Work Stream 2 – Co-developing, evaluating and enabling implementation, scale up and sustainability

Maximizing existing knowledge
We will combine and analyze data from previous studies that evaluated our proposed intervention to see what we can learn about how best to deliver Moving on ABC. We already spoken to 15 depressed breast cancer survivors before they used the intervention, 17 survivors after they used the intervention, and 12 family members about their experiences. By re-examining this data, we aim to gain a deeper understanding of their experiences, how the psychological intervention affected them and how we might deliver this in the best possible way. This will help us in determining how our intervention will be perceived, what will be the local setting in which interventions will be delivered, who will be delivering and who will receive the interventions and the process of implementation.

Co-designing an implementation strategy
We will host a one-day workshop and gather a group of diverse people for a day to decide on the best ways to implement our intervention that fits our community in a collaborative way. If we notice that certain perspectives or types of participants are missing, we’ll invite those who we have collaborated before, and ask them to recommend others they think should join. We will also invite community and religious leaders, health and education professionals and those involved in policy-making at national and provincial levels.
Process evaluation

We will work collaboratively with patients and community members and will find patterns or ideas that naturally emerge, creating overarching ideas based on that analysis. This analysis will enable us to understand key facilitators, lessons learned and barriers to implementing such intervention in our study sites – and make changes accordingly. We’ll create schedules, in Urdu, for interviews and focus groups that can be done online or in person. We’ll mix our findings with proven concepts to get a well-rounded understanding. This will help us identify the key factors that are essential for making sure our new intervention is adopted and maintained over time.

Work Stream 3 – Community and Social Media Campaign for prevention and early identification of breast cancer

In this work-stream, we will create a breast cancer prevention program using the COM-B Behavior Change Model, which focuses on three areas. Capability which include person’s mental and physical ability to act. Opportunity which include external factors that support or block the action and Motivation which include thoughts and automatic responses that drive a person to act. These three areas work together to shape behavior. The objectives include increasing awareness of breast cancer risk factors and preventive measures through a multi-model media campaign, promoting regular breast self-examinations, addressing cultural misconceptions, and evaluating the campaign’s effectiveness in improving communication about cancer awareness and treatment. A mixed-methods approach will engage active social media users aged 18 to 65, guiding the campaign across platforms like Facebook, Twitter, and Instagram. The initiative will co-produce content with 30 participants, including stakeholders and survivors, to develop interaction and impactful narratives.

Our campaign will gather data from social media metrics (views, engagement), Google Analytics, and user surveys. Impact stories will direct the campaign’s messaging for long-term sustainability. The content will be culturally tailored, translated, and aligned with the study’s objectives. A triangulation approach will integrate multiple data sources, and statistical analysis will assess changes in participants’ behaviour, capabilities, and motivations. Co-design courses with stakeholders will provide additional qualitative insights. Co-design is a participatory method to designing solutions that involves treating community members as equal partners. Especially in the public sector, co-design is a proven method of creative practice. Four principles effectively support co-design which includes: share power, use participatory means, prioritise relationships, and build capability.

There some campaigns already exist in Pakistan that encourage early detection through advocacy, free screenings, and awareness-raising events.

Work Stream 6 – Capacity Building in Research and Clinical Practice

The work-stream aims to build research capacity and capability in designing and conducting clinical trials in low- and middle-income countries (LMICs), with a focus on psychosocial interventions and care planning for depression and breast cancer. Within this WS we want to advance the use of innovative trial designs in global mental health research, ensuring trials are effective and locally relevant. The training programme will include introducing mental health research methods to early career researchers through certificate (50 students per year) and diploma (20 students per year). We will develop and deliver training in psychosocial interventions and care planning for therapists and supervisors working with depressed breast cancer survivors. In addition, using the train-the-trainer approach, we will train community health workers, nurses, and general practitioners in the assessment and early detection of breast cancer to improve research capacity in Pakistan. Our partner from Afghanistan, Dr Jandad, is supporting us in developing curriculum for this training. One very exciting output from this WS would be to enroll 6 PhD and 10 MPhil students to research oncology and mental health, focusing on breast cancer markers, psychosocial interventions, and the social impact of cancer, addressing health inequalities in LMICs like Pakistan.

Breast Cancer Awareness Session in Multan

Pakistan Institute of Living Learning organized a breast cancer awareness session 04-11-2024 at Rise Girls College, Multan, engaging over 70 plus students and teachers.Researchers from PILL discussed the causes of breast cancer and prevention strategies.

Rise College praised the initiative, expressing appreciation for the Pakistan Institute of living and learning efforts and recommending future sessions.

Breast Cancer Awareness Programme in Benazairabad

Pakistan Institute of Living and Learning (PILL) Shaheed Benazirabad (Nawabshah) conducted a Breast Cancer Awareness program in the community on 26th November 2024.

The session was organized for local Lady Health Supervisors (LHS), Lady Health Workers (LHWs), and women from the area. I engaged Miss Afshan, a psychologist from PILL, who provided valuable insights on early diagnosis, causes, prevention, and treatment of breast cancer, as well as the importance of psychosocial support.

All three of us—Mr. Mansoor Ahmed, Mr. Majid Sain Bux, and Miss Afshan from PILL—presented the Moving on After Breast Cancer (Moving on ABC) research initiative and conducted interviews with breast cancer survivors to discuss their journeys.

The community members expressed their gratitude to PILL Shaheed Benazirabad for organizing this important event and appreciated the efforts to raise awareness. They also pledged continued support for PILL’s awareness initiatives and the delivery of care.

During the session, participants not only gained crucial knowledge, but also engaged actively in discussions. This fostered a sense of unity and teamwork as they collectively addressed an important health issue, emphasizing the need for such efforts to raise awareness among women in Nawabshah and surrounding areas.

World Breast Cancer Day 2024 Commemorated at Bab ul Madinah Institute of Health Sciences, Peshawar

Peshawar, 15 October 2024 – World Breast Cancer Day with a successful event aimed at raising awareness about breast cancer diagnosis and treatment. The event drew an enthusiastic crowd of 60 participants, including female BS Nursing students, teachers and healthcare professionals. Dr. Alia and Dr. Maimoona, both esteemed professionals in the field of oncology, led the session, delivering insightful presentations that highlighted the importance of early detection, advancements in treatment options, and strategies for overcoming challenges associated with breast cancer. Their discussions were tailored to educate participants on how to recognize early symptoms, seek timely medical advice, and adopt healthier lifestyles as preventive measures. Psychologists from PILL Peshawar team also presented and highlighted the mental health aspects related to breast cancer.

Participants expressed appreciation for the speakers’ expertise and dedication to making complex medical information accessible. The event concluded with a collective pledge by participants to support breast cancer awareness initiatives and contribute to early detection efforts within their communities.

Uniting for a Cause: Breast Cancer Awareness

Participants expressed appreciation for the speakers’ expertise and dedication to making complex medical information accessible. The event concluded with a collective pledge by participants to support breast cancer awareness initiatives and contribute to early detection efforts within their communities.

Dr. Tayyeba Kiran Highlights Mental Health in Breast Cancer Care at ‘Turning the Tide’ Programme

Dr. Tayyeba Kiran was invited as a panelist to represent Pakistan Institute of Living and Learning at awareness programme “Turning the Tide” organised by NORI Hospital. During the panel discussion Dr Kiran talked about importance of prioritizing mental health during all stages of breast cancer starting from diagnosis to survivorship. She talked about depression, anxiety, self-image and self-esteem related concerns. She also highlighted the importance of social support to overcome mental health related difficulties during survivorship.

PILL Team Sparks Breast Cancer Awareness at Rawalpindi Women University

The PILL Team in Rawalpindi has successfully organised a breast cancer awareness session with students at Rawalpindi Women University. Dr. Huma Sabir, Assistant Professor of Surgery and a General Laparoscopic and Breast Surgeon at the Rawalpindi Medical University (RMU), talked about importance of early detection and self-examination, encouraging students to take charge of their health. Ms. Farah Zulqarnain from PILL discussed the emotional impact of breast cancer on patients and families, highlighting how young people can actively support awareness and prevention efforts.

Karachi, Community Awareness Session on Breast Cancer

A community awareness session on breast self-examination for early breast cancer detection was conducted in Karachi, with 50 women. During the session, participants openly shared their concerns and personal experiences related to potential symptoms, leading to referrals for further assessments where needed. The session also included comprehensive psychoeducation on the steps for self-examination, impacts of early detection, and associated risk factors, provided through both written materials and verbal guidance to enhance understanding and encourage proactive health practices.

Awareness Session in Multan

Breast cancer awareness event at Multan with community workers at BHU on 23rd October 2024.

Workshop on Research Planning and Scientific Writing

Rawalpindi Pill team participated in a one-day workshop on Research Planning and Scientific Writing, organized in collaboration with the Burns Unit PIMS Islamabad. The workshop aimed to enhance participants’ skills in designing research studies, drafting scientific manuscripts, and adopting evidence-based practices.At the end of the training, the team was honored with certificates presented by the hosting organization, BURNCON.

Training Attendees Explore Innovative Approaches to Supporting Patients with Chronic Illness

Prof Zainab F Zadeh and Dr Tayyeba Kiran attended one day training on “Working with long-term physical illness and medically unexplained symptoms: Help your patients reclaim their lives from illness, disability, pain or fatigue” facilitated by Professor Chris Williams, Fellow Royal College of Psychiatrists and Hon Fellow BABCP, on 6th November. During the session Dr Kiran and Prof Zadeh discussed the opportunity to co-adapt training material to incorporate this into the high intensity CBT intervention manual for breast cancer survivors with comorbid depression in Pakistan (NIHR205561)

Deductive Coding Session

Second session facilitated by Dr Helen Brooks on Deductive Coding in Framework Analysis

Framework Analysis Training Session: A Collaborative Learning Experience

An interactive training session on the Framework Analysis was facilitated by Helen Brooks (University of Manchester), work-stream 2 co-lead on our project “Integrated Psychosocial Care Plan for Comorbid Depression in Breast Cancer Patients in Low Resources Settings – NIHR205561”. The early career researchers got the opportunity to ask questions related to inductive coding, situations where Framework analysis is most suitable, and Gale’s approach.

Clinical and Cost-Effectiveness Discussion: ‘Moving on ABC’ Interventions

An interactive session was conducted with the ‘Moving on ABC’ team regarding the orientation session of WS1. The session focused on determining the clinical and cost-effectiveness of three interventions: 1) low-intensity guided self-help, 2) Moving on ABC Plus, and 3) Moving on ABC Plus combined with antidepressants.”

GDPR Training Session Conducted for NIHR RIGHT 6 Research Team

A training session was conducted by Dr Hyder Abbas on General Data Protection Regulations (GDPR) for research team working on the NIHR RIGHT 6 funded programme “Integrated Psychosocial Care Plan for Comorbid Depression in Breast Cancer Patients in Low Resources Settings – NIHR205561”. Dr Abbas has worked over 20 years in Hospital and in Family Medicine England. He has been a clinical governance and training lead in his practice and for local Health authorities. During the session, research team got opportunities to discuss topics such as breach of confidentiality, rights of participants to rectify information provided by them during research, data transfer etc.

CEI Meeting

An introductory meeting to plan CEI work for Moving on ABC in Sri Lanka

Moving on ABC Training

Prof Zainab F Zadeh and Dr Tayyeba Kiran attended one day interactive training programme on “15 minute CBT for use in clinical teams 2024: a 5 areas approach for use with adult and older adult patients” by Prof Christopher Williams (University of Glasgow, Five Areas Limited) on 16th October 2024. This was an excellent opportunity to brainstorm ideas on refinement of low intensity guided self-help intervention for depressed breast cancer survivors in NIHR RIGHT 6 funded project “Integrated Psychosocial Care Plan for Comorbid Depression in Breast Cancer Patients in Low Resources Settings” (NIHR205561)

3rd Investigators’ Meeting of Moving on ABC

Meeting with The Minister of Health, AJ&K

PILL team met with the Minister of Health, AJ&K, Dr. Nisar Ansar Abdali, today in Muzaffarabad. During the meeting, the team presented PILL’s ongoing projects and overall contributions to mental health and well-being. Dr. Abdali expressed keen interest in PILL’s initiatives and extended his full cooperation.
In a significant development, the Health Department of AJ&K has committed to providing space for PILL offices in Muzaffarabad, Rawalakot, and Mirpur. This collaboration is expected to strengthen mental health services and outreach in the region.

Rawalpindi Team Participated in the Pink Fest

The PILL Rawalpindi team participated in the Pink Fest in collaboration with the Pakistan Institute of Medical Sciences (PIMS). They organized a “Counseling and Support” stall for breast cancer patients, where the trained PILL team offered their services to visitors. Many participants also provided their consent to be contacted for future involvement in the “Moving on After Breast Cancer” (NIHR205561) project.

Meeting with CEO & Administration of Rehman Medical Institute

The PILL team had an excellent meeting with the CEO and administration of Rehman Medical Institute (RMI), Peshawar. RMI is a state-of-the-art medical institute offering a wide range of specialties in the medical field. It is the only medical institute in the region with an established Clinical Research Trial Unit, setting it apart as a leader in healthcare innovation and research.

The meeting focused on collaboration for the NIHR-funded project, “Moving on After Breast Cancer” (NIHR205561). The RMI administration appreciated PILL’s efforts, warmly welcomed the initiative, and expressed their interest in formalizing the partnership through a Memorandum of Understanding (MoU) to support and advance this significant cause.

Meeting with Dr. Akif Ullah Khan (Tamgh-e-Imtiaz)

PILL team had a productive meeting with Dr. Akif Ullah Khan (Tamgha-e-Imtiaz) Director of the Institute of Radiotherapy and Nuclear Medicine (IRNUM) Hospital and Chairman of the IRNUM Patient Welfare Society. The discussion focused on fostering support and collaboration for the NIHR-funded”Moving on After Breast Cancer” project (NIHR205561).
IRNUM, renowned as the largest cancer hospital in Khyber Pakhtunkhwa, plays a vital role in providing advanced cancer care to patients from the region and across the border.
During the meeting, Dr. Akif Ullah Khan extended a warm welcome to the PILL team and expressed his commitment to supporting this significant initiative, emphasizing its importance in improving the quality of life for breast cancer survivors.

Day 4 Highlights – 10th Global Capacity Building Programme, Dubai

The day featured a focused session on Risk Assessment, led by Dr. Rakhshi Memon, followed by workstream leads identifying potential risks and mitigation strategies for their respective areas. Additionally, Dr. Tayyeba Kiran presented the Trial Delivery Manual, sparking productive discussions on implementation.

10th Global Capacity and Capability Building Programme, Dubai

The third day featured an engaging Planning and Review Session, focusing on all workstreams of NIHR Funded Project (NIHR 205561) Moving on After Breast Cancer Plus Programme. Key discussions included Clinical and Cost-Effectiveness of Adaptive Interventions, Co-Development, Scale-up, and Sustainability, Community and Social Media Campaign, Economic Impact of Mental Health, Policy Engagement, Capacity Building in Research and Practice and Breast Cancer Registry Setup

The day ended with a collective discussion on the way forward for impactful implementation.

A Productive Meeting Co-Chaired by Dr. Tayyeba Kiran & Prof Zia ul Haq

PILL Peshawar Team Held a productive meeting co-chaired by Dr. Tayyeba Kiran and Prof. Zia Ul Haq, Vice Chancellor of Khyber Medical University. The discussion focused on the planning and progress review of the Moving on ABC project in KPK. Additionally, strategic planning and mapping were conducted to ensure optimal outcomes.

Global Mental Health Expert Leads Session on Developing Delivery Manual for SMART Trial

Prof Nusrat Husain, Director Global Mental Health, University of Manchester, co-application and workstream lead on the NIHR RIGHT 6 funded project “Integrated Psychosocial Care Plan for Comorbid Depression in Breast Cancer Patients in Low Resources Settings” (NIHR205561), conducted an interactive one – day session with research team to provide guidance on developing a “step by step” delivery manual for SMART trial. The session was co-facilitated by Prof Mowadat H Rana, consultant psychiatrist, and Dr Aneela Maqsood, lead center for research on suicide prevention, Fatima Jinnah Women University.

Innovating Health Solutions: PILL Presents at Shaukat Khanum Hospital Seminar

An e-poster competition took place at a seminar organized by Shaukat Khanum Hospital at PC Hotel Lahore. Mr. Suleman Shakoor, representing the Health Economics group of PILL, presented a poster on the burden of oral cancer in Pakistan. The event highlighted significant health challenges and fostered discussion on innovative solutions.