Advancement in the Maturing Science of Cultural Adaptations of Evidence-Based Interventions

Objective: Concerns about the maturing science of cultural adaptation of evidence-based interventions (EBIs) have encompassed deficient standardization of theoretical frameworks and inefficiencies adapting multiple EBIs for multiple ethnic groups. Others argue that original EBIs applied with fidelity address universal processes applicable across ethnicity without adaptation. Study goals were to (1) establish a unifying data-driven framework for culturally adapting mental health EBIs for ethnic minorities, and (2) provide information for the fidelity debate by examining the extent to which fidelity to core EBI components is achieved in the cultural adaptation process. Method: A systematic review of primary research was conducted utilizing an inductive approach via thematic synthesis to code 20 years of cultural EBI adaptation studies for mental health problems in ethnic minorities. Studies were coded for adapted EBI components and extent of EBI modification. Results: Results yielded the Cultural Treatment Adaptation Framework (CTAF), an overarching data-driven framework providing common concepts and language for adapted treatment components that unifies cultural adaption science. Findings also demonstrated patterns of adapted components. All adapted EBIs (100%) yielded changes in peripheral (engagement and treatment delivery) components. In contrast, only 11.11% of culturally adapted EBIs yielded core therapeutic component modifications. Instead, 60.0% required core additions that address sociocultural, cultural skill, and psychoeducation needs. Conclusion: Fidelity to core components is largely preserved in cultural adaptation, but core component addendums, delivery, and contextualization are substantially changed. The CTAF and its patterns represent a key step in advancement of a maturing cultural adaptation science. What is the public health significance of this article? This study developed an overarching data-driven framework that provides common concepts and language for adapting components of mental health evidence-based interventions for ethnic minority populations. This framework, which was derived from analyzing previous cultural adaptations of evidence-based interventions, shows that fidelity to core change components is preserved in cultural adaptation, but that core component addendums, treatment delivery, and contextualization are substantially changed. Findings can be used to guide future cultural competency research and practice.