Hopeful Endless Caring to Maintain Normal Life: A Grounded Theory of Thai Mothers’ Caring for Adult Children with Schizophrenia

Main Article Content

Thidarat Kanungpiarn
Patraporn Tungpunkom
Kannika Kantaruksa
Nonglak Chaloumsuk


             Owing to multiple roles, including caregiving provision, mothers of children with schizophrenia experience a high level of stress. How these mothers adapt themselves to this caregiving, in addition to their other roles in the family, requires understanding before the development of an intervention. This study explored the process of adaptation among 20 Northeastern Thai mothers caring for children with schizophrenia who had provided such care for more than one year. They were interviewed in-depth, and Strauss and Corbin’s grounded theory approach was used for collecting and analyzing.

             Hopeful endless caring to maintain normal life emerged as the core category, and consisted of three phases. Phase 1, Dealing with immediate care demands, involved mothers responding to their situation with supernatural rituals, combining treatment, finding medical treatment, and taking advice. Phase 2, Adjusting ourselves, involved mothers trying to adjust the caring and strategies, living situation, and their mental state. In Phase 3, Restoring self-balance, they adjusted their mind, tried to heal body and mind, reframed thoughts, and tried to get back to normal.

            The findings provide a deep understanding of mothers’ adaptation process toward their caregiving over time, based on their perspectives. In developing a robust program to improve adaptation competency, mental health care providers, including nurses, need to understand what could be involved in the lives of caregivers, and take steps to realize each person’s uniqueness, and that adapting to caregiving is a process. Heath professionals thus need to adjust interventions to be most appropriate for the different phases experienced by mothers.

Article Details

How to Cite
Kanungpiarn T, Tungpunkom P, Kantaruksa K, Chaloumsuk N. Hopeful Endless Caring to Maintain Normal Life: A Grounded Theory of Thai Mothers’ Caring for Adult Children with Schizophrenia. PRIJNR [Internet]. 2021 Mar. 25 [cited 2023 Feb. 4];25(2):171-84. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/241078
Original paper


National Collaborating Centre for Mental Health. Schizophrenia: core interventions in the treatment and management of schizophrenia in adults in primary and secondary care (updated). Leicester: British Psychological Society; 2009. [internet] 2020 May 31. [cited 2019 May 30]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK11681/pdf/Bookshelf_NBK11681.pdf

Parekh P. What is schizophrenia? The American Psychiatric Association (APA). Washington, DC; 2017. [Internet]. 2020 June 14. [cited 2020 June 13]. Available from: https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia.

Liu N, Zhang J. Experiences of caregivers of family member with schizophrenia in China: a qualitative study. Perspect Psychiatr Care. 2020;56:201‐212. doi:10.1111/ppc.12412.

Poonnotok P, Thampanichawat W, Patoomwan A, Sangon S. Struggling to restore normalcy: Thai parents’ experiences in being caregivers of children with early schizophrenia. Pacific Rim Int J of Nurs Res [Internet]. 2016 Jan 25 [cited 2020 Aug 9];20(1):71-4. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/36348

Kılıç AK, Saruc S. Life experience of mothers who have children with schizophrenia in Turkey: desperation, pain, and anxiety. Int J Health Sci (Qassim). 2015;3(3):33-43. doi.org/10.15640/ijhs.v3n3a4.

Napa W, Tungpunkom P, Sethabouppha H, Klunklin A, Fernandez RF. A grounded theory study of Thai family caregiving process for relatives with first episode psychosis. Pacific Rim Int J of Nurs Res [Internet]. 2017 May 5 [cited 2020 Aug 9];21(2):158-70. Available from: https://

he02.tci thaijo.org/index.php/PRIJNR/article/view/74254

Chen et al. The burden, support, and needs of primary family caregivers of people experiencing schizophrenia in Beijing communities: a qualitative study. BMC Psychiatry. 2019; 19(75): 1-10. doi:10.1186/s12888-019-2052-4.

Lazarus, RS, Folkman S. Stress, appraisal, and coping. New York: Springer Publishing; 1984, pp.181-225.

Roy C, Andrews HA. The Roy Adaptation Model. 2nd ed. Stamford: Prentice-Hall; 1999.

Tungpunkom P, Srikhachin P, Napa W, Chaniang S. Caregiving experiences of families living with patients with schizophrenia: A systematic review. JBI Database System Rev Implement Rep. 2013;11(8):145-564. doi:10.11124/jbisrir-2013-881.

Srikhachin P, Thapinta D, Sethabouppha H, Thungjaroenkul P. Expressed emotion among family caregivers of persons with schizophrenia: a causal model study. Pacific Rim Int J of Nurs Res [Internet]. 2016 Oct 31 [cited 2020 Aug 10];20(4):337-49. Available from: https://he02.tcithaijo.org/index.php/PRIJNR/article/view/56401

Poonnotok P, Kaewmart N, Asarath T, Pratoomsri W. Making it better: experiences of Thai caregivers in managing psychotic symptoms of persons with schizophrenia. J Health Res. 2019; 33(3):238-46. doi:10.1108/JHR-09-2018-0102.

Amaresha CA, Venkatasubramanian G, Muralidhar D. Perspectives about illness, attitudes, and caregiving experiences among siblings of persons with schizophrenia: a qualitative analysis. Indian J Psychol Med. 2019; 41(5):413-19. doi:10.4103/IJPSYM.IJPSYM_318_19.

Thongkun S. An adaptation process of schizophrenic patients, wives: a case study in Nakhon Panom Province [master’s thesis]. Khonkhaen: Khonkhaen University;2002 (in Thai).

Kanungpiarn T. Experience of caregiver in caring for people with schizophrenia in community. J Nurs Division. 2016;40(1):57-66 (in Thai).

Suhita BM, Wahyuni CU, Notobroto HB, Yusuf, A. The adaptation model of care giver in treating family members with schizophrenia in Kediri East Java. Jurnal Ners. 2017;12(1):74-80. doi:10.20473/jn.v12i1.3513.

Tungpunkom P. Staying in balance: skill and role development in psychiatric caregiving [dissertation]. San Francisco: The University of San Francisco; 2000.

Wiens SE, Daniluk JC. Loss and change: the challenges of mothering an adult child with schizophrenia. Int J Qual Health Care. 2017;3(1):26-33. doi:10.5430/ijh. v3n1p26.

Imkome E, Waraassawapati K. Perspectives and experiences of primary caregivers of individuals with schizophrenia in Thailand. Issues Ment Health Nurs. 2018;39(10):1-7. doi:10.1080/01612840.2018.1488312.

Benzies KM, Allen MN. Symbolic interactionism as a theoretical perspective for multiple method research. JAN. 2008;33(4):541-47. doi:10.1046/j.1365-2648.2001.01680.x.

Blumer H. Symbolic interactionism: perspective and method. New Jersey: Prentice-Hall; 1969.

Strauss A, Corbin J. Basics of qualitative research: grounded theory procedures and techniques. Newbury Park, CA: Sage Publications; 1990.

Strauss A, Corbin J. Basics of qualitative research: grounded theory procedures and techniques for developing grounded theory. 2nd ed. Thousand Oaks, CA: Sage Publications; 1998.

Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory. 3rd ed. California: Sage Publications; 2008.

Lincoln YS, Guba GE. Naturalistic inquiry. Newbury Park, CA: Sage Publications; 1985.

Bai XL, Luo ZC, Wang A, Guan ZY, Zhong ZY, Sun M, et.al. Challenge of parents caring for children or adolescents with early‐stage schizophrenia in China: a qualitative study. Perspect Psychiatr Care. 2020; 1–8. doi:10.1111ppc.12492.

Kanjanasarnthana C, Chettasurat B, Saengkrai A. The warmth of Isan way. Inst Cult Art J. 2014;15(2); 79-89.

Mills AC, Wong-Anuchit C, Poogpan J. A concept analysis of Thum-jai: a Thai coping strategy. Pacific Rim Int J of Nurs Res [Internet]. 2017 Jul 10 [cited 2020 Aug 9];21(3):234-43. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/78114

Akgül Gök F, Duyan V. ‘I wanted my child dead’ – Physical, social, cognitive, emotional and spiritual life stories of Turkish parents who give care to their children with schizophrenia: a qualitative analysis based on empowerment approach. Int J Soc Psychiatry. 2020;66(3):249-58. doi:10.1177/0020764019899978.

Young L, Murata L, McPherson C, Jacob JD, Vandyk, AD. Exploring the experiences of parent caregivers of adult children with schizophrenia: a systematic review. Arch. Psychiatr Nurs. 2019;33(1):93-103. doi:10.1016/j.apnu.2018.08.005.

Bellini LC, Cunha MS, da Silva TFC, Giacon BCC. The experience of being a mother of and individual with schizophrenia. Cienc Cuid Saude. 2016;15(4):701-7. doi:10.4025/ cienccuidsaude. v%vi%i.34527.

Cleary M, West S, Hunt GE, McLean L, Kornhaber R. A qualitative systematic review of caregivers’ experiences of caring for family diagnosed with schizophrenia. Issues Ment Health Nurs. 2020;41(8):667-83. doi:10.1080/01612840.2019.1710012.