Adapting iSupport program around the world: a cross‐cultural study

Abstract

AbstractBackgroundiSupport is an online evidence‐based intervention developed by the World Health Organization (WHO) to provide training and support to informal caregivers of people with dementia. WHO provides general guidelines to support countries adapting the intervention to local contexts and needs. iSupport is being adapted by a variety of teams in over 30 countries composing an international network. Cultural adaptation of evidence‐based interventions has the potential to increase their effectiveness, usability, and scalability (Theobald et al., 2018). This cross‐cultural investigation aims to collect and synthesize methodologies used for the cultural adaptation of iSupport worldwide.MethodWe designed and conducted this qualitative study under the auspices and in collaboration with the WHO’s brain health unit who led communication with iSupport network members. Between August‐September 2022, we carried out online semi‐structured interviews with local study coordinators and implementers. We explored definitions of cultural adaptation, methods used, stakeholders’ and caregivers’ involvement, and measures used to ensure and monitor external validity. Interviews lasted on average one hour, and we conducted thematic analysis of verbatim transcripts.ResultWe interviewed 25 participants from 11 countries, including Wales, Australia, and Spain where we conducted multiple interviews as they run multiple adaptation processes. We found that the length of the process was variable, caregivers’ associations were always involved, and the implementers were mainly research and/or governmental institutions. The adaptation process included focus groups as data collection method and a constant exchange with WHO. Active listening and flexibility were essential to the adaptation process, while team multidisciplinary was a plus. Common challenges included difficulties in recruiting caregivers, limited time and economic resources for the project, and cultural diversity within the same country. Lessons learnt included the importance of involving caregivers and actively listening to them, multiple stakeholders’ involvement, the complexity and richness of multifaceted national cultures, the importance to adapt different program formats, and the need to further harmonize adaptation and monitoring procedures.ConclusionOur results provide support to the promotion of knowledge exchange among and beyond the iSupport international network, which facilitates the harmonization of iSupport implementation procedures and informs best design and implementation practices.