Cultural Adaptation in Translational Research: Field Experiences

Abstract

The increase in the incidence of HIV/AIDS among minorities in the United States and in certain developing nations has prompted new intervention priorities, stressing the adaptation of efficacious interventions for diverse and marginalized groups. The experiences of Florida International University's AIDS Prevention Program in translating HIV primary and secondary prevention interventions among these multicultural populations provide insight into the process of cultural adaptations and address the new scientific emphasis on ecological validity. An iterative process involving forward and backward translation, a cultural linguistic committee, focus group discussions, documentation of project procedures, and consultations with other researchers in the field was used to modify interventions. This article presents strategies used to ensure fidelity in implementing the efficacious core components of evidence-based interventions for reducing HIV transmission and drug use behaviors and the challenges posed by making cultural adaptation for participants with low literacy. This experience demonstrates the importance of integrating culturally relevant material in the translation process with intense focus on language and nuance. The process must ensure that the level of intervention is appropriate for the educational level of participants. Furthermore, the rights of participants must be protected during consenting procedures by instituting policies that recognize the socioeconomic, educational, and systemic pressures to participate in research.

Adapting Efficacious Interventions

“…In outcome evaluations, cultural factors, such as value and belief systems, communication norms, literacy levels, and level of schooling, can affect what questions may appropriately be asked, how, and of whom; and how they are interpreted and answered by study participants (Conner, 2004;Greenfield, 1997;Hopson, Lucas, & Peterson, 2000;SenGupta, Hopson, & ThompsonRobinson, 2004). In addition to threatening a study's internal validity, culturally inappropriate frameworks and procedures may raise ethical questions concerning such issues as participants' ability to provide informed consent and the potential of the evaluation to further disempower populations that have already been marginalized (Bamberger, 1999;Dévieux, Jean-Gilles, et al, 2004;Dévieux et al, 2005;Hopson, 1999;Merryfield, 1985;SenGupta et al, 2004).…”

A Model for Adapting Evidence-based Behavioral Interventions to a New Culture: HIV Prevention for Psychiatric Patients in Rio de Janeiro, Brazil

“…Modifying existing interventions to produce optimal ''fit'' with the values and beliefs of a specific cultural group (Castro, Barrera, & Martinez, 2004;Devieux et al, 2005;Kumpfer et al, 2002) requires awareness of the ways in which concepts are verbally conveyed among its members (Bayer, 1995(Bayer, -1996. Understanding the cultural contexts in which risk behaviors occur and protective factors develop, and refining culturally specific message delivery strategies also are necessary (Marin, 1993;Wilson & Miller, 2003).…”

Cognitive-Behavioral Stress Management Interventions for Ethnic-Minority HIV-Positive Alcohol/Drug Abusers in Resource Limited and Culturally Diverse Communities

“…Other STIs are likely to further accelerate HIV disease progression in HIV+ AOD users, who are especially susceptible to reinfection because of their immune-compromised status from AOD use and their numerous health problems [4] . CBSM is unique in being developed as a secondary prevention strategy to reduce morbidity and address the distinctive daily living challenges associated with HIV infection and treatment, such as the need to sustain rigorous, long-term ARV adherence [5][6][7][8] . In the beginning, CBSM was tested as an intervention to improve quality of life and health outcomes for HIV infected individuals by using relaxation and coping skills training to reduce negative mood and slow disease progression [7,8] .…”

“…As ARV regimens were introduced, CBSM was refined to also enhance adherence to prescribed regimens. Malow and Dévieux were extensively involved in this study [5,6,9,10] and in applying CBSM to drug abusers. CBSM has been shown effective in improving adherence and quality of life and coping with stress.…”

“…We have been motivated to pursue this line of research because of the existing evidence that CBSM may promote clinical improvement in affective distress and positive changes in relevant behavioral and coping skills, social support and stress levels, which may be particularly problematic in HIV-positive subgroups with multiple problems. Such psychosocial outcomes are important because these in turn are posited to translate into enhanced medical adherence and safe sex, since these behavioral changes are unlikely to occur if individuals are severely stressed, socially isolated, lacking in coping skills and/or abusing alcohol or drugs [5,6,22] . According to Moos [23] , CognitiveBehavioral (CB) interventions may be useful because they mirror protective social processes in the life contexts of participants' lives: "These processes involve bonding, goal direction and monitoring from family, friends, religion and other aspects of traditional society; participating in rewarding activities that preclude or reduce the likelihood of substance use; selecting and emulating individuals who model conventional behavior and shun substance use and building selfconfidence and effective coping skills" (p. 14).…”