Abstract
BackgroundDigital mental health interventions leverage digital communication technology to address the mental health needs of populations. Culturally adapting interventions can lead to a successful, scalable mental health intervention implementation, and cultural adaptation of digital mental health interventions is a critical component to implementing interventions at scale within contexts where mental health services are not well supported.ObjectiveThe study aims to describe the cultural adaptation of a digital mental health intervention Step-by-Step in order to address depression among Chinese young adults.MethodsCultural adaptation was carried out in four phases following Ecological Validity Model: (1) stage setting and expert consultation; (2) preliminary content adaptation; (3) iterative content adaptation with community members; (4) finalized adaptation with community feedback meetings. Cognitive interviewing was applied to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Six mental health experts and 34 Chinese young adults were recruited for key informant interviews and focus group discussions.ResultsWe adapted the text and illustrations to fit the culture among Chinese young adults. Eight elements of the intervention were chosen as the targets of cultural adaptation (e.g., language, metaphors, content). Samples of major adaptations included: adding scenarios related to university life (relevance), changing leading characters from a physician to a peer and a cartoon (acceptability), incorporating two language versions (traditional Chinese and simplified Chinese) in the intervention (comprehensibility), and maintaining fundamental therapeutic components (completeness).ConclusionThis study showed the utility of using Ecological Validity Model and a four-point procedure framework for cultural adaptation and achieved a culturally appropriate version of the Step-by-Step program for Chinese young adults.
Highlights
Digital mental health interventions leverage digital communication technology to address the mental health needs of populations
After questions about major mental health problems, existing mental health services, and client’s typical coping strategies, we focused on the content of SbS with questions related to the appropriateness of the program, delivery method, characters, storyline, illustrations, and expressions
A total of 41 Chinese young adults participated in the FGD (26 Macao Chinese)
Summary
Digital mental health interventions leverage digital communication technology to address the mental health needs of populations These interventions incorporate information provision, screening, assessment, and monitoring, intervention, and social support [1]. The program utilizes narrative stories with illustrations to teach participants behavioral activation techniques and skills (e.g., activity scheduling), provide information (e.g., list for social and health service providers), augmented with nonspecialist guidance [10]. It consists of five 20– 30 minutes sessions that teach techniques of stress management, planning physical and social activities, reducing avoidance coping, improving self-acceptance, and preventing relapse. Adapting interventions can lead to a successful, scalable mental health intervention implementation, and cultural adaptation of digital mental health interventions is a critical component to implementing interventions at scale within contexts where mental health services are not well supported
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