric Rating Scale (BPRS)
  • documented history of medication non-adherence, as recorded in medical records
  • availability of a primary caregiver and
  • ability to communicate in Thai and via telephone using the LINE application

Inclusion criteria for family members were:

  • being a family member living in the same household as the patients and serving as the primary caregiver for at least six months without financial compensation
  • Aged 20 to 60 years
  • ownership of a mobile phone capable of using the LINE application
  • no prior participation in family psychoeducation programs
  • ability to speak, read, and write Thai
  • no history of psychiatric disorders, including schizophrenia, bipolar disorder, or major depressive disorder.

Exclusion criteria for both patients and caregivers were:

  • acute exacerbation of psychotic symptoms requiring hospitalization during the study period
  • missing one or more scheduled intervention sessions
  • inability of the researcher to contact the family caregiver within one week despite repeated attempts.

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: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: control
Participants in the control group received routine outpatient psychiatric care only. No structured family psychoeducation was provided during the study period.
Experimental: Mobile based Family Psychoeducation Program
Mobile based Family Psychoeducation Program, In addition to routine treatment, a structured 7week Online Psychoeducation Program delivered via the LINE application. The program was developed based on the Vulnerability Stress Model and aimed to reduce expressed emotion among family caregivers and improve medication adherence in patients with first-episode schizophrenia. The intervention consisted of seven video-based sessions, each lasting no more than 10 minutes, delivered weekly over seven consecutive weeks through a private LINE chat. Content covered program orientation, knowledge about schizophrenia, medication management and adherence, stigma and coping strategies, expressed emotion and family communication, stress management, and early warning signs of relapse.
Behavioral: Mobile based family psychoeducation program
A structured 7week Online Psychoeducation Program delivered via the LINE application. The program was developed based on the Vulnerability Stress Model and aimed to reduce expressed emotion among family caregivers and improve medication adherence in patients with first-episode schizophrenia. The intervention consisted of seven video-based sessions, each lasting no more than 10 minutes, delivered weekly over seven consecutive weeks through a private LINE chat. Content covered program orientation, knowledge about schizophrenia, medication management and adherence, stigma and coping strategies, expressed emotion and family communication, stress management, and early warning signs of relapse.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Expressed Emotion
Time Frame: From enrollment (week 1) to post treatment at week 8
Expressed Emotion was measured using the Thai Expressed Emotion Scale (TEES), developed by Sunpaveerawong. The instrument consists of 49 items encompassing seven components of expressed emotion. Negative expressed emotion includes Critical Comments (items 1-7), Hostility (items 8-15), Emotional Overinvolvement (items 16-20), and Emotional Under involvement (items 42-49), totaling 28 items. Positive expressed emotion includes Warmth (items 21-27), Positive Remarks (items 28-34), and Emotion Regulation (items 35-41), totaling 21 items.
From enrollment (week 1) to post treatment at week 8

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Medication Adherence
Time Frame: From enrollment (week 1) to post treatment at week 8
was assessed using the Medication Adherence Report Scale (MARS), The instrument consists of 5 items evaluating non-adherent behaviors: forgetting to take medication, altering dosage, temporarily stopping medication, intentionally skipping doses, and taking less medication than prescribed. Each item is rated on a 5-point Likert scale (1-5). A total score of 25 indicates full adherence, whereas scores <25 indicate some degree of non-adherence.
From enrollment (week 1) to post treatment at week 8

Collaborators and Investigators

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

Sponsor

Mahidol University

Investigators

  • Study Chair: Yajai Sitthimongkol, PhD, Faculty of Nursing, Mahidol University

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 (Actual)

May 26, 2025

Primary Completion (Actual)

September 14, 2025

Study Completion (Actual)

September 14, 2025

Study Registration Dates

First Submitted

April 16, 2026

First Submitted That Met QC Criteria

April 16, 2026

First Posted (Actual)

April 22, 2026

Study Record Updates

Last Update Posted (Actual)

April 27, 2026

Last Update Submitted That Met QC Criteria

April 22, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Faculty of Nursing (Registry Identifier: Mahidol University)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Prohibited from laws

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.

Clinical Trials on First- Episode Schizophrenia

Clinical Trials on Mobile based family psychoeducation program

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Congo

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe