Promoting Interventions for Climate Change to Upscale Resilience in District Astore

NCT07557199 | Not Yet Recruiting

• 1 other identifier: 6200101665/ R19954/53732
• Study Type: interventional
• Target: 1,350
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Disaster Preparedness; Climate Change and Health

Keywords

Climate change adaptation; Disaster resilience; Community-based intervention

Outcome Measures

Primary Outcomes (2)

• Household disaster resilience (DRI)

  Household disaster resilience will be assessed using the Disaster Resilience Index (DRI), a 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.

  At baseline and endline (12 month)

• Household vulnerability

  Household vulnerability will be assessed using the Multidimensional Livelihood Vulnerability Index (MLVI), a composite measure capturing susceptibility to shocks across three domains. Adaptive Capacity reflects the ability to cope with and adjust to stressors, including access to resources, livelihood diversity, and social support. Sensitivity captures the degree to which households are affected by shocks, based on their wellbeing, health, food and water security, and environmental conditions. Exposure measures the extent to which households experience environmental and socio-economic shocks that threaten livelihoods.

  At baseline and endline (12 month)

Secondary Outcomes (2)

• Food security

  At baseline and endline (12 month)

• Mental Health

  At baseline and endline (12 month)

Other Outcomes (3)

• Financial Literacy

  At baseline and endline (12 month)

• Household Disaster Preparedness

  At baseline and endline

• Health Knowledge and Practices

  At baseline and endline (12 month)

Study Arms (3)

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.

Other: Community Interventions (CI)

Community + Primary Healthcare Intervention (CHI)

EXPERIMENTAL

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.

Other: Community + Primary Healthcare Intervention (CHI)

Control

NO INTERVENTION

Clusters do not receive any additional intervention beyond existing services and standard conditions during the study period.

Interventions

Community Interventions (CI) OTHER

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.

Community Interventions (CI)

Community + Primary Healthcare Intervention (CHI) OTHER

The community-based resilience intervention combined with active involvement of Lady Health Workers and primary healthcare providers to reinforce interventions delivered through VMCs and strengthen linkages between communities and health services.

Community + Primary Healthcare Intervention (CHI)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Permanent residents of the selected study area Aged 18 years and above Willing to provide informed consent

You may not qualify if:

• Individuals not providing informed consent Temporary residents or non-residents of the study are

Sponsors & Collaborators

• Dr Jai Kumar Das: lead
• The Hospital for Sick Children: collaborator
• International Development Research Centre, Canada: collaborator

Study Sites (1)

Aga Khan University

Karachi, Sindh, 74800, Pakistan

Location

MeSH Terms

Interventions

Residence Characteristics

Intervention Hierarchy (Ancestors)

Demography; Population Characteristics; Epidemiologic Measurements; Public Health; Environment and Public Health

Central Study Contacts

Dr. Jai Kumar Das, PhD

CONTACT

0213486 69826; jai.das@aku.edu

Akber Ali, Masters

CONTACT

+92-307-777-1403; akber.ali@aku.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Associate Professor and Assistant Director

Model Details: 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.

Study Record Dates

• First Submitted: April 23, 2026
• First Posted: April 29, 2026
• Study Start: April 30, 2026
• Primary Completion (Estimated): April 30, 2027
• Study Completion (Estimated): May 1, 2027
• Last Updated: April 29, 2026

Record last verified: 2026-04

Locations

PA (1)