Core Components of Effective Cultural Translation and Adaptation of Evidence-Based Interventions In the Middle East

Background and Purpose: All too often, efficacious psychosocial evidence-based interventions fail when adapted from one culture to another. International translation requires a deep understanding of the local culture, established service practices, and knowledge of obstacles and promoters to treatment implementation. Such knowledge coupled with local site-specific partnering governmental and community-based agencies can successfully facilitate rigorous and effective cultural adaptations of empirically-supported psychosocial and mental health treatments. The current exploration of effective translations and implementation of evidence-based treatments with children in child welfare and juvenile justice institutions in The Hashemite Kingdom of Jordan provides the initial foundation for intervention adaptation. This study systematically sought to identify; 1) obstacles and 2) promoters to the implementation of psychosocial or mental health treatment, services, or interventions in Arab countries, as well as 3) recommendations for treatment adaption from clinical research studies conducted in Arab communities.

Methods: Peer-reviewed articles were searched over the past twenty-five years, from 1985 through 2010 using two databases. The search strategy included the following criteria: psychosocial treatment, services, practices, or interventions; culture comparisons, differences, or cultural translation; Middle East, Arab, Arabic, Islam, Muslim, Palestine, Jordan, Iran, Iraq, Syria, Saudi Arabia, United Arab Emirates, Kuwait, Lebanon, Bahrain, Qatar, Oman, Yemen, or Egypt; and published in the English language. The initial search identified 768 articles (278 in PsycINFO, 490 in MEDLINE). Following a review for eligibility, 23 articles were coded and included in the analysis. The authors maintained over 95% inter-rater reliability across all articles. Discrepancies in coding were resolved through consensus.

Results: The review identified more barriers then promoters to effective translation and adaptation of empirically supported psychosocial interventions. The first set of barriers related to obstacles within the local and cultural environment, specifically stigma around mental health, service engagement, etiological differences concerning the causes or origins of mental illness, cultural beliefs/values and roles, and difficulties related to language, translation, and customs. The second set of barriers centered on difficulties with initial engagement with services, including service availability and access. The third set of barriers highlighted problems to the continued use of services or treatment adherence. Although fewer, three areas of promoters were also identified. The first set highlighted the importance of partnering and working within the local and cultural environment, such as strategies to engage with local and cultural beliefs, traditional social and health services, while building local partnerships. The second set focused on the need to engage with acceptable intervention characteristics, such as incorporating established and appropriate therapeutic processes as well as facilitating capacity building with local practitioners. The third set of promoters centered on developing culturally appropriate treatment strategies and techniques, including accepted treatment modalities and a need to address and reduce stigma.

Conclusions and Implications: Effective cultural translation and adaptation of evidence-based interventions into Arab communities is feasible. Ten recommendations for practice, policy and research are presented to facilitate and guide the initial step for effective research translation and intervention adaptation.