Cultural adaptation, implementation, and analysis of a task-sharing group-based psychological intervention in Nepal

Low- and middle-income countries (LMICs) and humanitarian settings often have a high burden of psychological distress but also lack access to mental health care. This gap in treatment has led to the increasing use of task-sharing interventions that utilize non-specialists to deliver quality care. Before wide-scale dissemination, it is necessary for these interventions to be tested for feasibility, acceptability, and effectiveness. The dissertation presents an example of the necessary steps in testing a psychological intervention in an LMIC setting. These steps include a) cultural adaptation, b) testing for feasibility and acceptability, c) testing for effectiveness, and d) clarifying and testing the mechanisms for intervention effectiveness. This implementation process was conducted with World Health Organization’s Group Problem Management Plus (PM+), a trans-diagnostic, task-sharing psychosocial intervention in Nepal. Prior PM+ trials followed a similar process when testing for intervention effectiveness. This dissertation presents the first time that Group PM+ was tested in the Nepal context and the first trials that also included male participants.