ABSTRACT:
This paper reports on a collaborative research project between the State University of Campinas, Brazil, and Yale University, USA, aimed at adapting and implementing a peer support (PS) intervention for people with severe mental disorders within a public mental health system in a middle-income country. The study responds to global calls for greater service user involvement, recovery-oriented care, and culturally responsive mental health interventions. The objective is to describe and analyse the strategy used to involve service users as key stakeholders throughout the implementation process, focusing on the role of a community advisory board (CAB) composed by thirteen mental health service users. Stakeholder involvement was structured across pre-implementation, implementation, and post-implementation phases, guided by the Consolidated Framework for Implementation Research (CFIR). During pre-implementation, biweekly CAB meetings identified contextual barriers and facilitators and informed the cultural adaptation of PS training materials developed in the USA. During implementation, monthly CAB meetings monitored a pilot study in which six trained peer supporters provided PS to 38 service users across three community-based mental health centres (CAPS III) in Campinas. In the post-implementation phase, a working group derived from the CAB continues to co-produce research outputs. Across CFIR domains, key facilitators included shared ethical values such as mutuality and experiential knowledge, institutional commitment, and participatory training processes. Major barriers included persistent stigma and hierarchical biomedical practices. Adaptations to the PS training involved simplifying language and revising the modules content to enhance local relevance. To support implementation fidelity, a subgroup of CAB members supervised the peer supporters during the pilot phase. The CAB strategy was central to embedding service user perspectives in the implementation process, enhancing cultural relevance and equity. This experience highlights the importance of participatory governance structures for scaling recovery-oriented mental health interventions in public health systems, particularly in low- and middle-income country contexts.