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Cultural adaptation: Tools for evidence based practice with diverse populations

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This multiauthored work brings together the scholarly and the clinical in its analysis of two separate yet inextricably linked endeavors in psychology: the cultural adaptation of existing interventions and the movement toward evidence-based practice (EBP). The unifying theoretical framework of this volume promotes culturally adapted EBPs as productive and empirically viable approaches to treating ethnic minorities and culturally diverse groups. Chapter authors describe cultural adaptations of conventional EBPs for a variety of psychological problems across a wide range of cultures and ethnicities — Latino/as, Chinese, African Americans, and American Indians among them. Cultural Adaptations will appeal to clinicians who treat an ethnically and culturally diverse clientele, as well as to researchers, scholars, and students, who will value the conceptual and methodological discussions of evidence-based psychological practice and cultural adaptations of psychotherapeutic techniques.
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... [13][14][15][16] Cultural adaptation of interventions is defined as "systematic modification of an evidence-based treatment (EBT) or intervention protocol to consider language, culture and context in such a way that it is compatible with the client's cultural patterns, meanings and values." 17 Cultural adaptation may include adaptation to the focus community's language, culture and attitudes, and being attentive to specific needs. It can also include obtaining input from key figures within these communities to avoid mismatches with parents' prior knowledge and beliefs and stimulating acceptance, participation, and completion of the intervention. ...
... The identified empirical profiles were related to theoretical distinctions from the literature, including IM, 23 family interventions, 40 cultural adaptation, and prevention science. 10,17 Our framework distinguishes various concrete actions to shape cultural adaptation across all phases of program development. Future program developers may use an integrated approach to the development of future programs (perhaps similar to the first profile), but it is also possible to complement a more restricted focus on cultural adaptation from a specific profile with other profiles to incorporate adaptation into the development of interventions in a structured fashion, because the identified profiles are independent and complementary. ...
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Background and Objectives: Various interventions aim to reduce obesity and promote healthy lifestyles among different cultural groups. Methods: We have conducted a systematic literature review, following PRISMA guidelines (registered at https://doi.org/10.17605/OSF.IO/HB9AX), to explore profiles of cultural adaptation and parenting approach of lifestyle interventions for families with young children (1-4 years). Results: Our search (in CINAHL, ERIC, PsycINFO, PubMed, Scopus, and SSCI) yielded 41 studies reporting 31 interventions. Drawing on Intervention Mapping, we applied a newly developed framework with various indicators of cultural adaptation and a parenting approach to analyze interventions. Our review shows clear differences in the level of cultural adaptation. A categorical principal component analysis revealed 6 different empirical profiles of cultural adaptation. Conclusions: Based on our profiles, we discuss how cultural adaptation can be strengthened in the design of future early interventions aimed at promoting a healthy lifestyle.
... Interestingly, more than half of the sample reported not knowing how to access EBPs, and more than a quarter had not received EBP training in the previous year. Attitudes of divergence from research could be minimized with the provision of resources (e.g., training and supervision) focused on how to evaluate and adapt EBPs to Puerto Ricans and Latin American communities (Bernal & Domenech Rodríguez, 2012). ...
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This study investigated the needs and attitudes toward EBPs among an interdisciplinary sample of mental health professionals in Puerto Rico. An anonymous survey was distributed to social workers, psychologists, and professional counselors (N=237). Using structural equation modeling, four dimensions of attitudes towards EBPs (openness, divergence, appeal, and requirement) were regressed on various individual and organizational factors. Some socio-demographic characteristics, educational opportunities, and organizational factors significantly contributed to specific attitudes related to the adoption of EBPs. Female participants and those working in rural settings scored higher in the openness to innovation dimension. Greater organizational support and graduating from a private institution were associated with more divergence from research, while married individuals and those trained on EBPs scored lower on this dimension. The lack of exposure to EBPs in college and younger age predicted greater interest in the appeal of adopting an EBP intervention (i.e., would adopt an EBP if it made sense). No differences in attitudes toward EBPs were found by professional discipline or work setting (i.e., clinical, community, and schools). Recommendations to increase openness and interest in the appeal of EBPs among Spanish-speaking professional communities in Latin America are highlighted.
... Following adaptation frameworks, including for cultural adaptation (15) (16), and taking this information into account, and in discussion with experts within NIMHANS and the wider BEACON team, the materials, plans for delivery and training package were adapted. Revisions to the package were made through expert panel reviews, codesign workshops with NCD counsellors and feedback sessions from NCD patients and caregivers. ...
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Introduction The increasing burden of depression and non-communicable disease (NCD) is a global challenge, especially in low- and middle-income countries (LMIC) considering the resource constraints and lack of manpower in these settings. Brief psychological therapies such as behavioural activation (BA), have shown to be effective for the treatment of depression. However, their feasibility and effectiveness for depression in people with NCDs in Indian community setting has not been systematically evaluated. Hence, in this study, we conceptualize to adapt BA into Indian NCD context, thus to improve the management of depression in people with NCD in India. Aims To (1) adapt BA for the Indian NCD context, (2) test the acceptability, feasibility and implementation of the adapted BA intervention (BEACON intervention package, BIP), and (3) test the feasibility of a randomised controlled trial evaluation of BIP for the treatment of depression compared with enhanced usual care. Methods Following well-established frameworks for intervention adaptation, we first adapted BA (to fit the linguistic, cultural and resource context) for delivery in India. The intervention was also adapted for potential remote delivery via telephone. In a randomised controlled trial, we will then test acceptability, feasibility and implementation of the adapted BA intervention (BEACON Intervention package, BIP). We also test if a randomised controlled feasibility trial can be delivered effectively and estimate important parameters (e.g. recruitment and retention rates and completeness of follow up) needed to design a future definitive trial. Findings will be used to refine procedures for a future definitive trial evaluation of the effectiveness (and cost-effectiveness) of the BIP compared with enhanced usual care for the treatment of depression in NCDs. Ethics and dissemination The study has received ethics approval by the University of York Health Sciences Research Governance Committee, UK; the Health Ministry Screening Committee, India; and the Ethics Committee (Behavioural Sciences Division), NIMHANS, Bangalore, India. Trial Registration CTRI/2020/05/025048 [Registered on: 06/05/2020], http://ctri.nic.in This research was funded by the National Institute for Health Research (NIHR) (17/63/130) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.
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In contemporary therapeutic practice, the intersection of cultural competence and mental health care is a critical focus. This chapter delves into the intricate interplay between cultural identity, spirituality, and disability, highlighting the multifaceted nature of these intersections.
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The U.S. Department of Veterans Affairs has endorsed the Skills Training in Affective and Interpersonal Regulation (STAIR) therapy as an effective intervention for reducing PTSD symptoms, enhancing self-regulation, and improving interpersonal efficacy. However, Spanish-speaking veterans at the VA Caribbean Healthcare System lacked access to STAIR manuals in their preferred language. This study addressed this gap by translating and culturally adapting the STAIR therapy participant manual using the Ecological Validity Model (EVM). The materials were then tested in a randomized intervention with six Caribbean Spanish-speaking male veterans, aged 23-62, diagnosed with PTSD who received mental health services at the Primary Care Mental Health Integration (PC-MHI) level of care. Nonparametric tests were used to evaluate symptom progression, and content analysis was conducted on semi-structured interviews. There were no statistically significant changes in PTSD, emotion regulation, or interpersonal problems within the groups. However, participants in the intervention group reported clinically significant changes regarding PTSD symptoms. Interviews with therapists and STAIR participants highlighted improvements in social engagement and interpersonal boundaries. The intervention was found to be feasible and acceptable at PC-MHI. The culturally adapted Spanish version of the STAIR manual proved to be effective, suggesting that STAIR may be a viable approach for reducing PTSD symptoms and improving interpersonal and self-regulation strategies among Spanish-speaking veterans in primary care settings. A randomized control trial is recommended to further explore its efficacy.
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Autism is a form of disorder having high prevalent rate in more than 80 nations globally, and there have been few studies that examine this disorder from a cultural perspective. In this literature review, an overview of autism’s awareness and culture, citing relevant instances from both advanced and less advanced nations is provided. From the result, it was discovered that ASD are expressed in diverse ways based on various cultures. The level of understanding and perception of caregivers about ASD are influenced by demographic factors such as social economic status, gender, and educational level. Notwithstanding, these factors appear to impact residents of advanced nations since they not only already have a system that is stable and complete but also have legislation for ASD. Contrastingly, individuals residing in developing nations that are witnessing resource imbalance, likewise encounter relative lack of ASD perception, screening and diagnosis. To provide relatively affordable and accessible service to children suffering from ASD across the globe, it is necessary to intensify effort in the future.
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Discrepancies between parent and youth perceptions of their relationship are a common aspect of generational acculturation gaps influencing immigrant families. Programs designed to strengthen parenting practices among immigrant Latino families commonly address immigration stresses, including differences between parent and youth perceptions, but little is known about discrepancies in their appraisals of program effects on parenting behavior. A randomized trial was conducted examining effects on parent behavior of a program for immigrant families with youth aged 10-14, developed through community-based participatory research principles. Families (346 parents and youth) were recruited by organizations serving Latino families in a Midwestern metropolitan area and randomly assigned to the eight-session psychoeducation and skill-building program or a waitlist control. Parents and youth completed self-report measures at pre-intervention, post-intervention (4 months), and a 6-month follow-up regarding parents' expression of acceptance , efforts to solicit information about the child's experiences, and consistency of discipline, key foci of the program. Based on social cognition theory, the study focused on possible differences in parents' and youths' perceptions of change in parenting behavior. Parents in the treatment group reported pre-post improved acceptance , consistent discipline, and solicitation, whereas youth reported improvement only in parental solicitation,
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Scaling up effective interventions in public health is complex and comprehensive, and published accounts of the scale-up process are scarce. Key aspects of the scale-up experience need to be more comprehensively captured. This study describes the development of a guide for reflecting on and documenting the scale-up of public health interventions, to increase the depth of practice-based information of scaling up. Reviews of relevant scale-up frameworks along with expert input informed the development of the guide. We evaluated its acceptability with potential end-users and applied it to two real-world case studies. The Scale-up Reflection Guide (SRG) provides a structure and process for reflecting on and documenting key aspects of the scale-up process of public health interventions. The SRG is comprised of eight sections: context of completion; intervention delivery, history/background; intervention components; costs/funding strategies and partnership arrangements; the scale-up setting and delivery; scale-up process; and evidence of effectiveness and long-term outcomes. Utilization of the SRG may improve the consistency and reporting for the scale-up of public health interventions and facilitate knowledge sharing. The SRG can be used by a variety of stakeholders including researchers, policymakers or practitioners to more comprehensively reflect on and document scale-up experiences and inform future practice.
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Evidence-based programs (EBPs) delivered in elementary schools show great promise in reducing risk for emotional and behavioral disorders (EBDs). However, efforts to sustain EBPs in school face barriers. Improving EBP sustainment thus represents a priority, but little research exists to inform the development of sustainment strategies. To address this gap, the Sustaining Evidenced-Based Innovations through Multi-level Implementation Constructs (SEISMIC) project will (a) determine if malleable individual, intervention, and organizational factors predict EBP treatment fidelity and modifications during implementation, sustainment, or both; (b) assess the impact of EBP fidelity and modifications on child outcomes during implementation and sustainment; and (c) explore the mechanisms through which individual, intervention, and organizational factors influence sustainment outcomes. This protocol article describes SEISMIC, which builds upon a federally funded randomized clinical trial evaluating BEST in CLASS, a teacher-delivered program for K to Grade 3 children at risk for EBDs. The sample will include 96 teachers, 384 children, and 12 elementary schools. A multi-level, interrupted time series design will be used to examine the relationship between baseline factors, treatment fidelity, modifications, and child outcomes, followed by a mixed-method approach to elucidate the mechanisms that influence sustainment outcomes. Findings will be used to create a strategy to improve EBP sustainment in schools.
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