Cross-cultural adaptation of motivational interviewing for use in rural Nepal.
Cross-cultural adaptation of motivational interviewing for use in rural Nepal.
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在尼泊尔农村使用的动机访谈的跨文化适应。
DOI：
10.1186/s40359-021-00557-y
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发表时间：
2021-04-01
期刊：
影响因子：
3.6
通讯作者：
Acharya B
中科院分区：
文献类型：
--
作者：
Rimal P;Khadka S;Bogati B;Chaudhury J;Rawat LK;Bhat KC;Manandhar P;Citrin D;Maru D;Ekstrand ML;Swar SB;Aryal A;Kohrt B;Shrestha S;Acharya B
动机式访谈（MI）在促进多种健康状况下的行为改变方面有坚实的证据基础。MI关注个体，并假定患者具有自主性。在个人主义和自主性可能不那么突出的环境中，跨文化调适可能面临若干挑战。社会文化因素，如性别、阶层、种姓，会阻碍个体决策。关键知情人的观点是新干预措施跨文化调适的一个重要方面。在此，我们分享在尼泊尔农村将MI概念翻译并调适到当地语言和文化中的经验，在那里家庭和社区在影响一个人的行为方面起着核心作用。
我们与关键知情人一起开发、翻译、实地测试并调适了一个尼泊尔语的MI培训模块，以便首次在这种文化背景下深入了解MI的调适情况。关键知情人是五名监督社区卫生工作者的尼泊尔护士。我们使用结构化观察笔记来描述跨文化调适过程中的挑战和经验。我们开展这项研究是作为一项关于利用MI提高艾滋病治疗依从性的大型研究的一部分。
参与者认为MI是一种有效的干预措施，有可能帮助那些参与治疗情况不佳的患者。关于患者自主性，他们最初分享了家庭成员试图强行改变患者行为但未成功的例子。这些讨论达成的共识是，每当家庭成员限制患者的自主性时，患者会暂时顺从，但随后又会恢复其不健康的行为。此外，参与者强调，即使患者有改变的动机（例如，回来复诊），他们的家庭成员可能也不“允许”。讨论后提出的建议是，卫生工作者可能需要分别与患者和家庭成员进行MI，以了解每个人的动机，并使这些动机与患者的需求相一致。
MI带有一些文化假设，特别是关于个人自由和自主性的假设。因此，在这些假设可能不成立的文化中，MI的调适面临挑战。然而，结合关键知情人观点的跨文化调适能够产生创造性的策略，既承认患者的自主性，又承认他们作为复杂社会结构成员的角色，以促进行为改变。
Motivational Interviewing (MI) has a robust evidence base in facilitating behavior change for several health conditions. MI focuses on the individual and assumes patient autonomy. Cross-cultural adaptation can face several challenges in settings where individualism and autonomy may not be as prominent. Sociocultural factors such as gender, class, caste hinder individual decision-making. Key informant perspectives are an essential aspect of cross-cultural adaptation of new interventions. Here, we share our experience of translating and adapting MI concepts to the local language and culture in rural Nepal, where families and communities play a central role in influencing a person’s behaviors. We developed, translated, field-tested, and adapted a Nepali MI training module with key informants to generate insights on adapting MI for the first time in this cultural setting. Key informants were five Nepali nurses who supervise community health workers. We used structured observation notes to describe challenges and experiences in cross-cultural adaptation. We conducted this study as part of a larger study on using MI to improve adherence to HIV treatment. Participants viewed MI as an effective intervention with the potential to assist patients poorly engaged in care. Regarding patient autonomy, they initially shared examples of family members unsuccessfully dictating patient behavior change. These discussions led to consensus that every time the family members restrict patient's autonomy, the patient complies temporarily but then resumes their unhealthy behavior. In addition, participants highlighted that even when a patient is motivated to change (e.g., return for follow-up), their family members may not “allow” it. Discussion led to suggestions that health workers may need to conduct MI separately with patients and family members to understand everyone’s motivations and align those with the patient’s needs. MI carries several cultural assumptions, particularly around individual freedom and autonomy. MI adaptation thus faces challenges in cultures where such assumptions may not hold. However, cross-cultural adaptation with key informant perspectives can lead to creative strategies that recognize both the patient’s autonomy and their role as a member of a complex social fabric to facilitate behavior change.
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影响因子：
4.4
作者：
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通讯作者：
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影响因子：
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DOI：
10.1016/j.hjdsi.2018.05.002
发表时间：
2018-09-01
影响因子：
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作者：
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通讯作者：
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通讯作者：
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