Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: Mixed-methods results from the DSM-5 international field trial
Open accessAbstract
Background: There is a need for clinical tools to identify cultural issues in diagnostic assessment. Aims: To assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice. Method: Mixed-methods evaluation of field trial data from six countries. The CFI was administered to diagnostically diverse psychiatric out-patients during a diagnostic interview. In post-evaluation sessions, patients and clinicians completed debriefing qualitative interviews and Likert-scale questionnaires. The duration of CFI administration and the full diagnostic session were monitored. Results: Mixed-methods data from 318 patients and 75 clinicians found the CFI feasible, acceptable and useful. Clinician feasibility ratings were significantly lower than patient ratings and other clinician-assessed outcomes. After administering one CFI, however, clinician feasibility ratings improved significantly and subsequent interviews required less time. Conclusions: The CFI was included in DSM-5 as a feasible, acceptable and useful cultural assessment tool.
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The CFI has been evaluated internationally in the United States, Canada, Kenya, Peru, the Netherlands, India, and Mexico and generally found clinically acceptable and useful in these varied settings.
“The CFI has been evaluated internationally in the United States, Canada, Kenya, Peru, the Netherlands, India, and Mexico and generally has been found to be clinically acceptable and useful in these varied settings.”
From Update on the Cultural Formulation Interview (2020) · cites this paper as [10]
The study-design passage lists sites in Canada, India, Kenya, the Netherlands, Peru and the USA, but not Mexico. The Main findings report that patients and clinicians generally found the CFI acceptable and clinically useful across the trial sites. Thus the assessment is supported for six of the seven countries named, not Mexico. (LLM, conf=0.90)
Experimental — accuracy not yet measuredClinicians' initial concerns about feasibility were significantly reduced after the second time they used the CFI, suggesting a rapid learning curve.
“Clinicians' initial concerns about feasibility were significantly reduced after the second time they used the CFI, suggesting a rapid learning curve.”
From Update on the Cultural Formulation Interview (2020) · cites this paper as [10]
The Main findings section reports that clinicians’ feasibility scores rose substantially by their second CFI administration, supporting a rapid learning curve. The Practice effects section reports significant improvement with practice, but does not establish that the change from the first to the second use was itself statistically significant; the stated second-use significance comparison is with acceptability and utility scores. (LLM, conf=0.85)
Experimental — accuracy not yet measuredInvesting about 20 minutes of an initial evaluation on a cultural assessment has value in terms of possible effects on communication, engagement, diagnostic accuracy, and treatment participation.
“Results demonstrated the value of investing about 20 minutes of an initial evaluation on a cultural assessment in terms of possible effects on communication, engagement, diagnostic accuracy, and treatment participation.”
From Update on the Cultural Formulation Interview (2020) · cites this paper as [10]
With practice, the CFI takes approximately 20 minutes to complete.
“With practice, the CFI takes approximately 20 minutes to complete.”
From Update on the Cultural Formulation Interview (2020) · cites this paper as [10]
The CFI is feasible, acceptable, and useful in international field trials.
“Mixed-methods evaluation found the CFI to be feasible, acceptable, and useful.”
From Update on the Cultural Formulation Interview (2020) · cites this paper as [10]
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References 42 · Cited by 130
Research works printed but not linked: 1
- [12]12. Lewis-Ferna ´ndez R. The cultural formulation. Transcult Psychiatry 2009; 46: 379-82.
- Authors
- Lewis-Fernández, R., Aggarwal, N. K., Lam, P. C., Galfalvy, H., Weiss, M. G., Kirmayer, L. J., Paralikar, V., Deshpande, S. N., Díaz, E., Nicasio, A. V., Boiler, M., Alarcón, R. D., Rohlof, H., Groen, S., van Dijk, R. C. J., Jadhav, S., Sarmukaddam, S., Ndetei, D., Scalco, M. Z., Bassiri, K., Aguilar-Gaxiola, S., Ton, H., Westermeyer, J., & Vega-Dienstmaier, J. M.
- Affiliations
- Swiss Tropical and Public Health Institute (CH)
- Mayo Clinic (US)
- University of Nairobi (KE)
- University of Minnesota (US)
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2017-04
- Volume
- 210
- Issue
- 4
- Pages
- 290-297
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2551797356
- Semantic Scholar
- 83f6cb4180d297d00480db0aaeaaf020682e9e6e
- Cited by
- 130
- References
- 42
- Citations by year
- 2026: 19 · 2025: 11 · 2024: 15 · 2023: 12 · 2022: 9 · 2021: 9 · 2020: 28 · 2019: 13 · 2018: 10 · 2017: 4
- FWCI
- 97.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- New York State Office of Mental Health
- Yale University
- University of Minnesota
- Universität Basel
- McGill University
- University College London
- Universiteit van Amsterdam
- Dr. Ram Manohar Lohia Hospital
- GGZ Drenthe
- University of Toronto
- Jewish General Hospital
- Liga Portuguesa Contra o Cancro
- University of California, Davis
- University of California, San Francisco
- Department of Psychiatry, Columbia University
- Department of Psychiatry, University of Toronto
- National Institute of Mental Health (K23MH102334)
- National Institute on Minority Health and Health Disparities
- Topics
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Social Sciences › Cultural Studies › Cultural, Psychoanalytic, and Sociopolitical Reflections
- Keywords
- Cultural Formulation Interview, DSM-5, cultural assessment, psychiatric outpatients, diagnostic interview, feasibility, acceptability, clinical utility, clinician perspectives, patient perspectives, cross-cultural psychiatry
- MeSH terms
- Adult, Mental Disorders, Feasibility Studies, Female, Humans, Interview, Psychological, Male, Middle Aged, Patient Acceptance of Health Care, Psychiatric Status Rating Scales, Diagnostic and Statistical Manual of Mental Disorders, Culturally Competent Care
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