Community Mental Health Services Faith-Healing Referral Contracts and Antipsychotic Initiation Delay in Ghanaian Catchments: A Target-Trial Emulation

Faith-healing referral contracts between community mental health services and Pentecostal healing camps in Ghanaian catchments create a structured pathway in which first-episode psychosis patients are referred to prayer camps before antipsychotic initiation. the present analysis characterises the operating characteristics of a before-after-control-impact design intended to estimate the causal effect of such contracts on antipsychotic initiation delay, using a target-trial emulation framework. No observational data are used or claimed. Under a declared variance structure with between-cluster standard deviation of 6.0, residual standard deviation of 4.5 and intraclass correlation of 0.64, power was estimated across 2000 replications per design cell 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 analysis specifies the identification assumptions, the estimand and the sensitivity of power to the intraclass correlation, and it establishes the boundary conditions under which a target-trial emulation of referral contracts can support causal inference about antipsychotic initiation delay in Ghanaian community mental health settings.