A Culturally Adapted Cognitive Behavioral Therapy Group: A Randomized Controlled Trial

Objective This study aimed to evaluate a culturally adapted cognitive behavior therapy (CBT) group for Chinese people with depression that aimed to alter participants’ negative beliefs of themselves, which were influenced by traditional Chinese cultural values. Method In this randomized controlled trial, 43 participants diagnosed with depression were randomly allocated to a 10-session culturally adapted CBT group or treatment as usual (TAU). A research assistant, who was blinded to the group allocation process, used the Chinese Beck Depression Inventory-II to assess participants’ depressive symptoms during the pre-treatment and post-treatment periods. Results The results of the mixed linear model for repeated measures showed that the CBT group had significantly greater improvement in depressive symptoms than treatment as usual, with a medium effect size. Conclusion This study supports the efficacy and effectiveness of the culturally adapted CBT group in facilitating clinically significant improvement in Chinese people with depression.

Practitioner Experiences Responding to Suicide Risk for Survivors of Human Trafficking in the Philippines

Human trafficking survivors experience elevated suicide risk in comparison to the general population. Anti-trafficking service providers in the Philippines have identified capacity building in suicide prevention as a critical priority given the insufficient number of trained mental health professionals and lack of culturally adapted evidence-based interventions in the Philippines. We conducted a focused ethnography exploring the experiences of non-mental health professionals working in the anti-human trafficking sector in the Philippines in responding to suicidality among survivors of human trafficking ( n = 20). Themes included: emotional burden on service providers, manifestations of stigma regarding suicide, lack of clarity regarding risk assessment, lack of mental health services and support systems, transferring responsibility to other providers, and the need for training, supervision, and organizational systems. We discuss implications for training service providers in the anti-human trafficking sector, as well as cultural adaptation of suicide prevention interventions with human trafficking survivors in the Philippines.

Cross-cultural Adaptation, Reliability and Validity of the Cantonese-Chinese Cumberland Ankle Instability Tool (CAIT-HK)

Acute ankle sprains are common amongst athletes, and screening is essential in preventing these long-term sequelae. Self-reported questionnaires, such as the Cumberland Ankle Instability Tool (CAIT), may help identify individuals with chronic ankle instability. To date, a Cantonese-Chinese version of the CAIT does not exist. Although several studies have cross-culturally adapted the CAIT into Chinese and Taiwan-Chinese, there are cultural differences in language use. A cross-cultural adaptation and validation of the CAIT were carried out: 46 individuals who were native in Cantonese completed the Cantonese-Chinese version of the CAIT and Chinese Foot and Ankle Outcome Score. For the test-retest analysis, the intraclass correlation coefficient was 0.874. Internal consistency showed a Cronbach's ɑ value of 0.726. Construct validity against the FAOS was fair but significant with a Spearman's correlation coefficient of 0.353, 0.460, 0.303, 0.369 and 0.493 for the categories of symptoms, pain, daily function, sports function, and quality of life respectively. A cut-off score of 20.5 was determined to differentiate healthy individuals from those with chronic ankle instability for this study population. The original English CAIT was successfully translated, cross-culturally adapted and validated into Cantonese-Chinese.

Translation, Cross-Cultural Adaptation and Validation of the Gestational Diabetes Mellitus Knowledge Questionnaire in the Western Cape, South Africa

Background. Gestational diabetes mellitus (GDM) is a major public health concern. The International Diabetes Federation estimated that the global prevalence of hyperglycemia in pregnancy is 16.2%. In South Africa, the most recent prevalence of GDM ranges between 9.1-25.8%. Serious adverse events associated with GDM can be mitigated by lifestyle modifications and education. Good comprehension of GDM, and improved understanding has been shown to translate into better glycemic control and reduces peri-natal complications. Assessing the knowledge base of mothers with GDM, whether in a country like South Africa, or any other similar country, is therefore imperative in bridging the gap and improving their understanding and control of their condition. Objective. To ascertain the validity and reliability of translated, cross-culturally adapted South African English, Afrikaans and isiXhosa versions of the Malaysian GDM Knowledge Questionnaire (M-GDMKQ). Methods. This mixed-method study was conducted prospectively within a high-risk antenatal clinic setting. The study consisted of three phases. Women ≥18-years, with GDM who were able to read basic level English, Afrikaans or isiXhosa; and attended the high-risk antenatal clinic throughout the index pregnancy were consecutively sampled and stratified into three language groups across phases. Results. The cross-culturally adapted English, Afrikaans and isiXhosa South African GDMKQ demonstrated reasonable face and content validity. Kappa values ranged between Kappa (SE), -0.03 (0.18) to 0.89 (0.13) for the English version, Kappa (SE), -0.07 (0.18) to 0.53 (0.13) for the Afrikaans version and Kappa (SE), 0.28 (0.18) to 0.87 (0.17) for the isiXhosa version respectively. Cronbach alpha for the individual questions ranged from 0.31 to 0.90, while correlation between overall scores was rho=0.79 (p<0.001). Conclusion. While the translated and cross-culturally adaptation South African English, Afrikaans and isiXhosa versions of the GDMKQ were found to be feasible, acceptable and easy to comprehend, more research is required to confirm validity and reliability.

Cross-cultural adaptation of the Activities of Daily Living Questionnaire-Brazil in Parkinson’s disease

ABSTRACT Background: Culturally adapted measures to assess the performance of activities of daily living (ADL) in individuals with Parkinson’s disease (PD) are limited in Brazil. Objective: To adapt the ADL Questionnaire to the Brazilian culture and to analyze its reproducibility in individuals with PD. Methods: The ADL Questionnaire was translated and cross-culturally adapted to Brazilian Portuguese language. Reproducibility was analyzed using test-retest reliability and agreement values. The test-retest reliability of the individual items and total scores were calculated. The limits of agreement were verified using the Bland-Altman plot. The standard error of measurement (SEM) and the minimum detectable change (MDC) were calculated. Patients who were classified on a score of 1–4 on the modified Hoehn and Yahr scale were eligible. Results: No divergence was identified between the original and the adapted version, which demonstrated adequate semantic and conceptual equivalence. The Bland-Altman plot showed no systematic changes in the mean test-retest scores. The intraclass correlation coefficient (ICC) was 0.98 (95% confidence interval [95%CI] 0.93–0.99), and all individual items showed good levels of reliability (>0.60). The SEM (SEM%) and MDC (MDC%) values were 3.0 (6.75%) and 8.2 (18.7%), respectively. These values are within the recommended values. Conclusions: The ADL-Brazil Questionnaire is a reliable instrument to be used for clinical and research purposes to assess self-perceptions of ADL performance in individuals with PD.

A Culturally Adapted Timed-Activity RCT for Latinos With ADRD and Caregivers: Feasibility, Acceptability, and Effects

Latinos are twice as likely to develop Alzheimer’s disease (AD) compared to non-Latino whites, yet, account for &lt;2% of clinical trial participants in AD research. This randomized controlled trial examined the feasibility, acceptability and effects of a culturally-adapted timed-activity intervention designed to promote quality of life (QOL) and reduce behavioral symptoms in older Latinos with AD and their caregivers. Healthy Patterns [Pautas Saludables] was implemented among 40 Spanish-speaking dyads. Measures assessed at baseline and 4 weeks post-intervention, indicate improvements in sleep efficiency (p=.06) and QOL (p=.01) among intervention participants. Pautas Saludables was found to be feasible and acceptable. Intervention attendance rate was &gt;90% with low attrition (n=0); no adverse events. Most (74%) rated timed-activity sessions as helpful and appropriate; 58% recommended refreshers. Results provide evidence that Latinos with AD will participate in clinical trials and can improve on key health outcomes, when interventions are adapted to meet their cultural needs.

Cultural Adaptations to Recruitment Strategies and Community-Based Interventions for Dementia Caregivers

Nearly 30 years after the 1993 National Institute of Health Revitalization Act, minority groups’ low participation in research remains (which required the inclusion of women and racial/ethnic minority groups into government-funded clinical trials). This is particularly the case for participation in research on Alzheimer’s Disease and related dementias (ADRD). Deeply rooted historical race-based mistreatment in research and in the health care system at large persist as barriers to low-participation of minorities (i.e. Black/African American, Hispanic/Latino) and immigrants in research studies, who remain at disparate risk for adverse ADRD health outcomes and expedited mortality. The use of culturally adapted approaches in recruitment strategies and community-based interventions might be helpful to encourage the participation of underrepresented groups into research. As such, this presentation highlights three studies that seek to use cultural adaptation to inform recruitment strategies and community-based interventions. First, Dr. Parker will present how tenets from Critical Race Theory can be used to inform culturally-adapted recruitment strategies of Black/African American caregivers into community-based research by drawing upon two ongoing studies: a randomized trial providing caregiver support through Adult Day Services (ADS) and the evaluation of impact of ADS on stress levels of Black/African American using biomarker measures. Next, Ms. Johnson will present results on cultural adaptions to the ADS-Plus Program for Spanish-speaking populations. Finally, Dr. Nkimbeng will present on the process of culturally-tailoring dementia education for African immigrants in Minnesota. Findings from this presentation identify opportunities for researchers to use cultural adaptations to encourage participation of underrepresented populations into ADRD research.