Perceived Feasibility, Acceptability, and Cultural Adaptation for a Mental Health Intervention in Rural Haiti

Confronting mental health stigma in Haitian Americans suffering from mental health challenges

BACKGROUND

Haitian Americans have been disproportionately exposed to risk factors known to play a significant role in the development of mental illness. Yet despite the documented effectiveness of mental health treatment, a high proportion of Haitian Americans with mental health disorders have not received care.

LOCAL PROBLEM

Internalized stigma of mental illness (ISMI) was reported as one of the primary reasons Haitian Americans do not seek help for mental illnesses, resulting in poor long-term outcomes for individuals and families in this community. This quality improvement project characterized ISMI among Haitian Americans, examined associated demographic factors, and tested the impact of a culturally relevant ISMI educational video intervention on willingness to seek mental health treatment.

METHODS

Haitian Americans who self-reported mental illness ( N = 20) were recruited from a South Florida clinic. Descriptive statistics, correlations, and thematic analyses were completed to analyze the data.

INTERVENTIONS

Participants completed the nine-item ISMI scale, watched an educational video about ISMI, completed a post-intervention survey, and engaged in conversations about mental health and ISMI.

RESULTS

Sixty-five percent of participants reported mild levels of ISMI. Sex was significantly correlated with ISMI ( r = -0.458, p = .042); male participants experienced higher levels of ISMI. The educational video improved participants' knowledge of ISMI, and 85% indicated increased willingness to seek treatment.

CONCLUSIONS

When caring for Haitian Americans with mental illnesses, nurse practitioners should initiate conversations about ISMI, consider gender differences in mental illness beliefs and attitudes, and provide culturally responsive psychoeducational interventions to promote more mental health treatment utilization.

The Cultural Adaptation of Step-by-Step: An Intervention to Address Depression Among Chinese Young Adults

BACKGROUND

Digital 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.

OBJECTIVE

The 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.

METHODS

Cultural 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.

RESULTS

We 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).

CONCLUSION

This 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.