The use of the cultural formulation interview at Helen Joseph Hospital Psychiatric Unit

Tsikoane, Mpho
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Introduction: The Cultural Formulation Interview (CFI) is an updated version of the Outline of Cultural Formulation that has been included in the DSM-5. The CFI has been identified as a cross-cultural assessment too and allows for a more structured collection of data enabling the clinician to make a more comprehensive assessment. Purpose and study objectives: The aim of this study therefore was to describe the self-reported experience of culture in the expression of psychiatric illness and the role of cultural factors in the presentation of psychiatric problems, by administering the CFI in a group of patients in a local psychiatric unit. Methodology: The study is a qualitative research that uses qualitative methods to describe the answers to the 16 questions that comprise the CFI as given by psychiatric patients. Interviews were conducted until data saturation had been achieved, which resulted in 22 interviews being conducted. Results: A brief descriptive analysis of the demographic variables of participants was done, followed by a content analysis of their documented responses to the different CFI questions. The most common themes identified in the process were: “culture”, “religion”, “stigma”, “insight” and “integration of treatment modalities”. The field notes of the investigator were also summarised, concluding that conducting the interview was difficult at times especially, due to barriers resulting from language and educational difficulties. CFI content themes were also compared with current literature. Conclusion: In this limited, local investigation, not all of the CFI questions in its current format offered any additional information that was not already a component of the current Colleges of Medicine of South Africa’s College of Psychiatrists’ long case presentation format. It does not seem to be necessary to conduct the CFI as a separate component of assessment, but some aspects of the CFI questions can be incorporated in the current long case format to offer some elaborated insight into local patients’ cultural explanation of illness. Some questions were repetitive and could therefore be clustered together as a single question. It has also been of note that patients felt misunderstood by their health-care providers if cultural considerations were not included and that they would prefer an approach which integrates western and local (African) cultural treatment modalities
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Psychiatry