Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers

Abstract

Background Electronic mental (e-mental) health interventions can address mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish a better fit with the cultural group and to achieve better treatment outcomes. Objective This study aimed to describe the cultural adaptation of the World Health Organization’s e-mental health program Step-by-Step for overseas Filipino workers. We used a framework which posits that cultural adaptation should enhance (1) relevance, wherein the cultural group can relate with the content; (2) acceptability, where the cultural group will not find any element offensive; (3) comprehensibility, where the program is understandable; and (4) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino and male and female versions. Methods Overall, 3 experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for overseas Filipino workers. We then adapted the program and obtained feedback from 28 overseas Filipino workers from diverse industries through focus group discussions. We conducted 7 and 9 focus group discussions with male and female participants, respectively. Per discussion, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided iterative program adaptations, which were again shown to participants for validation and improvement. Results Several issues were raised by participants about the generic version of Step-by-Step. There were elements deemed irrelevant, like unfitting characters, lack of Filipino values, and unsuitable problems and activities. There were unacceptable components that were stigmatizing, political, inappropriate to context or subgroups, and too feminine for male users. Some elements were incomprehensible, unclear, or complicated. To address these issues, we made key adaptations. To enhance relevance, we adapted the narrative to match the experiences of overseas Filipino workers, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), political or unacceptable content was removed, and the program was made suitable for overseas Filipino workers from different sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms, and ensured that text and illustrations matched. We also used Taglish (ie, merged English and Filipino) when participants deemed pure Filipino translations sounded odd or incomprehensible. Finally, we retained the core elements and concepts included in the original Step-by-Step program to maintain completenes...

A digital mental health intervention to reduce depressive symptoms among overseas Filipino workers: protocol for a pilot hybrid type 1 effectiveness-implementation randomized controlled trial

“…The participant numbers of qualitative methods will be determined following the number of participants in trial and established methods for qualitative research [ 48 ]. Online recruitment via social media is also an effective strategy used during the feasibility study [ 26 , 49 ]. Facebook recruitment advertisements and other targeted social media messaging via opinion leaders within the Filipino community will also be used.…”

“…The intervention also seeks to ensure no participants will experience stigma from participating. The content of the intervention will look like illustrated story within the mobile application and any sensitive or potentially culturally offensive wordings are removed or reworded based on our completed qualitative cultural adaptation [ 26 ].…”

“…As part of the EU-funded STRENGTHS project [ 25 ], Step-by-Step is currently being evaluated as a self-guided intervention with a contact-on-demand guidance model. The current study in Macao uses a similar guidance model to the one used in the STRENGTHS trials and adapted the intervention content for OFWs with a rigorous cultural adaptation method [ 26 ].…”

“…A small uncontrolled feasibility study was conducted to evaluate recruitment and screening methods and evaluate the guidance model and trends in symptom change [ 26 ]. Initial results demonstrated that social media-based recruitment is most likely to succeed, supplemented with word of mouth through community influencers and direct recruitment methods through referrals from local NGOs, the Philippines Consulate, and pastoral counsellors.…”

Differential impact of affective and cognitive symptoms on remission of major depression – Authors' reply

“…Digital treatments and guided self-help expanded within a step-care model could also offer scalable and equitable alternatives to face-to-face treatment for those who do not need specialist care, and for non-Chinese migrant workers. 5 The current unrest is an opportunity to enhance public mental health in Hong Kong. In the wake of this emergency, mental health system strengthening can provide a more responsive and effective public mental health infrastructure, which is essential for long-term stability, harmony, and wellbeing.…”