Adaptation of a Behavioural Activation Intervention for Depression in People with Diabetes in Bangladesh and Pakistan: DiaDeM Intervention

Abstract

The cultural tailoring of interventions is a cost-effective approach to reach underserved populations. There are multiple frameworks for intervention adaptation, however, information on their use in practice, and sources to guide the adaptations is limited. The aim of this paper is to describe our experience using intervention adaptation frameworks and illustrate the adaptation process of a behavioural activation intervention for depression in people with type 2 diabetes in Bangladesh and Pakistan. We were guided by the intervention mapping adaptation framework for development and evaluation of health interventions and the Bernal and the Escoffery frameworks to address the cultural components of the adaptation. We performed a needs assessment, developed a logic model and systematically searched for available evidence-based interventions. To obtain evidence to guide the adaptations, we conducted a literature review, a qualitative study and workshops with community, expert advisory panels and a co-design group which systematically fed into the adaptation process. We co-produced the materials (training manual and booklet) with stakeholders. Finally, an implementation and evaluation plan was produced to test the feasibility and effectiveness of the intervention. We selected 3 interventions that had a good fit for our target population. Guided by the logic model, we identified core components of these interventions that could not be changed. We made changes in the language, pictures, illustrations, intervention dose and delivery (self-guided versus facilitator), inclusion of carers and/or family members, and training intensity. We developed a protocol to test the feasibility and effectiveness of the intervention considering key changes from the original intervention and the characteristics of the new setting and target population. Intervention adaptation frameworks proved to be valuable tools to guide the intervention process, and ensure the inclusion of multiple sources of evidence and key stakeholders.

Effectiveness and cost-effectiveness of a culturally tailored Behavioural Activation intervention (DiaDeM) for treating Depression in Type 2 Diabetes: Protocol for a parallel arm, multi-country, randomised controlled trial in South Asia

“…The DiaDeM trial aims to test the potential of a culturally adapted behavioural activation intervention (DiaDeM) as a suitable and cost-effective treatment to address depression among individuals with Type 2 Diabetes who are living in South Asian settings. We have identified an evidence-based intervention and further adapted it for cultural appropriateness in South Asian users and settings [28]. Our plans for implementing the trial are based on a robust study design, backed by the use of validated measures for outcome evaluation.…”

“…To understand the "mechanisms of action" through which the intervention affects behaviour, we identified behavioural change techniques and the mechanisms of action they target. Full details of the adaptation process are described in detail elsewhere [28]. DiaDeM will be delivered by non-mental health specialist staff (diabetes staff working as nutritionists, health educators, nurses, or paramedics etc).…”

Effectiveness and implementation of psychological interventions for depression in people with non-communicable diseases in South Asia: Systematic review and meta-analysis

“…The protocol has been published at the International prospective register of systematic reviews (PROSPERO) and is accessible at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020220287 (Zavala et al., 2020 ).…”