The adaptation process can be described within a framework that serves as a benchmark for development or assessment of future adaptations. Culturally adapted interventions were more efficacious than usual treatment in proportion to the degree of adaptation. There is insufficient evidence to show that adapted interventions are better than non-adapted interventions. Features of context, intervention and design influenced efficacy. Investigating whether adaptation improves efficacy, most importantly amongst ethnic minorities, requires better designed trials with comparisons against unadapted interventions.

Background An ‘ethnic’ or ‘group’ density effect in psychosis has been observed, whereby the risk of psychosis in minority group individuals is inversely related to neighbourhood-level proportions of others belonging to the same group. However, there is conflicting evidence over whether this effect differs between minority groups and limited investigation into other moderators. Aims To conduct a comprehensive systematic review and meta-analysis of the group density effect in psychosis and examine moderators. Method Four databases were systematically searched. A narrative review was conducted and a three-level meta-analysis was performed. The potential moderating effect of crudely and specifically defined minority groups was assessed. Country, time, area size and whether studies used clinical or non-clinical outcomes were also tested as moderators. Results Thirty-two studies were included in the narrative review and ten in the meta-analysis. A 10 percentage-point decrease in own-group density was associated with a 20% increase in psychosis risk (OR = 1.20, 95% CI 1.09−1.32, P < 0.001). This was moderated by crudely defined minority groups (F6,68 = 6.86, P < 0.001), with the strongest associations observed in Black populations, followed by a White Other sample. Greater heterogeneity was observed when specific minority groups were assessed (F25,49 = 7.26, P < 0.001). Conclusions This is the first review to provide meta-analytic evidence that the risk of psychosis posed by lower own-group density varies across minority groups, with the strongest associations observed in Black individuals. Heterogeneity in effect sizes may reflect distinctive social experiences of specific minority groups. Potential mechanisms are discussed, along with the implications of findings and suggestions for future research.

This is a repository copy of Facebook, relatedness and exercise motivation in university students: A mixed methods investigation.

BackgroundA group density effect in psychosis has been observed, whereby minority groups living in areas where there is a high proportion of their own group are at a lower risk of psychosis than minorities residing in neighbourhoods where their group is less represented. However, there is conflicting evidence over whether the group density effect differs by minority group, and limited investigation into other potential moderators.AimsTo conduct a comprehensive systematic review and meta-analysis of the group density effect in psychosis, examine moderating factors, and discuss possible mechanisms driving the effect.MethodFour electronic databases were systematically searched for studies reporting on the group density effect in psychosis. Evidence was qualitatively synthesised, and a three-level ‘multilevel’ meta-analysis was conducted on eligible studies. We assessed whether the pooled effect was moderated by broadly and specifically defined minority groups. Country, time, geographic unit, and outcome were also tested as moderators. We drew upon a wider evidence-base to explore potential mechanisms.ResultsThe search yielded 2652 unique articles, twenty-eight studies were included in the qualitative synthesis, and fourteen of these were eligible for meta-analysis. A ten percentage-point decrease in own-group density was associated with a 36% increase in psychosis risk [OR=1.36 (95% CI 1.11-1.65), p=0.003]. In line with the qualitative synthesis, the pooled effect was moderated by broadly defined minority groups [F6, 74=3.58, p=0.004] and when more specific minority groups were considered, a stronger moderating effect was observed [F21, 59=4.93, p&lt;0.0001]. Other moderator tests were non-significant.ConclusionsThis is the first review to provide meta-analytic evidence that the risk of psychosis posed by lower own-group density environments is not uniform across minority groups. This may reflect experiences of disempowerment which may arise differently in particular groups. This is explored further, along with implications of findings and avenues for future research.

suggests that class-based identities can also lead to density associations with mental health, but that it is the symbolic signifiers of class, and not material aspects, which activate class identities in this way.