Thinking local, thinking healthy: Cultural and contextual adaptation of the Thinking Healthy Programme in Nepal

Background: The thinking healthy program (THP) is an evidence-based psychological intervention for perinatal depression designed for delivery by nonspecialist health workers. To ensure its relevance in Nepal, we adapted THP using the mental health Cultural Adaptation and Contextualization for Implementation (mhCACI) framework. Methods: Using mhCACI's 10-step process, we applied a participatory approach involving a multidisciplinary team to adapt both content and implementation strategies. A qualitative study nested within a pilot trial was conducted to assess feasibility and acceptability of adapted THP through in-depth interviews with perinatal women (n = 20), family members (n = 11) and focus group discussions with Female Community Health Volunteers (FCHVs) (n = 16). Results: FCHVs were selected as delivery agents. Implementation adaptations included reducing the number of THP sessions from 16 to 8, integration of additional 2.5-day Foundational Helping Skills training and skill-based training methods. Manual revisions included simplified language, cultural idioms, visual aids and locally relevant examples. Referral pathways for gender-based violence, suicide and severe mental illness were included. The adapted THP was well received by providers and recipients. Conclusion: The adaptation demonstrates how global interventions can be contextually tailored for low-resource settings while preserving therapeutic integrity, offering a scalable model for community-based mental health care.