Cultural Adaptation of an Evidence-Based Youth Intervention to Address Mental Health Among Youth in Colombia

Background: In Colombia, over 9 million people, including 4.2 million children, adolescents, and young adults have been impacted by decades of armed conflict. Despite the elevated rates of mental health problems among conflict-affected adolescents, evidence-based mental health interventions are scarce. In this study, diverse stakeholders collaborated to culturally adapt and pilot-test an existing scalable, evidence-based mental health intervention to conflict-affected Colombian youth in an effort to address the scarce availability of mental health service provision for this population.

Methods: We used the ADAPT-ITT framework to engage in a rigorous cultural adaptation of an existing evidence-based mental health youth intervention. The framework consists of eight steps: 1) Assessment of community needs, 2) Deciding on the intervention to be adapted, 3) Administration of intervention sessions, 4) Production of manual with adaptations, 5) Topical experts’ feedback, 6) Integration of feedback, 7) Training staff who will deliver the culturally adapted sessions, and 8) Testing of culturally adapted intervention using mixed-methodology. Qualitative and quantitative data were gathered and analyzed throughout the adaptation process. The adaptation of this intervention was made possible through a collaborative effort that involved academia, local government, non-governmental organizations, and community members.

Results: Data from the Assessment phase indicated that conflict-affected youth were in great need of an intervention that addressed mental health. In the Production phase, several changes were made to the initial intervention in order to ensure that the intervention content was relevant and acceptable to conflict-affected youth. Finally, data from the Testing phase indicated significant improvements in emotion regulation and disability, indicating it is a promising intervention among conflict-affected Colombian youth. Moreover, qualitative data from the Testing phase indicated the culturally-adapted intervention is acceptable among Colombian youth and mental health providers.

Conclusions: Guided by the ADAPT-ITT framework and in collaboration with different stakeholders, this study successfully adapted an evidence-based intervention for conflict-affected Colombian youth. The stakeholders played pivotal roles in providing insights and feedback on how best to tailor the program to the local context. Through our collaborative approach, we ensured that the adaptation was not only informed by research but also embedded within the lived experiences and needs of those it aims to serve. By involving these critical stakeholders, we ensured there was a sense of ownership and sustainability within the community, especially with the facilitators who were trained and are leaders in their community. Initial findings of the intervention suggest improvements in emotion regulation and functional impairment among conflict-affected Colombian youth. Future studies need to evaluate the scale-up of the intervention to test its effectiveness in improving youth mental health.