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No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings

机译：没有文化适应的实施：在人道主义环境中有文化适应低强度心理干预的过程

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Background:Despite the widely recognised importance of cultural adaptation to increase the effectiveness of psychological interventions, there is little guidance on its process. 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 gathering tool to identify local population characteristics. Next, the results were taken forward for the (2) formulation of adaptation 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 consultation to 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 evaluations with local experts.Results:The information gathering phase 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. The adaptation hypotheses phase 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 consultation subsequently 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 the external evaluation supported the adaptations made to the protocols.Conclusion:The proposed four-step process offers a useful guide for how to 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.? The Author(s) 2020.
机译：背景：尽管众所周知的文化适应重要性提高心理干预的有效性，但对其过程几乎没有指导。根据现有理论开发，我们应用了四步的过程，以文化适应低强度的心理干预，以便在人道主义环境中使用。方法：采用四步过程来调整谁低强度心理干预（即问题管理加上或PM +）与流离失所者委内瑞拉斯和哥伦比亚哥伦比亚人一起使用。首先，迅速的桌面评论被用作（1）信息收集工具，以识别当地人口特征。接下来，对改性假设的（2）制剂进行结果，从而筛选PM +方案以识别适应组件，在生态有效性模型上绘制。三，标记为适应的元素是向（3）本地咨询首先，验证所识别的组件，以识别需要适应的其他区域，第三，以适应干预协议。最后，通过与当地专家的外部评估进行了调整的干预协议。结果：信息收集阶段产生关于针对干预，可用性和心理社会支持的集团社会经济方面的关键信息。寻求护理的现有障碍。适应假设阶段进一步确定了需要更清楚的关键概念的解释，需要对敏感主题来匹配局部态度（例如，家庭暴力，自杀的思想）以及确定文化适当的社会支持。在这些前两个阶段构建，当地咨询随后导致修订的PM +协议。适应的协议与原始格式不同，他们关注这些人口群体独有的问题，在这种背景下表达了心理困扰的方式，以及包含本地可用的支持。外部评估的结果支持对协议的适应。结论：建议的四步过程为如何在人道主义环境中适应低强度心理干预的有用指南。尽管有一些局限性，但我们表明即使时间和资源稀缺，也可以在文化上适应心理干预。我们邀请进一步测试，复制和改进此方法。作者2020年。

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