Cultural adaptation and preliminary evaluation of the psychosis REACH family intervention in Pakistan

Most individuals with mental disorders reside in low- and middle-income countries (LMICs), where care is often provided by family members. However, Family Interventions for psychosis (FIp) are rarely adapted for LMIC contexts. Using a validated cultural adaptation framework, we adapted Psychosis Recovery by Enabling Adult Carers at Home (Psychosis REACH) - an intervention designed for delivery outside of clinical settings - and evaluated the adapted version (Ca-REACH) among families affiliated with a mental health rehabilitation clubhouse in Lahore, Pakistan. A Fountain House clinician delivered Ca-REACH to 40 caregivers of individuals with psychosis through eight in-person group sessions. Feasibility was demonstrated across multiple process indicators: all 40 caregiver-resident dyads consented (100% recruitment), caregiver retention was high, session attendance averaged 96.5% and assessments were completed at baseline, post-intervention and 4-month follow-up. Data completeness among residents was 85%. Perceived feasibility, acceptability and appropriateness (FIM, AIM, IAM) all exceeded the benchmark score of 4.0 (<i>M</i> = 4.42-4.79). Caregivers demonstrated significant improvements in anxiety and psychological well-being, with marginal reductions in depression. Residents showed significant improvements in PANSS general and total symptom scores. Findings support the acceptability and promise of Ca-REACH as a feasible, culturally responsive, community-delivered FIp in a low-resource setting.