Family Decision Making and Self-Determination Among Consumers With Schizophrenia in China: Cross-Cultural Implications

Objectives:Self-determination is viewed as an important ingredient of successful recovery in psychiatric rehabilitation. The concept of autonomy, a key component of self-determination, may be of less importance in Chinese cultures, whereby an individual’s choices may be in conflict with the family’s expectations. This study aimed to develop an instrument to measure opinions about self-determination among Chinese consumers and their family members.Methods:A 27-item questionnaire, the Consumer and Family Decision Making Scale (CFDMS), was constructed to measure consumers’ and family members’ views of self-determination in various aspects of daily life. A total of 364 (182 consumers of psychiatric services with a diagnosis of schizophrenia and 182 of their family members) participated in the study.Results:The CFDMS was found to possess good psychometric properties and appears to be a reliable and valid instrument for assessment of consumers’ decision making. (The Cronbach’s alphas of psychiatric care and treatment factor, personal and social function factor, community and daily living factor, and money management factor were as follows: .86, .89, .87 and .76. The respective test-retest reliabilities were as follows: .81, .89, .80, and .88). Chinese consumers preferred autonomous decision making in regard to personal and social functioning and community and daily living but preferred to defer decisions regarding psychiatric care and treatment and money management to others. Family members and consumers had similar views.Conclusions:Deferring decisions to family members is common in Chinese families. The emphasis on autonomy in Western health care may need to be reconsidered in the treatment of Chinese consumers. Chinese families have a strong influence on treatment decisions, and providers must respect this style and remain nonjudgmental when dealing with situations or decisions that may be contradictory to their own culture and values.