[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"health-study-detail:100635785":3},{"organization":4,"outcomesModule":7,"designInfo":33,"detailedDescription":41,"studyPopulation":38,"armGroups":42,"interventions":58,"overallOfficials":38,"centralContacts":67,"locations":77,"responsibleParty":96,"collaborators":100,"id":106,"slug":107,"hasResults":108,"nctId":109,"briefTitle":110,"officialTitle":111,"acronym":112,"eligibilityCriteria":113,"healthyVolunteers":108,"sex":114,"minAge":115,"maxAge":38,"enrollmentInfo":116,"targetDuration":38,"studyType":119,"phases":120,"briefSummary":122,"conditions":123,"keywords":127,"overallStatus":79,"whyStopped":38,"lastUpdateSubmitDate":131,"lastUpdatePostDateStruct":132,"startDateStruct":135,"completionDateStruct":137,"leadSponsor":139,"locationsCount":140},{"fullName":5,"class":6},"Aga Khan University","OTHER",{"primaryOutcomes":8,"secondaryOutcomes":13,"otherOutcomes":23},[9],{"measure":10,"description":11,"timeFrame":12},"Household disaster resilience (DRI)","Household disaster resilience will be assessed using the Disaster Resilience Index (DRI), a validated multidimensional composite measure of a household's ability to withstand, adapt to, and recover from shocks. The DRI comprises three domains: Coping Capacity, reflecting baseline resources and conditions that enable immediate response; Adaptive Capacity, capturing the ability to adjust and respond effectively through access to systems, resources, and support; and Transformative Capacity, measuring longer-term potential to learn, improve, and strengthen resilience over time. The score ranges from 0 to 1, with higher values indicating greater household resilience.","At baseline and endline (12 month)",[14,17,20],{"measure":15,"description":16,"timeFrame":12},"Household Vulnerability Index (MLVI)","Household vulnerability measured using the Multidimensional Livelihood Vulnerability Index (MLVI), a composite measure comprising exposure, sensitivity, and adaptive capacity domains. Scores range from 0 to 1, with higher scores indicating greater household vulnerability to climate-related shocks.",{"measure":18,"description":19,"timeFrame":12},"Food security","Food security will be assessed using the Household Food Insecurity Access Scale (HFIAS), developed by the Food and Nutrition Technical Assistance (FANTA) project. The HFIAS is a standardized tool that measures household access to food over the past four weeks, generating a continuous score (range: 0-27), with higher scores indicating greater food insecurity",{"measure":21,"description":22,"timeFrame":12},"Mental Health","Mental health and psychological resilience will be accessed by Psychological Trauma index focused on post-traumatic stressful symptoms following climate related shocks. Mental health and psychological resilience will be assessed using the Psychological Trauma Index, a structured questionnaire measuring post-traumatic stress symptoms following climate related shocks. The index includes six items covering intrusive memories, emotional distress, avoidance, social withdrawal, irritability, and concentration difficulties.\n\nEach item is scored on a 5-point Likert scale (1 = Not at all, 5 = Very Frequently). Total scores range from 6 to 30, with higher scores indicating worse outcomes (greater severity of trauma symptoms). Lower scores reflect fewer symptoms and better psychological resilience.",[24,27,30],{"measure":25,"description":26,"timeFrame":12},"Financial Literacy","Financial literacy will be assessed through structured survey questions on access to financial services (e.g., household members with bank accounts), insurance coverage, savings and borrowing practices, bill payment regularity, expense planning, and ability to meet emergency needs. Outcomes will be reported as individual indicators (counts and proportions)",{"measure":28,"description":29,"timeFrame":12},"Household Disaster Preparedness","Household disaster preparedness will be assessed through structured survey questions covering awareness of disaster management, integration of preparedness knowledge into household plans, availability of emergency supplies, evacuation knowledge, prior preparedness actions, and exposure to community training or organizations involved in disaster response. Outcomes will be reported as individual indicators (counts and proportions)",{"measure":31,"description":32,"timeFrame":12},"Health Knowledge and Practices","Health knowledge and practices will be assessed using a structured questionnaire evaluating knowledge and reported practices related to climate-sensitive health risks. Responses will be summarized as count and proportions",{"allocation":34,"interventionModel":35,"interventionModelDescription":36,"primaryPurpose":37,"observationalModel":38,"timePerspective":38,"maskingInfo":39},"RANDOMIZED","PARALLEL","This study is a three-arm, parallel-group cluster randomized controlled trial conducted in District Astore. Clusters are defined as villages or groups of villages to reflect the local geographic and administrative structure and to minimize contamination across study arms. A total of 30 clusters will be randomly selected from all eligible clusters and allocated in a 1:1:1 ratio to: (1) community-based intervention, (2) community-based intervention plus primary healthcare engagement, and (3) control. This design enables estimation of both the independent effect of community-based interventions and the incremental benefit of integrating primary healthcare providers and Lady Health Workers.","PREVENTION",null,{"masking":40,"maskingDescription":38,"whoMasked":38},"NONE","District Astore, located in the mountainous region of Gilgit-Baltistan, is highly vulnerable to climate-related risks, including glacial lake outburst floods (GLOFs), landslides, extreme weather events, and rising temperatures. Its rugged terrain, geographic isolation, dependence on climate-sensitive livelihoods, and limited infrastructure exacerbate the impact of environmental shocks on health and socioeconomic conditions. These vulnerabilities make Astore an appropriate setting to evaluate scalable interventions aimed at strengthening community resilience.\n\nThis study is a three-arm cluster randomized controlled trial conducted, where cluster is a village or group of villages. From total available clusters, 30 clusters will be randomly selected and allocated equally across three study arms. Within each cluster, households will be selected through simple random sampling following a complete household listing.\n\nTwo intervention arms and one control arm are included. The first intervention arm delivers structured, community-led adaptation and resilience activities through Village Management Committees (VMCs), formed with representation from local stakeholders including elders, teachers, and vulnerable households. The second intervention arm builds upon this approach by incorporating formal engagement of Lady Health Workers and primary healthcare providers to strengthen health-related components, improve service linkage, and enhance outreach to high-risk populations. The control arm does not receive additional inputs.\n\nIntervention components, informed by prior vulnerability assessments, include training and capacity-building on disaster preparedness and response, livelihood diversification, financial literacy, and health awareness. These are delivered through participatory group sessions, simulation exercises, and community mobilization activities over a one-year period. Training sessions are conducted monthly during the initial six months and bi-monthly thereafter, using standardized curricula adapted to the local context.\n\nPrimary outcome is change in the Disaster Resilience Index (DRI), assessed at baseline and endline. Secondary outcomes include changes in Multidimensional livelihood vulnerability index (MLVI), health care-seeking, morbidity and mortality, nutrition, environmental resilience, and mental health. Process indicators evaluate intervention delivery, participation, and preparedness mechanisms such as emergency planning, financial coping strategies, and household disaster preparedness. A rapid assessment will be conducted if a major climate-related hazard occurs during the study period to estimate real-world impact under disaster conditions.\n\nAnalysis follows an intention-to-treat approach, applying mixed-effects regression models to account for clustering at the community level. Difference-in-differences (DID) estimation will be used to assess intervention effects over time while adjusting for relevant covariates.\n\nThis trial will generate context-specific evidence on the effectiveness of integrated community and health system approaches in enhancing resilience in coastal, climate-affected populations, with potential implications for scale-up in similar settings.",[43,49,54],{"label":44,"type":45,"description":46,"interventionNames":47},"Community Interventions (CI)","EXPERIMENTAL","Clusters receive a structured package of community-led adaptation and resilience interventions delivered through Village Management Committees (VMCs). Activities include training and participatory sessions on disaster risk reduction, livelihood diversification, financial literacy, and health awareness. Sessions are conducted using participatory learning approaches to strengthen household and community adaptive capacity.",[48],"Other: Community Interventions",{"label":50,"type":45,"description":51,"interventionNames":52},"Community + Primary Healthcare Intervention (CHI)","Clusters receive the same community-based interventions as Arm 1, with additional engagement of Lady Health Workers and primary healthcare providers. Health system actors support delivery of health-related components, promote care-seeking, and strengthen linkages between communities and health services to enhance resilience outcomes.",[48,53],"Other: Primary Healthcare Intervention",{"label":55,"type":56,"description":57,"interventionNames":38},"Control","NO_INTERVENTION","Clusters do not receive any additional intervention beyond existing services and standard conditions during the study period.",[59,63],{"type":6,"name":60,"description":61,"armGroupLabels":62,"otherNames":38},"Community Interventions","A structured package of community-led activities delivered through Village Management Committees, including participatory training on disaster risk reduction, livelihood diversification, financial literacy, and health awareness to strengthen household and community resilience.",[50,44],{"type":6,"name":64,"description":65,"armGroupLabels":66,"otherNames":38},"Primary Healthcare Intervention","Lady Health Workers and primary healthcare providers to reinforce interventions delivered through VMCs and strengthen linkages between communities and health services.",[50],[68,73],{"name":69,"role":70,"phone":71,"phoneExt":38,"email":72},"Dr. Jai Kumar Das, PhD","CONTACT","0213486 69826","jai.das@aku.edu",{"name":74,"role":70,"phone":75,"phoneExt":38,"email":76},"Akber Ali, Masters","+92-307-777-1403","akber.ali@aku.edu",[78],{"facility":5,"status":79,"city":80,"state":81,"zip":82,"country":83,"countryCode":84,"cosmosGeoPoint":85,"geoPoint":90,"contacts":91},"RECRUITING","Karachi","Sindh","74800","Pakistan","PK",{"type":86,"coordinates":87},"Point",[88,89],67.0104,24.8608,{"lat":89,"lon":88},[92,93,94],{"name":69,"role":70,"phone":71,"phoneExt":38,"email":72},{"name":74,"role":70,"phone":75,"phoneExt":38,"email":76},{"name":69,"role":95,"phone":38,"phoneExt":38,"email":38},"PRINCIPAL_INVESTIGATOR",{"type":97,"investigatorFullName":98,"investigatorTitle":99,"investigatorAffiliation":5,"oldNameTitle":38,"oldOrganization":38},"SPONSOR_INVESTIGATOR","Dr Jai Kumar Das","Associate Professor and Assistant Director",[101,103],{"name":102,"class":6},"The Hospital for Sick Children",{"name":104,"class":105},"International Development Research Centre, Canada","OTHER_GOV","100635785","promoting-interventions-for-climate-change-to-upscale-resilience-in-district-astore-100635785",false,"NCT07557199","Promoting Interventions for Climate Change to Upscale Resilience in District Astore","Promoting Interventions for Climate Change to Upscale Resilience (PICCTURE) Trial in District Astore","PICCTURE","Inclusion Criteria:\n\n1. Permanent residents of the selected study area\n2. Aged 18 years and above\n3. Willing to provide informed consent\n\nExclusion Criteria:\n\n1- Temporary residents or non-residents of the study are","ALL","18 Years",{"count":117,"type":118},1350,"ESTIMATED","INTERVENTIONAL",[121],"NA","The PICCTURE trial is a cluster randomized controlled study that will be conducted in District Astore, Pakistan, to evaluate the effectiveness of community-based interventions in improving resilience to climate-related hazards. The study compares community-led adaptation and resilience strategies and community interventions integrated with primary healthcare engagement against a control group. The objective is to determine whether these approaches improve household-level resilience, adaptive capacity, and health-related outcomes in a mountainous, climate-vulnerable population.",[124,125,126],"Climate Change","Health Behavior \u002F Well-Being","Disaster Planning",[128,129,130],"Climate change adaptation","Disaster resilience","Community-based intervention","2026-10-05",{"date":133,"type":134},"2026-10-08","ACTUAL",{"date":136,"type":134},"2026-06-01",{"date":138,"type":118},"2027-05",{"name":98,"class":6},1]