Our aim was to translate and culturally adapt three evidence-informed leaflets on the work–health interface from English into Norwegian. Integral to this aim was the exploration of the quality and acceptability of each of the adapted leaflets to Norwegian-speaking stakeholders; general practitioners, people who deal with health issues in the workplace, and the general population.

Common health problems, such as musculoskeletal pain, account for most workdays lost and disability benefits in Norway. To facilitate return to work, it may be important to have access to evidence-informed information on the work–health interface for stakeholders involved in sickness absence processes. However, there is limited information material available in Norwegian that is tailored for the different stakeholders. Cultural adaptation is an emerging strategy for implementing health information across different populations and regions. Guidelines on cultural adaptation are not well-suited for translating and adapting evidence-informed health information material.

We conducted a pragmatic cultural adaptation process informed by existing guidelines. Our conceptual framework for adaptation is situated between adaptation and translation and comprises appraisal, forward- and back-translation, review in multiple steps, sense checking, and re-designing using a transcreation approach. Using an online survey, we aimed to evaluate the overall quality, value, acceptability, and clarity of each of the adapted leaflets to a total of 30 end-users.

We translated and culturally adapted three leaflets from English to Norwegian. Adapted leaflets were found to be clearly presented, acceptable, and valued by 45 Norwegian end-users. No differences in key concepts between original and back-translated leaflets emerged through the review process by the original author and forward translators. We used a pragmatic approach in this study that might be useful to others culturally adapting evidence-informed health information material.

Community health workers and promotoras (CHW/Ps) increasingly support research conducted in communities but receive variable or no training. We developed a culturally and linguistically tailored research best practices course for CHW/Ps that can be taken independently or in facilitated groups. The purpose of this study was to evaluate the facilitated training.

CHW/Ps were recruited from communities and partners affiliated with study sites in Michigan, Florida, and California. They participated in virtual or in-person training facilitated by a peer in English or Spanish and then completed a survey about their abilities (i.e., knowledge and skills for participating in research-related work) and perceptions of the training. Linear regression analyses were used to examine differences in training experience across several factors.

A total of 394 CHW/Ps, mean age 41.6 ± 13.8 years, completed the training and survey (n = 275 English; 119 Spanish). Most CHW/Ps were female (80%), and 50% identified as Hispanic, Latino, or Spanish. Over 95% of CHW/Ps rated their abilities as improved after training; 98% agreed the course was relevant to their work and felt the training was useful. Small differences were observed between training sites.

Most CHW/Ps rated the training positively and noted improved knowledge and skills for engaging in research-related work. Despite slight site differences, the training was well received, and CHW/Ps appreciated having a facilitator with experience working in community-based settings. This course offers a standard and scalable approach to training the CHW/P workforce. Future studies can examine its uptake and effect on research quality.

1. (1) Integrating psychological services into physical health services has the potential to improve access to psychological support for minority groups facing multi-morbidity, such as Irish Travellers. This approach offers a less stigmatised route for individuals to receive help and involves fewer administrative processes, which may pose challenges for those with varying levels of literacy ability.

2. (2) This case example presents initial evidence that short-term transdiagnostic cognitive behavioural therapy can be an effective intervention for reducing depression and anxiety symptoms in older people from an Irish Traveller background.

3. (3) Successful outcomes in this case example hinged on:

   1. (a) A comprehensive formulation that considered the client’s full identity (e.g. cultural identity, intergenerational connections, cohort beliefs, physical health needs) in addition to their presenting problem.

   2. (b) Adapting the intervention to accommodate for culturally relevant aspects of the individual’s presentation. This involved modifying homework to reduce the literacy requirements, involving a trusted family member as a co-therapist, and integrating culturally relevant language into the therapy.

4. (4) This case report underscores the scarcity of rigorous research involving Irish Traveller populations and emphasises the need for further exploration of their experiences of mental health difficulties and engagement with mental health services. Further research should actively involve Irish Travellers to identify unmet needs and explore potential adaptations for therapeutic interventions. This would help to ensure accurate representation and prevent the homogenisation of this diverse group of individuals.

Community health workers and promotoras (CHW/Ps) have a fundamental role in facilitating research with communities. However, no national standard training exists as part of the CHW/P job role. We developed and evaluated a culturally- and linguistically tailored online research best practices course for CHW/Ps to meet this gap.

After the research best practices course was developed, we advertised the opportunity to CHW/Ps nationwide to complete the training online in English or Spanish. Following course completion, CHW/Ps received an online survey to rate their skills in community-engaged research and their perceptions of the course using Likert scales of agreement. A qualitative content analysis was conducted on open-ended response data.

104 CHW/Ps completed the English or Spanish course (n = 52 for each language; mean age 42 years SD ± 12); 88% of individuals identified as female and 56% identified as Hispanic, Latino, or Spaniard. 96%–100% of respondents reported improvement in various skills. Nearly all CHW/Ps (97%) agreed the course was relevant to their work, and 96% felt the training was useful. Qualitative themes related to working more effectively as a result of training included enhanced skills, increased resources, and building bridges between communities and researchers.

The CHW/P research best practices course was rated as useful and relevant by CHW/Ps, particularly for communicating about research with community members. This course can be a professional development resource for CHW/Ps and could serve as the foundation for a national standardized training on their role related to research best practices.

Anxiety disorders are highly prevalent and debilitating conditions that show high comorbidity rates in adolescence. The present article illustrates how Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) was adapted for Iranian adolescents with anxiety disorders.

A total of 54 adolescents with comorbid anxiety disorders participated in a randomized, waitlist-controlled trial of group weekly sessions of either UP-A or waitlist control (WLC). Primary and process of change outcomes were assessed at baseline, posttreatment, and 1-month follow-up.

Significant changes were observed over time on major DSM-5 anxiety disorder symptoms (F(2, 51) = 117.09, p < 0.001), phobia type symptoms (F(2, 51) = 100.67, p < 0.001), and overall anxiety symptoms (F(2, 51) = 196.29, p < 0.001), as well as on emotion regulation strategies of reappraisal (F(2, 51) = 17.03, p < 0.001), and suppression (F(2, 51) = 21.13, p < 0.001), as well as on intolerance of uncertainty dimensions including prospective (F(2, 51) = 74.49, p < 0.001), inhibitory (F(2, 51) = 45.94, p < 0.001), and total intolerance of uncertainty (F(2, 51) = 84.42, p < 0.001), in favor of UP-A over WLC.

Overall, results provide a cultural application of the UP-A and support the protocol as useful for improving anxiety disorders as well as modifying of emotion regulation strategies and intolerance of uncertainty dimensions in Iranian adolescents. Future directions and study limitations are discussed.

Standardized measures for assessing neurological patients needing palliative care remain scarce. The Integrated Palliative care Outcome Scale for neurological patients in its short form (IPOS Neuro-S8) helps assess and identify patients’ symptom burden and needs early but has not yet been validated in German. The aim was to culturally adapt and translate the IPOS Neuro-S8 into the German health-care context and evaluate its face and content validity.

Cultural adaptation study following the first 6 out of 8 phases of the Palliative care Outcome Scale measures manual: (1) conceptual definition, (2) forward translation to German, (3) backward translation to English, (4) expert review, (5) cognitive debriefing, (6) proofreading. Neurological patients needing palliative care and clinical staff of the Department of Palliative Medicine or Neurology of the University Hospital of Cologne were included. Data were analyzed using thematic content analysis and descriptive statistics.

A total of 13 patients and 16 clinical staff participated in this study. The expert review panel (phase 4) consisted of 11 additional members. While patients (n = 9) and clinical staff (n = 11) confirmed that the IPOS Neuro-S8 is an intelligible tool that is well accepted (phase 5), some linguistic and cultural differences were found between the original English and German versions. These mainly concerned the items mouth problems and spasms.

The German version of the IPOS Neuro-S8 has demonstrated face and content validity and captures relevant symptoms of neurological patients needing palliative care. Its psychometric properties, including construct and criterion validity, will be investigated next.

1. (1) Adapting CBT to non-Western patients should be based on empirical evidence.

2. (2) The potential need for adaptation of CBT might depend on the acceptability of unadapted CBT.

3. (3) Acceptability is assumed to be related to patients’ values.

1. (1) To understand the views of Indian patients and therapists based on their experience of CBT.

2. (2) To understand the need for cultural adaptation of CBT in India.

3. (3) To understand the adaptations by therapists while using CBT in clinical practice.

4. (4) To gain perspective on how CBT can be culturally adapted to meet the needs of the Indian population.

1. (1) Leveraging digital and virtual platforms to deliver psychosocial interventions may contribute to addressing the significant treatment gap in low-resource settings.

2. (2) CBT-informed guided self-help is feasible and acceptable in the treatment of common mental disorders in Pakistan.

3. (3) The results of this study merit a larger, appropriately powered confirmatory randomized controlled trial to determine clinical and cost effectiveness.

School-based mental health literacy (MHL) interventions are increasingly trialled outside of the country in which they were developed. However, there is a lack of published studies that qualitatively explore their cultural adaptation. This study investigated the reasons for adaptations made and suggested to a Canadian MHL curriculum (The Guide) within the English school context.

Semi-structured interviews were conducted with 11 school staff responsible for the planning and/or implementation of The Guide across three schools in the South East of England, as part of the Education for Wellbeing (EfW) feasibility study. Transcripts were analysed using a hybrid, deductive-inductive thematic analysis.

Adaptations made and suggested included dropping and emphasising content, and adapting language, examples and references. Most adaptations were proactive and related to The Guide's implementation methods, including developing more interactive and student-led approaches. Staff Capacity and Expertise, Timetabling, and Accessibility of Resources were identified as logistical reasons for adaptations. Philosophical reasons included Consistency of Messages, Student Characteristics, Reducing Stigma and Empowering Students, National and Local Context, and Appropriate Pedagogic Practices.

Overall, recommendations were for immediately implementable lesson plans informed by teachers' knowledge about best pedagogic practices in England. Adequate training, attended by both senior leadership and those implementing, was also emphasised. While ensuring that the core components are clear, MHL interventions should be developed with a necessary level of flexibility to accommodate contextual characteristics. Future research should ensure that adaptations are captured through process and implementation evaluations conducted alongside efficacy trials.

Dietary recommendations (DR) in the USA may be inadequate at improving diets in racial/ethnic minority communities and may require redesign of the systems driving their development over the long term. Meanwhile, cultural adaptation of evidence-based DR may be an important strategy for mitigating nutrition disparities, but less is known about the adaptability of these recommendations to meet the needs of diverse groups. We examined the content and origin of major DRs – aspects that provide context on their potential universality across populations and evaluated their potential for cultural adaptation.

Case studies of Dietary Approaches to Stop Hypertension (DASH), the Mediterranean diet (MD), the EAT-Lancet diet (EAT) and the NOVA classification system.

United States.

Racial/ethnic minority populations.

Current DR differ in their origin/evolution but are similar in their reductionist emphasis on physical health. DASH has been successfully adapted for some cultures but may be challenged by the need for intensive resources; MD may be more beneficial if applied as part of a broader set of food procurement/preparation practices than as just diet alone; EAT-Lancet adaptation may not honor existing country-specific practices that are already beneficial to human and environmental health (e.g. traditional/plant-based diets); evidence for cultural adaptation is limited with NOVA, but classification of levels of food processing has potential for widespread application.

For DR to equitably support diverse populations, they must move beyond a Eurocentric or ‘general population’ framing, be more inclusive of cultural differences and honour social practices to improve diet and reduce disparities.

Because of the high burden of untreated mental illness in humanitarian settings and low- and middle-income countries, scaling-up effective psychological interventions require a cultural adaptation process that is feasible and acceptable. Our adaptation process incorporates changes into both content and implementation strategies, with a focus on local understandings of distress and treatment mechanisms of action.

Building upon the ecological validity model, we developed a 10-step process, the mental health Cultural Adaptation and Contextualization for Implementation (mhCACI) procedure, and piloted this approach in Nepal for Group Problem Management Plus (PM+), a task-sharing intervention, proven effective for adults with psychological distress in low-resource settings. Detailed documentation tools were used to ensure rigor and transparency during the adaptation process.

The mhCACI is a 10-step process: (1) identify mechanisms of action, (2) conduct a literature desk review for the culture and context, (3) conduct a training-of-trainers, (4) translate intervention materials, (5) conduct an expert read-through of the materials, (6) qualitative assessment of intervention population and site, (7) conduct practice rounds, (8) conduct an adaptation workshop with experts and implementers, (9) pilot test the training, supervision, and implementation, and (10) review through process evaluation. For Group PM+, key adaptations were harmonizing the mechanisms of action with cultural models of ‘tension’; modification of recruitment procedures to assure fit; and development of a skills checklist.

A 10-step mhCACI process could feasibly be implemented in a humanitarian setting to rapidly prepare a psychological intervention for widespread implementation.