Ecological validity and cultural sensitivity for outcome research: Issues for the cultural adaptation and development of psychosocial treatments with Hispanics

Abstract

This article has two objectives. The first is to provide a culturally sensitive perspective to treatment outcome research as a resource to augment the ecological validity of treatment research. The relationships between external validity, ecological validity, and culturally sensitive research are reviewed. The second objective is to present a preliminary framework for culturally sensitive interventions that strengthen ecological validity for treatment outcome research. The framework, consisting of eight dimensions of treatment interventions (language, persons, metaphors, content, concepts, goals, methods, and context) can serve as a guide for developing culturally sensitive treatments and adapting existing psychosocial treatments to specific ethnic minority groups. Examples of culturally sensitive elements for each dimension of the intervention are offered. Although the focus of the article is on Hispanic populations, the framework may be valuable to other ethnic and minority groups.

Guided Act and Feel Indonesia – Internet-based Behavioral Activation Intervention for Depression in Indonesia: A Systematic Cultural Adaptation

“…Furthermore, we attended to the eight culturally sensitive elements necessary for cultural adaptation of a psychosocial treatment: language, persons, metaphors, content, concepts, goals, methods, and context (Bernal et al, 1995). In the results section, we describe how we tailored each phase of the FMAP during our current study and how we adapted the eight cultural elements in both the behavioral activation content, and the internet-based intervention program presentation, to ensure the intervention became appropriate for those from an Indonesian cultural background.…”

“…suicide prevention community), lay counselors as a community-based organization and agency, and patients as users. The data collected for adaptation by the FMAP (Hwang, 2009), and the elements for cultural adaptation (Bernal et al, 1995) were analyzed using a qualitative approach.…”

“…The adaptation was conducted to ensure that participants from different cultural backgrounds benefit from the treatment (Bernal, Bonilla, & Bellido, 1995;Hwang, 2009). This is especially relevant for the current study because Dutch culture and Indonesian culture are very different.…”

“…For example, during the treatment, they used more general terms that align with local health beliefs, because most patients did not regard their symptoms as related to "mental disorder" . A study in Kenya (Papas et al, 2010) adapted cognitive behavioral therapy to be more culturally sensitive to Kenyan culture by using Bernal and colleagues' eight cultural elements (Bernal et al, 1995). For example, they used local idioms of important terms and activities during the treatment, and recruited counselors from various ethnic backgrounds, since the patients came from different cultural backgrounds across Kenya (Papas et al, 2010).…”

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families

“…Despite movement toward addressing client culture through widespread calls for cultural responsiveness in mental health (Bernal et al 1995;U.S. Department of Health and Human Services 2001;Sue 1998), those in the mental health services field continue to grapple with the amorphous concept of culture that they encounter that unconsciously affects client engagement and treatment response.…”