From Global to Local: Cultural Adaptation of Self-Help Plus Intervention for Medical Students’ Mental Health Support. An Experience from Pakistan

Background: Medical students frequently experience psychological distress due to intense academic demands and high-stakes assessments.Scalable psychological interventions such as Self-Help Plus (SH+) may support student well-being, but contextual adaptation is required to ensure relevance within medical education.Objective: To adapt the SH+ intervention culturally and contextually for medical students while maintaining the core principles of Acceptance and Commitment Therapy (ACT). Methods:The adaptation followed Bernal's cultural adaptation framework.Modifications aligned the intervention with the academic and clinical realities of medical training while preserving fidelity to the original SH+ model. Results:The core structure and therapeutic components of SH+ were largely compatible with the medical education context and required no major structural changes.Key adaptations included simplifying psychological terminology and contextualizing ACT concepts through experiences common in medical training, such as examinations, Objectively Structured Practical Examination (OSPE) anxiety, ward rotations, and professional identity formation.A major adaptation involved removing the pre-recorded audio format, which students perceived as time-consuming and less engaging, and replacing it with facilitator-led interactive sessions.Peer support elements were incorporated to enhance engagement, reflection, and shared learning. Conclusion:The adapted SH+ intervention preserved therapeutic fidelity while improving contextual relevance and feasibility for medical students, offering a scalable strategy to support stress management and resilience in medical education