Psychosocial Counseling Research Articles

ДІЯЛЬНІСТЬ СЛУЖБ ТЕЛЕФОНУ ДОВІРИ В ПЕРІОД ПАНДЕМІЇ

Hotline services remain a responsible component of suicide prevention and an important part of psychosocial counseling during the period of rapid development of information technologies and social networks. The COVID-19 pandemic throws new challenges to hotline services due to forced restrictions on direct communication between people. The most important functions of remote counseling services during this period are to inform about safe behavior during a pandemic, and to reduce anxiety and stress, the absence of health and life hazards, restrictions on joint communication and the need for isolation and removal. As a result of the analysis of information available through Internet search engines, there are currently about 30 hotlines in Ukraine, which provide consulting services both for certain categories of client and for all comers. There are four specialized national hotlines in Ukraine, which are operated by non-governmental organizations. Regarding the models of organization of hotlines in Ukraine, in contrast to Western European countries, where the volunteer model predominates, the professional model is mostly presented, i.e., the organization on the basis of professional counseling of specialists such as psychologist, medical doctor (usually psychiatrist), lawyer, social worker, pedagogue, etc. In some services, "peer to peer" model of counselling is present at the same time as professional counseling, in particular, on the National HIV / AIDS hotline and Lifeline Ukraine for veterans. During the pandemic period, new hotlines have been established, in particular in countries such as China, the United States, Brazil, and Ukraine, and a significant increase in the number of hotline calls (Germany, Austria). We interviewed 23 respondents, including 10 professional hotline consultants and 13 hotline volunteers. According to the respondents, during the pandemic period, the number of requests related to information about COVID-19. There is a lot of inaccurate information in the information space about coronavirus treatment, vaccination, the requirement to use personal protective equipment, the importance of state quarantine restrictions and the requirement to limit physical contact with other people. Therefore, the hotline consultants have a new task – to provide reliable and verified information on the spread of COVID-19, the importance of contacting a family doctor in case of ill health, debunking myths and fakes. In Ukraine, there is an increase in appeals from people belonging to "at risk" groups – the elderly, health care workers, people with chronic diseases who have fears and feelings about physical and psychological well being. There has also been an increase in calls about domestic violence and other domestic problems. The rise of the volunteer movement, which could observed in Ukraine since 2014, has given impetus to the wider introduction of the volunteer model in the field of hotline services also during the pandemic.

Transition-Related Discussions Among Adolescent Females With Turner Syndrome: Current Practices and Associated Factors

ObjectiveTo examine the current transition practices and factors associated with the occurrence and timing of transition-related discussions among adolescents with Turner syndrome (TS). MethodsA retrospective chart review was conducted at a large pediatric academic center among females with TS seen between 12 and 25 years of age. Medical/developmental characteristics, the age at transition, documented transition-related discussions, and the utilization of transition readiness assessment tools were abstracted. Analyses were conducted to examine the age/occurrence of discussions and associated factors. ResultsRecords of 112 patients were reviewed. The average age of TS diagnosis was 7.6 ± 5.8 years, and the average age of those that transitioned from pediatric to adult care (n = 21) was 20.1 ± 2.0 years. Only 22% of individuals had documented discussions regarding transition to adult care, and no transition readiness tools were utilized. The majority of transition-related discussions began between 11 and 15 years. Estrogen and cardiovascular counseling were common (84% and 75%, respectively). Less than half of the subjects had reproductive (40%), lifestyle (43%), and psychosocial (12%) discussions. Cardiovascular conditions were associated with transition to adult care discussions, and neurodevelopmental conditions were associated with psychosocial counseling. In those that transitioned to adult care, transition-related discussions occurred in only half of patients. ConclusionOur findings emphasize the need for the development and implementation of a standardized transition process for adolescents with TS, with particular attention to transition to adult care and reproductive, lifestyle, and psychosocial counseling. The utilization of formal transition tools may also help prepare these girls for transition to adult care.

Policy Analysis on the Mental Health Needs of Overseas Filipino Workers: Addressing Gaps through Evidence-based Policy Reform

Background. There is an increasing number of distressed Overseas Filipino Workers (OFWs) due to adverse working conditions and unresolved post-repatriation issues. The enactment of the Republic Act 11036 (Mental Health Act) in 2018 supports the commitment of the State in promoting and protecting the mental health of every Filipino.
 Methods. A systematic review of literature was conducted to generate evidence-based policy tools for the round table discussion conducted by the UP Manila Health Policy Development Hub, engaging all major stakeholders from all sides of the policy issue. Strengths and challenges of the current government initiatives in the phases of predeployment, deployment, repatriation, and reintegration were discussed to attain consensus policy recommendations.
 Results. Increased migration led to a cascade of distressed OFWs and their subsequent need for trained mental health professionals. In host countries, challenges in on-site services include (i) limited psychiatry practice as prescribed by law of the host countries, (ii) reciprocity of the host country in allowing more welfare officers, and (iii) budget to support more plantilla items of Assistance to Nationals (ATN) staff. The inter-agency collaboration and legal support for all phases of migration should be holistic and set.
 Conclusions and Recommendations. From the literature review and policy discussion, consensus recommendations included strengthening pre-deployment preparation, curbing the trafficking of minors, improving psychiatry practice through the Bilateral Labor Agreement, developing psychosocial counseling competencies among front line host country personnel, enhancing telecounselling services and exploring telemedicine, among others.

Depressive symptoms and use of HIV care and medication-assisted treatment among people with HIV who inject drugs.

Vietnam, Indonesia, and Ukraine have major burdens of IDU and HIV. We estimated the prevalence of depressive symptoms at baseline among people living with HIV who inject drugs, evaluated associations between depression at baseline and 12-month HIV care outcomes and medication-assisted treatment (MAT), and evaluated the study intervention effect by baseline depression subgroups. HPTN 074 was a randomized study. The study intervention included psychosocial counseling, systems navigation, and antiretroviral treatment (ART) at any CD4+ cell count. Moderate-to-severe depression was defined as a Patient Health Questionnaire-9 score of 10 or above. ART and MAT were self-reported. Eligibility criteria were: 18-60 years of age, active IDU, and viral load of at least 1000 copies/ml. Adjusted probability differences (aPD) were estimated using inverse-probability weighting. A total of 502 participants enrolled from April 2015 to June 2016. Median age was 35 years; 85% identified as men. Prevalence of baseline moderate-to-severe depression was 14% in Vietnam, 14% in Indonesia, and 56% in Ukraine. No evident associations were detected between baseline depression and ART, viral suppression, or MAT at 12-month follow-up. The study intervention improved the proportions of people who inject drugs achieving 12-month viral suppression in both the depressed [intervention 44%; standard of care 24%; estimated aPD = 25% (95% confidence interval: 4.0%, 45%)] and nondepressed subgroups [intervention 38%; standard of care 24%; aPD = 13% (95% confidence interval: 2.0%, 25%)]. High levels of depressive symptoms were common among people living with HIV who inject drugs in Ukraine but were less common in Vietnam and Indonesia. The study intervention was effective among participants with or without baseline depression symptoms.

The Role of Emotion in Cancer Surgery Decisions: Applying Concepts From Decision Psychology.

The Role of Emotion in Cancer Surgery Decisions: Applying Concepts From Decision Psychology.

A cross-sectional study on the attitudes and perceptions of outpatients towards palliative care at the Hong Kong Queen Mary Hospital Hospice Centre.

Palliative care aims to improve the quality of life for patients and their families, by helping them to cope with problems associated with illness. It targets four aspects of health: physical, psychological, social, and spiritual. Most of the current literature on palliative care is limited to the perspectives of health professionals. This study aims to investigate the views of outpatients receiving palliative care at the Hong Kong Queen Mary Hospital Hospice Centre (HKQMHHC), which offers palliative care services to cancer patients. This observational cross-sectional study was performed with the completion of a single paper- based original questionnaire over 18 afternoon clinic sessions on Thursdays and Fridays from December 2017 to February 2018 at the HKQMHHC. The questionnaire was designed to examine patients' perspectives; in particular, the Edmonton Symptom Assessment Scale (ESAS) was used to assess their symptoms. Descriptive and univariate analyses were performed. One hundred patients attending HKQMHHC were included in the study. The study revealed that all the mean scores for aspects of care offered at the centre were above 8, on a scale of 0-10 with 0 being extremely inadequate and 10 being extremely adequate. Each respondent was able to identify an average of 1.82 of the 4 aspects of palliative care. Eighty-seven percent of respondents perceived the physical aspect of this care to be of the highest priority. A negative correlation (P<0.05) was found between the extent of symptoms experienced by the patient and their satisfaction towards the services offered. Patients generally held very positive attitudes, reflecting that the services sufficiently met their needs. However, owing to their rather limited knowledge, this may have restricted their perspectives to a largely superficial level, as many discerned palliative care to be simply targeting physical health with medical consultations. Considering the implications of the results, the addition of accessibility and education components to Hong Kong's current system of palliative care is crucial in the betterment of such services for patients. There should also be increased local coverage of palliative care services to facilitate convenience of access. With reference to the World Health Organisation (WHO) palliative care model, the inclusion of a continued spectrum of services, such as physical and mental health activities and psychosocial counselling, should be reinforced throughout the progression of disease so as to better help patients to cope with illness. The discovery of the relationship between extent of symptoms experienced and patients' satisfaction towards services provided is a new direction for further study.

Assessing psychosocial conditions for social reintegration of former Maoist combatants and communities in Nepal

ABSTRACT While the disarmament, demobilisation and reintegration literature emphasises that social reintegration of ex-combatants is key to sustainable peace, few analyses exist, leading to limited understanding of reintegration dynamics and subsequently ad hoc programme design. We examined the psychosocial conditions faced by 223 ex-combatants from the People’s Liberation Army and 213 host community stakeholders in Nepal in 2012 and 2013, specifically investigating the relation between Post-Traumatic Stress Disorder (PTSD), factional ties and Readiness to Reconcile in ex-combatants. Despite ex-combatants’ positive attitudes and perceptions of their host communities, many struggled to generate an income. Ex-combatants who were likely to suffer from PTSD reported lower readiness to reconcile with former enemies. Having factional ties did not impact willingness to reconcile, but was associated with reduced PTSD. Most community stakeholders positively regarded the arrival of these ex-combatants. However, a minority expressed alarm about political differences, war grievances and ex-combatants’ problematic behaviour. Critical activities identified to facilitate social reintegration are psychosocial trauma support and counselling, social interaction and peace education programmes and continued socio-economic support for both communities and ex-combatants.

Students' perspectives on interventions to reduce stress in medical school: A qualitative study.

The mental health of medical students remains to be a matter of concern. Numerous setting-based and individual-based interventions for student mental health have been proposed in the literature. However, the student perspective on those interventions has been largely neglected. This study aims to explore how medical students perceive different interventions and if they desire any additional changes with regard to their studies. Eight focus groups with 71 participants were conducted at a large German medical school. Focus groups were recorded, transcribed and content-analyzed using MAXQDA 18. We found that medical students prefer setting-based interventions. Most proposed interventions were on a setting-based level. For instance, students asked for more information on the university’s psychosocial counseling services and for better information management regarding contact persons. Interventions proposed in the literature received mixed reactions: Several participants did not favour a pass/fail grading system. Students considered a peer-to-peer mentoring program for freshmen very helpful. Students had diverse attitudes towards Balint groups. They approved of several self-management courses, most of them being related to time or stress management. Interestingly, the most urgently wanted interventions appear to be rather easy to implement (e.g. a mentoring program). This study explored the medical student perspective on student mental health interventions. Additionally, our study illustrates the benefit and feasibility of involving students early on in the conception of interventions. Further research with a representative sample is needed to obtain broader information on the acceptance of the suggested interventions.

Opinion & Special Articles: Competency in Serious Illness Communication for Neurology Residents.

Until 2019, the only reference that the Accreditation Council for Graduate Medical Education (ACGME) made to discussion of patients' care values was an indirect one: that neurology residents must “demonstrate knowledge of palliative care, including adequate pain relief as well as psychosocial support and counseling for patients and families.”1 In 2009, a nationwide study demonstrated neurology residents' poor knowledge of palliative care across multiple domains, including discussing end-of-life care preferences.2

Lived experiences of palliative care among people living with HIV/AIDS: a qualitative study from Bihar, India

ObjectivesThis study aimed to assess the lived experiences of palliative care among critically unwell people living with HIV/AIDS (PLHA), caregivers and relatives of deceased patients. It also aimed to understand...

Relationship Between Marriage Satisfaction and Sexual Functions in Couples Undergoing Infertility Treatment

Objectives To determine the relationship between marriage satisfaction and sexual functions in couples undergoing infertility treatment. Methods This cross-sectional study was conducted with 110 heterosexual couples who attended an outpatient infertility clinic in Turkey, between June 2018 and June 2019. Results In the study, 77.3% of the women and 43.6% of the men receiving infertility treatment experienced sexual dysfunction. Increased marital satisfaction is linked with better sexual function for infertile couples. Age, economic status, duration of marriage, type of marriage, duration of treatment, marriage satisfaction were determined to be significant predictive factors of the sexual functions of the infertile couples. Conclusion Healthcare providers may apply psychosocial care, education and counseling services toward increasing the marriage satisfaction and sexual functions of infertile couples.

Integration of mental health counselling into chronic disease services at the primary health care level: Formative research on dedicated versus designated strategies in the Western Cape, South Africa.

To explore health care providers' views on the acceptability and feasibility of two models for integrating facility-based counsellor delivered mental health counselling into chronic disease care, and how such an approach could be improved in South Africa. Fourteen focus group discussions and 25 in-depth individual interviews were conducted with 109 health care workers and facility managers from 24 primary health clinics in the Western Cape, South Africa. Findings suggested that despite recent efforts to integrate mental health counselling into chronic disease services for common mental disorders, there remains limited availability of psychosocial and psychological counselling. Feedback on the two models of integration suggested equipoise and the potential of a hybrid approach where these approaches may be tailored to the specific needs and available resources of each facility. Participants identified constraints within the health system and broader social context that require consideration for integrating mental health counselling into chronic disease care. Although study participants unanimously agreed that counselling for common mental disorders should be integrated into chronic disease services, they had differing views on the type of model that should be adopted. There is a need for further testing of the two models and aspects of the health service that may require strengthening to implement any such model.

PREVALENCE OF DEPRESSION AMONG UNIVERSITY STUDENTS: A CROSS-SECTIONAL STUDY

The prevalence of depression among Malaysians is on the rise. The current state of work and social pressures caused the depression to be declared as the common mental illness among Malaysian by 2020. This mental illness may cause mental health problems among university students due to stress resulted from stressful events in the university environment. Without proper treatment, this can cause disability and even suicide. However, knowing the fact that depression is a treatable illness, therefore, address the illness, and develop preventive strategies in managing mental wellbeing is needed. The primary objective of the present study is to determine the prevalence and severity of depression among university students in Malaysia. This quantitative and cross-sectional study employed 175 undergraduate students from a public university in a rural area. Depression and the severity of the depression were assessed using the validated Patient Health Questionnaire (PHQ-9). Descriptive statistics were used to analyse the data to answer research objectives. Approximately 23.43% of participants experienced depression, which included 1.68% of mild depression, 8.98% of moderate depression, and moderately severe depression, and the remaining 3.37% of severe depression. A considerable proportion of undergraduate students with depression found in this study has called upon the management of the university to pay serious and priority attention to develop psychosocial counselling or targeted intervention for identified depressed students.

Mental health interventions in healthcare workers in infectious disease outbreak-A systematic review

BackgroundExtended evidence has established that healthcare workers face several mental health problems during a disease outbreak, which could have a long-term impact. To address these issues, elaboration and implementation of psychological/psychiatric interventions or strategies is of utmost importance. In this context, this systematic review aimed at identifying strategies to manage mental health issues in healthcare workers during infectious disease outbreaks.MethodsPubMed, Cochrane, Scopus and Web of Science were searched to retrieve pertinent articles published in English until May 2020. Articles reporting measures, interventions, strategies, or recommendations to manage mental health problems in healthcare workers during an infectious disease outbreak, of any study design were included. The quality assessment was performed according to the study design of the included articles.ResultsOur search strategy produced a total of 2358 articles. After the screening process 33 articles met the inclusion criteria, addressing COVID-19 (40%), followed by SARS (21%) and Ebola Virus (15%). The findings emphasized that organisations should follow an evidence-based approach and establish comprehensive programs to assist hospital staff during disease outbreaks. The preliminary results show that the creation of a psychological response team, training, e-learning, courses, psychosocial counselling, screening instruments and telemedicine activities could improve the capacity of response and coping, and reduce mental health issues in healthcare workers.ConclusionsTo minimize the psychological impact of future infectious disease outbreaks, evidence-based intervention strategies should be implemented to retain mental health among healthcare workers. Our results may provide the necessary insights that could be applied during the COVID-19 pandemic.Key messages During infectious disease outbreaks healthcare workers are faced with mental health issues, that need to be addressed through tailored interventions offering coping strategies and increase resilience.Mental health related interventions or strategies include the implementation of professional training, psychosocial counselling, courses, and the creation of a psychological response team.

Integrating psycho–social counselling in TB Services in Armenia

Abstract Background Community or family-based DOT improves clinical outcomes and quality of life of TB patients compared to facility-based DOT. Based on a previously conducted clinical trial and recommended best practice guidelines, Armenia started the institutionalization of the family-based DOT in 2019, as an important component of the integrated people-centered approach in TB treatment. Psycho-social counselling and education played a crucial role in preparing patients/family members for this new model of care. Methods To facilitate the family-based DOT, multidisciplinary counseling teams consisting of a TB nurse and a psychologist or a TB nurse and a social worker were formed and further incorporated into the existing TB care system. After a systematic evaluation the strongest applicants were shortlisted, interviewed, and selected. They underwent a three-day training, improving their knowledge on TB disease, its transmission, diagnosis and treatment; patient counseling with an emphasis on motivational interviewing techniques; and people-centered TB care. A comprehensive package of procedural documents was developed to facilitate the counseling teams work process, including a guideline on counseling, reporting forms, and patients' educational materials. At an early stage of TB treatment, the counseling teams provide psycho-social counselling to patients and their families, and educate them on TB risk factors and infection control. Results The counselling teams have been based in the National Center of Pulmonology of the RA and provide psycho-social counselling to all drug susceptible TB patients and their family members all over Armenia. The counseling teams prepare patients/family members for the family-based DOT and provide continuous support during the entire treatment. The integration of counselling teams in the TB care system has provided the required human resource and capacity for the successful adoption of a new model of people-centered TB care in Armenia.

Understanding Men's Experiences With Prostate Cancer Stigma: A Qualitative Study.

The purpose of this study was to explore the experiences and perspectives of men who have had prostate cancer to better understand the effect of prostate cancer and associated stigmas on men in the Canadian province Newfoundland and Labrador (NL). Eleven men from NL who have had prostate cancer participated in semistructured interviews exploring their perspectives and experiences of prostate cancer and stigma. A social-ecological framework was used to understand experiences from different domains. Interviews were analyzed using Lichtman's three Cs approach. Analysis focused on establishing themes of the participants' lived experience of prostate cancer and related stigma. Participants described how emasculating a prostate cancer diagnosis can feel. They identified ways prostate cancer negatively affected their behaviors and sense of self, described coping with the diagnosis and different strategies, and talked about broader system change required to address prostate cancer stigma. Participants expressed a need for additional support from healthcare providers (HCPs). HCPs, such as oncology nurses, may be able to reduce stigmatization by providing patient navigation, improving information delivery, or providing psychosocial counseling to individuals experiencing feelings of internal or external stigmatization related to prostate cancer.

Deaths in Prison Custody: A Scoping Review of the Experiences of Staff and Bereaved Relatives

Abstract Prison populations are growing globally with an increase in older and infirm prisoners, as well as longer prison sentences, meaning more prisoners are likely to die while incarcerated. This scoping review explored the experiences of death in prison custody on staff and relatives. Ovid MEDLINE, Embase, CINAHL and PsycINFO were professionally searched, followed by a hand search. Empirical and non-empirical studies of deaths in prison custody were screened. Data extraction used Arksey and O’Malley’s framework. Thematic analysis was underpinned by Braun and Clarke for identifying, analysing and reporting patterns. From 12,127 citations retrieved, 174 were selected for full-text review and 22 were included in the final scoping review. Thematic analysis revealed four themes: (i) transformative effect, (ii) time delays, (iii) conflicts of interest and (iv) support. Prison staff avoided contaminating their personal lives. Families were distressed by inaccurate and untimely information, inappropriate constraints and poor communication. Staff balanced security and humanitarian needs. Bereaved relatives and staff felt isolated, alienated and unsupported. Unmet advocacy, communication and social care needs, poor end-of-life and bereavement care could be improved through staff training and social work intervention. Staff need psychosocial support, supervision and counselling.

Psychosocial After-Care to Increase Quality of Life?

This study examines to what extent individuals who need psychosocial support actually benefit from the following support services: capability-oriented activities, mobile caring and support, psychosocial counselling centre, and assisted living. Furthermore, the impact of these support services on clients' quality of life is investigated. We statistically analysed data (n = 2,099) collected via client satisfaction surveys over five years (2013 to 2017). The clients reported the benefits they experienced regarding various aspects such as living, coping with everyday life, or confidence, as well as their perceived quality of life. The data suggest, that psychosocial after-care can improve and stabilize clients' quality of life. Clients of all types of support services reported similar improvements of their quality of life. However, clients from different types of support services reported different kinds of benefits, and, accordingly, improvements in quality of life were predicted from different kinds of benefits.

Impact of naturopathy, yoga, and dietary interventions as adjuvant chemotherapy in the management of stage II and III adenocarcinoma of the colon.

Naturopathy, Yoga and Dietary interventions are known to improve the quality of life in cancer patients. We aim to evaluate the effect of naturopathy interventions along with adjuvant chemotherapy in patients who underwent surgery for Adenocarcinoma of the Colon. A total of 116 adult patients were randomised in to one of the two groups; the experimental group received naturopathy, Yoga and Dietary interventions and the control group received psycho-social counselling in addition to standard chemotherapy. Haematological, biochemical and psychological evaluations were performed at set intervals during a total period of eighteen months starting from the first cycle of adjuvant chemotherapy. Results showed that the overall hemoglobin (p < 0.0001) and carcinoembryonic antigen (CEA) (p = 0.0038) levels were statistically significant in patients on the experimental arm. The rest of the laboratory parameters, viz. total leukocyte count, platelet counts, and serum creatinine levels, for overall data was not statistically significant in both the groups. Psychological attributes such as anxiety, depression, symptom severity, and Functional Living Index: Cancer (FLIC) were found to be statistically significant (p < 0.0001) in the experimental subjects as compared with those in the control. On the whole, men benefited more than women from the study interventions. We conclude that Yoga and Naturopathy interventions in addition to chemotherapy show improvement in overall functional life index along with improvement in haemoglobin in patients with stages II and III Adenocarcinoma of Colon.

Comparing a standard and tailored approach to scaling up an evidence-based intervention for antiretroviral therapy for people who inject drugs in Vietnam: study protocol for a cluster randomized hybrid type III trial

BackgroundPeople who inject drugs (PWID) bear a disproportionate burden of HIV infection and experience poor outcomes. A randomized trial demonstrated the efficacy of an integrated System Navigation and Psychosocial Counseling (SNaP) intervention in improving HIV outcomes, including antiretroviral therapy (ART) and medications for opioid use disorder (MOUD) uptake, viral suppression, and mortality. There is limited evidence about how to effectively scale such intervention. This protocol presents a hybrid type III effectiveness-implementation trial comparing two approaches for scaling-up SNaP. We will evaluate the effectiveness of SNaP implementation approaches as well as cost and the characteristics of HIV testing sites achieving successful or unsuccessful implementation of SNaP in Vietnam.MethodsDesign: In this cluster randomized controlled trial, two approaches to scaling-up SNaP for PWID in Vietnam will be compared. HIV testing sites (n = 42) were randomized 1:1 to the standard approach or the tailored approach. Intervention mapping was used to develop implementation strategies for both arms. The standard arm will receive a uniform package of these strategies, while implementation strategies for the tailored arm will be designed to address site-specific needs.Participants: HIV-positive PWID participants (n = 6200) will be recruited for medical record assessment at baseline; of those, 1500 will be enrolled for detailed assessments at baseline, 12, and 24 months. Site directors and staff at each of the 42 HIV testing sites will complete surveys at baseline, 12, and 24 months.Outcomes: Implementation outcomes (fidelity, penetration, acceptability) and effectiveness outcomes (ART, MOUD uptake, viral suppression) will be compared between the arms. To measure incremental costs, we will conduct an empirical costing study of each arm and the actual process of implementation from a societal perspective. Qualitative and quantitative site-level data will be used to explore key characteristics of HIV testing sites that successfully or unsuccessfully implement the intervention for each arm.DiscussionScaling up evidence-based interventions poses substantial challenges. The proposed trial contributes to the field of implementation science by applying a systematic approach to designing and tailoring implementation strategies, conducting a rigorous comparison of two promising implementation approaches, and assessing their incremental costs. Our study will provide critical guidance to Ministries of Health worldwide regarding the most effective, cost-efficient approach to SNaP implementation.Trial registrationNCT03952520 on Clinialtrials.gov. Registered 16 May 2019.