Developing a Culturally Adapted Occupational Mental Health Intervention for Healthcare Workers in Post-Conflict Northern Nigeria

Healthcare workers in post-conflict North East Nigeria experience severe occupational mental health burdens from compound trauma exposure, yet no evidence-based culturally adapted occupational mental health interventions have been developed for this population. This doctoral study used intervention development methodology to create, pilot, and evaluate a culturally adapted occupational mental health intervention for healthcare workers in Borno and Adamawa States. A five-phase Medical Research Council complex intervention framework guided the study. Phases One and Two conducted systematic evidence synthesis and qualitative needs assessment with 120 healthcare workers and 25 local mental health specialists. Phase Three adapted the WHO Group Problem Management Plus approach through 12 co-design workshops with community stakeholders. Phase Four conducted a randomized controlled pilot trial with 160 participants. Phase Five undertook process evaluation and implementation fidelity assessment. The adapted intervention, delivered by trained peer facilitators over eight weeks, incorporated Islamic spiritual coping frameworks, community solidarity principles, and trauma-informed psychoeducation modules. Pilot trial results demonstrated significant reductions in psychological distress (PHQ-9 change: -6.3 versus -1.8 in controls, p less than 0.001) and improvements in work functioning scores. Fidelity assessment confirmed 78.9 percent protocol adherence. The study produces an original, rigorously developed occupational mental health intervention with demonstrated preliminary efficacy in a complex humanitarian health context and recommends a full multi-site randomized controlled trial in North East Nigeria. Keywords: mental health intervention, post-conflict, healthcare workers, cultural adaptation, North East Nigeria.