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Table 4 Participant response to focus group questions (7 focus groups, n = 58)

From: An integrated approach to mental health and disaster preparedness: a cluster comparison with earthquake affected communities in Nepal

Theme Representative quotes
Response to - What are the primary stressors in your life right now?
 Ongoing hazards/threats We have felt hundreds of aftershocks after the earthquake./Thundering and lightning also scared us very much./There are different kind of disaster and flooding and landslide along with earthquake./This is the season of monsoon./ Even the temporary shelter is about to collapse./There is destruction everywhere.
 Distress People still do have fear and stress./ Restlessness, it’s difficult to sleep, children do not even want to sleep./ We are very much scared./ I feel that the ground is shaking again./ We have been trying to forget everything, but we keep on dreaming about it./ Just spent all day crying without eating./ Irritated for small reasons./ We do not have any interest to work, could not even laugh./ We are dependent on alcohol to minimize stress./ Children will not go to school, even parents are avoiding their job, thinking that they are going to die soon.
 Social division/disintegration After the earthquake fighting and quarrelling has been increasing in the society./ Most of the children and women were affected because of this fighting./ Those who did not get relief materials were angry. People who are clever get relief materials and those who are not didn’t get any./ People are fighting about land./ After the earthquake occurred, people are scattered, living apart from relatives and friends, this might be the reason for stress./ These days, there are high chances of robbery and theft.
 Lack of basic resources After the earthquake, most of the houses are collapsed and all of our needs were increased but there were not enough resources, no money and no source of income./ Parents are not able to fulfill the basic needs of their children./ We don’t have work so we don’t have money./ Our field was washed away./ Our economic condition is very poor so how we would build house again./ We need to sell our land in a cheap price./ We have problem of drinking water./ Crops will last for 2–3 months and after that we will not have food.
Response to - What did you learn from the intervention?
 Disaster preparedness Now we know how to protect our lives and belongings during the disaster, so we are very much relieved./ After taking the training, all the responsibilities in the family are divided and we have already packed our belongings, important documents are kept safely, medicines are kept and stored some rice, dal, wheat and flour safely in a drum./ We realize that we need to prepare necessary materials in a bag so we can just grab it./ We have learned to share information with family, friends and community about disaster preparedness.
 Coping skills to manage distress After joining this training, irritation and fright has decreased./ We learned some techniques to get free from mental stress - breathing exercise, meditation./ We were very much scared and disturbed by the earthquake, but this training has helped us to come out from this fear. It has brought peace in our lives./ Different kind of exercise for different kind of thoughts. If we are having difficulties in sleeping then can do body relaxation exercise./ After the training we were feeling light./ I used to get very angry and after I learned that exercise, I am being able to control my anger./ My stress level has decreased./ We must try to cope instead of avoiding.
 Willingness to provide mental health support We are helping each other, providing emotional support./ I have taught my family and children how to minimize stress by doing exercises./ I have taught my brother a technique to control his anger./ If people are suffering or stressed because of disaster, because his house collapsed, we can console them./ To have feelings of helping others is useful./ If people are having problems we need to hear their problems. Before we used to neglect them but now, we have a feeling to help and support them.
 Willingness to seek mental health support Even we have stress, fear and anxiety, we should not keep it to ourselves, and we have to share it with others, so that we could feel lighter./ When I have restlessness and uncertain thoughts then I share it with my friends./ [During the training] we were able to share our thoughts about heart-mind related problems.
 Importance of working together to solve challenges The training has taught us to be cooperative, to help each other and to maintain good relationship with the society./ Unity is strength. If we work together in the society it will be easier to cope up with a natural disaster like an earthquake./ If an elephant gets separated from his herd a lion can attack him but if he is in the group no one can touch him./ We should maintain good relationship, be cooperative./ Before we used to think why do we need to help, but now we learn that we need to save others as well. So without depending on any other organization or government, we can do better if we work together, help each other.