The authors’ primary aim was to draw upon previous research to inform the development of a framework for adapting interventions to different cultural groups. A secondary aim was to explore the degree to which previous cultural adaptations adhered to the core components of evidence-based interventions (EBIs).
To achieve their aims, the authors conducted a systematic literature review of studies from 1996 – 2014 that adapted psychotherapeutic EBIs to ethnic minorities. Studies were excluded if they used EBIs that were delivered in self-help format; if they amalgamated components from different EBIs; or if they used primarily behavioural interventions aimed at improving physical health. The review included 45 studies. As the majority of research in the field used qualitative research methods, the authors used a thematic synthesis to code themes within and across studies. They followed an inductive, systematic process which culminated in a theoretical framework for making cultural adaptations to EBIs.
The framework distinguishes core elements of treatment from peripheral ones to help researchers consider their options for adapting EBIs. Core elements are those thought to mediate symptom change whereas peripheral elements concern engagement and treatment delivery. The authors provided specific examples of how the different types of adaptations have been applied in previous research. An example they provided of an adaption to engagement was changing the location of treatment to a place more accessible and less stigmatising, such as the client’s home. An example of an adaption to treatment delivery was using culturally-appropriate idioms or metaphors.
To address their secondary aim, the authors reported the frequencies of studies that made cultural adaptations, categorised by the different elements of their framework. All 45 (100%) studies adapted peripheral elements, whereas only five (11.11%) modified existing core elements (60% added core components however). Therefore, the authors concluded that cultural adaptation does not usually require deviating from the core components of EBIs and they discussed the utility of their framework for informing clinical practice and research. However, they noted limitations of their study (e.g. the lack of quantitative data pertaining to the effectiveness of the adaptations).