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

2021 ◽  
Vol 8 ◽  
Author(s):  
Manaswi Sangraula ◽  
Brandon A. Kohrt ◽  
Renasha Ghimire ◽  
Pragya Shrestha ◽  
Nagendra P. Luitel ◽  
...  
Keyword(s):  
Mental Health ◽  
Cultural Adaptation ◽  
Psychological Intervention ◽  
Cultural Models ◽  
Implementation Strategies ◽  
Mechanisms Of Action ◽  
Qualitative Assessment ◽  
Psychological Interventions ◽  
Adaptation Process ◽  
Step Process

Abstract Background Because of the high burden of untreated mental illness in humanitarian settings and low- and middle-income countries, scaling-up effective psychological interventions require a cultural adaptation process that is feasible and acceptable. Our adaptation process incorporates changes into both content and implementation strategies, with a focus on local understandings of distress and treatment mechanisms of action. Methods Building upon the ecological validity model, we developed a 10-step process, the mental health Cultural Adaptation and Contextualization for Implementation (mhCACI) procedure, and piloted this approach in Nepal for Group Problem Management Plus (PM+), a task-sharing intervention, proven effective for adults with psychological distress in low-resource settings. Detailed documentation tools were used to ensure rigor and transparency during the adaptation process. Findings The mhCACI is a 10-step process: (1) identify mechanisms of action, (2) conduct a literature desk review for the culture and context, (3) conduct a training-of-trainers, (4) translate intervention materials, (5) conduct an expert read-through of the materials, (6) qualitative assessment of intervention population and site, (7) conduct practice rounds, (8) conduct an adaptation workshop with experts and implementers, (9) pilot test the training, supervision, and implementation, and (10) review through process evaluation. For Group PM+, key adaptations were harmonizing the mechanisms of action with cultural models of ‘tension’; modification of recruitment procedures to assure fit; and development of a skills checklist. Conclusion A 10-step mhCACI process could feasibly be implemented in a humanitarian setting to rapidly prepare a psychological intervention for widespread implementation.

Development of a Systematic Framework for Cultural Adaptation and Contextualization of Evidence-Based Psychological Interventions

2020 ◽  
Author(s):  
Manaswi Sangraula ◽  
Brandon A. Kohrt ◽  
Renasha Ghimire ◽  
Pragya Shrestha ◽  
Nagendra P. Luitel ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Cultural Adaptation ◽  
Systematic Approach ◽  
Cultural Models ◽  
Mechanisms Of Action ◽  
Qualitative Assessment ◽  
Feasibility Trial ◽  
Psychological Interventions ◽  
Adaptation Process ◽  
Step Process

Abstract Background Innovative interventions to address mental health needs in low- and middle-income countries (LMICs) have increased. Before implementation, it is important to culturally adapt these interventions. There is a pressing need for a systematic approach that is feasible in settings with resource constraints, to guide not only content modification but also implementation elements to inform scalability and quality assurance. We harmonized existing guidance in cultural adaptation to develop a transparent framework for rapid and systematic cultural adaptations. We piloted this approach in Nepal for Group Problem Management Plus (PM+), a trans-diagnostic, task sharing intervention, for adults with psychological distress in humanitarian settings. Methods Building upon the ecological validity model, a 10-step process was used to adapt the Group PM + intervention in preparation for a feasibility trial in Nepal. A process evaluation was conducted after the trial to gather feedback on the adaptations. Detailed documentation tools were used to ensure rigor during the adaptation process. Findings The complete adaptation included a 10-step process; 1) Identify mechanisms of action, 2) Conduct a literature desk review for the culture and context, 3) Conduct a Training of Trainers (ToT), 4) Translate intervention materials, 5) Conduct an expert read-through of the materials, 6) Qualitative assessment of intervention population and site, 7) Conduct practice rounds, 8) Conduct an adaptation workshop with experts and implementers, 9) Pilot test the training, supervision, and implementation, and 10) Review through process evaluation. An iterative process with rapid modification of content and procedures was necessary. For Group PM+, key adaptations were harmonizing the mechanisms of action with cultural models of distress; modification of recruitment procedures to assure fit between cultural models of distress and population; and development of a skills checklist to monitor facilitator engagement with mechanisms of action. Conclusion A 10-step cultural adaptation process could feasibly be implemented in a humanitarian setting to rapidly prepare a psychological intervention for widespread implementation. Having a standard systematic approach will help develop a body of literature and lessons to facilitate the process for greater cultural appropriateness and effectiveness of psychological interventions worldwide.

scholarly journals Cultural Adaptation of a Scalable Psychological Intervention for Burundian Refugee Adolescents in Tanzania: a Qualitative Study

2021 ◽  
Author(s):  
Aneeha Singh ◽  
Ashley Nemiro ◽  
Aiysha Malik ◽  
Marie-France Guimond ◽  
Estella Nduwimana ◽  
...  
Keyword(s):  
Mental Health ◽  
Cultural Adaptation ◽  
Psychological Intervention ◽  
Early Adolescents ◽  
End Users ◽  
Qualitative Assessment ◽  
Gender Based Violence ◽  
Low Literacy ◽  
Gender Based ◽  
Internalising Problems

Abstract Background: There is an urgent need for evidence-based, scalable, psychological interventions to improve the mental health of adolescents affected by adversity in low-resource settings. Early Adolescents Skills for Emotions (EASE) was developed by the WHO as a brief, transdiagnostic, group intervention for early adolescents exhibiting internalising problems, delivered by trained and supervised non-specialist providers. This study describes the cultural adaptation of EASE for Burundian adolescents living in Mtendeli refugee camps in Tanzania.Methods: A phased approach to adaptation of the EASE intervention and its implementation, was adopted and comprised of: (1) a desk review to synthesize existing research on mental health issues in conflict-affected Burundian communities, (2) a rapid qualitative assessment involving free listing and key informant interviews with multiple stakeholders, (3) cognitive interviews with end users, and (4) a two-part adaptation workshop involving the implementing partner staff, members of the refugee community and mental health experts. We applied the Bernal framework to systematically document and track adaptations across eight dimensions of the intervention.Results: Problems associated with worry, stress, sadness, shame and fear were identified as amongst the most critical mental health concerns, alongside a range of experiences of different forms of violence (such as gender-based violence, violence when fleeing from their homes) and associated problems. Problems associated with violence that included past experiences of fleeing as well as ongoing problems of gender-based violence in the camp. The most significant adaptations that were required included providing options for low literacy of participants, safety planning to address the high prevalence of sexual violence, simplification of strategies for the benefit of the end users and of non-specialist facilitators, and implementation changes to consider involvement of refugee incentive workers. A majority of changes were across dimensions of language, people, metaphors, content, methods and context, while there were fewer changes regarding the goals and concepts of EASE. Conclusions: The approach to adaptation of a psychological intervention suggested both minor and major required changes. Adaptations based on the findings of this study are anticipated to enhance relevance and acceptability of the EASE intervention and its delivery for camp-residing Burundian refugees in Tanzania.

scholarly journals Cultural adaptation of a scalable psychological intervention for Burundian refugee adolescents in Tanzania: a qualitative study

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Aneeha Singh ◽  
Ashley Nemiro ◽  
Aiysha Malik ◽  
Marie-France Guimond ◽  
Estella Nduwimana ◽  
...  
Keyword(s):  
Mental Health ◽  
Cultural Adaptation ◽  
Psychological Intervention ◽  
Early Adolescents ◽  
End Users ◽  
Qualitative Assessment ◽  
Gender Based Violence ◽  
Low Literacy ◽  
Gender Based ◽  
Internalising Problems

Abstract Background There is an urgent need for evidence-based, scalable, psychological interventions to improve the mental health of adolescents affected by adversity in low-resource settings. Early Adolescents Skills for Emotions (EASE) was developed by the WHO as a brief, transdiagnostic, group intervention for early adolescents exhibiting internalising problems, delivered by trained and supervised lay providers. This study describes the cultural adaptation of EASE for Burundian adolescents living in Mtendeli refugee camps in Tanzania. Methods A phased approach to adaptation of the EASE intervention and its implementation, was adopted and comprised of: (1) a desk review to synthesize existing research on mental health issues in conflict-affected Burundian communities, (2) a rapid qualitative assessment involving free listing and key informant interviews with multiple stakeholders, (3) cognitive interviews with end users, and (4) a two-part adaptation workshop involving the implementing partner staff, members of the refugee community and mental health experts. We applied the Bernal framework to systematically document and track adaptations across eight dimensions of the intervention. Results Problems associated with worry, stress, sadness, shame and fear were identified as amongst the most critical mental health concerns, alongside a range of experiences of different forms of violence (such as gender-based violence, violence when fleeing from their homes) and associated problems. Problems associated with violence that included past experiences of fleeing as well as ongoing problems of gender-based violence in the camp. The most significant adaptations that were required included providing options for low literacy of participants, safety planning to address the high prevalence of sexual violence, simplification of strategies for the benefit of the end users and of lay facilitators, and implementation changes to consider involvement of refugee incentive workers. A majority of changes were across dimensions of language, people, metaphors, content, methods and context, while there were fewer changes regarding the goals and concepts of EASE. Conclusions The approach to adaptation of a psychological intervention suggested both minor and major required changes. Adaptations based on the findings of this study are anticipated to enhance relevance and acceptability of the EASE intervention and its delivery for camp-residing Burundian refugees in Tanzania.

scholarly journals Development of a psychological first-aid model in inpatients with COVID-19 in Wuhan, China

2020 ◽  
Vol 33 (3) ◽  
pp. e100292 ◽  
Author(s):  
Wenhong Cheng ◽  
Fang Zhang ◽  
Yingqi Hua ◽  
Zhi Yang ◽  
Jun Liu
Keyword(s):  
Mental Health ◽  
Health Workers ◽  
Psychological Intervention ◽  
Mental Healthcare ◽  
First Aid ◽  
Mental Health Workers ◽  
Psychological Interventions ◽  
Medical Systems ◽  
Psychological First Aid ◽  
Face To Face

BackgroundFacing the social panic and substantial shortage of medical resources during the coronavirus disease 2019 (COVID-19) outbreak, providing psychological first-aid to inpatients is essential for their rehabilitation and the orderly operating of medical systems. However, the closed-ward environment and extreme shortage of onsite mental health workers have limited the use of traditional face-to-face diagnosis and psychological interventions.AimTo develop a mental health intervention model for inpatients that can be applied during a widespread epidemic, such as COVID-19.MethodsIn a medical team stationed in Leishenshan Hospital, Wuhan, China, we integrated onsite and online psychological support resources to implement a graded psychological intervention system. The onsite psychiatrist established trust with the patients and classified them into categories according to their symptom severity. While face-to-face evaluation and intervention are critical for effective online support, the online team effectively extended the scope of the ‘first-aid’ to all patients.ConclusionThis integrated onsite and online approach was effective and efficient in providing psychological interventions for inpatients during the crisis. Our model provides a realistic scheme for healthcare systems in or after the COVID-19 epidemic and also could be adopted in areas of the world with insufficient mental healthcare resources.

Conflict recognition, prevention and resolution in mental health interpreting

2012 ◽  
Vol 11 (2) ◽  
pp. 207-228 ◽  
Author(s):  
Krisztina Zimányi
Keyword(s):  
Mental Health ◽  
Cultural Adaptation ◽  
Cross Cultural ◽  
Host Community ◽  
Process Models ◽  
Adaptation Process ◽  
Conflict Prevention ◽  
Potential Conflict ◽  
Cross Cultural Adaptation ◽  
The Stranger

This article investigates the application of Kim’s (2001) theory of communication and cross-cultural adaptation to identifying and resolving areas of conflict in mental health interpreting in Ireland and, by extension, in the wider field of community interpreting. In the context of Kim’s theoretical framework, the interpreter is the ‘stranger,’ a newcomer who undergoes a cross-cultural adaptation process in an unfamiliar environment, i.e. the host community. Potential areas of conflict in community interpreting in general and mental health interpreting in particular are examined in connection with the interrelated factors that underpin Kim’s structure and process models. It is argued that these factors also provide a framework for the mapping of conflict prevention and resolution in community interpreting. Kim’s theory is further extended to examine the complexity of potential conflict between all participants in interpreter-mediated encounters as well as possible prevention and resolution strategies.

scholarly journals TechCare: Mobile-assessment and therapy for psychosis: An intervention for clients within the early intervention service

2016 ◽  
Vol 33 (S1) ◽  
pp. S608-S608 ◽  
Author(s):  
N. Gire ◽  
I.B. Chaudhry ◽  
F. Naeem ◽  
J. Duxbury ◽  
M. Riley ◽  
...  
Keyword(s):  
Mental Health ◽  
Real Time ◽  
Learning Algorithm ◽  
Psychological Intervention ◽  
Feasibility Trial ◽  
Psychological Interventions ◽  
Intervention Service ◽  
Qualitative Work ◽  
Competing Interest ◽  
The Uk

IntroductionIn the UK, mental illness is a major source of disease burden costing in the region of £105 billion pounds. mHealth is a novel and emerging field in psychiatric and psychological care for the treatment of mental health difficulties such as psychosis.ObjectiveTo develop an intelligent real-time therapy (iRTT) mobile intervention (TechCare) which assesses participant's symptoms in real-time and responds with a personalised self-help based psychological intervention, with the aim of reducing participant's symptoms. The system will utilise intelligence at two levels:– intelligently increasing the frequency of assessment notifications if low mood/paranoia is detected;– an intelligent machine learning algorithm which provides interventions in real-time and also provides recommendations on the most popular selected interventions.AimThe aim of the current project is to develop a mobile phone intervention for people with psychosis, and to conduct a feasibility study of the TechCare App.MethodsThe study consists of both qualitative and quantitative components. The study will be run across three strands:– qualitative work;– test run and intervention refinement;– feasibility trial.ResultsPreliminary analysis of qualitative data from Strand 2 (test run and intervention refinement) in-depth interviews with service users (n = 2) and focus group with health professionals (n = 1), highlighted main themes around security of the device, multimedia and the acceptability of psychological interventions being delivered via the TechCare App.ConclusionsResearch in this area can be potentially helpful in addressing the demand on mental health services globally, particularly improving access to psychological interventions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Reporting Cultural Adaptation in Psychological Trials – The RECAPT criteria

2021 ◽  
Vol 3 (Special Issue) ◽  
Author(s):  
Eva Heim ◽  
Ricarda Mewes ◽  
Jinane Abi Ramia ◽  
Heide Glaesmer ◽  
Brian Hall ◽  
...  
Keyword(s):  
Mental Health ◽  
Cultural Adaptation ◽  
Online Survey ◽  
Common Mental Disorders ◽  
Task Force ◽  
Psychological Interventions ◽  
Consolidation Process ◽  
Intervention Adaptation ◽  
Set Up ◽  
Randomised Controlled

Background There is a lack of empirical evidence on the level of cultural adaptation required for psychological interventions developed in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies to be effective for the treatment of common mental disorders among culturally and ethnically diverse groups. This lack of evidence is partly due to insufficient documentation of cultural adaptation in psychological trials. Standardised documentation is needed in order to enhance empirical and meta-analytic evidence. Process A “Task force for cultural adaptation of mental health interventions for refugees” was established to harmonise and document the cultural adaptation process across several randomised controlled trials testing psychological interventions for mental health among refugee populations in Germany. Based on the collected experiences, a sub-group of the task force developed the reporting criteria presented in this paper. Thereafter, an online survey with international experts in cultural adaptation of psychological interventions was conducted, including two rounds of feedback. Results The consolidation process resulted in eleven reporting criteria to guide and document the process of cultural adaptation of psychological interventions in clinical trials. A template for documenting this process is provided. The eleven criteria are structured along A) Set-up; B) Formative research methods; C) Intervention adaptation; D) Measuring outcomes and implementation. Conclusions Reporting on cultural adaptation more consistently in future psychological trials will hopefully improve the quality of evidence and contribute to examining the effect of cultural adaptation on treatment efficacy, feasibility, and acceptability.

scholarly journals Cultural Adaptation of Scalable Psychological Interventions: A New Conceptual Framework

2019 ◽  
Vol 1 (4) ◽  
Author(s):  
Eva Heim ◽  
Brandon A. Kohrt
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Conceptual Framework ◽  
Empirical Evidence ◽  
Cultural Adaptation ◽  
Culturally Diverse ◽  
Common Mental Disorders ◽  
Psychological Interventions ◽  
Experimental Approaches ◽  
Diverse Groups

The worldwide mental health treatment gap calls for scaling-up psychological interventions, which requires effective implementation in diverse cultural settings. Evidence from the field of global mental health and cultural clinical psychology indicates cultural variation in how symptoms of common mental disorders are expressed, and how culturally diverse groups explain the emergence of such symptoms. An increasing number of studies have examined to what extent cultural adaptation enhances the acceptability and effectiveness of psychological interventions among culturally diverse groups. To date, this evidence is inconclusive, and there is a lack of studies that dismantle the multiple types of modifications involved in cultural adaptation. Based on empirical evidence from ethnopsychological studies, cultural adaptation research, and psychotherapy research, the present paper offers a new conceptual framework for cultural adaptation that lays the groundwork for future empirical research. The cultural adaptation framework encompasses three elements: i) cultural concepts of distress; ii) treatment components; and iii) treatment delivery. These three elements have been discussed in literature but rarely tested in methodologically rigorous studies. Innovative research designs are needed to empirically test the relevance of these adaptation elements, to better understand the substantial modifications that enhance acceptability and effectiveness of psychological interventions. Using a theory-driven approach and innovative experimental designs, research on cultural adaptation has the potential not only to make psychological treatments more accessible for culturally adverse groups, but also to further advance empirical research on the basic question about the “key ingredients” of psychotherapy. The phenomenology of common mental disorders, as well as mind-body concepts, vary across cultures. Cultural adaptation may enhance the acceptability and effectiveness of psychological interventions. There is a lack of empirical evidence on the substantial modifications in cultural adaptation. Theory-driven, experimental approaches are needed in cultural adaptation research. The phenomenology of common mental disorders, as well as mind-body concepts, vary across cultures. Cultural adaptation may enhance the acceptability and effectiveness of psychological interventions. There is a lack of empirical evidence on the substantial modifications in cultural adaptation. Theory-driven, experimental approaches are needed in cultural adaptation research.

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