Developing and feasibility testing of Hamdard Force: an intervention to build the capacity of a community mental health workforce in Pakistan

As part of a Mental Health and Psychosocial Support (MHPSS) initiative, this study presents the process of developing an intervention to build the capacity of a community mental health workforce in Pakistan - Hamdard Force (HF). Our objective was to build the capacity of a community mental health workforce to provide basic psychosocial support, identify people with mental healthcare needs, and refer them to relevant services. For this purpose, we explored implementation challenges, developed a context-specific intervention based on adaptation of the Psychological First Aid (PFA) Guide, and developed integrated digital resources. We used a multi-method design guided by the ADAPT implementation science framework to systematically develop an intervention to build the capacity of a community mental health workforce in four stages. In the first stage, we identified the challenges for training a community workforce. In the second stage, we addressed these challenges by adapting the PFA Guide across three domains of structure, content, and digital design; and developed training resources needed for implementation. In the third stage, we tested the processes of recruitment, training and supervision. Lastly, we planned a pilot implementation. For structural adaptation, we developed the guide into a modular design with interactive quizzes. For content adaptation, we addressed gaps in mental health literacy; knowledge-to-practice skills; cultural and healthcare context; and for scalable and sustainable implementation. We modified and simplified the content and added step-by-step instructions to convert it into a practical guide. We used the adapted guide to develop digital resources, including online courses in Urdu and English, and a HF mobile application to access the courses, seek supervision, and refer people with mental healthcare needs. Finally, we used FRAME guidance to document these adaptations. Through intersectoral collaboration, a large number of people were registered on the web portal, while only 107 completed the online courses in two weeks, showing a significant improvement in their knowledge and encouraging feedback supporting the intervention. Hamdard Force is a feasible intervention to build the capacity of a community mental health workforce in low-resource settings.