A Technology-Assisted Platform for Delivering Caregiver Skills Training in Rural Pakistan: A Formative Acceptability Study

Background Scaling non-specialist-delivered psychosocial interventions requires infrastructure for provider training, supervision, quality assurance, monitoring and referral. Developing these functions separately for each intervention can create fragmented systems and duplicate resources. The Technology-Assisted Platform for Mental Health (TAP) was developed as reusable digital implementation infrastructure that facilitates task-shifted intervention delivery and initially validated for a perinatal depression intervention. This study examined whether the substantially different World Health Organization Caregiver Skills Training programme (WHO CST) could be configured within TAP and assessed the preliminary prototype’s acceptability in rural Pakistan. Methods A two-phase formative study was conducted in rural Rawalpindi District between September 2025 and July 2026. First, four multidisciplinary workshops mapped CST’s content, delivery processes and implementation requirements onto the existing TAP architecture. Three family peer-provider dyads then undertook simulated usability testing, informing iterative prototype refinement. Second, TAP-CST was field-tested, followed by qualitative interviews with CST trainers (n = 2), family peer-providers (n = 2) and caregiver-users (n = 3). Interviews were informed by the Theoretical Framework of Acceptability and analysed using framework analysis. Results CST’s nine group sessions and three home visits were configured as structured digital workflows without altering their core content or sequence. CST-specific processes were incorporated across TAP’s six implementation functions: identification and screening, competency-based training, intervention delivery and decision support, supervision, monitoring and outcome assessment, and risk management and referral. Simulated testing identified minor problems involving navigation, video access and session flow, which were addressed before field testing. Across participant groups, TAP-supported delivery was viewed as acceptable, useful and contextually relevant. Family peer-providers valued having structured guidance, activities and videos available at the point of delivery, reducing reliance on recalled training and increasing perceived confidence. Trainers reported greater continuity between provider preparation and intervention delivery. Caregiver-users found provider-facilitated videos and activities understandable and applicable to interactions with their children. Acceptability was therefore associated with the combination of accessible digital guidance and family peer-provider support, rather than digitisation alone. The longer-term operation of supervision, monitoring and referral functions was not established. Conclusions WHO CST could be configured within TAP while preserving its core intervention content and delivery structure. The preliminary prototype was acceptable to trainers, family peer-providers and caregiver-users, providing early support for TAP’s potential as reusable implementation infrastructure across different psychosocial interventions. Larger-scale studies should evaluate provider competence, fidelity, effectiveness, equitable reach, costs and sustainability.