Cultural adaptation of Hap-pas-Hapi, an internet and mobile-based intervention for the treatment of psychological distress among Albanian migrants in Switzerland and Germany

Abstract

Background Internet- and mobile-based mental health interventions have the potential to narrow the treatment gap in ethnic groups. Little evidence exists on the cultural adaptation of such interventions. Cultural adaptation of evidence-based interventions distinguishes between surface and deep structure adaptation. Surface refers to matching materials (e.g., illustrations, language) or methods of treatment delivery to the target population, whereas deep structure adaptation considers cultural concepts of distress (CCD). So far, CCD have only been considered to a limited extent in cultural adaptation of psychological interventions, and there is a lack of well documented adaptation procedures. Aims With a cross-disciplinary and mixed-method approach, following a new conceptual framework for cultural adaptation of scalable psychological interventions, this study aimed to develop both surface and deep structure adaptations of an internet- and mobile-based intervention called Hap-pas-Hapi for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. Methods A qualitative ethnopsychological study was conducted to examine the target group's CCD. Focus group discussions, an online survey, and individual key informant interviews were utilised to evaluate the original intervention, adaptation drafts and the final adapted intervention. A reporting system was developed to support the decision-making process and to report all adaptations in a transparent and replicable way. Results The ongoing involvement of target population key informants provided valuable feedback for the development of a more person-centred intervention, which might enhance treatment acceptance, motivation and adherence. Discussion This study provides empirical and theory-based considerations and suggestions for future implementation that may foster acceptability and effectiveness of culturally adapted evidence-based interventions.

Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review

“…Illustrated environment/burdens Mental health Low medical infrastructure due to war 61 , 95 , 144 Countries, politics Eventually adding information about good habits when living in Sweden, e.g., eating 63 , 134 Education Low socio-economic status, low level of parents education 139 Burdens High level of pressure for academic excellence as stressor for adolescents, lack of siblings could lead to decreased social skills, loneliness 136 4. Illustrated values/traditions Handling relationships/sexuality/marriage Changing/excluding parts related to unmarried cohabitation 79 Value/importance of family/community Include families and friends in the treatment goals to take into account possible consequences in the family and community that might be more relevant for participants than their own individual suffering 90 Value/importance of religion/respect/spirituality Include a trustful relationship with God 97 – 99 Other values Longing for their country 77 5. Language translation Translating intervention English to Chinese 88 Translating to dialect Rephrasing in Canadian English 131 Providing various language options to choose Offer more language options (supply native language support for all important services) 111 6.…”

“…Visualisation of language Use of metaphors Metaphors that appeal better and depict distress and recovery 69 , 89 Use of verbal expressions (sayings, quotes) Cultural specific terms like ‘ciclovía’ (bike rides on sundays) 73 , 138 Use of symbols The Local name selected for the programme—Selge—has two meanings: clear and sober 82 8. Difference in concepts of mental health and its treatment Poor knowledge Rather somatic symptoms (e.g., fatigue, decreased energy, weight changes) 123 Stigmatisation of mental health problems Framing the goal of the intervention as a stress management tool or academic performance tool instead of mental health intervention, in order to reduce the stigma 141 Distrust in treatment/confidentiality Increase trust in the app: lessen worries about data protection or doubts whether the programme would actually help 111 Related to religion/supernatural powers Fatalistic assumption that suffering is given by fate or by God and has to be endured 90 9. Goals of treatment Increase understanding/acceptance of mental disorders Addressing myths about depression and its treatment 125 Increase understanding on treatment possibilities Informing on PTSD and its management in stressful environments 87 Enhance coping strategies Improvement of parent-adolescent communication to enhance protective factor of family 139 10.…”

Metaphors For Trauma: A Cross‐Cultural Qualitative Comparison in Brazil, India, Poland, and Switzerland

“…An example of how metaphors can be used in the cultural adaptation of psychological interventions is provided by Shala et al. (2020).…”

“…In practice, this method can improve the cultural adaption of trauma interventions by taking into consideration different vocabularies, implicit worldviews, collective practices, and the historical background related to psychological suffering. An example of how metaphors can be used in the cultural adaptation of psychological interventions is provided by Shala et al (2020).…”

A Feasibility Study of the WHO Digital Mental Health Intervention Step-by-Step to Address Depression Among Chinese Young Adults

“…Germany, the WHO developed the web version of Step-by-Step (SbS) (17), which was later developed into a mobile app and culturally adapted for a diversity of populations (18)(19)(20)(21)(22)(23). In order to evaluate the effectiveness and implementation of SbS in a Chinese tertiary educational setting, SbS was culturally adapted (23), followed by the current feasibility study that preliminarily tested the adapted intervention, and informed the study process of a future randomized controlled trial (RCT), which is now planned (24), guided by the developmentevaluation-implementation process (25) and implementation evaluation framework (26,27).…”