Hope As a Salient Resource Among Latinos with Schizophrenia and Their Family Members

Background and Purpose: Hope is an important component of recovery for individuals with schizophrenia.  It has been linked to improved quality of life, subjective well-being, and self-esteem.  In addition, it has been associated with decreased self-stigmatizing beliefs among clients and decreased burden among family caregivers. Hope is most commonly conceptualized as a cognitive process consisting of personal agency with the ability to develop pathways to goals.  While this definition encompasses central characteristics of hope, it does not consider social context and its potential influence on how hope is perceived and fostered.  This study explored hope among Latinos with schizophrenia and their family caregivers to gain a greater understanding of how it is experienced in this cultural context.

Methods: Participants came from a NIMH-funded controlled study to develop an intervention involving low-acculturated Latino family members caring for a relative with schizophrenia. Data for the current study came from a follow-up study examining perceptions of salient treatment outcomes among intervention group participants. Purposive sampling was used to collect data from 34 participants – (14 clients; 20 family caregivers).  Semistructured in-depth interviews were analyzed using thematic analysis, comparing codes across and within client and family member transcripts. After independent coding by team members, results were compared to reach consensus. A codebook was developed and memo-writing was used throughout the analysis process to document decisions regarding theme development.

Results: Findings revealed the following themes: (1) hope’s meaning, (2) role of hope in mental illness, and (3) strategies to increase and maintain hope.  Participants’ meaning of hope was strongly associated with their religious and spiritual beliefs (“hope has a spiritual connection”). Not only were religion and spirituality important to how hope was conceptualized, often linking these to faith, but they were also key to increasing hope.  Hope was also perceived as goal oriented and interestingly, these goals were centered on family relationships (“hope for the whole family”).  Hope was seen as a coping mechanism for clients in illness management and family members in caregiving. Moreover, hope served to motivate clients’ recovery process (“hope is doing everything possible not to be hospitalized”).  Clients expressed a strong belief that family support was an integral part of developing and maintaining hope. Family members identified knowledge gained through family psychoeducation as a source of hope.  Overall, participants’ views and experiences went beyond a dispositional to a holistic view of hope.

Conclusions and Implications: Hope was conceptualized as a multidimensional construct and was a vital resource for participants.  Specifically, there was an emphasis on contextual factors that included religion and spirituality and interpersonal relationships. Given that the majority of Latinos with schizophrenia live with family, the prominent role of interpersonal relationships was congruent with this group’s experience.  Findings underscore the need to expand our understanding of how hope is perceived and developed among Latinos and other underserved groups.  It can lead to better recognition of this salient resource to incorporate its varied dimensions into treatment models that fully address the needs and strengths of individuals with schizophrenia and their families.