Barriers to implementing the DSM-5 cultural formulation interview: a qualitative study

The Outline for Cultural Formulation (OCF) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) marked an attempt to apply anthropological concepts within psychiatry. The OCF has been criticized for not providing guidelines to clinicians. The DSM-5 Cultural Issues Subgroup has since converted the OCF into the Cultural Formulation Interview (CFI) for use by any clinician with any patient in any clinical setting. This paper presents perceived barriers to CFI implementation in clinical practice reported by patients (n = 32) and clinicians (n = 7) at the New York site within the DSM-5 international field trial. We used an implementation fidelity paradigm to code debriefing interviews after each CFI session through deductive content analysis. The most frequent patient threats were lack of differentiation from other treatments, lack of buy-in, ambiguity of design, over-standardization of the CFI, and severity of illness. The most frequent clinician threats were lack of conceptual relevance between intervention and problem, drift from the format, repetition, severity of patient illness, and lack of clinician buy-in. The Subgroup has revised the CFI based on these barriers for final publication in DSM-5. Our findings expand knowledge on the cultural formulation by reporting the CFI's reception among patients and clinicians.

Re-imagining the 'social' in the nutrition sciences

OBJECTIVE

In response to The New Nutrition Science Project's Giessen Declaration, we provide here a case for a more fully described and integrated 'social' dimension within the nutrition sciences.

DESIGN

This paper explores what we mean when we argue for socially engaged nutrition sciences (SENS), and describes the disciplinary fields, epistemologies and methodologies that contribute to SENS' potential rich diversity and value. Additionally, the current positioning of 'social nutrition' research within the nutrition sciences is critiqued.

RESULTS

There is fairly broad acceptance of the 'social' as an important contributor to successful public health nutrition situation analyses, intervention planning and implementation. However, we assert that the 'social' is not merely a contributor, the usual position, but is central. Implications for policy and practice that could follow from this shift in approach are outlined.

CONCLUSIONS

We call for researchers, educators, policy makers and practitioners alike to re-imagine the role and purpose of social science enquiry that could enable the delivery of more socially engaged nutrition sciences.

Cultural translation of interventions: diabetes care in American Samoa

Translation of research advances into clinical practice for at-risk communities is important to eliminate disease disparities. Adult type 2 diabetes prevalence in the US territory of American Samoa is 21.5%, but little intervention research has been carried out there. We discuss our experience with cultural translation, drawing on an emerging implementation science, which aims to build a knowledge base on adapting interventions to real-world settings. We offer examples from our behavioral intervention study, Diabetes Care in American Samoa, which was adapted from Project Sugar 2, a nurse and community health worker intervention to support diabetes self-management among urban African Americans. The challenges we experienced and solutions we used may inform adaptations of interventions in other settings.