A FEASIBILITY STUDY OF THE CULTURALLY ADAPTED SOLACE PROGRAM (STIGMA OF LIVING AS AN AUTISM CARER) TO REDUCE STIGMA IN MOTHERS OF CHILDREN WITH AUTISM IN PAKISTAN: A TWO-ARM FEASIBILITY TRIAL

Abstract

Background: Stigma tied to autism poses serious consequences for the mental well-being of caregivers. In collectivist societies like Pakistan, where family reputation and community perception carry substantial weight, this burden falls heavily on mothers who provide day-to-day care. The SOLACE (Stigma of Living as an Autism Carer) program—an eight-session psychosocial intervention originally piloted in the United Kingdom—targets caregiver mental health by strengthening resistance to stigma. The current study set out to evaluate whether a culturally adapted version of SOLACE is feasible, acceptable, and practical for Pakistani mothers raising children with autism. Methods: A two-arm feasibility trial using 1:1 allocation took place between November and December 2024 in Lahore, Pakistan. Nine eligible mothers were randomized either to the adapted SOLACE intervention (n=5) or to a wait-list control condition (n=4). The program ran over eight face-to-face group sessions lasting 90–120 minutes each, held twice a week. Feasibility was gauged through recruitment and retention figures, attendance records, fidelity checks, and structured feedback from participants. Qualitative responses were examined through directed content analysis. Results: Completers attended 91.7% of sessions on a per-protocol basis. Attrition stood at 33.3%, with both withdrawals stemming from personal circumstances unrelated to the program. Across every acceptability measure, participant ratings surpassed 96%. Fidelity remained intact throughout. Notable cultural modifications included an exclusive face-to-face delivery format, training in respectful assertiveness, two additional dedicated sessions designed exclusively for fathers, and compilation of Urdu-language psychoeducation resources. Mothers described heightened awareness of stigma, stronger self-advocacy, and shared their unanimous willingness to recommend the program to other parents. Conclusion: The adapted SOLACE program proved feasible, well-received, and culturally resonant among Pakistani mothers of autistic children, warranting progression to a fully powered randomized controlled trial.