No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings
No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings
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DOI：
10.1186/s13031-020-00290-0
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发表时间：
2020-07-14
影响因子：
3.6
通讯作者：
Vallieres, Frederique
中科院分区：
文献类型：
--
作者：
Perera, Camila;Salamanca-Sanabria, Alicia;Vallieres, Frederique
背景尽管人们广泛认识到文化适应对于提高心理干预有效性的重要性，但对其过程却缺乏指导。基于现有的理论开发，我们应用了四个步骤的过程，以适应文化的低强度的心理干预用于人道主义环境。方法四步过程适用于适应世界卫生组织低强度的心理干预（即问题管理加，或PM+）用于流离失所的委内瑞拉人和哥伦比亚人。首先，快速案头审查被用作一种信息收集工具，以确定当地人口的特点。接下来，将结果用于（2）制定适应假设，从而筛选PM+协议以确定适应组件，借鉴生态有效性模型。第三，将标记为适应的要素用于（3）地方磋商，以首先核实确定的适应内容，确定需要适应的其他领域，第三，调整干预协议。最后，通过（4）与当地专家的外部评估对适应的干预方案进行审查。结果信息收集阶段产生了关于干预目标群体的社会经济方面的关键信息，心理健康和心理社会支持的可用性和需求，以及获得护理的现有障碍。适应假设阶段进一步确定了对关键概念进行更明确解释的必要性，敏感主题与当地态度相匹配的必要性（例如，家庭暴力、自杀念头），以及确定文化上适当的社会支持。在前两个阶段的基础上，当地磋商随后导致了修订的PM+协议。改编后的协议不同于原来的格式，他们的重点是这些人口群体特有的问题，在这种情况下，心理困扰的表达方式，并列入当地现有的支持。外部评价的结果支持对方案所作的调整。结论所提出的四步流程为如何在人道主义背景下适应低强度心理干预提供了有益的指导。尽管有一些限制，我们表明，即使在时间和资源稀缺，它是可能的和必要的文化适应心理干预。我们邀请进一步测试，复制和改进这一方法。
Background Despite the widely recognised importance of cultural adaptation to increase the effectiveness of psychological interventions, there is little guidance on itsprocess. 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 gatheringtool to identify local population characteristics. Next, the results were taken forward for the (2) formulation ofadaptation 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 consultationto 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 evaluationswith local experts. Results Theinformation gatheringphase 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. Theadaptation hypothesesphase 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 consultationsubsequently 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 theexternal evaluationsupported the adaptations made to the protocols. Conclusion The proposed four-step process offers a useful guide forhowto adapt low-intensity psychological intervention within humanitarian settings. Despite some limitations, we show that even when time and resources are scarce it is possible and necessary to culturally adapt psychological interventions. We invite further testing, replication, and improvements to this methodology.