Hamdard Force: A scalable, data-informed community-based intervention to develop a mental health workforce in Pakistan

BackgroundAs part of a MHPSS initiative, this study presents the process of developing a scalable community-based mental health intervention - Hamdard Force - which involved training and monitoring the performance of a community workforce. The Psychological First Aid (PFA) has been adapted for Pakistan to develop the digital resources for this intervention. Our objective was to train the Hamdard Force to provide basic psychosocial support, identify people with mental healthcare needs, and refer them to relevant services. MethodsWe used a multi-method design guided by the ADAPT implementation science framework to systematically adapt PFA and develop a scalable community intervention in four stages. In the first stage, we identified the constraints and facilitators for PFA implementation. To address these challenges, we adapted PFA across three domains of structure, content, and digital design. In third stage, we tested the process of recruitment and training of Hamdard Force. Lastly, we designed and tested a Hamdard Force mobile application for seeking supervision, referring people to the MHPSS service, and seeking support for their well-being. ResultsThe implementation challenges included gaps in mental health literacy; knowledge-to-practice skills; cultural and healthcare context; and for scalable and sustainable implementation. We used the FRAME approach to report the adaptations. For structural adaptation, we developed the guide into a modular design with interactive quizzes. We modified and simplified the content and added step-by-step instructions to convert it into a practical guide. Digital adaptation entailed converting the content into online courses in Urdu and English, incorporating audiovisual content and tools for course evaluation. We tested the intervention for recruitment, training and supervision of Hamdard Force with encouraging insights. ConclusionHamdard Force offers a scalable, community-based intervention to strengthen mental healthcare. Through digital resources, the intervention demonstrates a mechanism for effective implementation in low-resource settings.