Cognitive Processing Therapy for Spanish-speaking Latinos: A Formative Study of a Model-Driven Cultural Adaptation of the Manual to Enhance Implementation in a Usual Care Setting

Abstract

Objective As part of a larger implementation trial for Cognitive Processing Therapy (CPT) for posttraumatic stress disorder (PTSD) in a community health center, we used formative evaluation to assess relations between iterative cultural adaption (for Spanish-speaking clients) and implementation outcomes (appropriateness & acceptability) for CPT. Method Qualitative data for the current study were gathered through multiple sources (providers: N=6; clients: N=22), including CPT therapy sessions, provider field notes, weekly consultation team meetings, and researcher field notes. Findings from conventional and directed content analysis of the data informed refinements to the CPT manual. Results Data-driven refinements included adaptations related to cultural context (i.e., language, regional variation in wording), urban context (e.g., crime/violence), and literacy level. Qualitative findings suggest improved appropriateness and acceptability of CPT for Spanish-speaking clients. Conclusion Our study reinforces the need for dual application of cultural adaptation and implementation science to address the PTSD treatment needs of Spanish-speaking clients.

Treating posttraumatic stress disorder across cultures: A systematic review of cultural adaptations of trauma‐focused cognitive behavioral therapies

“…Community stakeholders were described as involved in the adaptation process in eight papers (Bigfoot & Schmidt, ; Damra et al, ; Kaysen et al, ; O'Donnell et al, ; Rodriguez, ; Schulz et al, ; Valentine et al, ; Whealin et al, ). These steps included the use of focus groups, qualitative interviews, and translation processes before recommending adaptations to the identified intervention.…”

“…Regarding consultation with stakeholders, the stakeholders mentioned as involved in the adaptation process were most commonly local therapists delivering the treatment (Asukai et al, ; McMullen et al, ; Murray et al, ; O'Callaghan et al, ; Rodriguez, ; Schulz et al, ; Valentine et al, ), or other counsellors from the community (e.g., professionals from service organizations; tribal leaders, school teachers; Bigfoot & Schmidt, ; Damra et al, ; Goodkind et al, ; Kaysen et al, ; O'Donnell et al, ; Whealin et al, ). In four studies, the adaptation process included consultation with consumers of the treatment (e.g.…”

“…Six studies (Damra et al, ; Kaysen et al, ; Murray et al, ; O'Donnell et al, ; Valentine et al, ; Whealin et al, ) described iterative processes of adapting the therapy that included manual translation, meetings with key stakeholders, training of local therapists, and pilot testing of the adapted interventions followed by evaluation by the treatment stakeholders. Schulz et al () described a process with fewer steps that involved translation of the materials and a feasibility study.…”

“…Other adaptations included adding techniques or interventions that were observably in line with the culture (e.g., relaxation techniques; Schulz et al, ). The eight studies that described surface level cultural adaptations only included language translations, simplification or tailoring of materials and language (Bass et al, ; Rodriguez, ; Schottelkorb et al, ; Schulz et al, ; Valentine et al, ), changes in analogies (Murray et al, ; O'Donnell et al, ) and in visual materials (Wang et al, ).…”

The role of context in the implementation of trauma-focused treatments: effectiveness research and implementation in higher and lower income settings

“…This perspective is just beginning to influence research on TFTs in HICs [19], while it is often been at the core of research in LMICs [16]. There are similarities across contexts that, if addressed, could help expand access to TFTs.…”