Changes in quality of life among people with psychosis and their caregivers participating in a community-based rehabilitation intervention in Malawi: A mixed-methods analysis

Psychotic disorders are a leading cause of disability in Malawi. Community-based rehabilitation (CBR) interventions may improve quality of life (QOL) for people with lived experience of psychosis (PWLE) and their caregivers by addressing functional challenges and promoting empowerment and social reintegration. However, understanding how QOL may evolve over the course of participation in CBR in low-resource settings remains unknown. This analysis examined changes in QOL among PWLE and their caregivers participating in a CBR intervention in Malawi using a mixed-methods approach. We analyzed qualitative and quantitative data from the intervention arm of a two-arm pilot randomized controlled trial comparing a CBR intervention to enhanced usual care in Blantyre, Malawi (NCT06080477). Eligible participants were over 18, diagnosed with schizophrenia spectrum disorder, and had a caregiver willing to participate. Thirty PWLE and 58 caregivers completed interviewer-administered surveys at 6 and 12 months. In-depth qualitative interviews were conducted with a subsample of 12 PWLE and 14 caregivers between 6 and 9 months. Qualitative data were analyzed thematically. Quantitative data were summarized descriptively to assess changes in QOL, functioning, and functional outcomes over time. Qualitative findings highlighted improvements in QOL across multiple domains. PWLE described improvements in mental and physical health, increased independence, and social reintegration that contributed to better QOL. Caregivers reported improved mental health, reduced caregiving burden, and reintegrating into society improved QOL. Quantitative findings aligned with reported themes for PWLE. Mean QOL scores improved from 48.5 at baseline to 52.7 at 12 months. Mean psychosis severity scores decreased from 67.7 to 40.2. Functional outcomes such as employment, community engagement, and monthly income generation improved across the study period. CBR interventions are well-positioned to support psychosis management and improve overall QOL among PWLE and their family members in Malawi, supporting their broader implementation.