Differential Cultural Adaptation Designs: A Relevant Methodological Approach to Empirically Test the Differential Implementation Feasibility and Efficacy of Cultural Adapted Interventions

Background and Purpose: The cultural adaptation of evidence-based parenting interventions constitutes a promising alternative to reduce mental health disparities in the U.S. However, there is a dearth of differential cultural adaptation studies aimed at testing differentially culturally adapted interventions. Differential designs allow researchers to identify contrasting feasibility and efficacy as associated with various levels of adaptation. The purpose of this paper is to present implementation feasibility and initial efficacy findings from a program of cultural adaptation prevention research with Latino immigrants in the U.S. Specifically, we aimed to examine whether a culturally-enhanced adapted parenting intervention with culture-specific sessions, had a significantly higher effect on feasibility and efficacy outcomes, compared to a culturally adapted intervention focused exclusively on parenting components.

Methods: This NIMH-funded investigation compared and contrasted the impact of two differentially culturally adapted versions of the evidence-based parenting intervention known as Parent Management Training, the Oregon Model (PMTO^TM). Participants were allocated to one of three conditions: (a) a culturally adapted version of PMTO (only included PMTO core components), (b) a culturally-enhanced version of PMTO (core PMTO components and culturally-focused themes were included in this intervention), and (c) a wait-list control condition. The culturally focused sessions in the enhanced intervention were developed according to findings from an exploratory qualitative study (n=83 parents). Measurements were implemented at baseline (T1), treatment completion (T2) and 6-month follow up (T3). Qualitative data from 112 parents allocated to the culturally adapted interventions were examined to explore perceived satisfaction with the adapted interventions. Initial efficacy of the adapted interventions was examined by analyzing quantitative outcome data from 190 parents. A multilevel modeling approach was utilized to analyze parenting (i.e., quality of parenting skills) and child adaptation outcomes (i.e. children’s externalizing and internalizing behaviors).

Results: Findings indicate high implementation feasibility of both interventions, with an overall 86% retention rate of families, including 84% of fathers. Participants’ qualitative reports indicated high satisfaction with both adapted interventions and parents in the enhanced conditions were highly satisfied with culture-specific sessions. Multilevel modeling findings indicated contrasting findings with regards to initial efficacy, with gender and intervention effects. Specifically, whereas parents in both adapted interventions showed statistically significant improvements of their quality of parenting skills when compared to parents in the wait-list control condition, only mothers in the culturally-enhanced intervention had statistically significant improvements on children’s internalizing symptoms when compared to the two alternative intervention conditions. Similarly, only fathers allocated to the culturally-enhanced intervention had statistically significant reductions on children internalizing and externalizing symptomatology when compared to the original adapted intervention and the wait-list control condition.

Conclusions and Implications: Data illustrate the benefits of implementing differential cultural adaptation designs. Specifically, whereas parents in both adapted interventions reported high levels of satisfaction with the core parenting components, parents allocated to the culturally-enhanced intervention showed additional benefits with regards to perceived child adaptation. Implications will be discussed focused on the relevance of utilizing differential research designs for studies seeking to integrate cultural adaptation and implementation science.