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Bandal A, Hernández S, Mustafa R, Choy K, Edwards N, Guarchaj M, Mejía Alvarez M, Sane A, Tschida S, Maliye C, Miller A, Raut A, Srinivasan R, Turner M, Wagenaar BH, Ertem I, Grazioso MDP, Gupta SS, Krishnamurthy V, Rohloff P. Methodology for adapting a co-created early childhood development intervention and implementation strategies for use by frontline workers in India and Guatemala: a systematic application of the FRAME-IS framework. Glob Health Action 2024; 17:2338324. [PMID: 38726569 PMCID: PMC11089920 DOI: 10.1080/16549716.2024.2338324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/28/2024] [Indexed: 05/15/2024] Open
Abstract
There is little evidence on optimizing the effectiveness and implementation of evidence-based early childhood development (ECD) interventions when task-shifted to frontline workers. In this Methods Forum paper, we describe our adaptation of the International Guide for Monitoring Child Development (GMCD) for task-shifting to frontline workers in Guatemala and India. In 2021-2022, implementers, trainers, frontline workers, caregivers, and international GMCD experts collaborated to adapt the GMCD for a task shifted implementation by frontline workers. We used an eight-step co-creating process: assembling a multidisciplinary team, training on the existing package, working groups to begin modifications, revision of draft modifications, tailoring of visual materials and language, train-the-trainers activities, pilot frontline worker trainings, final review and feedback. Preliminary effectiveness of adaptations was evaluated through narrative notes and group-based qualitative feedback following pilot trainings with 16 frontline workers in India and 6 in Guatemala. Final adaptations included: refining training techniques to match skill levels and learning styles of frontline workers; tailoring all visual materials to local languages and contexts; design of job aids for providing developmental support messages; modification of referral and triage processes for children in need of enhanced support and speciality referral; and creation of post-training support procedures. Feedback from pilot trainings included: (1) group consensus that training improved ECD skills and knowledge across multiple domains; and (2) feedback on ongoing needed adjustments to pacing, use of video-based vs. role-playing materials, and time allocated to small group work. We use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) framework to document our adaptations. The co-creating approach we use, as well as systematic documentation of adaptation decisions will be of use to other community-based early childhood interventions and implementation strategies.
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Affiliation(s)
- Amruta Bandal
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | - Sara Hernández
- Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala
| | - Revan Mustafa
- Department of Pediatrics, Acıbadem Maslak Hospital, Istanbul, Turkey
| | - Karyn Choy
- Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala
| | - Namrata Edwards
- Early Childhood Development and Disabilities, Ummeed Child Development Centre, Mumbai, India
| | - Magdalena Guarchaj
- Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala
| | | | - Anushree Sane
- Early Childhood Development and Disabilities, Ummeed Child Development Centre, Mumbai, India
| | - Scott Tschida
- Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala
| | - Chetna Maliye
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | - Ann Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Abhishek Raut
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | - Roopa Srinivasan
- Early Childhood Development and Disabilities, Ummeed Child Development Centre, Mumbai, India
| | - Morgan Turner
- Department of Global Health, University of Washington, Seattle, USA
| | - Bradley H. Wagenaar
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Ilgi Ertem
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Subodh S. Gupta
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | - Vibha Krishnamurthy
- Early Childhood Development and Disabilities, Ummeed Child Development Centre, Mumbai, India
| | - Peter Rohloff
- Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, USA
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Wambua GN, Stein A, Seedat S, Sijbrandij M, Baisley K, Shahmanesh M, Seeley J, Ngwenya N. Adaptation and feasibility of WHO PM+ for adolescents living with HIV in KwaZulu-Natal Province, South Africa: an implementation feasibility study protocol. BMJ Open 2024; 14:e088992. [PMID: 38986556 PMCID: PMC11243136 DOI: 10.1136/bmjopen-2024-088992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/21/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Adolescents living with HIV (ALHIV) are an extremely vulnerable population, with the burden of mental health problems carefully documented together with the constraints for receiving timely and adequate management of the problems, especially in rural settings. Problem Management Plus (PM+) is a scalable psychological intervention for individuals impaired by distress in communities exposed to adversity. Initially developed for adult populations, few studies have assessed its potential to address adolescent distress. This study aims to co-adapt PM+ with an adherence component (PM+Adherence) for ALHIV and to evaluate its acceptability and feasibility in rural Kwa-Zulu Natal Province, South Africa. METHODS AND ANALYSIS We will use a mixed-methods approach over three phases. The first phase will include a realist synthesis and collection of formative data from up to 60 ALHIV, caregivers and healthcare providers to inform the adaptation of WHO PM+, including the components of an adherence module. During the second phase, we will undertake the cultural adaptation of the PM+Adherence intervention. The third phase will involve a hybrid type 3 implementation strategy among ALHIV aged 16-19 years (n=50) to implement and evaluate the feasibility of the culturally co-adapted PM+Adherence. The feasibility indicators to be evaluated include reach, adoption, attrition, implementation and acceptability of the adapted intervention, which will be assessed qualitatively and quantitatively. In addition, we will assess preliminary effectiveness using an intention-to-treat approach on HIV-related indicators and mental health outcomes at baseline, end intervention, 2-month follow-up during the 6-month implementation. DISCUSSION We expect that the PM+Adherence will be acceptable and can feasibly be delivered by lay counsellors in resource-limited rural KwaZulu-Natal. ETHICS AND DISSEMINATION Ethical clearance has been obtained from the University of KwaZulu-Natal Biomedical Research Ethics Committee, (BREC/00005743/2023). Dissemination plans include presentations at scientific conferences, peer-reviewed publications and community level.
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Affiliation(s)
| | - Alan Stein
- Africa Health Research Institute, Durban, KwaZulu Natal, South Africa
- University of Oxford, Oxford, UK
| | - Soraya Seedat
- SAMRC/SU Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Marit Sijbrandij
- Vrije Universiteit, Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Kathy Baisley
- Africa Health Research Institute, Durban, KwaZulu Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, Durban, KwaZulu Natal, South Africa
- University College London, London, UK
| | - Janet Seeley
- Africa Health Research Institute, Durban, KwaZulu Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
- University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa
| | - Nothando Ngwenya
- Africa Health Research Institute, Durban, KwaZulu Natal, South Africa
- University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa
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Fischer R, Bailey Y, Shankar M, Safaeinili N, Karl JA, Daly A, Johnson FN, Winter T, Arahanga-Doyle H, Fox R, Abubakar A, Zulman DM. Cultural challenges for adapting behavioral intervention frameworks: A critical examination from a cultural psychology perspective. Clin Psychol Rev 2024; 110:102425. [PMID: 38614022 DOI: 10.1016/j.cpr.2024.102425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/14/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
We introduce the bias and equivalence framework to highlight how concepts, methods, and tools from cultural psychology can contribute to successful cultural adaptation and implementation of behavioral interventions. To situate our contribution, we provide a review of recent cultural adaptation research and existing frameworks. We identified 68 different frameworks that have been cited when reporting cultural adaptations and highlight three major adaptation dimensions that can be used to differentiate adaptations. Regarding effectiveness, we found an average effect size of zr = 0.24 (95%CI 0.20, 0.29) in 24 meta-analyses published since 2014, but also substantive differences across domains and unclear effects of the extent of cultural adaptations. To advance cultural adaptation efforts, we outline a framework that integrates key steps from previous cultural adaptation frameworks and highlight how cultural bias and equivalence considerations in conjunction with community engagement help a) in the diagnosis of behavioral or psychological problems, b) identification of possible interventions, c) the selection of specific mechanisms of behavior change, d) the specification and documentation of dose effects and thresholds for diagnosis, e) entry and exit points within intervention programs, and f) cost-benefit-sustainability discussions. We provide guiding questions that may help researchers when adapting interventions to novel cultural contexts.
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Affiliation(s)
- Ronald Fischer
- Institute D'Or for Research and Education, Sao Paulo, Brazil; School of Psychology, Victoria University of Wellington, New Zealand.
| | | | - Megha Shankar
- Division of General Internal Medicine, Department of Medicine, University of California San Diego, USA
| | - Nadia Safaeinili
- Division of Primary Care and Population Health, Stanford School of Medicine, USA
| | - Johannes A Karl
- School of Psychology, Dublin City University, Dublin, Ireland; School of Psychology, Victoria University of Wellington, New Zealand
| | - Adam Daly
- School of Psychology, Dublin City University, Dublin, Ireland
| | | | - Taylor Winter
- School of Mathematics and Statistics, University of Canterbury, New Zealand
| | | | - Ririwai Fox
- School of Psychology, University of Waikato, Tauranga, New Zealand
| | - Amina Abubakar
- Aga Khan University, Nairobi, Kenya & Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Donna Michelle Zulman
- Division of Primary Care and Population Health at Stanford University & Center for Innovation to Implementation (Ci2i) at VA Palo Alto, USA
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Shrivastava R, Singh A, Khan A, Choubey S, Haney JR, Karyotaki E, Tugnawat D, Bhan A, Naslund JA. Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India. SSM - MENTAL HEALTH 2023; 4:100230. [PMID: 38188869 PMCID: PMC10769151 DOI: 10.1016/j.ssmmh.2023.100230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Background Community health workers (CHWs) face high levels of stress (both professional and personal) and risk of burnout, highlighting the need for efforts to promote their mental health and well-being. This study seeks to develop a digital stress reduction program for CHWs in rural India. Methods A stepwise design process was employed to adapt and digitize the evidence-based World Health Organization's Self-Help Plus (SH+) intervention for addressing psychological distress among CHWs in Madhya Pradesh, India. This involved participatory design workshops with CHWs to ensure that the digital stress reduction intervention would be relevant for their needs and the local culture and context. Small groups of CHWs reviewed the adapted program content, allowing the research team to make refinements such as simplifying language, tailoring content to the local setting, and ensuring that program materials are both interesting and relevant. Simultaneously, the research team digitized the content, leveraging a combination of video and graphical content, and uploaded it to the Sangath Learning Management System, a digital platform accessible on a smartphone app. Results In total, 18 CHWs contributed to the adaptation of the SH+ content and digital intervention development. Participants commented on finding some terms difficult to follow and recommended simplifying the language and providing detailed explanations. Participants offered positive feedback on the adapted content, expressing that they found the examples covered in the material both relatable and relevant to their own personal experiences at home and in the workplace. By combining participants' insights and comments with feedback from content experts, it was possible to finalize a digital Hindi version of the SH+ intervention for CHWs in rural India. Conclusions This study is timely given the continued detrimental impacts of the COVID-19 pandemic, and offers a promising and potentially scalable digital program to alleviate psychological distress among frontline health workers.
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Affiliation(s)
| | | | | | | | | | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Katende D, Nalweyiso N, Nabulime G, Nakuya K, Mubiru MC, Sekitoleko I, Baisley K, Nyirenda M, Grosskurth H. Sustainability capacity and health worker normalisation of a successful non-communicable disease (NCD) health systems intervention within primary care settings in Uganda: a quantitative approach to a qualitative question. BMC Health Serv Res 2023; 23:970. [PMID: 37679742 PMCID: PMC10486082 DOI: 10.1186/s12913-023-09948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Interventions for non-communicable diseases are increasingly implemented and evaluated in sub-Saharan Africa, but little is known about their medium- to long-term sustainability beyond the end of research funding. A cluster randomised trial conducted between 2013 and 2016 in Uganda and Tanzania showed that an intervention package to improve hypertension (HT) and type-2 diabetes mellitus (DM) care was highly effective in increasing service readiness and quality of care. The present study assesses the sustainability of the intervention 4 years after the trial in Uganda. METHODS The study was conducted in 2020 in 22 primary care health facilities (HFs) (3 referrals and 19 lower-level units) that had received the intervention package until trial end (2016), to assess their current capacity and practice to sustain ongoing intervention activities for HT and DM care. Through a cross-sectional survey, 4 pre-defined domains (i.e., cognitive participation, coherence, collective action, and reflexive monitoring) were examined with regard to health worker (HW) normalization and 8 pre-defined domains for intervention sustainability (i.e., organisational capacity, local environment, funding stability, partnerships, communication, evaluation, adaptation, and strategic planning), using the normalisation tool and the program sustainability tool (PSAT). Summary scores were assessed by domains and facility level. RESULTS Overall normalization strength was adequate at 4.0 (IQR: 3.8, 4.2) of a possible 5 with no evidence of association with HF level (p = 0.40); cognitive participation (buy-in) and reflexive monitoring (appraisal) were strongest at > 4 across all HF levels. All HF levels were weak (< 4) on collective action (teamwork) and coherence (sense-making). Only collective action differed by level (p < 0.002). Overall intervention sustainability was suboptimal at 3.1 [IQR: 1.9, 4.1] of a possible 7 with weak scores on funding stability (2.0), supportive partnerships (2.2), and strategic planning (2.6). Domain differences by HF level were significant for environmental support (p = 0.02) and capacity in organisation (p = 0.01). Adequate strength at a cut-off mean of ≥5 did not differ by HF level for any domain. CONCLUSIONS Four years after their introduction, practice-dependent intervention elements e.g., local organisational context, HW knowledge or dedication were sustained, but external elements e.g., new funding support or attracting new partners to sustain intervention efforts were not. Whenever new interventions are introduced into an existing health service, their long-term sustainability including the required financial support should be ensured. The quality of services should be upheld by providing routine in-service training with dedicated support supervision.
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Affiliation(s)
- David Katende
- London School of Hygiene and Tropical Medicine, London, UK.
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda.
| | | | | | - Kevin Nakuya
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Isaac Sekitoleko
- London School of Hygiene and Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kathy Baisley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Moffat Nyirenda
- London School of Hygiene and Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
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Knettel BA, Knippler E, Martinez A, Sardana S, Agor D, Mwobobia J, Ledbetter L, Amiri I, Relf MV, Goldston DB. A scoping review of counseling interventions for suicide prevention in Africa: Few studies address this life-saving aspect of mental health treatment. J Affect Disord 2023; 328:183-190. [PMID: 36806597 PMCID: PMC10068682 DOI: 10.1016/j.jad.2023.02.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Nearly 800,000 people die by suicide each year, with 77 % occurring in low- and middle-income countries. Suicide is underestimated in many African settings due to challenges in data collection, stigma, and policies that promote silence; nonetheless, rates of suicide in Africa are consistently higher than global averages. METHODS We conducted a scoping review of counseling interventions assessing suicide outcomes among adults in Africa using MEDLINE, Embase, PsycINFO, African Index Medicus, CABI Global Health, and Proquest databases. Study screening and data extraction was informed by the JBI Manual for Evidence Synthesis. RESULTS Of 2438 abstracts reviewed, 33 studies met criteria for full-text review and 13 were included in the analysis. Interventions served several populations, including people living with HIV, out of school youth, university students, and women undergoing obstetric fistula repair. There was a near-equal split in individual versus group counseling modalities and the use of professional versus lay counselors. The majority of interventions had primary outcomes focused on other mental health or social variables with a secondary focus on suicide. Mechanisms of change for suicide prevention were poorly articulated. LIMITATIONS The review was limited to English-language studies conducted after 2001 and excluded qualitative studies and those with fewer than 10 participants. CONCLUSIONS There is a clear paucity of research in this area, particularly in the lack of randomized clinical trials and studies with suicide prevention as their primary outcome. Researchers should seek to develop or adapt evidence-based, culturally-resonant interventions to reduce the burden of suicide on the African continent.
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Affiliation(s)
- Brandon A Knettel
- Duke University School of Nursing, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Elizabeth Knippler
- Duke University School of Nursing, Durham, NC, USA; Duke Center for AIDS Research, Duke University, Durham, NC, USA
| | - Alyssa Martinez
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Srishti Sardana
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
| | - David Agor
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - Judith Mwobobia
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Leila Ledbetter
- Duke University Medical Center Library and Archives, Durham, NC, USA
| | - Ismail Amiri
- Duke Global Health Institute, Duke University, Durham, NC, USA; Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Michael V Relf
- Duke University School of Nursing, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - David B Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
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Rabbani F, Akhtar S, Nafis J, Khan S, Siddiqi S, Merali Z. Addition of mental health to the lady health worker curriculum in Pakistan: now or never. HUMAN RESOURCES FOR HEALTH 2023; 21:29. [PMID: 37072767 PMCID: PMC10112305 DOI: 10.1186/s12960-023-00814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
The technical advisory group of the World Health Organization (Geneva, Switzerland) has suggested person-centered and community-based mental health services in response to the long-term and far-reaching mental health impacts of the COVID-19 pandemic. Task shifting is a pragmatic approach to tackle the mental health treatment gap in low- and middle-income countries. Pakistan is dismally resourced to address the mental health challenges. Pakistan's government has established a lady health worker's program (LHW-P) which can be effectively utilized to provide some basic mental health services at community doorsteps. However, lady health workers' current curriculum does not include mental health as a subject. WHO's Mental Health Gap Intervention Guide (mhGAP-IG) Version 2.0 for mental, neurological, and substance use disorders in non-specialist health settings can be adapted and utilized to be included as part of the LHW-P curriculum in Pakistan. Thus, the historical lack of access to mental health support workers, counsellors, and specialists can be addressed. Additionally, this will also help to reduce the stigma associated with seeking mental health care outside the boundaries of home, mostly at a huge cost.
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Affiliation(s)
- Fauziah Rabbani
- Brain and Mind Institute, Aga Khan University, Karachi, Pakistan.
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan.
| | - Samina Akhtar
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Javeria Nafis
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Shahid Khan
- Population and Public Health Stream, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Zul Merali
- Brain and Mind Institute, Aga Khan University, Karachi, Pakistan
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Greene MC, Bonz A, Isaacs R, Cristobal M, Vega C, Andersen LS, Angulo A, Armijos A, Guevara ME, Benavides L, Cruz ADL, Lopez MJ, Moyano A, Murcia A, Noboa MJ, Rodriguez A, Solis J, Vergara D, Wainberg M, Tol WA. Community-based participatory design of a psychosocial intervention for migrant women in Ecuador and Panama. SSM - MENTAL HEALTH 2022; 2. [DOI: 10.1016/j.ssmmh.2022.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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