Translation and Contextualisation of the Substance Use Disorders Module of the WHO mhGAP Intervention Guide for Primary Care Settings in Pakistan

Abstract

Background: Substance use disorders (SUDs) are a leading public health concern worldwide, particularly in low- and middle-income countries (LMICs), with an estimated 75% treatment gap. To bridge this gap, the World Health Organization (WHO) launched the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) to scale up mental health services globally and strengthen the capacity of non-specialists equipped with skills to deal with SUDs. However, its implementation in Pakistan remains limited due to the lack of an accessible Urdu-language version for frontline healthcare workers. This study describes the process of translating and contextualising the mhGAP-IG SUD module to address treatment and implementation gaps within low-resource primary healthcare settings.

Methods: We used a qualitative research design within a participatory approach. The mhGAP-IG SUD module was first translated into Urdu using the MAPI guidelines. Focus group discussions (N = 23) with key stakeholders—primary care physicians (PCPs), mental health professionals, and social workers—were conducted, along with five cognitive debriefing interviews with PCPs. A six-step framework thematic analysis informed the contextualisation and comprehension of the Urdu version of the mhGAP-IG SUD module.

Results: During contextualisation, multiple linguistic and conceptual adaptations were made without altering clinical algorithms (e.g., defining terminologies). These adaptations also featured contextually familiar expressions to improve comprehension and relevance (e.g., adding brief descriptions of technical terms) and the use of dual-language terminologies.

Conclusion: This study presents a systematic translation and contextualisation of the mhGAP-IG SUD module. The resulting Urdu version, currently published on the WHO website, is culturally appropriate and offers support to primary healthcare workers. This work demonstrates that successful contextualisation requires a culturally grounded and participatory approach. We recommend the inclusion of this guide in pre-service training and its integration into Pakistan’s primary healthcare system to ensure long-term policy support.