Cultural Adaptation and Implementation Strategy of a Recovery-Oriented Mental Health Training Intervention (REFOCUS-THAIREC) for Healthcare Workers in Thailand: An Experience-Based Co-Design

Background: Healthcare workers are key in supporting mental health recovery, though the approach is poorly understood in many Asian countries. In Thailand, no recovery-oriented training currently exists, highlighting the need for a culturally adapted intervention that incorporates locally meaningful concepts and clarifies unfamiliar recovery principles. The present study aimed to culturally adapt an existing recovery training intervention (REFOCUS/REFOCUS-PULSAR) for use by healthcare workers in Thailand (REFOCUS-THAIREC). Methods: Experience-Based Co-Design (EBCD) was used to culturally adapt content and implementation strategies of the REFOCUS/REFOCUS-PULSAR interventions, guided by the ADAPT framework and the Model for Adaptation Design and Impact. Thirty-one participants were involved one or more of the EBCD stages, including healthcare professionals (HCPs), people with mental illness (PwM), and carers. Results: Four key adaptations were identified: a catalyst film illustrating service user experiences, a recovery-oriented care planning component, two case studies illustrating recovery journeys, and a recovery-oriented language guide. Six implementation strategies were proposed, including experiential learning, digital delivery options, preparation for lived experience trainers, separate training streams for professional and non-professional groups, practical care planning tools and the use of recovery outcome measures. Conclusion: REFOCUS-THAIREC provides a culturally relevant training approach for Thai healthcare workers and a foundation for implementing recovery-oriented practice in community mental health services. Patient or Public Contribution: Mental health service users, carers and HCPs were involved as partners in the co-design process and reviewed research materials, including the Thai Global INSPIRE questionnaire, interview topic guide and training manua.