Background The mhGAP Humanitarian Intervention Guide (mhGAP-HIG) offers an evidence-based intervention to strengthen the capacity of non-specialists to manage mental, neurological, and substance use conditions in humanitarian contexts. The Ministry of Planning, Development and Special Initiatives (MoPD&SI) developed a Mental Health and Psychosocial Support (MHPSS) service model for Pakistan in 2021. As part of the model, this study identified implementation gaps and described the process of contextualizing mhGAP-HIG to address them.

Methods We explored the implementation gaps through a three-step process, including a desk review, a focus group discussion, and four key informant interviews with relevant stakeholders. A thematic analysis using the framework method was applied. We followed the World Health Organization’s recommended process for contextualization and conducted an adaptation workshop. This was followed by a comprehensive review of the guide with reference to the country’s healthcare context and clinical practices, and a Delphi consensus achieving 90% success. We field tested the contextualized guide with training of trainers; and training of primary healthcare workers using pre- and post- knowledge assessment, analyzed via paired t-test.

Results We identified four implementation gaps: knowledge, skills and attitude, knowledge-to-practice, training resource, and supervision gaps. While contextualizing, these gaps were addressed by incorporating additional knowledge; cultural constructs; instructions for interview, examination and interventions; and translating these instructions into Urdu language. To address the training resource gaps, the MoPD&SI published the adapted guide as a national resource; and developed a mobile application that serves as a complete reference and provides integrated features for remote supervision. The field testing of the adapted guide demonstrated its educational effectiveness, relevance, user-friendliness, and feasibility for implementation.

Conclusions This study presents a systematic contextualization and field-testing of mhGAP-HIG. It demonstrates that successful contextualization requires a culturally grounded, system-aware, and stakeholder-informed approach. We recommend integrating the guide into pre-service training and ensure policy support for integration into primary care for long-term outcomes.

The authors have declared no competing interest.

The reporting and publication of this research are not funded by any organization.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was conducted as part of the Mental Health and Psychosocial Support Project, approved by the Ministry of Planning, Development & Special Initiatives in compliance with ethical standards and consent protocols under letter no. 6(262) HPC/2020.

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The data that support the findings of this study are available from the Health Section at the Ministry of Planning, Development & Special Initiatives, Government of Pakistan. Confidentiality restrictions apply to the availability of the data used under the license for the current study, and so are not publicly available. However, the data can be made available from the authors upon reasonable request after formal approval from the Ministry of Planning, Development & Special Initiatives, Pakistan.