This article has two objectives. The first is to provide a culturally sensitive perspective to treatment outcome research as a resource to augment the ecological validity of treatment research. The relationships between external validity, ecological validity, and culturally sensitive research are reviewed. The second objective is to present a preliminary framework for culturally sensitive interventions that strengthen ecological validity for treatment outcome research. The framework, consisting of eight dimensions of treatment interventions (language, persons, metaphors, content, concepts, goals, methods, and context) can serve as a guide for developing culturally sensitive treatments and adapting existing psychosocial treatments to specific ethnic minority groups. Examples of culturally sensitive elements for each dimension of the intervention are offered. Although the focus of the article is on Hispanic populations, the framework may be valuable to other ethnic and minority groups.

The Beck Depression Inventory (BDI) is a widely used self-report measure for depression. This study has two objectives: (a) to revise, develop, and adapt a Spanish language BDI (BDI-S) that takes the criteria for the diagnosis of major depression according to the DSM-IV into consideration; and (b) to evaluate the psychometric properties (internal reliability and construct validity) of the revised version of the BDI (BDI-S). A sample of 351 undergraduate students at the University of Puerto Rico participated in this study. The participants who agreed to participate in the study and signed the consent form completed self-report measures related to depression (BDI-S, CES-D, and LCSd-7), dysfunctional cognition (DAS-A and IBT), stressful life events (LES), and social support (CAS). The coefficient of internal consistency obtained for the 22 BDI-S items was.88. The correlation coefficients between the BDI-S and instruments that measured other constructs (not depression) were lower than the correlation coefficients between instruments that measured the same constructs. Factor analysis revealed that the factor loading for the BDI-S was congruent with dimensions of depression reported in the literature. These results generally support the internal consistency and the construct validity of the BDI-S.

Psychotherapy research has not received much attention among Latinos in the U.S. or in Latin America including Puerto Rico. The present study explores factors associated with the effectiveness of psychotherapy with a sample of Puerto Ricans. Seventy-nine persons who received psychotherapy participated in a study aimed at evaluating the process and outcome of psychotherapy. Participants completed a questionnaire on the effects of treatment on the presenting problem. Information from the questionnaire and other information from the clinical records included the BDI and the Symptom Check List-36 scores, the number of sessions received, etc. constituted the data set. The results show that symptomatic severity, age. the number of sessions, and the therapeutic alliance were associated with effectiveness. Also, the alliance explained 45% of the variance in effectiveness. The results suggest that the therapeutic alliance merits further study in psychotherapy research and in clinical training.

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BackgroundColombia’s universal health coverage programme has enrolled 98% of the population, thereby improving financial protection and health outcomes. The right to participate in the organisation of healthcare is enshrined in the 1991 Colombian Constitution. One participatory mechanism is the legal and regulatory provision that citizens can form user associations. This study examines the functionality of health insurance user associations and their influence on citizen empowerment and health insurance responsiveness.MethodsThe mixed methods study includes document review (n=72), a survey of beneficiaries (n=1311), a survey of user associations members (n=27), as well as interviews (n=19), focus group discussions (n=6) and stakeholder consultations (n=6) with user association members, government officials, and representatives from insurers, the pharmaceutical industry, and patient associations. Analysis used a content–process–context framework to understand how user associations are designed to work according to policy content, how they actually work in terms of coverage, public awareness, membership, and effectiveness, and contextual influences.FindingsColombia’s user associations have a mandate to represent citizens’ interests, enable participation in insurer decision-making, ‘defend users’ and oversee quality services. Insurers are mandated to ensure their enrollees create user associations, but are not required to provide resources to support their work. Thus, we found that user associations had been formed throughout the country, but the public was widely unaware of their existence. Many associations were weak, passive or entirely inactive. Limited market competition and toothless policies about user associations made insurers indifferent to community involvement.ConclusionCurrently, the initiative suffers from low awareness and low participation levels that can hardly lead to empowered enrollees and more responsive health insurance programmes. Yet, most stakeholders value the space to participate and still see potential in the initiative. This warrants a range of policy recommendations to strengthen user associations and truly enable them to effect change.