Culturally Adapted Family Psychoeducation and Expressed Emotion Among Schizophrenia Caregivers in South Sulawesi: A Quasi-Experimental Study

Abstract

Family expressed emotion is a relational construct particularly relevant to ongoing schizophrenia care. This study examined culturally adapted family psychoeducation and expressed emotion among schizophrenia caregivers in south sulawesi using a non-equivalent two-group pretest–posttest quasi-experiment. The study took place at Dadi Regional Psychiatric Hospital, South Sulawesi, Indonesia, between November 2025 and January 2026 and included 65 family caregivers, including 32 in the intervention group and 33 in the comparison group, recruited consecutively. The intervention consisted of structured family psychoeducation anchored in the Bugis–Makassar values sipakatau (mutual human dignity), sipakalebbi (respect), and sipakainge’ (mutual reminding). Outcomes were assessed using family expressed-emotion questionnaire and categorisation into high and low expressed emotion. The proportion classified as having high expressed emotion fell from 62.5% to 9.4% in the culture-adapted group, versus 75.8% to 66.7% under comparison care. Mean expressed-emotion scores declined from 46.78 to 42.94 in intervention caregivers and from 50.61 to 49.52 in controls. The analysis reports a between-group Mann–Whitney p value below 0.001; the control group also showed a within-group difference (p = 0.027), so the comparison was not completely static. In interpretation, a culturally recognisable language of respect, human dignity, and supportive correction may make psychoeducational messages more acceptable while shifting responses away from criticism and overinvolvement. The design and measurement constraints mean that associations should not be represented as definitive causal effects.