No abstract

Few studies addressing the mental health needs of Latinos describe how interventions are tailored or culturally adapted to address the needs of their target population. Without reference to this process, efforts to replicate results and provide working models of the adaptation process for other researchers are thwarted. The purpose of this article is to describe the process of a cultural adaptation that included accommodations for health literacy of a brief telephone cognitive-behavioral depression intervention for Latinos in low-resource settings. We followed a five-stage approach (i.e., information gathering, preliminary adaptation, preliminary testing, adaptation, and refinement) as described by Barrera, Castro, Strycker, and Toobert (2013) to structure our process. Cultural adaptations included condensation of the sessions, review, and modifications of materials presented to participants including the addition of visual aids, culturally relevant metaphors, values, and proverbs. Feedback from key stakeholders, including clinician and study participants, was fundamental to the adaptation process. Areas for further inquiry and adaptation identified in our process include revisions to the presentation of "cognitive restructuring" to participants and the inclusion of participant beliefs about the cause of their depression. Cultural adaptation is a dynamic process, requiring numerous refinements to ensure that an intervention is tailored and relevant to the target population.

Context Latino immigrants constitute a large portion of the Spanish and U.S. immigrant populations, yet a dearth of research exists regarding barriers to retention in behavioral health care. Objectives To identify and compare perceived barriers related to behavioral health care among first and second generation Latinos in Boston, Madrid, and Barcelona, and evaluate whether the frequency of behavioral health care use in the last year was related to these barriers. Design, Setting and Participants Data come from the International Latino Research Partnership project. First or second generation self-identified Latino immigrants ages 18+ who resided more than one year in the host country were recruited from community agencies and primary care, mental health, substance abuse, and HIV clinics. Main Outcome Measures Eleven barriers were assessed and compared across sites. The relationship between barriers and behavioral services visits within the last year was evaluated, adjusting for socio-demographics, clinical measures, degree of health literacy, cultural and social factors. Results Wanting to handle the problem on one's own, thinking that treatment would not work, and being unsure of where to go or who to see were the most frequently reported barriers for Latino immigrants. Previous treatment failure, difficulties in transportation or scheduling, and linguistic barriers were more likely to be reported in Boston; trying to deal with mental health problems on one's own was more commonly reported in Barcelona and Madrid. Two barriers associated with number of visits were concerns about the cost of services and uncertainty about where to go or who to see. Conclusions After adjusting for socio-demographics, clinical measures, degree of health literacy, cultural and social factors, barriers still differed significantly across sites. Efforts to improve behavioral health services must be tailored to immigrants' context, with attention to changing attitudes of self-reliance and outreach to improve access to and retention in care.