Developing a Nonspecialist-led Mental Health Intervention for Female Caregivers of Young Children in Rural China

Maternal mental health issues are pervasive in rural China, yet community-based interventions are scarce. To address this gap, we developed the Thinking Healthy Extended Program, a nonspecialist-led intervention designed to promote mental health among female caregivers of children under the age of three, including mothers and grandmothers, in resource-constrained areas of China. Drawing on an adapted Stages of Implementation Science framework, this study describes the Exploration and Installation phases of a four-phase intervention development process. During the Exploration phase, we assessed caregivers’ mental health needs and preferences for intervention delivery through in-depth interviews. The Installation phase comprised three stages: developing the overall curriculum structure, identifying and validating curriculum topics, and integrating these topics into a comprehensive curriculum based on feedback from interviews, focus group discussions, and cognitive walkthroughs. The development process took place from 2022 to 2024 in a prefecture in southwestern China and involved 73 caregivers of children aged 6-36 months. The resulting 24-session curriculum integrates simplified cognitive reframing techniques, behavioral activation, caregiving skills, and peer support. This study demonstrates the feasibility of a systematic and participatory approach to developing a mental health intervention for low-resource populations.