Co-designing maternal mental health interventions and implementation strategies under climate stress in Nigeria: a participatory workshop

Abstract

Background Climate change is a risk multiplier in low- and middle-income countries, threatening maternal mental health and early childhood development. In Nigeria, environmental shocks intensify these risks, yet responses remain fragmented across sectors. Using a participatory implementation-science approach, this study co-designed a psychosocial intervention package and accompanying implementation strategies to protect maternal mental health under climate stress. Methods A full-day co-creation workshop was conducted in Enugu, Nigeria, involving 16 stakeholders (affected mothers, community health workers, community leaders, data collectors, and policymakers). Grounded in prior systematic review, national quantitative, and qualitative evidence, the workshop utilised participatory inquiry to map implementation determinants and the Expert Recommendations for Implementing Change (ERIC) taxonomy to select and categorise implementation strategies. Participants progressed through determinant mapping, appraisal of candidate components from Low-Intensity Psychological Interventions (LIPI) and WHO Problem Management Plus (PM+), delivery framework co-design, and strategy prioritisation via dot-voting. Results Stakeholders identified environmental shocks as key drivers of maternal anxiety, distress, and trauma. From eight candidate components, participants retained five for the preliminary Climate Adaptation and Psychosocial Support (CANOPY) candidate package: behavioural activation, cognitive restructuring, managing worries and problems, lifestyle, and strengthening social support. Three PM + components were discarded as duplicative, whereas strengthening social support was added to leverage existing community networks. Participants developed three preliminary delivery frameworks pairing psychosocial support with environmental protection. These frameworks represent proposed delivery channels requiring further operational specification. Voting favoured immediate, actionable implementation strategies and frontline health-system strengthening over slower legislative and structural reforms. Conclusion Stakeholders pragmatically prioritised feasible, frontline community and health system strategies over structural policies. Prospective implementation of the CANOPY package would likely require addressing workforce shortages and stigma while leveraging informal social safety nets and faith-based structures. Voting outcomes are presented as exploratory participant preferences within the workshop, and prospective implementation of CANOPY is presented as a future step requiring further operationalisation and evaluation.