No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings

Abstract

Background: Despite the widely recognised importance of cultural adaptation to increase the effectiveness of psychological interventions, there is little guidance on its process. Developed based on existing theory, we applied a four-step process to culturally adapt a low-intensity psychological intervention for use in humanitarian settings. Methods: The four-step process was applied to adapt a WHO low-intensity psychological intervention (i.e. Problem Management Plus, or PM+) for use with displaced Venezuelans and Colombians in Colombia. First, a rapid desk review was used as an (1) information gathering tool to identify local population characteristics. Next, the results were taken forward for the (2) formulation of adaptation hypotheses, whereby PM+ protocols were screened to identify components for adaptation, drawing on the Ecological Validity Model. Third, the elements flagged for adaptation were taken forward for (3) local consultation to firstly, verify the components identified for adaptation, to identify other areas in need of adaptation, and thirdly, to adapt the intervention protocols. Finally, the adapted intervention protocols were reviewed through (4) external evaluations with local experts. Results: The information gathering phase yielded key information on the socioeconomic aspects of the groups targeted for intervention, the availability and need for mental health and psychosocial support, and existing barriers to accessing care. The adaptation hypotheses phase further identified the need for clearer explanations of key concepts, the need for sensitive topics to match local attitudes (e.g., domestic violence, thoughts of suicide), and the identification of culturally appropriate social supports. Building on these first two phases, local consultation subsequently resulted in revised PM+ protocols. The adapted protocols differed from the original format in their focus on the problems unique to these population groups, the way that psychological distress is expressed in this context, and the inclusion of locally available supports. The results of the external evaluation supported the adaptations made to the protocols.

Barriers and facilitators for scaling up mental health and psychosocial support interventions in low- and middle-income countries for populations affected by humanitarian crises: a systematic review

“…Health system related barriers imply that mental health interventions in humanitarian crises need to be developed by taking these context-specific characteristics and fragilities of the systems into account to maximise scalability of the intervention. This can be ensured early on in the research process through adapting the intervention to the delivery systems and the populations it will serve [ 48 ]. Our review also identified a number of socio-economic and cultural factors compounded by crises that can further prevent people from accessing MHPSS services (e.g.…”

Development of the mental health cultural adaptation and contextualization for implementation (mhCACI) procedure: a systematic framework to prepare evidence-based psychological interventions for scaling

“…Although an existing cultural adaptation methodology has been presented to adapt individual PM+ with refugee populations (Perera et al ., 2020 ), our approach has several advantages including a central focus on the processes that lead to change (i.e. mechanisms of action), attention to implementation parameters beyond content modification (e.g.…”

Barriers and drivers to service delivery in global mental health projects

“…Researchers have recommended the decentralization of mental health services, provision of integrated and holistic care within primary health care and communities, and the strengthening of health systems [6,7] to redress key barriers to GMH implementation. Ensuring the appropriateness of mental health interventions through formative research to understand and incorporate culturally and contextually appropriate approaches to mental health, well-being and recovery have also been identified as important considerations for successful mental health service delivery [8][9][10].…”