PROJECT ABSTRACT Family psychoeducation for adults living with psychotic disorders in Tanzania (KUPAA Trial) Psychotic disorders such as schizophrenia contribute to the global burden of disease in low- and middle- income countries (LMICs) yet mental health services have been severely neglected. Family Psychoeducation is an evidence-based practice from high-income countries that could have a significant impact in settings such as Africa and other regions worldwide where resources are limited and family involvement in treatment is fundamental. In response to PAR-21-130, this R01 will evaluate the impact of a culturally tailored version of family psychoeducation called KUPAA (meaning “to soar” in Swahili) that is group-based and family-involved in a low-income country context. The KUPAA intervention was recently pilot tested with adults living schizophrenia-spectrum disorders and their families in Tanzania. The proposed hybrid effectiveness- implementation clinical trial would individually randomize patient-caregiver pairs to either the group-based intervention or the standard of care across 14 health facilities in four regions of Tanzania. The overall objective is to improve recovery outcomes for individuals with schizophrenia-spectrum disorders. Aim #1: Determine the effectiveness of KUPAA vs. standard of care for an outpatient population (n=432) by reducing disability and improving quality of life (primary outcomes); and reducing hospitalizations and reducing perceived family burden for caregivers (secondary outcomes) among matched patient-caregiver dyads. Aim #2: Examine the mechanisms of change underlying KUPAA as a group-based, family-involved intervention. Aim #3: Evaluate implementation outcomes guided by the Consolidated Framework for Implementation Research (CFIR) via mixed methods (n=122 semi-structured interviews, observational data, cost data). This project is a collaboration between the University of North Carolina at Chapel Hill, Duke University and four Tanzanian institutions: Muhimbili University of Health and Allied Sciences in Dar es Salaam, Mbeya Zonal Referral Hospital in Mbeya, Mirembe National Mental Health Hospital in Dodoma, and Kilimanjaro Christian Medical University College in Moshi. This proposal aligns with the NIMH cross-cutting global mental health theme and will contribute to NIMH’s goal of advancing mental health services to strengthen public health by providing insights on an adapted evidence-based practice designed for lower-resource settings that could also inform domestic implementation strategies for scaling family psychoeducation in the U.S.