• By Dartington SRU
  • Posted on Tuesday 25th September, 2012

No longer lost in translation?

strong>Most evidence-based programs have been developed and tested in the United States and other English-speaking countries, leading to skepticism among practitioners elsewhere about "foreign imports." Cultural adaptation is the obvious answer, but can it be done without compromising program effectiveness?Evidence-based parenting and family intervention programs are effective in improving parenting skills, parent-child relationships and long-term outcomes for children. However, the most convincingly tested programs have been developed in the United States and other English-speaking countries, giving rise to skepticism about their suitability for use in other language and cultural contexts. In Europe, especially, there is widespread debate about how far "foreign" interventions have to be culturally sensitive and whether adaptation will allow them to retain their effectiveness.Given the expense of translating materials and re-filming videos, some skeptics go further, arguing that cultural needs can better be met by developing home grown products that apply similar principles to effective programs, without replicating them.Against this line of argument, Karol Kumpfer, American developer of the Strengthening Families Program (SFP) that has been implemented in 22 different countries (including the UK and 11 other European states), insists that cultural adaption of evidence-based programs offers the best route to positive outcomes and that basing programs on “principles of effective prevention” does not prove that they work.As a program targeting adolescent substance misuse, SFP has been positively evaluated in international randomized controlled trials and has been estimated to reduce under-age alcohol use by 18 per cent. In the US, a 10-year follow-up of young people who took part in trials when they were aged 12 indicated reductions of up to 300 per cent in lifetime mental health diagnoses among those from SFP families compared with the control group.Kumpfer and her team warn against developing new programs unless the commitment (and funding) exists to test them in multiple high-quality RCTs and to develop effective delivery systems. A better approach, they suggest, is to identify proven international programs that best fit the group of children, young people and families being targeted and make “minor program adaptations that make the program more culturally sensitive and tailored to a cultural group’s traditional world views.”From their experience of implementing SFP with different ethnic groups, the authors argue that culturally adapted programs can be expected to increase enrolment and attendance compared with interventions that are culturally "blind." In five-year studies with African, Hispanic, Pacific Islander, American Indian and Asian populations, culturally specific versions of SFP were found to increase recruitment and retention of families by 40 per cent on average.However, they point out that methods for carrying out the necessary adaptations have not been delineated or tested. In response, they outline a 10-step model. Central to this, they suggest, is establishing a cultural adaptation team that includes representatives from families as well as the original program developer. They recommend starting with minimal adaptation and introducing gradual changes, with routine testing to discover what works best.The challenge of cultural adaptation, they contend, is to preserve the underlying theory and avoid eliminating or modifying core program components. The focus should be on adjusting language, colloquialisms and examples, and on recognizing cultural norms of what constitutes acceptable or undesirable behavior. Consideration should also be given to culturally appropriate program delivery, including the choice of service providers and venues.According to Kumpfer’s team: “Changes to program content may be necessary if a consumer group needs or wants certain programmatic content not offered by the original model.” But their experience suggests the content can often stay the same; it is the form of delivery that most frequently needs to change – for example, using lay workers instead of professionals, delivering material via the internet rather than in school classrooms and holding sessions in a community centre not a child welfare office. The sting in the tail is that despite Kumpfer’s efforts, the culturally adapted versions of SFP used with minority ethnic groups in the US successfully boosted attendance without yielding significantly improved behavioral outcomes. So was it worth it? Almost certainly "yes," for the gains in parent engagement alone; but further research is needed into how to get better outcomes and further justify the cost of cultural adaptation.**********ReferenceKumpfer, K. L., Magalhães, C. and Xie, J. (2012) Cultural adaptations of evidence-based family interventions to strengthen families and improve children’s developmental outcomes. European Journal of Developmental Psychology 9 (1), 104-116.

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