Cultural adaptation of evidence-based treatments is a pressing priority for global health, and previous research has informed recommendations for guiding the process of translation and adaptation. As research in the domain of cultural adaptation and evaluation of evidence-based treatments progresses, it is critical that researchers communicate key lessons learned, so that models of adaptation can be continuously refined and reconsidered. The work described in this article aimed to translate and culturally adapt an online intervention to address symptoms of posttraumatic stress—the PTSD Coach Online—for use with young adults in Egypt. The cultural adaptation framework proposed by Bernal and colleagues (1995) was used, and focus groups and interviews with members of the target population, mental health professionals, and service users were conducted. The authors encountered a number of challenges in treatment adaptation that generated important insights for future work. Specifically, this case study highlights the importance of translation teams with diverse backgrounds and experiences, the critical nature of iterative feedback throughout the adaptation process, and the importance of a long time-horizon for optimal adaptation.
The Egyptian Revolution of 2011 resulted in high‐level exposure to sociopolitical violence, placing a large burden on the mental health care system that cannot be effectively met given the small number of available providers in Egypt. We conducted a nonblinded, randomized controlled pilot trial of an online, self‐directed tool for managing posttraumatic stress symptoms (PTSS). The study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of the PTSD Coach Online–Arabic. Trauma‐exposed Egyptian adults with clinically significant PTSS (N = 87; intervention group: n = 41) completed assessments at baseline, weekly over the treatment period, posttest, and 3‐month follow‐up. Of participants who completed weekly surveys, 88.9% used the program; 22.0% of participants reported regular, weekly use. Most tools received good likeability and perceived benefit scores, but lower perceived benefit scores on three tools suggest that some content may require additional adaptation. Intent‐to‐treat analyses using multilevel modeling with multiple imputation to account for missing data were conducted. Effect sizes for PTSS were below the cutoff for small effects at posttest, d = −0.14, but demonstrated a small positive effect at 3‐months, d = −0.25. There was a small positive effect of treatment on anxiety at posttest, d = −0.37, and a medium effect at 3‐month follow‐up, d = −0.49. Treatment effects for depressed mood were below the cutoff for small effects at posttest and 3‐months, ds = −0.14 and −0.18. These findings suggest that the PTSD Coach Online–Arabic may be a promising supplemental resource for support in this setting.
Background The growing worldwide refugee crisis highlights the needs for increased access to mental health services, including in the large urban cities in the Middle East to which refugees are frequently displaced and in which access to such services is limited. The current study offers an initial evaluation of narrative exposure therapy as a treatment for posttraumatic stress disorder among Sudanese refugees in Cairo, delivered by lay counselors. Sudanese refugees with no prior background in counseling were given 27 h of training in narrative exposure therapy. They then delivered this to seven members of the same refugee community with a diagnosis of posttraumatic stress disorder at a local community center, and this was evaluated using a pre-post design and a focus-group with the intervention recipients. Results Despite the small sample size, over the course of the intervention there was significant decrease in trauma and anxiety symptoms, and a close to significant decrease in depression. Moreover, the focus group participants generally spoke positively about their experiences. Conclusions To the best of the authors’ knowledge, this is the first study to examine the viability of lay counselors delivering narrative exposure therapy to refugees with posttraumatic stress disorder in a complex urban setting. The findings suggest that this approach has promise and support the case for a randomized control trial of narrative exposure therapy delivered in this manner in such a setting.
The following study describes the usability and the acceptability of an online intervention for the treatment of posttraumatic stress disorder (PTSD), PTSD Coach Online that was culturally adapted and translated into local Egyptian dialect. The adapted intervention was piloted in a randomized control trial with 87 Egyptians meeting clinical criteria for a diagnosis of PTSD. Of the 41 participants who participated in the treatment condition, 15 participants (10 females, 5 males) were randomly selected to take part in a semistructured interview to explore their user experience. Favorable feedback centered on the program's ease of access, user-friendly tools, and cultural appropriateness. Participants also described benefits including increased awareness of PTSD, symptom reduction, and increased willingness to seek psychological support online or in person. In contrast, participants highlighted some drawbacks of the online program, particularly the need for further support or some kind of "human" interaction as well as feelings that the information was not sufficiently personalized and that activities could have been more interesting. The findings suggest that while the PTSD Coach Online-Arabic is unlikely to be an effective stand-alone support, approximately half of the sample indicated that the availability of online tools is important for accessibility of mental health care, particularly for those concerned with stigma. As such, it may be an important supplemental offering for other forms of ongoing care and support. Future research may consider integrated approaches to care that were highlighted as being of particular interest to participants. Clinical Impact StatementQuestion: Are online psychotherapy interventions an acceptable and effective way to help manage the symptoms of posttraumatic stress disorder (PTSD) amongst Egyptians exposed to trauma? Findings:The PTSD Coach Online-Arabic is an online tool that service users can adopt in managing their symptoms. It is culturally acceptable, helps to overcome barriers such as stigma in the Middle East and opens the door to further engagement in psychotherapy amongst Egyptians. Meaning: Online psychotherapy is an acceptable and valuable clinical tool in treating mental health conditions such as PTSD and clinicians can direct service users to the PTSD Coach Online-Arabic intervention as an additional resource to manage the symptoms of PTSD in Egypt. Next Steps: It is indicated that further research to refine the PTSD Coach Online-Arabic is needed to increase effectiveness and engagement, particularly the addition of a human element of support in accessing the intervention.
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