The Cultural Adaptation of Step-by-Step: An Intervention to Address Depression Among Chinese Young Adults
Open accessAbstract
Background: Digital mental health interventions leverage digital communication technology to address the mental health needs of populations. Culturally adapting interventions can lead to a successful, scalable mental health intervention implementation, and cultural adaptation of digital mental health interventions is a critical component to implementing interventions at scale within contexts where mental health services are not well supported. Objective: The study aims to describe the cultural adaptation of a digital mental health intervention Step-by-Step in order to address depression among Chinese young adults. Methods: Cultural adaptation was carried out in four phases following Ecological Validity Model: 1) Stage setting and expert consultation; 2) Preliminary content adaptation; 3) Iterative content adaptation with community members; 4) Finalized adaptation with community feedback meetings. Cognitive interviewing was applied to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Six mental health experts and 34 Chinese young adults were recruited for key informant interviews and focus group discussions. Results: We adapted the text and illustrations to fits the culture among Chinese young adults. Eight elements of the intervention were chosen as the targets of cultural adaptation (e.g., language, metaphors, content). Samples of major adaptations included: adding scenarios related to university life (relevance), changing leading characters from a physician to a peer and a cartoon (acceptability), incorporating two language versions (traditional Chinese and simplified Chinese) in the intervention (comprehensibility), and maintaining fundamental therapeutic components (completeness). Conclusion: This study showed the utility of using the Ecological Validity Model and a four-point procedure framework for cultural adaptation and achieved a culturally appropriate version of the Step-by-Step program for Chinese young adults.
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Additional adaptations of SbS have been tested with Albanian, Chinese, and Filipino populations.
“Additional adaptations of SbS have been tested with Albanian [34], Chinese [35], and Filipino [36] populations.”
From Effects of a self-guided digital mental health self-help intervention for Syrian refugees in Egypt: A pragmatic randomized controlled trial (2024) · cites this paper as [35]
The Discussion and Conclusion report that SbS was culturally adapted for Chinese young adults, and the Methods describe Chinese participants reviewing its materials in focus groups. But the Discussion says a feasibility study and effectiveness trial were still planned, so the source does not establish that the adapted intervention had been tested with the target population. (LLM, conf=0.85)
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- Authors
- Sit, H. F., Ling, R., Lam, A. I. F., Chen, W., Latkin, C. A., & Hall, B. J.
- Affiliations
- University of Macau (MO)
- Johns Hopkins University (US)
- Sun Yat-sen University (CN)
- Corresponding author
- Hall, Brian J.
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2020-07-07
- Volume
- 11
- Pages
- 650-650
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC7359726
- OpenAlex
- W3039383824
- Cited by
- 93
- References
- 47
- Citations by year
- 2026: 18 · 2025: 25 · 2024: 25 · 2023: 6 · 2022: 16 · 2021: 3
- FWCI
- 5.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- World Health Organization
- Johns Hopkins University
- Universidade de Macau (MYRG2018)
- Peking University
- 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, digital mental health interventions, depression, young adults, Chinese young adults, Ecological Validity Model, cognitive interviewing, peer support, language adaptation, college student life, acceptability
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