Adaptation of an integrated Behavioural Activation and physical activity intervention for women with depression and type 2 diabetes mellitus in Pakistan

Background Integrated Behavioural Activation and physical activity interventions (BAcPAc) have the potential to tackle depression and type 2 diabetes mellitus (T2DM) multimorbidity. However, such interventions, developed in high-income countries, may need to be adapted and contextualized to be appropriate for use in low and middle-income countries. The objective of this study was to adapt a BAcPAc intervention to tailor it for women with depression and T2DM living in Pakistan. Methods Two co-design informed workshops with key stakeholders (people with depression and T2DM, carers, healthcare workers, and social workers) were conducted. The purpose of workshop 1 was to identify facilitators and barriers to the delivery of the original BAcPAc intervention as per the domains of the Bernal cultural adaptation framework (language, persons, metaphors, content, concepts, goals, methods, context). Based on the findings of workshop 1, changes were made to the original intervention. Stirman’s adaptation classification was used to map the changes. In workshop 2, participants’ feedback was used to refine and finalise the contents of the adapted intervention. Results A total of 21 participants attended workshop 1, while 16 participants attended workshop 2. Barriers and enablers were identified in all domains of the Bernal’s framework. Changes were made in the language, pictures/illustrations, intervention dose and delivery, training intensity, and evaluation measures. Conclusion This study produced a theoretically informed, culturally adapted BAcPAc intervention for women with depression and T2DM living in Pakistan.