Beyond ‘Expressed Emotion’: Development and validation of a contextual measure of family communication and involvement in the context of psychosis in Ethiopia
Bibliographic record
Abstract
Abstract Background and Aim Family caregiving environments significantly influence psychosis outcomes, yet existing measures like Expressed Emotion lack cultural relevance in non-Western settings. This study aimed to develop and validate a socio-culturally appropriate Family Communication and Involvement (FCI) scale in Ethiopia. Methods An initial FCI scale (version 0) was generated by integrating items from existing measures of aspects of family communication with findings from an ethnographic study with Ethiopian families caring for a relative with psychosis. To ensure content validity and clarity, items underwent translation, back-translation, expert consensus review, and cognitive interviews (n=20). The resulting FCI v1.0 (37 items) was piloted with 201 people with psychosis in rural Ethiopia. Exploratory factor analysis, item-item/item-total correlations, and test-retest reliability (n=50) informed stakeholder discussions to reduce items, leading to a 24-item, two-factor structure. The final 24-item scale (FCI v2) was validated with a separate sample of 401 people with psychosis in Addis Ababa. Confirmatory factor analysis (CFA) assessed structural validity. Convergent validity was evaluated against the WHO Disability Assessment Schedule and the Brief Psychiatric Rating Scale–Expanded. Results The scale demonstrated robust psychometric performance: excellent internal consistency (Cronbach’s α = 0.92) and acceptable convergent validity, correlating with disability (WHODAS, r = - 0.45) and symptom severity (BPRS-E, r = -0.48). Confirmatory factor analysis supported the 24-item bi-factor with acceptable model fit. Conclusion The FCI scale is a culturally grounded, psychometrically sound tool for assessing family communication and involvement in Ethiopia. It holds promise for use in similar non-Western settings where family support and sociocultural influences shape mental health care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".