Background Better methods of assessing patients' and family members' causal models of illness are needed to improve adherence with biomedical interventions and to design services that meet the needs of consumers.

Aims To develop a quantitative measure suitable for assessing the relationship of causal beliefs to expressed emotion, stigma, care-seeking and adherence.

Method The Causal Models Questionnaire for Schizophrenia, which includes 45 causes identified during indepth interviews with family members, was administered to 245 family members of 135 patients with DSM-III-R schizophrenia in Suzhou and Siping, China at the time of admission to hospital.

Results Respondents, who identified a mean of 2.5 causes (range 1-10, mode 2), attributed 84% of the cause of schizophrenia to social, interpersonal and psychological problems. Hence, their beliefs do not concur with Chinese professionals' ideas about the biomedical causes of schizophrenia. Multivariate analyses identified the socio-economic factors that influence family members' causal beliefs.

Conclusions Despite the complexity of causal models, measures can be developed that will help improve clinicians' communication with patients and understanding of help-seeking behaviours.

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