Satir model-based health literacy programme for behaviour modification in patients with stable schizophrenia

To develop a Satir model-based health literacy programme for individuals with stable schizophrenia and evaluate its effects on health literacy, health behaviours, relapse prevention, and key metabolic indicators.

The study comprised three phases: (1) situation analysis and health literacy survey in 972 outpatients with stable schizophrenia, (2) programme development and validation by five experts, and (3) a 12-week quasi-experimental pilot study in 24 outpatients with stable schizophrenia. Outcome measures included health literacy, health behaviours, relapse prevention behaviours, and metabolic indicators.

In total, 15 men and nine women (mean age, 43.0 years) with stable schizophrenia completed the programme. After intervention, health literacy significantly improved (d = 0.56, p = 0.012), particularly in the accessing domain (d = 0.93, p < 0.001), while improvements in the understanding (d = 0.41, p = 0.055), appraising, and applying domains were not significant. Health behaviours also significantly improved (d = 0.61, p = 0.006), with a trend towards improved dietary habits (p = 0.051). Relapse prevention behaviours also significantly improved (d = 0.54, p = 0.015), particularly in the early warning sign monitoring domain (d = 0.45, p = 0.038). Triglyceride levels significantly decreased by a mean of 47.29 mg/dL (r = 0.59, p = 0.025), while HDL cholesterol significantly increased by a mean of 4.83 mg/dL (d = 0.69, p = 0.003).

The Satir model-based health literacy programme is feasible for rehabilitation in patients with stable schizophrenia. By fostering personal responsibility and intrapersonal restructuring, the programme empowered patients towards active self-regulation. Addressing the internal 'iceberg' is essential for sustainable metabolic health and recovery in schizophrenia.