Health: Journal Articles

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Open Access
Task-shifting or problem-shifting? How lay counselling is redefining mental healthcare
(Public Library of Science (PLoS), 2024) Chase L; Shrestha P; Datta G; Forsythe N; Jain S; Maharjan SM; Mathias, Kaaren; Miguel-Lorenzo X; Ranganathan S; Shrestha S; Sidgel K; Subba P; Gautam K; Gurung D; Ntow MC; Montague-Cardoso K
Open Access
Comparison of Multiple Hop Test Kinematics Between Force-Platforms and Video Footage – A Cross Sectional Study
(Australian International Academic Centre, online-publication-date) Sharp , Anthony P.; Cronin , John B.; Neville , Jonathon; Diewald , Shelley N.; Stolberg , Michael; Draper , Nick; Walter, Sibi
Background: Multiple hop performances have been assessed using force-platforms and motion-capture cameras. However, the accessibility of these technologies might be a hindering factor for many performance coaches. Currently, tablet devices are being used as alternatives to measure jumping and hopping performances. Objective: This study aimed to compare multiple hop kinematics using the Kinovea application with force-platforms, the gold standard. Methods: Using an observational cross-sectional study design, male athletes (n=44; age 20.1 ± 1.4 years) completed triple hops (3-Hop) and quintuple hops (5-Hop) on force-platforms while being filmed using an iPad. Ground contact time, flight time and total time were analysed using Kinovea and compared with the force platform data. Results: Statistical analysis showed a high level of agreement across all variables of interest but significant differences (flight time; -2.14 to -5.96 %, ground contact time; 4.89 to 5.83 %, total time; -0.37 to -0.58%) were observed across all variables of interest. A systematic bias for flight and ground contact times were seen for 3-Hop and 5-Hop. Conclusion: The use of iPad and Kinovea application can be used as a valid alternative to measure multiple hop kinematics when performance coaches do not have access to expensive force-platforms or motion-capture cameras.
Open Access
The inconvenient truth of illiteracy inequality intersectionality of socio-demographic disadvantage
(2021) Gandhi , Sunita; Mathias, Kaaren; Seefeldt , Linda; Delaney , Thomas
This study analyses adult illiteracy in Lucknow, focusing on inequalities between different geographical regions, castes, age groups and genders. The reading ability of 1.06 million people in the 15–60 age group was tested, and the literacy rate found to be 65%—substantially lower than the census figures of 77% for Lucknow and 68% for Uttar Pradesh. Each socio-demographic dimension measured was a key determinant of literacy—disadvantaged groups had literacy rates substantially below the mean. Socio-demographic determinants also compound each other, highly disadvantaging some subgroups, an aspect that policymakers must take into consideration when developing policies to increase literacy equity.
Open Access
Prevalence and Risk Factors for Musculoskeletal Pain when Running During Pregnancy: A Survey of 3102 Women
(Springer Science and Business Media LLC, 2024) Wyatt, Hannah; Sheerin , Kelly; Hume , Patria; Hébert-Losier , Kim
Background: Musculoskeletal pain while running is a concern to women during pregnancy and can lead to running cessation. To support women who wish to run during pregnancy, it is essential to understand the sites, severities and personal risk factors associated with musculoskeletal pain. Objective: The aim was to investigate prevalence and risk factors for musculoskeletal pain when running during pregnancy. Methods: An online survey was completed by women who had a child in the past 5 years and ran prior to and during pregnancy. Pain frequency informed prevalence rates by body site, and logistic regression odds ratios (ORs) and 95% confidence intervals were calculated. Results: A total of 3102 women of 23 ethnicities from 25 countries completed the survey. Women were 22–52 years old when they gave birth and ran 2–129 km/week during the 0.5–35 years before the birth of their youngest child. Women ran significantly less distance and less often during pregnancy than before pregnancy. Most women (86%) experienced pain while running during pregnancy (59% pelvis/sacroiliac joint, 52% lower back, 51% abdomen, 44% breast, 40% hip). The highest prevalence of severe-to-worst pain was at the pelvis/sacroiliac joint (9%). Women at greatest risk of pain while running during pregnancy had a previous injury (OR = 3.44) or were older (OR = 1.04). Women with a previous child were less likely to experience breast pain (OR = 0.76) than those running during their first pregnancy. Conclusion: Healthcare practices to reduce pain should focus on regions of greatest musculoskeletal change during pregnancy, specifically the pelvis, lower back and abdomen. Efforts to support women to run for longer throughout pregnancy should focus on pain at the pelvis and breasts.
Open Access
Mana whenua engagement in Crown and Local Authority-initiated environmental planning processes: A critique based on the perspectives of Ngāi Tahu environmental kaitiaki
(Wiley, 2021) Bennett C; Matunga H; Steyl S; Borell, Phil; De Jesus Dionisio, Maria Rita ; Hāpuku A
In New Zealand, the Crown and Local Authorities are required to engage with iwi in resource management matters, yet iwi engagement is a widely recognised weakness in many resource management professionals' skillsets. Coloniality permeates many interactions with iwi, and reflects a profession where practitioners' skillsets have not kept pace with developments in resource management legislation that better recognise the rights and interests of mana whenua. This article explores the real-life impacts of this skill paucity on Ngāi Tahu environmental kaitiaki, and, through a Braided River methodological approach comprised of Kaupapa Māori research and Narrative Inquiry, offers recommendations for best practice mana whenua engagement. The article concludes by discussing the coloniality of planning, and how this impacts practitioners' ability to implement these best practice recommendations.
Open Access
Gym and Fitness Injuries amongst those Aged 16–64 in New Zealand: Analysis of Ten Years of Accident Compensation Corporation Injury Claim Data
(Springer Science and Business Media LLC, 2024) Cuthbertson-Moon M; Hume PA; Wyatt, Hannah; Carlson I; Hastings B
Background: To provide epidemiological data for minor and moderate-to-serious injury claims for gym and fitness related injuries amongst those aged 16–64 in New Zealand, to inform the development of an injury prevention program. Methods: Retrospective analytical review of gym and fitness related injury entitlement minor and moderate- to-serious Accident Compensation Corporation (ACC) claims from 1 July 2011 to 30 June 2020. Data were analysed by cause of injury, geographical region, sex, age, body site and injury type. Qualitative analysis of free text describing the activity causing the injury was conducted. Results: Over the ten-year period, 16–64 year olds made 345,254 injury claims, costing ACC NZ$241,298,275 in treatment charges. Soft tissue injuries were the most prevalent making up 96% (331,343) of all claims and 88% (NZ$213,049,197) of the total charges. Strenuous movement with lifting (n = 154,467, 47%), strenuous movement without lifting (n = 84,469, 25%), impact/contact with object (n = 39,610, 12%) and impact/contact with ground (n = 25,351, 8%) were the top four mechanisms resulting in injury, accounting for 92% of soft tissue injuries. Males and females aged 21 to 30 years old were most frequently injured. The four most injured body sites (lower back/spine, shoulder, knee, neck/back of head) accounted for 63% of injuries in females, and 65% in males. Conclusions: The most common cause of injury from gym and fitness activity claims in 16–64 year olds in New Zealand was lifting/carrying/strain resulting in lower back/spine and shoulder (including clavicle/blade) soft tissue injuries. Soft tissue injuries accounted for 96% of the total claims. Males and females aged 21 to 30 years old were most frequently injured age group.
Open Access
Critical reflections on the concept and impact of “scaling up” in Global Mental Health
(SAGE Publications, 2023) Bayetti C; Bakhshi P; Davar B; Khemka GC; Kothari P; Kumar M; Kwon W; Mathias, Kaaren; Mills C; Montenegro CR; Trani JF; Jain S
The field of Global Mental Health (GMH) aims to address the global burden of mental illness by focusing on closing the “treatment gap” faced by many low- and middle-income countries (LMICs). To increase access to services, GMH prioritizes “scaling up” mental health services, primarily advocating for the export of Western centred and developed biomedical and psychosocial “evidence-based” approaches to the Global South. While this emphasis on scalability has resulted in the increased availability of mental health services in some LMICs, there have been few critical discussions of this strategy. This commentary critically appraises the scalability of GMH by questioning the validity and sustainability of its approach. We argue that the current approach emphasizes the development of mental health services and interventions in “silos,” focusing on the treatment of mental illnesses at the exclusion of a holistic and contextualized approach to people's needs. We also question the opportunities that the current approach to GMH offers for the growth of mental health programmes of local NGOs and investigate the potential pitfalls that scalability may have on NGOs’ impact and ability to innovate. This commentary argues that any “scaling up” of mental health services must place sustainability at the core of its mission by favouring the growth and development of local solutions and wider forms of support that prioritize social inclusion and long-lasting mental health recovery.
Open Access
Dignity and Right to health award: ICMDA leadership in Christian health and development initiative
(Christian Journal for Global Health, 2019) Mathias, Kaaren; Burke , Michael
The Dignity and Right to Health Award (DRH) is an activity of the International Christian Medical and Dental Association (ICMDA) Leadership in Christian Health and Development Initiative. The WHO Constitution (1946) envisages “... the highest attainable standard of health as a fundamental right of every human being.”
Open Access
Scaling a group intervention to promote caregiver mental health in Uttarakhand, India: A mixed-methods implementation study.
(Cambridge University Press (CUP), 2023) Agarwal , Disha; Bailie , Christopher R.; Rana, Samson; Balan , Laxman; Grills , Nathan J.; Mathias, Kaaren
Caregivers are integral to health and social care systems in South Asian countries yet are themselves at higher risk of mental illness. Interventions to support caregiver mental health developed in high-income contexts may be contextually inappropriate in the Global South. In this mixed-methods study, we evaluated the implementation and scaling of a locally developed mental health group intervention for caregivers and others in Uttarakhand, India. We describe factors influencing implementation using the updated Consolidated Framework for Implementation Research, and selected implementation outcomes. Key influencing factors we found in common with other programs included: an intervention that was relevant and adaptable; family support and stigma operating in the outer setting; training and support for lay health worker providers, shared goals, and relationships with the community and the process of engaging with organisational leaders and service users within the inner setting. We identified further factors including the group delivery format, competing responsibilities for caregivers and opportunities associated with the partnership delivery model as influencing outcomes. Implementation successfully reached target communities however attrition of 20% of participants highlights the potential for improving outcomes by harnessing enablers and addressing barriers. Findings will inform others implementing group mental health and caregiver interventions in South Asia.
Open Access
Does the "Nae Umeed" group intervention improve mental health and social participation? A pre–post study in Uttarakhand, India
(Cambridge University Press (CUP), 2023) Bailie , Christopher R.; Pillai , Pooja S; Goodwin Singh , Atul; Leishman , Jed; Grills, Nathan J.; Mathias, Kaaren
Abstract There are few evidence-based interventions to support caregiver mental health developed for low- and middle-income countries. Nae Umeed is a community-based group intervention developed with collaboratively with local community health workers in Uttarakhand, India primarily to promote mental wellbeing for caregivers and others. This pre–post study aimed to evaluate whether Nae Umeed improved mental health and social participation for people with mental distress, including caregivers. The intervention consisted of 14 structured group sessions facilitated by community health workers. Among 115 adult participants, 20% were caregivers and 80% were people with disability and other vulnerable community members; 62% had no formal education and 92% were female. Substantial and statistically significant improvements occurred in validated psychometric measures for mental health (12-Item General Health Questionnaire, Patient Health Questionnaire-9) and social participation (Participation Scale). Improvements occurred regardless of caregiver status. This intervention addressed mental health and social participation for marginalised groups that are typically without access to formal mental health care and findings suggest Nae Umeed improved mental health and social participation; however, a controlled community trial would be required to prove causation. Community-based group interventions are a promising approach to improving the mental health of vulnerable groups in South Asia.
Open Access
Mutuality as a method: advancing a social paradigm for global mental health through mutual learning
(Springer Science and Business Media LLC, 2023) Bemme , Dörte; Roberts , Tessa; Ae-Ngibise , Kenneth A.; Gumbonzvanda , Nyaradzayi; Joag , Kaustubh; Kagee , Ashraf; Machisa , Mercilene; van der Westhuizen , Claire; van Rensburg , André; Willan , Samantha; Wuerth , Milena; Aoun , May; Jain , Sumeet; Lund , Crick; Mathias, Kaaren; Read , Ursula; Taylor Salisbury , Tatiana; Burgess, Rochelle A.
Purpose: Calls for “mutuality” in global mental health (GMH) aim to produce knowledge more equitably across epistemic and power differences. With funding, convening, and publishing power still concentrated in institutions in the global North, efforts to decolonize GMH emphasize the need for mutual learning instead of unidirectional knowledge transfers. This article reflects on mutuality as a concept and practice that engenders sustainable relations, conceptual innovation, and queries how epistemic power can be shared. Methods: We draw on insights from an online mutual learning process over 8 months between 39 community-based and academic collaborators working in 24 countries. They came together to advance the shift towards a social paradigm in GMH. Results: Our theorization of mutuality emphasizes that the processes and outcomes of knowledge production are inextricable. Mutual learning required an open-ended, iterative, and slower paced process that prioritized trust and remained responsive to all collaborators’ needs and critiques. This resulted in a social paradigm that calls for GMH to (1) move from a deficit to a strength-based view of community mental health, (2) include local and experiential knowledge in scaling processes, (3) direct funding to community organizations, and (4) challenge concepts, such as trauma and resilience, through the lens of lived experience of communities in the global South. Conclusion: Under the current institutional arrangements in GMH, mutuality can only be imperfectly achieved. We present key ingredients of our partial success at mutual learning and conclude that challenging existing structural constraints is crucial to prevent a tokenistic use of the concept.
Open Access
A qualitative study to explore various meanings of mental distress and help-seeking in the Yamuna Valley, North India
(Medknow, 2021) Rawat , Meenal; Jadhav , Sushrut; Bayetti , Clement; Mathias, Kaaren
Context: In rural India, mental healthcare remains limited due to scant state services and incongruency between provider- and patient-framing distress. Help-seeking by people with mental health problems is related to how meanings of distress are understood differently by individuals, based on their interaction with various actors in the community and the available cultural explanation within their local ecologies. Methodology: This study examines the mutually constituted relationship between meanings of mental distress and help-seeking among people residing in the Upper Yamuna Valley, Uttarakhand, North India. This qualitative study builds on six in-depth interviews with people with severe mental health issues and one person with epilepsy, referred as people with psychosocial disability (PPSD) in the study. The data analysis was iterative and followed thematic approach. Results: The study found that personal belief based on one's experience, such as negative self-judgment and wider cultural explanations, such as supernatural beliefs, as well as gender roles, impacted the way people address their mental health problems, in turn shaping their help-seeking behavior. Participants lost hope for a cure after years of trying to find an effective solution. Moreover, lack of access to care and remoteness of the mountainous area made help-seeking and recovery feel impossible. Conclusions: This study underscores the need for researchers and policy professionals to explore the local context and culture to improve care and treatment quality. The study also explains that personal explanation of psychosocial problems and help seeking are not unidirectional. It is a complex phenomenon layered with the local contexts which should be addressed in clinical practice, as well as future research. Finally, clinicians' training should address the local cultural language of distress to identify the problem and suggest an effective solution.
Open Access
Opening up the ‘black-box’: what strategies do community mental health workers use to address the social dimensions of mental health?
(Springer Science and Business Media LLC, 2024) Jain, Sumeet; Pillai , Pooja; Mathias, Kaaren
Purpose: Community-based workers promote mental health in communities. Recent literature has called for more attention to the ways they operate and the strategies used. For example, how do they translate biomedical concepts into frameworks that are acceptable and accessible to communities? How do micro-innovations lead to positive mental health outcomes, including social inclusion and recovery? The aim of this study was to examine the types of skills and strategies to address social dimensions of mental health used by community health workers (CHWs) working together with people with psychosocial disability (PPSD) in urban north India. Methods: We interviewed CHWs (n = 46) about their registered PPSD who were randomly selected from 1000 people registered with a local non-profit community mental health provider. Notes taken during interviews were cross-checked with audio recordings and coded and analyzed thematically. Results: CHWs displayed social, cultural, and psychological skills in forming trusting relationships and in-depth knowledge of the context of their client's lives and family dynamics. They used this information to analyze political, social, and economic factors influencing mental health for the client and their family members. The diverse range of analysis and intervention skills of community health workers built on contextual knowledge to implement micro-innovations in a be-spoke way, applying these to the local ecology of people with psychosocial disabilities (PPSD). These approaches contributed to addressing the social and structural determinants that shaped the mental health of PPSD. Conclusion: Community health workers (CHWs) in this study addressed social aspects of mental health, individually, and by engaging with wider structural factors. The micro-innovations of CHWs are dependent on non-linear elements, including local knowledge, time, and relationships. Global mental health requires further attentive qualitative research to consider how these, and other factors shape the work of CHWs in different locales to inform locally appropriate mental health care.
Open Access
Women's freedom of movement and participation in psychosocial support groups: Qualitative study in northern India
(Springer Science and Business Media LLC, 2019) Gailits N; Mathias, Kaaren; Nouvet E; Pillai P; Schwartz L
Background: Depression, the world's leading cause of disability, disproportionately affects women. Women in India, one of the most gender unequal countries worldwide, face systemic gender disadvantage that significantly increases the risk of common mental disorders. This study's objective was to examine the factors influencing women's participation in psychosocial support groups, within an approach where community members work together to collectively strengthen their community's mental health. Methods: This community-based qualitative study was conducted from May to July 2016, across three peri-urban sites in Dehradun district, Uttarakhand, Northern India. Set within an NGO-run mental health project, data were collected through focus group discussions with individuals involved in psychosocial support groups including women with psychosocial disabilities as well as caregivers (N = 10, representing 59 women), and key informant interviews (N = 8) with community members and mental health professionals. Data were analyzed using a thematic analysis approach. Results: The principal barrier to participating in psychosocial support groups was restrictions on women's freedom of movement. Women in the community are not normally permitted to leave home, unless going to market or work, making it difficult for women to leave their home to participate in the groups. The restrictions emanated from the overall community's attitude toward gender relations, the women's own internalized gender expectations, and most significantly, the decision-making power of husbands and mothers-in-law. Other factors including employment and education shaped women's ability to participate in psychosocial support groups; however, the role of these additional factors must be understood in connection to a gender order limiting women's freedom of movement. Conclusions: Mental health access and gender inequality are inseparable in the context of Northern India, and women's mental health cannot be addressed without first addressing underlying gender relations. Community-based mental health programs are an effective tool and can be used to strengthen communities collectively; however, attention towards the gender constraints that restrict women's freedom of movement and their ability to access care is required. To our knowledge, this is the first study to clearly document and analyze the connection between access to community mental health services in South Asia and women's freedom of movement.
Open Access
Establishing a child and adolescent mental health center in Herat, Afghanistan: a project description
(Elsevier BV, 2023) Najm , Abdul Fattah; Niazi , Aziz-ur-Rahman; Alekozay , Mina; Allan , Emily B.; Mathias, Kaaren
Objective: Afghanistan has witnessed a long-lasting 4-decade armed conflict, which together with high levels of poverty and interpersonal violence, resulted in high incidence and prevalence of mental disorders in general population, including children and adolescents. Until mid-2018, there was neither mental health care facility nor a child psychiatrist in Afghanistan. Here, we report the establishment of the first children and adolescents’ mental health center (CAMHC) in Herat province of Afghanistan. Methods: In July 2018, CAMHC was initiated at Mental Health Training Center – Herat. CAMHC was initially planned by the International Assistance Mission (IAM) and Herat Public Health Directorate; and financially supported by the Tearfund UK, the United Methodist Committee on Relief and Tearfund Australia. The target population of CAMHC was children and adolescents in Herat and neighboring provinces, healthcare professionals, staff of government and non-governmental organizations, school teachers and community leaders. Results: A group of eight mental health professionals were trained and made the interdisciplinary board for diagnosis and management of mental disorders in children and adolescents. During the initial three-year period, 2 448 patients, including 1 264 (51.6%) boys and 1 184 (48.4%) girls, presented with mental disorders to CAMHC. Diagnosis and management of mental disorders were performed according to standard international protocols. Eighteen awareness-raising seminars were held; 2 000 leaflets, 10 000 posters, and 30 000 brochures were prepared and distributed; and two short video clips were produced and broadcast via IAM website, social media and local TV channels. A database was developed to house for project data, assessment of outcomes and reporting to stakeholders. Conclusion: Establishment of CAMHC resulted in significant achievements in diagnosis and management of mental disorders among children and adolescents, healthcare staff capacity building, and awareness-raising about mental disorders. Data obtained in CAMHC offers government, mental health professionals and the community the opportunity of improving mental health in the region.
Open Access
Outcomes of a brief mental health and resilience pilot intervention for young women in an urban slum in Dehradun, North India: A quasi-experimental study
(Springer Science and Business Media LLC, 2018) Mathias, Kaaren; Pandey, A.; Armstrong , G.; Diksha , P.; Kermode , M.
Background: Mental illness is a leading cause of the disease burden among young people. Poor mental health is linked to childhood adversity such as gender inequality, poverty and low educational attainment. Psycho-social assets in adolescents can moderate these impacts and be strengthened. The aim of this study was to assess the effectiveness of a brief mental health and resilience intervention among disadvantaged young women in urban North India. Methods: We used an uncontrolled repeated measures design to evaluate the effectiveness of the 15-module mental health and resilience curriculum among young women residing in a slum in Dehradun, Uttarakhand. Standardised psychometric assessments were done to assess outcomes of the intervention at three time-points: pre-intervention (T1), post-intervention (T2), and 8-months post-intervention (T3), covering domains of self-efficacy, resilience, anxiety, depression and gender attitudes. Results: Young women completing the intervention (n=106) had all left school before 10th class. A statistically significant improvement in all psychometric measures was found at T2. These improvements were sustained at T3 in the areas of anxiety, depression and gender equality attitudes, while the measures of resilience and self-efficacy had declined to baseline. Conclusions: This intervention delivered by community-based peers among highly disadvantaged young women can lead to sustained improvements in anxiety and depression and attitudes to gender equality. While other studies in LMIC have shown increased adolescent resilience through peer-led curriculums, this study demonstrates improvements in mental health and gender attitudes can endure 8-months post-intervention. This low-cost, brief intervention can improve mental health resiliency and self-efficacy among disadvantaged young people. Further research should explore how to bring sustained improvements in resilience.
Open Access
This pākehā life: an unsettled memoir
(2022) Mathias, Kaaren
Open Access
The governance of local health systems in the era of Sustainable Development Goals: Reflections on collaborative action to address complex health needs in four country contexts
(BMJ, 2019) Schneider, Helen; Zulu , Joseph Mumba; Mathias, Kaaren; Cloete , Keith; Hurtig , Anna-Karin
This analysis reflects on experiences and lessons from four country settings - Zambia, India, Sweden and South Africa - on building collaborations in local health systems in order to respond to complex health needs. These collaborations ranged in scope and formality, from coordinating action in the community health system (Zambia), to a partnership between governmental, non-governmental and academic actors (India), to joint planning and delivery across political and sectoral boundaries (Sweden and South Africa). The four cases are presented and analysed using a common framework of collaborative governance, focusing on the dynamics of the collaboration itself, with respect to principled engagement, shared motivation and joint capacity. The four cases, despite their differences, illustrate the considerable challenges and the specific dynamics involved in developing collaborative action in local health systems. These include the coconstruction of solutions (and in some instances the problem itself) through engagement, the importance of trust, both interpersonal and institutional, as a condition for collaborative arrangements, and the role of openly accessible information in building shared understanding. Ultimately, collaborative action takes time and difficulty needs to be anticipated. If discovery, joint learning and developing shared perspectives are presented as goals in themselves, this may offset internal and external expectations that collaborations deliver results in the short term.
Open Access
Empowering community control over alcohol availability as a suicide and self-harm prevention measure: Policy opportunity in Aotearoa New Zealand
(Elsevier BV, 2022) Boden , J; Hetrick S, S; Bowden, N; Fortune, S; Marek, Lukas; Theodore, R; Ruhe, T; Kokaua, J; Hobbs, Matt
One of the most pressing issues in public health in Aotearoa New Zealand (NZ) is our rate of suicide and self-harm, particularly among young people.1,2 The 2018 New Zealand Government Inquiry into Mental Health and Addiction recognised the challenge of reducing these rates, and raised the important issue of the role of alcohol and other substance use in increasing suicide risk.
Open Access
Telehealth-delivered naturalistic developmental behavioural intervention with and without caregiver acceptance and commitment therapy for autistic children and their caregivers: Protocol for a multi-arm parallel group randomised clinical trial
(BMJ, 2023) McLay, Laurie; Emerson, Lisa-Marie; Waddington H; van Deurs, Jenna; Hunter J; Blampied, Neville; Hāpuku, Aaron; Macfarlane, Sonja; Bowden N; Van Noorden L; Rispoli M
Introduction Timely access to early support that optimises autistic children's development and their caregiver's mental health is critical. Naturalistic developmental behavioural interventions (NDBIs) and acceptance and commitment therapy (ACT) are evidence-based supports that can enhance child learning and behaviour, and adult well-being, respectively. The traditional face-to-face delivery of these approaches is resource intensive. Further, little is known about the benefit of parallel child-focused and caregiver-focused supports. The aims of this trial are to evaluate the effectiveness and social validity of telehealth-delivered, caregiver-implemented, child-focused NDBI and caregiver-focused ACT when delivered alone and in parallel, on autistic children's social communication and caregiver well-being. Methods and analysis The study will use a randomised, single-blind clinical trial with three parallel arms: NDBI; ACT and ACT+NDBI. We will recruit a minimum of 78, 2-5-year-old autistic children and their families throughout Aotearoa New Zealand. Support will be delivered over 13 weeks using a combination of culturally enhanced web-based modules and online group coaching. Primary outcome variables include children's social communication/engagement with their caregiver as well as caregiver stress and will be evaluated using a repeated measures multivariate analysis of variance. Outcome variables are assessed at baseline (before randomisation), immediately postparticipation and at 3-month follow-up. Ethics and dissemination The trial is approved by the Health and Disability Ethics Committee (2022 FULL 12058). The findings of this trial will be disseminated through peer-reviewed journals and national and international conference proceedings regardless of the magnitude/direction of effect. Additionally, data will be shared with stakeholder groups, service providers and health professionals. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12622001134718).