Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers (Preprint)

Abstract

Word length: 5590; 5192 excluding abstract/5000 2 Background: eMental Health interventions can address the mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish better fit with the cultural group and to achieve better treatment outcomes.Objective: The aim of this study is to describe the cultural adaptation of the World Health Organization's eMental Health program, Step-by-Step, for overseas Filipino workers (OFWs).We used a framework which posits that cultural adaptation should enhance: (a) relevance, in that the cultural group can relate with the content; (b) acceptability, where the cultural group will not find any element offensive; (c) comprehensibility, in that the program is understandable, and; (d) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino, and male and female versions. Methods: Three experienced Filipino psychologists provided their perspectives on the programand how it might be adapted for OFWs. We then adapted the program and obtained further feedback and suggestions from 28 OFWs working in diverse industries through focus group discussions (FGDs). We conducted seven FGDs with all-male participants and nine FGDs with all-female participants. In each FGD, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided a further round of iterative program adaptations, which were again shown to participants to seek additional feedback for validation and improvement. Results:We made a number of key adaptations to the Step-by-Step program. To enhance relevance, we adapted the program narrative to match OFW experiences, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), potentially political or unacceptable content was removed, and the 3 program was made suitable for OFWs working in a variety of sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms or ideas, and ensured that text and illustrations matched. We also used Taglish (i.e., merged English and Filipino) when participants deemed pure Filipino translations sounded odd or were difficult to understand. Lastly, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness. Conclusions:This study showed the utility of using the four-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. In the end, we achieved a culturally-appropriate adapted version of the Step-by-Step program for OFWs. We discuss lessons we learned in the process to guide future cultural adaptation projects of eMental Health interventions.