District Hospital Trauma Mental Health Screening Traditional Healer Disclosure Timing and Post-Traumatic Stress Disorder Referral Uptake Among Sierra Leonean Survivors: A Target-Trial Emulation of Dual-Care Disclosure Windows

Sierra Leonean survivors of traumatic injury frequently move between district hospital trauma mental health screening and traditional healing, yet the timing of disclosure to traditional healers relative to screening may shape whether survivors accept referral for post-traumatic stress disorder (PTSD) care. Power was estimated across 2000 design cells for cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points. The design requires 54 clusters to detect a 5-percentage-point effect at 80% power. The framework specifies disclosure timing as a time-varying treatment, defines the target trial's eligibility, treatment strategies, assignment, follow-up and outcome, and identifies the confounding and selection structures that a field implementation would need to address. The contribution is a design that makes the dual-care disclosure window an estimable target rather than an unmeasured correlate, and that clarifies why conventional screening evaluations in similar settings may misestimate referral uptake.