Using the ADAPT guidance to culturally adapt a brief intervention to reduce alcohol use among injury patients in Tanzania

Staton, Catherine A.; Zimmerman, Armand; Pesambili, Msafiri; Phillips, Ashley J.; Tupetz, Anna; Perez de Souza, Joao Vitor; Boshe, Judith; Pantalon, Michael H.; Swahn, Monica; Mmbaga, Blandina T.; Nickenig Vissoci, Joao Ricardo

doi:10.1371/journal.pgph.0004200

Cited by 4Substance Abuse Treatment and OutcomesHealth Policy Implementation ScienceAlcohol Consumption and Health Effects

Using the ADAPT guidance to culturally adapt a brief intervention to reduce alcohol use among injury patients in Tanzania

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Staton, Catherine A., Zimmerman, Armand, Pesambili, Msafiri, Phillips, Ashley J., Tupetz, Anna, Perez de Souza, Joao Vitor, Boshe, Judith, Pantalon, Michael H. +3 more·2025·PLOS Global Public Health

DOI 10.1371/journal.pgph.0004200PMC PMC11801724

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Abstract

Harmful alcohol use is a leading risk factor for injury-related death and disability in low- and middle-income countries (LMICs). Brief negotiational interventions (BNIs) in emergency departments (EDs) effectively reduce alcohol intake and re-injury rates. However, most BNIs are developed in high-income countries, with limited evidence of their effectiveness in LMICs. To address this gap, we culturally adapted a BNI for alcohol-related injury patients at Kilimanjaro Christian Medical Centre (KCMC), a tertiary hospital in Tanzania. Our study followed the ADAPT guidance to culturally adapt an existing high-income country BNI for use in the KCMC, a tertiary hospital in Tanzania. The adaptation included: 1) a systematic review of effective alcohol harm reduction interventions in similar settings; 2) consultations with local and international healthcare professionals experienced in counseling and substance abuse treatment; 3) group discussions to refine goals and finalize adaptations. The adapted BNI protocol and assessment scales ensured intervention fidelity. At KCMC, 30% of injury patients screened positive for alcohol use disorder (AUD), with a five-fold increased risk of injury, primarily from road traffic accidents and violence. A systematic review highlighted limited data on patient-level interventions in low-resource settings. Our adapted BNI, 'Punguza Pombe Kwa Afya Yako (PPKAY)', based on the FRAMES model, showed high feasibility and acceptability, with 84% of interventions achieving ≥80% adherence and 98% patient satisfaction. PPKAY is the first culturally adapted alcohol BNI for injury patients in an African ED. Our study demonstrates our approach to adapting substance use interventions for use in low resource settings and shows that cultural adaptation of alcohol use interventions is feasible, beneficial and empowering for our team. Our study lays a framework and method for other low resourced settings to integrate cultural adaptation into the implementation of a BNI in low resource EDs.

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Outcome assessors were blinded and trained to calculate alcohol use based on patient self-reporting using a standard timeline-follow-back method.
“train our blinded team members to calculate this based on patient self-reporting of alcohol use using a standard timeline-follow-back method [26].”
From Effectiveness of a brief intervention and text-based booster in the emergency department to reduce harmful and hazardous alcohol use: A pragmatic randomized adaptive clinical trial in Moshi, Tanzania (2025) · cites this paper as [26]
The Results section (‘Provide feedback’; page unavailable) describes AUDIT screening and feedback about patients’ alcohol use, not a timeline-follow-back calculation. The Methods section (‘Data collection and data analysis’; page unavailable) describes intervention fidelity review, but does not establish that blinded outcome assessors were trained to calculate alcohol use. Searches for timeline-follow-back and blinded assessors found no passage addressing those details. (LLM, conf=0.72)
Experimental — accuracy not yet measured

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Cultural Adaptation of a Brief Intervention to Reduce Alcohol Use Among Injury Patients in TanzaniaPreprint
Zimmerman, A., Pesambili, M., Phillips, A. J., Boshe, J., Mmbaga, B. T., Pantalon, M. H., Swahn, M. H., Hirshon, J. M., Vissoci, J. R. N., & Staton, C. A. (2021) · medRxiv · doi:10.1101/2021.07.21.21260811 · Cited by 6 · see citing works
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Effectiveness of a Brief Negotiational Intervention and Text-Based Booster to Reduce Harmful and Hazardous Alcohol Use in the Emergency Department of a Low-Resource Setting: A Pragmatic Randomized Adaptive Clinical Trial in Moshi, TanzaniaPreprint
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A PRACT: A Pragmatic Randomized Adaptive Clinical Trial to Investigate Brief Interventions in the Emergency Department in Tanzania
Vissoci, J. (2018) · Open Science Framework · doi:10.17605/osf.io/qz3kh

Authors: Staton, C. A., Zimmerman, A., Pesambili, M., Phillips, A. J., Tupetz, A., Perez de Souza, J. V., Boshe, J., Pantalon, M. H., Swahn, M., Mmbaga, B. T., & Nickenig Vissoci, J. R.
Affiliations: Duke University (US)
Kilimanjaro Christian Medical Centre (TZ)
Yale University (US)
Kennesaw State University (US)
Corresponding author: Staton, Catherine A.
ORCID: Staton, Catherine A.
Zimmerman, Armand
Phillips, Ashley J.
Tupetz, Anna
Perez de Souza, Joao Vitor
Boshe, Judith
Swahn, Monica
Mmbaga, Blandina T.
Nickenig Vissoci, Joao Ricardo
Venue: PLOS Global Public Health
Publisher: Public Library of Science (PLoS)
Published: 2025-02-06
Volume: 5
Issue: 2
Pages: e0004200
ISSN: 2767-3375 (ISSN-L)
DOI: 10.1371/journal.pgph.0004200
PMC: PMC11801724
OpenAlex: W4407199525
Cited by: 4
References: 50
Citations by year: 2026: 1 · 2025: 3
FWCI: 2.75
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: PLOS Global Public Health (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Fogarty International Center (TW010000-01A1)
National Institute on Alcohol Abuse and Alcoholism (1R01AA027512-01A1)
Topics: Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
Keywords: alcohol consumption reduction, alcohol-related injuries, emergency department, harm reduction, alcoholism, low- and middle-income countries, traffic accidents, violence, intervention fidelity, feasibility and acceptability, Tanzania

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Using the ADAPT guidance to culturally adapt a brief intervention to reduce alcohol use among injury patients in Tanzania

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