Building Frontline Capacity to Support Flood-Affected Women: A Pilot PFA and PM+ Intervention in Pakistan

Background and Purpose

The 2022 monsoon floods in Pakistan affected nearly 33 million people, with Sindh experiencing the most devastation. Global research shows that women experience a heightened psychological impact from disasters, which is further exacerbated in low-income countries like Pakistan due to fragile healthcare systems. This study piloted a low-cost, tailored intervention combining World Health Organization (WHO)- endorsed Psychological First Aid (PFA) and Problem Management Plus (PM+) to assess its effectiveness on the mental health of flood-affected women in Thatta and explore the experiences of health workers and recipients.

Methods

A mixed-methods design was used. In Phase I, a scoping visit informed the adaptation of PFA and PM+ manuals, followed by capacity-building training and pre/post assessments of N = 7 female health workers or Lady Health Visitors (LHVs). In Phase II, LHVs in Thatta recruited N = 40 flood-affected community women or Marvi workers (MWs), who were symptomatic for psychological distress (K-10 ≥ 20), and provided four monthly PFA and PM+ sessions. In both phases, convenience sampling was used for the selection of participants. Changes in depression, anxiety, PTSD, and resilience (PHQ-9, GAD-7, PCL-5, RS-14) were assessed at baseline and endline. Qualitative insights were gathered through FGDs with N =5 LHVs and IDIs with N= 6 MWs. A paired samples t-test was conducted to compare the pre- and post-training assessment scores of LHVs, and to compare the scores of MWs at baseline and endline. Whereas, thematic analysis was conducted using a deductive approach to analyze qualitative data.

Results

A paired sample t-test revealed a significant decrease in depression, anxiety, and PTSD scores of MWs at the end of the PFA and PM+ sessions (p < .001). No significant increase was observed in the resilience of MWs. Training assessments revealed an increase in the overall training scores of LHVs, with the highest growth in their PFA and PM+ dissemination skills. However, after accounting for Bonferroni correction for multiple comparisons, these results were insignificant. A thematic analysis of FGD and IDIs showed an increased understanding and application of coping strategies, emotional and psychological relief, empowerment, problem-solving skills, and greater community support and resilience. Barriers included socio-economic constraints and challenges in developing engagement and trust during the sessions, while facilitators involved support and readiness for the intervention.

Conclusion and Implications

The present study demonstrated preliminary evidence for the effectiveness of our low-cost, tailored PFA and PM+ intervention in reducing depression, anxiety, and PTSD symptoms among flood-affected women in Pakistan, though improvements in resilience were not statistically significant. Qualitative results revealed expressions of resilience among participants, including problem-solving skills, adoption of positive coping skills, and empowerment. To our knowledge, this is the first pilot study incorporating both PFA and PM+ strategies in a post-flood region like Sindh in Pakistan. These findings highlight the potential and scalability of culturally tailored and adapted, community-delivered interventions in disaster-affected settings. Additionally, the insights emphasize the need for policy reforms at the community level with a focus on building mental health capacity and support groups.