Cultural Adaptation of Evidence-Based Parent Training: A Qualitative Study about Clinicians' Experiences and Insights

Background and Purpose: This study investigates the experiences and insights of clinicians adapting an evidence-based intervention by addressing the diverse cultural backgrounds of the families they served in the child welfare system. Cultural adaptation highlights the need for taking cultural factors into consideration in the implementation of evidence-based interventions (EBIs). Development of the cultural adaptation of EBIs has been made conceptually and methodologically. However, gaps in knowledge exist regarding the cultural adaptation of EBIs. Existing research studies often emphasize the outcome effectiveness of culturally adapted EBIs and often do not offer in-depth information of the implementation process and the adaptations being made (Cabassa & Baumann, 2013; Domenech Rodríguez, Baumann, & Schwartz, 2011; Huey & Polo, 2008). In addition, balancing fidelity and adaptation has been highlighted as one of the primary issues around cultural adaptation of EBIs (Castro et al., 2010; Elliott & Mihalic, 2004). This study seeks to gain understanding of how cultural diversity can be addressed and incorporated into the delivery of an evidence-based parent training.  

Methods: The study was conducted within a state-wide project designed to reduce long-term foster care. The project used the Parent Management Training, Oregon Model (PMTO) as a core intervention. By utilizing the constructivist paradigm for qualitative research, face-to-face, individual interviews with 18 well-trained clinicians were conducted as the primary method for collecting data. A criterion sampling strategy ensured selecting study participants who have extensive knowledge and experience with PMTO. This study utilized constant comparative method as a way to systematically process and analyze collected data to gain in-depth understanding of the study participants’ accounts.

Results: Participants encountered a wide range of diversity when working with families, including racial/ethnic backgrounds, age, gender, behavioral health issues, religious beliefs, income level, educational background, immigration status, all of which affected the delivery of PMTO. All participants engaged in cultural adaptations, which were categorized into two themes: content-related (i.e., modifying the intervention content) and deliver-related adaptations (i.e., modifying the way participants delivered the content). In addition to making adaptations, participants used various strategies to engage parents and meet parents’ resistance to PMTO. Issues of balancing fidelity to the PMTO program and adaptation were captured in the following themes: a) inconsistent understanding of what and how to adapt, b) lack of systematic guidance.  

Conclusions and Implications: This study provides insights into cultural adaptation of EBIs. To prepare clinicians for effective implementation of evidence-based parent training and maximized opportunity for assisting clients with achieving positive outcomes, ongoing trainings supervision, and coaching are critical. A set of guidance can help therapist understand what types and to what extent adaptations are subject to compromising fidelity. Furthermore, it is important to continuously enhance clinicians’ critical thinking, clinical skills, and cultural competence through educational opportunities as they will always be called on to use these skills in this type of practice. This study suggests a new conceptual framework for culturally sensitive implementation of EBIs, which is informed by existing cultural adaptation framework, cultural competence practice, and evidence-based practice.