Abstract
BackgroundCanadians of South Asian (SA) origin comprise the largest racialized group in Canada, representing 25.6% of what Statistics Canada terms “visible minority populations”. South Asian Canadians are disproportionately impacted by the social determinants of health, and this can result in high rates of mood and anxiety disorders. These factors can negatively impact mental health and decrease access to care, thereby increasing mental health inequities. Cognitive Behavioural Therapy (CBT) in its current form is not suitable for persons from the non-western cultural backgrounds. Culturally adapted Cognitive Behavioural Therapy (CaCBT) is an evidence-based practice. CaCBT is more effective than standard CBT and can reduce dropouts from therapy compared with standard CBT. Thus, CaCBT can increase access to mental health services and improve outcomes for immigrant, refugee and ethno-cultural and racialized populations. Adapting CBT for growing SA populations in Canada will ensure equitable access to effective and culturally appropriate interventions.MethodsThe primary aim of the study is to develop and evaluate CaCBT for Canadian South Asian persons with depression and anxiety and to gather data from stakeholders to develop guidelines to culturally adapt CBT. This mixed methods study will use three phases: (1) cultural adaptation of CBT, (2) pilot feasibility of CaCBT and (3) implementation and evaluation of CaCBT. Phase 1 will use purposive sampling to recruit individuals from four different groups: (1) SA patients with depression and anxiety, (b) caregivers and family members of individuals affected by anxiety and depression, (c) mental health professionals and (d) SA community opinion leaders. Semi-structured interviews will be conducted virtually and analysis of interviews will be informed by an ethnographic approach. Phase 2 will pilot test the newly developed CaCBT for feasibility, acceptability and effectiveness via quantitative methodology and a randomized controlled trial, including an economic analysis. Phase 3 will recruit therapists to train and evaluate them in the new CaCBT.DiscussionThe outcome of this trial will benefit health services in Canada, in terms of helping to reduce the burden of depression and anxiety and provide better care for South Asians. We expect the results to help guide the development of better services and tailor existing services to the needs of other vulnerable groups.Trial registrationClinicalTrials.gov NCT04010890. Registered on July 8, 2019
Highlights
Canadians of South Asian (SA) origin comprise the largest racialized group in Canada, representing 25.6% of what Statistics Canada terms “visible minority populations”
This can result in high rates of mood and anxiety disorders, with SA individuals who immigrate to Canada at age or younger at a significantly higher risk compared to immigrants who came to Canada when they were or older [2, 3]
Key stakeholders from various SA communities living in the Greater Toronto Area (GTA), Vancouver and Ottawa will be engaged to inform the development of Culturally adapted Cognitive Behavioural Therapy (CaCBT) guidelines for depression and anxiety based on previously developed qualitative methodology [24,25,26,27,28]
Summary
The newly developed CaCBT guidelines will be evaluated for enhancing cultural competence among therapists already delivering CBT. Participants Twenty to thirty therapists not involved in the previous phases will be recruited from participating hospital and community organizations and will attend one full-day training course in CaCBT. Measurements Participants’ knowledge and attitudes will be assessed using pre- and post-training scores on a questionnaire derived from an existing competence in culturally adapted therapy framework [22]. A visual analogue scale will be used to measure their satisfaction and perceived competence before and after training. We will gather post-training feedback from participating therapists to further enhance our understanding. Analyses SPSSv25 will be used to measure the change in pre- and post-training scores in therapist competence and their satisfaction using the t-test and chi-square test
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