Improving Women's Mental Health Through Tele-based Wellbeing Centres in Bangladesh.

Will be measured via the WHOQOL-BREF, validated in the Bangladesh context, a standardised and globally recognised instrument developed by World Health Organisation (WHO)-WHOQOL Group, comprising four dimensions (physical health, psychological, social relationships, and environment). This instrument consists of 26 items rated on a 1 to 5 scale, which includes two independent items assessing overall perception of quality of life and general health, the remaining 24 items compute the four domain scores . The raw domain scores are derived from the mean score of items within each domain and will be transformed to either a 4-20 scale (to be comparable with the full WHOQOL-100) or a 0-100 scale to facilitate interpretation and statistical analysis.

MH GAP common presentation of conditions and diagnosis developed and validated by World Health Organization in Bangladesh context will be utilised by psychologist (during first and follow-up visits) of both arms for identifying usual conditions of depression, psychosis, bipolar disorder, epilepsy, mental health disorders, dementia, substance use disorders, and suicidal/self-harm ideation.

Will be measured via the validated World Health Organization-Five Well-Being Index (WHO-5) in Bangladesh context, designed to measure subjective psychological well-being over the past two weeks of women. This tool will be administered by psychologist of both arms during follow-up visits. The raw score of this scale ranges from zero to 25, zero representing worst possible mental well-being and 25 representing best possible mental well-being.

Will be measured using the validated General Health Questionnaire (GHQ-12) in the Bangladesh context, a widely used 12-item screening tool designed to assess overall psychological distress and detect non-psychotic mental health problems among participants. Score in GHQ-12 ranges from 0-12, where 0-3 refers normal psychological condition and 4-12 score refers to have potential psychological distress.

Exposure to gender-based violence will be measured using the standardised World Health Organization (WHO) Violence Against Women instrument. This globally recognised gold-standard tool systematically assesses partner-controlling behaviors, the frequency and severity of emotional, physical, and sexual violence, as well as the resulting impacts, injuries, and experiences of non-partner violence.

• Baseline Assessment (T0): The full, comprehensive WHO instrument will be administered once at baseline (T0) only by a trained FRA. This baseline module captures controlling behaviors, lifetime physical violence, lifetime sexual violence, non-partner sexual assault, childhood sexual abuse, and 12-month recall of spousal violence.
• Follow-up Assessments (T1, T2, T3): To eliminate overlapping recall periods and avoid unnecessary participant burden, all lifetime, childhood, and 12-month recall questions are omitted from follow-up visits. At T1 (2 months), T2 (4 months), and T3 (6 months), FRAs wi

A specialized 6-8 item Maternal and Child Immunization Tracking Module will be administered once during baseline enrolment (T0) only by trained Field Research Assistants (FRAs) to tracks maternal vaccination history during the current or most recent pregnancy, specifically identifying the receipt of Td/tetanus, according to the DHS Mothers Health and Contextual Factors. Instead of tracking child immunization, the adopted module focuses on the mother's decision-making factors and explores her future preferences for integrating vaccinations directly into routine antenatal care (ANC) visits versus utilizing separate EPI centers. This comprehensive data allows us to evaluate whether clinical recovery from mental distress (improved PHQ-9/GAD-7) positively influences a mother's preventive healthcare uptake and her receptiveness to future maternal immunization programs.

A direct cost comparison will be conducted by systematically tracking and evaluating the implementation and operational expenses associated with both intervention arms. This includes comparing the direct costs of the tele-counselling model (e.g., therapist time, electronic equipment, internet connectivity, and dedicated room establishment) against the standard in-person counselling modality to determine the financial feasibility and budget impact of scaling the Wellbeing Centre model.