Acceptability and efficacy of the culturally adapted problem management plus intervention for people with disability in Pakistan: a pilot cluster randomized controlled trial
BackgroundIn Pakistan, the mental health care for persons living with disabilities is insufficient, lacking a holistic approach to address their needs. This research evaluates the adapted PM+’s (IA-PM+) initial efficacy and acceptability in improving mental health among persons living with disabilit...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1413809/full |
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| author | Basharat Hussain Basharat Hussain Muhammad Tahir Khalily Muhammad Tahir Khalily Ahmed Waqas Atif Rahman Ioannis Angelakis Anum Nisar Sabir Zaman Tanveer Akhtar |
| author_facet | Basharat Hussain Basharat Hussain Muhammad Tahir Khalily Muhammad Tahir Khalily Ahmed Waqas Atif Rahman Ioannis Angelakis Anum Nisar Sabir Zaman Tanveer Akhtar |
| author_sort | Basharat Hussain |
| collection | DOAJ |
| description | BackgroundIn Pakistan, the mental health care for persons living with disabilities is insufficient, lacking a holistic approach to address their needs. This research evaluates the adapted PM+’s (IA-PM+) initial efficacy and acceptability in improving mental health among persons living with disabilities, contributing to the integration of mental health services within primary care settings in Pakistan.MethodsThis study employed a two-arm, single-blind cluster randomized controlled trial in a community setting within Union Council Kuri Dolal, Tehsil Gujjar Khan, District Rawalpindi-Pakistan. It compared an Active Treatment group, receiving five sessions of the IA-PM+ intervention, against a Delayed Treatment Control group. A total of 148 participants were randomized. Randomization occurred at the village level, with clusters assigned to either the intervention or control group. The intervention’s effectiveness and participant satisfaction were assessed using a variety of measures, including the GHQ-12, WHODAS 2.0, DASS-21, and the Client Satisfaction Questionnaire, at baseline, the 8th week, and during a 3-month follow-up. Qualitative feedback was gathered at the end of the study to assess the intervention’s acceptability among the participants.ResultsThe study achieved a 100% retention rate. Baseline demographics showed a majority male participation with a variety of disabilities predominantly lower limb. Significant improvements were noted in the intervention group across WHODAS scores (Cohen’s d= 0.66), PTSD symptoms (d= 0.75), and DASS scores for depression (d= 0.46), anxiety (d=0.65), and stress (d= 0.47). Similar trends were noted during the follow-up phases. However, life satisfaction scores initially higher in the control group evened out by follow-up, and perceived social support was consistently lower in the intervention group. High levels of client satisfaction were reported in the intervention group, with most participants finding the sessions beneficial and expressing willingness to recommend the service to others. The qualitative interviews revealed that the integration of religious practices, such as associating stress management techniques with Adhan, significantly enhanced the acceptability of the culturally adapted PM+ intervention. Participants reported that this cultural alignment made the coping strategies more relatable and easier to adopt, contributing to improvements in both their mental health and somatic symptoms.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT04981522, identifier NCT04981522. |
| format | Article |
| id | doaj-art-e1a675e462f0437789c9194a8e0cfaaf |
| institution | Kabale University |
| issn | 1664-0640 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj-art-e1a675e462f0437789c9194a8e0cfaaf2025-01-30T06:22:20ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402025-01-011510.3389/fpsyt.2024.14138091413809Acceptability and efficacy of the culturally adapted problem management plus intervention for people with disability in Pakistan: a pilot cluster randomized controlled trialBasharat Hussain0Basharat Hussain1Muhammad Tahir Khalily2Muhammad Tahir Khalily3Ahmed Waqas4Atif Rahman5Ioannis Angelakis6Anum Nisar7Sabir Zaman8Tanveer Akhtar9Department of Psychology, International Islamic University, Islamabad, PakistanDepartment of Psychology and Human Development, Karakoram International University Gilgit, Gligit, Gilgit-Baltistan, PakistanFaculty of Social Sciences and Humanities, Shifa Tameer-e-Millat University, Islamabad, PakistanDepartment of Neurosciences, School of Medical Sciences, Academic Fellow, Universiti Sains Malaysia, Penang, MalaysiaDepartment of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United KingdomDepartment of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United KingdomDepartment of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United KingdomDepartment of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United KingdomDepartment of Psychology, International Islamic University, Islamabad, PakistanDepartment of Psychology, International Islamic University, Islamabad, PakistanBackgroundIn Pakistan, the mental health care for persons living with disabilities is insufficient, lacking a holistic approach to address their needs. This research evaluates the adapted PM+’s (IA-PM+) initial efficacy and acceptability in improving mental health among persons living with disabilities, contributing to the integration of mental health services within primary care settings in Pakistan.MethodsThis study employed a two-arm, single-blind cluster randomized controlled trial in a community setting within Union Council Kuri Dolal, Tehsil Gujjar Khan, District Rawalpindi-Pakistan. It compared an Active Treatment group, receiving five sessions of the IA-PM+ intervention, against a Delayed Treatment Control group. A total of 148 participants were randomized. Randomization occurred at the village level, with clusters assigned to either the intervention or control group. The intervention’s effectiveness and participant satisfaction were assessed using a variety of measures, including the GHQ-12, WHODAS 2.0, DASS-21, and the Client Satisfaction Questionnaire, at baseline, the 8th week, and during a 3-month follow-up. Qualitative feedback was gathered at the end of the study to assess the intervention’s acceptability among the participants.ResultsThe study achieved a 100% retention rate. Baseline demographics showed a majority male participation with a variety of disabilities predominantly lower limb. Significant improvements were noted in the intervention group across WHODAS scores (Cohen’s d= 0.66), PTSD symptoms (d= 0.75), and DASS scores for depression (d= 0.46), anxiety (d=0.65), and stress (d= 0.47). Similar trends were noted during the follow-up phases. However, life satisfaction scores initially higher in the control group evened out by follow-up, and perceived social support was consistently lower in the intervention group. High levels of client satisfaction were reported in the intervention group, with most participants finding the sessions beneficial and expressing willingness to recommend the service to others. The qualitative interviews revealed that the integration of religious practices, such as associating stress management techniques with Adhan, significantly enhanced the acceptability of the culturally adapted PM+ intervention. Participants reported that this cultural alignment made the coping strategies more relatable and easier to adopt, contributing to improvements in both their mental health and somatic symptoms.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT04981522, identifier NCT04981522.https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1413809/fulldisability and mental healthlow-and middle-income countries (LMICs)problem management plus (PM+)community-based interventionsrandomized controlled trialpsychological well-being |
| spellingShingle | Basharat Hussain Basharat Hussain Muhammad Tahir Khalily Muhammad Tahir Khalily Ahmed Waqas Atif Rahman Ioannis Angelakis Anum Nisar Sabir Zaman Tanveer Akhtar Acceptability and efficacy of the culturally adapted problem management plus intervention for people with disability in Pakistan: a pilot cluster randomized controlled trial Frontiers in Psychiatry disability and mental health low-and middle-income countries (LMICs) problem management plus (PM+) community-based interventions randomized controlled trial psychological well-being |
| title | Acceptability and efficacy of the culturally adapted problem management plus intervention for people with disability in Pakistan: a pilot cluster randomized controlled trial |
| title_full | Acceptability and efficacy of the culturally adapted problem management plus intervention for people with disability in Pakistan: a pilot cluster randomized controlled trial |
| title_fullStr | Acceptability and efficacy of the culturally adapted problem management plus intervention for people with disability in Pakistan: a pilot cluster randomized controlled trial |
| title_full_unstemmed | Acceptability and efficacy of the culturally adapted problem management plus intervention for people with disability in Pakistan: a pilot cluster randomized controlled trial |
| title_short | Acceptability and efficacy of the culturally adapted problem management plus intervention for people with disability in Pakistan: a pilot cluster randomized controlled trial |
| title_sort | acceptability and efficacy of the culturally adapted problem management plus intervention for people with disability in pakistan a pilot cluster randomized controlled trial |
| topic | disability and mental health low-and middle-income countries (LMICs) problem management plus (PM+) community-based interventions randomized controlled trial psychological well-being |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1413809/full |
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