Cultural adaptation of minimally guided interventions for common mental disorders: a systematic review and meta-analysis.
Open accessAbstract
Background: Cultural adaptation of mental health care interventions is key, particularly when there is little or no therapist interaction. There is little published information on the methods of adaptation of bibliotherapy and e-mental health interventions. Objective: To systematically search for evidence of the effectiveness of minimally guided interventions for the treatment of common mental disorders among culturally diverse people with common mental disorders; to analyze the extent and effects of cultural adaptation of minimally guided interventions for the treatment of common mental disorders. Methods: We searched Embase, PubMed, the Cochrane Library, and PsycINFO for randomized controlled trials that tested the efficacy of minimally guided or self-help interventions for depression or anxiety among culturally diverse populations. We calculated pooled standardized mean differences using a random-effects model. In addition, we administered a questionnaire to the authors of primary studies to assess the cultural adaptation methods used in the included primary studies. We entered this information into a meta-regression to investigate effects of the extent of adaptation on intervention efficacy. Results: We included eight randomized controlled trials (RCTs) out of the 4911 potentially eligible records identified by the search: four on e-mental health and four on bibliotherapy. The extent of cultural adaptation varied across the studies, with language translation and use of metaphors being the most frequently applied elements of adaptation. The pooled standardized mean difference for primary outcome measures of depression and anxiety was -0.81 (95% CI -0.10 to -0.62). Higher cultural adaptation scores were significantly associated with greater effect sizes (P=.04). Conclusions: Our results support the results of previous systematic reviews on the cultural adaptation of face-to-face interventions: the extent of cultural adaptation has an effect on intervention efficacy. More research is warranted to explore how cultural adaptation may contribute to improve the acceptability and effectiveness of minimally guided psychological interventions for common mental disorders.
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When there is little to no therapist engagement, the cultural adaptation of mental health treatment approaches is essential.
“When there is little to no therapist engagement, the cultural adaptation of mental health treatment approaches is essential (Harper Shehadeh et al., 2016).”
From Internet-based self-administered intervention to reduce anxiety and depression symptomatology and improve well-being in 7 countries: protocol of a randomized control trial (2024) · cites this paper as Harper Shehadeh et al., 2016
Existing research showed that more extensive cultural adaptation of the interventions may be associated with larger effect sizes.
“existing research showed that more extensive cultural adaptation of the interventions may be associated with larger effect sizes”
From Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: Systematic review and meta-analysis (2019) · cites this paper as Harper Shehadeh et al., 2016
Harper Shehadeh et al. (2016) conducted a systematic review and meta-analysis to evaluate the extent of cultural adaptation and the effectiveness of interventions for common mental health disorders.
“For example, Harper Shehadeh et al. (2016) conducted a systematic review and meta-analysis to evaluate the extent of cultural adaptation and the effectiveness of interventions for common mental health disorders.”
From The assessment of grief in refugees and post-conflict survivors: a narrative review of etic and emic research (2018) · cites this paper as Harper Shehadeh et al., 2016
They developed a questionnaire to assess the level of adaptation for each study.
“They developed a questionnaire to assess the level of adaptation for each study.”
From The assessment of grief in refugees and post-conflict survivors: a narrative review of etic and emic research (2018) · cites this paper as Harper Shehadeh et al., 2016
They found that the level of adaptation had a positive effect on the effectiveness of the intervention.
“They found that the level of adaptation had a positive effect on the effectiveness of the intervention.”
From The assessment of grief in refugees and post-conflict survivors: a narrative review of etic and emic research (2018) · cites this paper as Harper Shehadeh et al., 2016
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Step-by-Step: a new WHO digital mental health intervention for depression
Carswell, K., Harper-Shehadeh, M., Watts, S., van’t Hof, E., Abi Ramia, J., Heim, E., Wenger, A., & van Ommeren, M. (2018) · mHealth · doi:10.21037/mhealth.2018.08.01 · Cited by 104 · see citing works
Self-citationBrown, F. L., de Graaff, A. M., Annan, J. R., & Betancourt, T. S. (2016) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12671 · Cited by 111 · see citing works
“A recent systematic review found that treatment effects increased with increased adaptations made (Harper Shehadeh et al., 2016), while another review found that adaptation to the explanation of the ‘illness’ was the solemoderator of intervention effectiveness (Benish et al., 2011).”
BackgroundHeim, E., Kohrt, B. A., Koschorke, M., Milenova, M., & Thornicroft, G. (2020) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796018000458 · Cited by 99 · see citing works
Self-citationDepression and Suicide Risk Screening
O’Connor, E., Perdue, L. A., Coppola, E. L., Henninger, M. L., Thomas, R. G., & Gaynes, B. N. (2023) · JAMA · doi:10.1001/jama.2023.7787 · Cited by 100 · see citing works
Sit, H. F., Ling, R., Lam, A. I. F., Chen, W., Latkin, C. A., & Hall, B. J. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00650 · Cited by 93 · see citing works
Killikelly, C., Bauer, S., & Maercker, A. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01957 · Cited by 71 · see citing works
Self-citationTol, W. A., Augustinavicius, J., Carswell, K., Brown, F. L., Adaku, A., Leku, M. R., García-Moreno, C., Ventevogel, P., White, R. G., & van Ommeren, M. (2018) · Global Mental Health · doi:10.1017/gmh.2018.14 · Cited by 69 · see citing works
“Several frameworks for the cultural adaptation of psychological interventions have been published (Bernal et al., 1995; Hwang, 2009; Barrera et al., 2013) with adapted interventions appearing to be more effective than non-adapted interventions (Benish et al., 2011; Harper Shehadeh et al., 2016).”
BackgroundAbi Ramia, J., Harper Shehadeh, M., Kheir, W., Zoghbi, E., Watts, S., Heim, E., & El Chammay, R. (2018) · Global Mental Health · doi:10.1017/gmh.2018.29 · Cited by 65 · see citing works
Self-citationReporting Cultural Adaptation in Psychological Trials – The RECAPT criteria
Heim, E., Mewes, R., Ramia, J. A., Glaesmer, H., Hall, B. J., Shehadeh, M. H., Ünlü, B., Kananian, S., Kohrt, B. A., Lechner‐Meichsner, F., et al. (2021) · Clinical Psychology in Europe · doi:10.32872/cpe.6351 · Cited by 70 · see citing works
Self-citationSpaaij, J., Kiselev, N., Berger, C., Bryant, R. A., Cuijpers, P. J., de Graaff, A. M., Fuhr, D. C., Hemmo, M., McDaid, D., Moergeli, H., et al. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.2002027 · Cited by 71 · see citing works
Addressing Mental Health Concerns in Refugees and Displaced Populations: Is Enough Being Done?
Grasser, L. R. (2022) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s270233 · Cited by 68 · see citing works
“In fact, when adaptation does occur to modify for language, culture, and context, the degree of adaptation is associated with higher intervention efficacy.(124) One approach may be offering listening sessions and basic needs assessments, providing space for social support networks to form within refugees and between r…”
BackgroundBuntrock, C., Harrer, M., Sprenger, A. A., Illing, S., Sakata, M., Furukawa, T. A., Ebert, D. D., Cuijpers, P. J., Adriaanse, M. C., Albert, S. M., et al. (2024) · The Lancet Psychiatry · doi:10.1016/s2215-0366(24)00316-x · Cited by 63 · see citing works
Bear, H. A., Ayala‐Nunes, L., Ramos, G., Manchanda, T., Fernandes, B., Chabursky, S., Walper, S., Watkins, E. R., & Fazel, M. S. (2024) · Journal of Medical Internet Research · doi:10.2196/48964 · Cited by 64 · see citing works
Uppendahl, J. R., Alözkan, C., Cuijpers, P. J., de Vries, R., & Sijbrandij, M. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00933 · Cited by 62 · see citing works
Kananian, S., Soltani, Y., Hinton, D. E., & Stangier, U. (2020) · Journal of Traumatic Stress · doi:10.1002/jts.22615 · Cited by 58 · see citing works
de Graaff, A. M., Cuijpers, P., Acarturk, C., Bryant, R., Burchert, S., Fuhr, D. C., Huizink, A. C., de Jong, J., Kieft, B., Knaevelsrud, C., et al. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1694347 · Cited by 57 · see citing works
Karyotaki, E., Miguel, C., Panagiotopoulou, O. M., Harrer, M., Seward, N., Sijbrandij, M., Araya, R., Patel, V., & Cuijpers, P. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.50 · Cited by 56 · see citing works
“It should be noted, though, that the method of cultural adaptation was minimally reported across the included studies, suggesting that the actual extent of cultural adaptation might have an effect on digital interventions ’ efficacy, as reported before (Shehadeh et al., 2016).”
ResultSalamanca-Sanabria, A., Richards, D., & Timulak, L. (2019) · Internet Interventions · doi:10.1016/j.invent.2018.11.005 · Cited by 49 · see citing works
Mabunda, D., Oliveira, D., Sidat, M., Cavalcanti, M. T., Cumbe, V., Mandlate, F., Wainberg, M. L., Cournos, F., & Mari, J. D. J. (2022) · International Journal of Mental Health Systems · doi:10.1186/s13033-022-00526-x · Cited by 59 · see citing works
“These interventions, however, need to be sensitive to the culture, values and needs of people locally [6, 7].”
BackgroundGarabiles, M. R., Harper Shehadeh, M., & Hall, B. J. (2019) · JMIR Formative Research · doi:10.2196/11600 · Cited by 50 · see citing works
Eylem, Ö., van Straten, A., de Wit, L. M., Rathod, S., Bhui, K. S., & Kerkhof, A. J. F. M. (2021) · Pilot and Feasibility Studies · doi:10.1186/s40814-021-00772-9 · Cited by 48 · see citing works
Li, S., Xi, Z., Barnett, P., Saunders, R., Shafran, R., & Pilling, S. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(23)00118-9 · Cited by 51 · see citing works
Brown, F. L., Aoun, M., Taha, K., Steen, F., Hansen, P., Bird, M., Dawson, K. S., Watts, S., Chammay, R. E., Sijbrandij, M., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00212 · Cited by 50 · see citing works
Ye, Z., Li, W., & Zhu, R. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.08.023 · Cited by 48 · see citing works
Balci, S., Spanhel, K., Sander, L., & Baumeister, H. (2022) · npj Digital Medicine · doi:10.1038/s41746-022-00569-x · Cited by 50 · see citing works
Spanhel, K., Schweizer, J. S., Wirsching, D., Lehr, D., Baumeister, H., Bengel, J., & Sander, L. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100252 · Cited by 46 · see citing works
Brady, B., Veljanova, I., Schabrun, S. M., & Chipchase, L. S. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-021999 · Cited by 44 · see citing works
Goodman, R., Tip, L. K., & Cavanagh, K. (2020) · Journal of Refugee Studies · doi:10.1093/jrs/feaa082 · Cited by 41 · see citing works
Spanhel, K., Hovestadt, E., Lehr, D., Spiegelhalder, K., Baumeister, H., Bengel, J., & Sander, L. B. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.832196 · Cited by 37 · see citing works
“Similarly, culturally adapted digital interventions are shown to be effective in reducing mental disorders (64, 67).”
BackgroundCulturally sensitive grief treatment and support: A scoping review
Aeschlimann, A., Heim, E., Killikelly, C., Arafa, M., & Maercker, A. R. A. (2024) · SSM - Mental Health · doi:10.1016/j.ssmmh.2024.100325 · Cited by 38 · see citing works
Self-citationThe Utility of a Mental Health App in Apprentice Workers: A Pilot Study
Deady, M., Glozier, N., Collins, D., Einboden, R., Lavender, I., Wray, A., Gayed, A., Calvo, R. A., Christensen, H. M., Harvey, S. B., et al. (2020) · Frontiers in Public Health · doi:10.3389/fpubh.2020.00389 · Cited by 31 · see citing works
Lal, S., Gleeson, J., Rivard, L., D’Alfonso, S., Joober, R., MALLA, A. K., & Álvarez‐Jiménez, M. (2020) · JMIR Formative Research · doi:10.2196/19887 · Cited by 34 · see citing works
Buus, N., Juel, A., Haskelberg, H., Frandsen, H., Larsen, J. L. S., River, J., Andreasson, K., Nordentoft, M., Davenport, T. A., & Erlangsen, A. (2019) · JMIR Mental Health · doi:10.2196/11965 · Cited by 32 · see citing works
Seale, J. P., Seale, D. M., Pande, Y., Lewis, T. M., Manda, W., Kasanga, L., Gibson, E. B., Hadfield, K., Ogoh, T., McGrath, R. E., et al. (2021) · The Journal of Positive Psychology · doi:10.1080/17439760.2021.1913640 · Cited by 33 · see citing works
“During GROW Zambia’s implementation, major attention was also given to cultural adaptability, which has been shown to enhance the efficacy of minimally guided psychological interventions (Harper Shehadeh et al., 2016).”
BackgroundShala, M., Morina, N., Burchert, S., Cerga-Pashoja, A., Knaevelsrud, C., Maercker, A., & Heim, E. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100339 · Cited by 29 · see citing works
“Smith et al. (2011) and Harper Shehadeh et al. (2016) found that the more adapted elements are considered in the adaptation, the higher the effectiveness of interventions.”
BackgroundInfluentialLal, S., Gleeson, J., MALLA, A. K., Rivard, L., Joober, R., Chandrasena, R. D., & Álvarez‐Jiménez, M. (2018) · JMIR Research Protocols · doi:10.2196/resprot.8810 · Cited by 28 · see citing works
“This type of information is needed to inform the interpretation of findings as well as implementation and scale-up [6].”
BackgroundInfluentialEgan, S. J., Johnson, C., Wade, T. D., Carlbring, P., Raghav, S., & Shafran, R. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100711 · Cited by 28 · see citing works
“Further research is also required on the degree and nature of cultural adaptation of internet interventions (Shehadeh et al., 2016; Spanhel et al., 2021), including AI-ICBT-P.”
BackgroundCultural Adaptation of a Low-Intensity Group Psychological Intervention for Syrian Refugees
Akhtar, A., Engels, M., Bawaneh, A., Bird, M., Bryant, R., Cuijpers, P., Hansen, P., Al-Hayek, H., Ilkkursun, Z., Kurt, G., et al. (2021) · Intervention · doi:10.4103/intv.intv_38_20 · Cited by 28 · see citing works
“Second, the adapted versions of the manualised intervention were prepared for use in upcoming trials and the effectiveness in comparison to the direct translation was not able to be determined (Akhtar et al., 2020; Sijbrandij et al., 2017; Uygun et al., 2020).”
MethodSoubutts, E., Marshall, P., Mcnaney, R., Shrestha, P., Davidson, B. I., Qu, C., Mindel, C., & Sefi, A. (2024) · International Conference on Human Factors in Computing Systems · doi:10.1145/3613904.3642641 · Cited by 28 · see citing works
“However, in a systematic review by [99], the authors reported that, while cultural adaption of e-mental health interventions demonstrates a significant capacity to reduce corresponding symptoms in the targeted population, there is a gap in sufficient reporting around cultural adaptation…”
Salamanca-Sanabria, A., Richards, D., Timulák, L., Castro-Camacho, L., Mojica-Perilla, M., & Parra-Villa, Y. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1634-x · Cited by 26 · see citing works
“04), or a 14% rise in pooled efficacy [53].”
BackgroundBeukes, E., Fagelson, M. A., Aronson, E., Muñoz, M., Andersson, G., & Manchaiah, V. (2020) · American Journal of Audiology · doi:10.1044/2019_aja-19-00014 · Cited by 25 · see citing works
Fabian, K. E., Foster, K. T., Chwastiak, L., Turner, M., & Wagenaar, B. H. (2023) · Translational Behavioral Medicine · doi:10.1093/tbm/ibad041 · Cited by 26 · see citing works
Rahmadiana, M., Karyotaki, E., Passchier, J., Cuijpers, P., van Ballegooijen, W., Wimbarti, S., & Riper, H. (2019) · Internet Interventions · doi:10.1016/j.invent.2018.11.002 · Cited by 25 · see citing works
“Results from a recent meta-analysis indicated that culturally adapted CBT interventions are more efficacious in reducing depressive and anxiety symptoms when compared with non-culturally adapted interventions (Shehadeh et al., 2016; Vally and Maggott, 2015; Hall et al., 2016).”
BackgroundSzlamka, Z., Hanlon, C., Tekola, B., Pacione, L. R., Salomone, E., WHO CST Team, Servili, C., & Hoekstra, R. A. (2022) · PLoS ONE · doi:10.1371/journal.pone.0272077 · Cited by 25 · see citing works
Anakwenze, O. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2022.115124 · Cited by 27 · see citing works
McDermott, L., Hameed, I., & Lau‐Zhu, A. (2024) · Trauma Violence & Abuse · doi:10.1177/15248380241262262 · Cited by 24 · see citing works
Spanhel, K., Burdach, D., Pfeiffer, T., Lehr, D., Spiegelhalder, K., Ebert, D. D., Baumeister, H., Bengel, J., & Sander, L. (2021) · Journal of Sleep Research · doi:10.1111/jsr.13493 · Cited by 24 · see citing works
“Such direct comparison trials are lacking, but are essential for further conclusions on the necessity of cultural adaptation in specific target groups (Harper Shehadeh et al., 2016; Heim & Kohrt, 2019; Ramos & Chavira, 2019; Spanhel et al., 2021).”
BackgroundInternet-Delivered Cognitive Behaviour Therapy
Richards, D., Enrique, Á., Palacios, J. E., & Duffy, D. J. (2018) · InTech eBooks · doi:10.5772/intechopen.71412 · Cited by 24 · see citing works
Killikelly, C., & Maercker, A. R. A. (2023) · Clinical Psychology in Europe · doi:10.32872/cpe.7655 · Cited by 23 · see citing works
“Earlier in the history of psychiatry, it had been largely assumed that the symptoms of disorder expressed in North American and European populations were representative globally.”
BackgroundSelf-citationChoi, I., Mestroni, G., Hunt, C. J., & Glozier, N. (2022) · JMIR Formative Research · doi:10.2196/35659 · Cited by 23 · see citing works
“suggests that highly culturally adapted digital mental health interventions are more efficacious [23].”
Chau, L. W., Lam, R. W. M., Minas, H., Hayashi, K., Nguyen, V. C., & O’Neil, J. (2025) · JMIR Mental Health · doi:10.2196/68296 · Cited by 30 · see citing works
Spanhel, K., Balci, S., Baumeister, H., Bengel, J., & Sander, L. (2020) · Systematic Reviews · doi:10.1186/s13643-020-01438-y · Cited by 22 · see citing works
“Previous research suggests that culturally adapting psychological interventions [40, 41] as well as IMI [48] may enhance their effectiveness in populations differing from the initial target group.”
BackgroundBöttche, M., Kampisiou, C., Stammel, N., El-Haj-Mohamad, R., Heeke, C., Burchert, S., Heim, E., Wagner, B., Renneberg, B., Böttcher, J., et al. (2021) · Clinical Psychology in Europe · doi:10.32872/cpe.4623 · Cited by 21 · see citing works
“Behavior Therapy, 47(6), 993-1014. https://doi.org/10.1016/j.beth.2016.09.005 Harper Shehadeh, M. H., Heim, E., Chowdhary, N., Maercker, A., & Albanese, E. (2016).”
BackgroundInfluentialSelf-citationAdvancing health equity and the role of digital health technologies: a scoping review
Bitomsky, L., Pfitzer, E., Nißen, M., & Kowatsch, T. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-099306 · Cited by 21 · see citing works
Balci, S., Küchler, A., Ebert, D. D., & Baumeister, H. (2023) · Clinical Psychology in Europe · doi:10.32872/cpe.9341 · Cited by 19 · see citing works
“However, a previous review suggested that culturally adapted face-to-face and online interventions resulted in reducing depression and anxiety (Harper Shehadeh et al., 2016).”
BackgroundSupporting Children Affected by War: Towards an Evidence Based Care System
Jordans, M. J. D., van den Broek, M., Brown, F. L., Coetzee, A. R., Ellermeijer, R. E. C., Hartog, K., Steen, F., & Miller, K. E. (2018) · Springer eBooks · doi:10.1007/978-3-319-97046-2_13 · Cited by 19 · see citing works
Advancing health equity and the role of digital health technologies: a scoping review protocol
Bitomsky, L., Pfitzer, E., Nißen, M., & Kowatsch, T. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-082336 · Cited by 18 · see citing works
Singh, A., Nemiro, A., Malik, A., Guimond, M.-F., Nduwimana, E., Likindikoki, S. L., Annan, J. R., & Tol, W. A. (2021) · Conflict and Health · doi:10.1186/s13031-021-00391-4 · Cited by 18 · see citing works
Juniar, D., van Ballegooijen, W., Karyotaki, E., van Schaik, A., Passchier, J., Heber, E., Lehr, D., Sadarjoen, S. S., & Riper, H. M. (2019) · JMIR Research Protocols · doi:10.2196/11493 · Cited by 20 · see citing works
Psychotherapy for depression and anxiety in low- and middle-income countries
Cuijpers, P. J., Eylem, Ö., Karyotaki, E., Zhou, X., & Sijbrandij, M. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814932-4.00008-2 · Cited by 18 · see citing works
Developments in Psychotraumatology: A Conceptual, Biological, and Cultural Update
Maercker, A. R. A., & Augsburger, M. (2019) · Clinical Psychology in Europe · doi:10.32872/cpe.v1i1.30294 · Cited by 18 · see citing works
Self-citationEquity by design principles for digital health interventions
Bitomsky, L., Nißen, M., & Kowatsch, T. (2025) · International Journal for Equity in Health · doi:10.1186/s12939-025-02645-6 · Cited by 21 · see citing works
“To this end, DHIs can enhance treatment outcomes and sustain engagement [26, 27].”
Cultural adaptation of CBT for Afghan refugees in Europe: A retrospective evaluation
Kananian, S., Starck, A., & Stangier, U. (2021) · Clinical Psychology in Europe · doi:10.32872/cpe.5271 · Cited by 16 · see citing works
“Although the effectiveness of cultural adaptation has been shown in several meta-analyses (Hall et al., 2016; Shehadeh et al., 2016), there is currently a lack of standardized documentation criteria.”
BackgroundLiem, A., Garabiles, M. R., Pakingan, K. A., Chen, W. L., Lam, A. I. F., Burchert, S., & Hall, B. J. (2020) · Implementation Science Communications · doi:10.1186/s43058-020-00072-y · Cited by 16 · see citing works
“This type of illustrated and adapted format is shown to be an effective digital mental health intervention format [44].”
BackgroundHeim, E., & Knaevelsrud, C. (2021) · Clinical Psychology in Europe · doi:10.32872/cpe.5513 · Cited by 14 · see citing works
Self-citationLal, S., Gleeson, J., D’Alfonso, S., Lee, H., Etienne, G., Joober, R., Lepage, M., & Álvarez‐Jiménez, M. (2023) · Schizophrenia · doi:10.1038/s41537-023-00352-1 · Cited by 13 · see citing works
Alrashdi, D. H., Alyafei, A., Alanazi, S. A., Meyer, C., & Gould, R. L. (2024) · Transcultural Psychiatry · doi:10.1177/13634615241227691 · Cited by 13 · see citing works
“It is important to culturally adapt psychological interventions because it could improve the appropriateness, efficacy, and implementation of EBTs to specific populations (Castellanos et al., 2020; Lau, 2006; Shehadeh et al., 2016).”
BackgroundMethodResultInfluentialOlaya, B., Feltz-Cornelis, C. M. V. D., Roijen, L. H., Merecz‐Kot, D., Sinokki, M., Naumanen, P., Shepherd, J., van Krugten, F. C. W., de Mul, M., Staszewska, K., et al. (2022) · Digital Health · doi:10.1177/20552076221131145 · Cited by 11 · see citing works
Sapkota, R. P., Valli, E., Wilhelms, A., Adlam, K., Bourgeault, L., Heron, V., Dickerson, K. C., Nugent, M., & Hadjistavropoulos, H. D. (2023) · Healthcare · doi:10.3390/healthcare11152135 · Cited by 10 · see citing works
“Furthermore, two meta-analyses found that greater treatment effectiveness was associated with a higher number of cultural adaptations made to various elements of the intervention [42,47].”
BackgroundGiusto, A. M., Missen, M. V., Kosgei, G., Njiriri, F., Puffer, E. S., Kwobah, E., Barasa, J., Turissini, M., Rasmussen, J. M., Ott, M. A., et al. (2023) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-023-01075-8 · Cited by 12 · see citing works
Cultural adaptation of an internet-based self-help app for grieving Syrian refugees in Switzerland
Aeschlimann, A., Heim, E., Hoxha, A., Triantafyllidou, V., Killikelly, C., Haji, F., Stoeckli, R. T., Aebersold, M., & Maercker, A. R. A. (2024) · BMC Public Health · doi:10.1186/s12889-024-20507-8 · Cited by 11 · see citing works
“In one meta-analysis, a higher number of adapted elements in IBIs was associated with higher effect sizes [39], and culturally adapting interventions also appears to increase adherence [40].”
BackgroundSelf-citationSchaub, M. P., Berman, A. H., López‐Pelayo, H., Boumparis, N., Khadjesari, Z., Blankers, M., Gual, A., Riper, H. M., & Pas, L. (2020) · Journal of Medical Internet Research · doi:10.2196/20368 · Cited by 11 · see citing works
Jankowska, M. (2019) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x18000211 · Cited by 11 · see citing works
“The available literature points to the agreement that the lack of consideration of cultural norms and values and socio-cultural contexts may impede access to and engagement with therapy (Chueng, 2012; Shedhadeh et al., 2016; Van Loon et al., 2013).”
Hamatani, S., Matsumoto, K., Ishibashi, T., Shibukawa, R., Honda, Y., Kosaka, H., Mizuno, Y., & Andersson, G. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.942936 · Cited by 9 · see citing works
“Because culturally compatible psychotherapies potentially may be effective (8), psychologists need to consider cultural sensitivity and ecological validity when developing treatment programs to maximize their potential effectiveness (5).”
BackgroundRosenbaum, S., Farello, A., Latimer, K., Vancampfort, D., Ventevogel, P., Richards, J. A., Warria, A. R., Ager, A., Bray, M., Snider, L., et al. (2025) · Mental health and physical activity · doi:10.1016/j.mhpa.2025.100701 · Cited by 10 · see citing works
Bleile, A. C. E., Koppenol‐Gonzalez, G. V., Verreault, K., Abeling, K., Hofman, E., Vriend, W., Hasan, A., & Jordans, M. J. D. (2021) · International Journal of Mental Health Systems · doi:10.1186/s13033-021-00450-6 · Cited by 10 · see citing works
Heim, E., Burchert, S., Shala, M., Hoxha, A., Kaufmann, M., Pashoja, A. C., Morina, N., Schaub, M. P., Knaevelsrud, C., & Maercker, A. R. A. (2024) · Clinical Psychology in Europe · doi:10.32872/cpe.2743 · Cited by 10 · see citing works
“Evidence on cultural adaptation of psychological interventions indicates a benefit of adapting psychological interventions to the target group (Griner & Smith, 2006; Harper Shehadeh et al., 2016; Smith et al., 2011).”
BackgroundSelf-citationMigration and Mental Health of Arabic-Speaking Communities
Hammad, J., & Hamid, A. (2021) · Mental health and illness worldwide · doi:10.1007/978-981-10-2366-8_37 · Cited by 10 · see citing works
Cultural adaptations of digital therapeutics
Naslund, J. A., & Spagnolo, J. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-90045-4.00001-0 · Cited by 9 · see citing works
Faro, A., Tejada, J., & Al‐Delaimy, W. K. (2025) · JMIR Public Health and Surveillance · doi:10.2196/72591 · Cited by 8 · see citing works
Cultural adaptation of interventions for common mental disorders
Sit, H. F., Hall, B. J., & Li, S. X. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(23)00153-0 · Cited by 8 · see citing works
Quiñonez-Freire, C., Vara, M. D., Herrero, R., Mira, A., García‐Palacios, A., Botella, C., & Baños, R. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100352 · Cited by 8 · see citing works
“A systematic methodology for cultural adaptations in the context of face-to-face therapy has been proposed (Barrera and Castro, 2006; Sidani et al., 2017), but more research is still needed in the IBIs context (Shehadeh et al., 2016).”
BackgroundMethodDzokoto, V. A. A., Anum, A., Affram, A. A., Agbavitoh, J. K. M., Dadzie, H. A. N., Mintah, R. K., Norman, Q. A., Owusu-Prempeh, C., Tawam, L. N., Turkson, S. M., et al. (2022) · International Perspectives in Psychology · doi:10.1027/2157-3891/a000015 · Cited by 8 · see citing works
Kumar, M., Verdeli, H., Saxena, S., Petersen, I., Huang, K., Othieno, C. J., Grote, N. K., Law, R., Unützer, J., & McKay, M. M. (2022) · Clinical Medicine Insights Psychiatry · doi:10.1177/11795573221075573 · Cited by 6 · see citing works
“Studies have also demonstrated that the extent of cultural adaptation positively impacts intervention fidelity.(49) See Figures 2 and 3 that detail the adaptation process.”
BackgroundReich, H., Zürn, D., & Mewes, R. (2021) · Clinical Psychology in Europe · doi:10.32872/cpe.5583 · Cited by 6 · see citing works
“Meta-analytic evidence showed that culturally adapted psychotherapy is more effective than unadapted therapy (Hall et al., 2016) and that the extent of cultural adaptation of minimally guided mental health interventions had an effect on intervention efficacy (Harper Shehadeh et al., 2016).”
Martinez, A. B., Lau, J. Y. F., Morillo, H. M., & Brown, J. S. L. (2022) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-022-02405-9 · Cited by 7 · see citing works
“Research has also shown the widening gap between the prevalence of mental disorders and the availability of mental health services [22].”
BackgroundRubeis, G., & Ketteler, D. (2020) · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie · doi:10.1055/a-1104-5459 · Cited by 7 · see citing works
“Als Ursache hierfür werden zunächst sprachliche Hürden angeführt [24].”
BackgroundInfluentialPerry, A., Gardener, C., Shieh, J., Hồ, Q. T., Doan, A., & Bhui, K. (2024) · Transcultural Psychiatry · doi:10.1177/13634615241228071 · Cited by 7 · see citing works
Opozda, M. J., Bonson, J., Vigona, J., Aanundsen, D., Paradisis, C., Anderson, P., Stahl, G., Watkins, D. C., Black, O., Brickley, B., et al. (2024) · International Journal for Equity in Health · doi:10.1186/s12939-024-02253-w · Cited by 5 · see citing works
“However, documentation of the processes of cultural adaptation is frequently poor [68], and there is a dearth of literature detailing mental health intervention adaptations [43] and cultural adaptations targeting Aboriginal and Torres Strait Islander populations.”
Background
- Authors
- Harper Shehadeh, M., Heim, E., Chowdhary, N., Maercker, A., & Albanese, E.
- Affiliations
- University of Zurich (CH)
- London School of Hygiene & Tropical Medicine (GB)
- University of Geneva (CH)
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2016-09-26
- Volume
- 3
- Issue
- 3
- Pages
- e44
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC5057065
- OpenAlex
- W2525437246
- Cited by
- 188
- References
- 52
- Citations by year
- 2026: 10 · 2025: 24 · 2024: 33 · 2023: 27 · 2022: 21 · 2021: 23 · 2020: 17 · 2019: 17 · 2018: 13 · 2017: 2 · 2016: 1
- FWCI
- 1.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
- SERVAL (Université de Lausanne) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Keywords
- cultural adaptation, self-help intervention, common mental disorders, depression, anxiety, e-mental health, bibliotherapy, multicultural communities, language translation, metaphor, intervention efficacy
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