Differential Comparative Designs: A Relevant Methodological Approach in the Cultural Adaptation Field

Introduction: The cultural adaptation of evidence-based parenting interventions holds great promise as an alternative to reduce mental health disparities. However, there is a dearth of differential cultural adaptation studies aimed at testing differentially culturally adapted interventions. The purpose of this paper is to present implementation feasibility and initial efficacy findings of a program of cultural adaptation prevention research with Latino immigrants in the US. The process of adaptation of two differentially culturally adapted parenting interventions will be discussed, in addition to implementation feasibility and initial efficacy results. Emphasis will be given to discuss research design decisions that were taken to prevent attrition in the study, as well as to ensure adequate participant exposure to the core components of the adapted interventions.

Methods: This NIMH-funded investigation compared and contrasted the impact of two differentially culturally adapted versions of the evidence-based parenting intervention known as Parent Management Training, the Oregon Model (PMTO^TM). Participants were allocated to one of three conditions: (a) a culturally adapted version of PMTO (only included PMTO core components), (b) a culturally-enhanced version of PMTO (core PMTO components and culturally-focused themes were included in this intervention), and (c) a wait-list control condition. The culturally focused sessions in the enhanced intervention were developed according to findings from a larger qualitative study (n=83 parents). Measurements were implemented at baseline (T1), treatment completion (T2) and 6-month follow up (T3). Quantitative outcome data were gathered to systematically examine implementation feasibility (e.g., rates of engagement and retention, level of satisfaction with the intervention) and initial efficacy (e.g., quality of parenting skills, children’s externalizing and internalizing behaviors).

Results: Findings indicate high implementation feasibility of both interventions, with an overall retention rate of 87% among families and 84% among fathers. Participants’ reports indicated high satisfaction with both adapted interventions. Multilevel modeling findings also indicated common and contrasting findings with regards to initial efficacy of both interventions, with a salient gender effect. Qualitative data were critical to the adaptation process as the sequence of implementation of culturally-focused sessions was modified according to findings from the pilot study to ensure participant engagement throughout the intervention.

Discussion: Data illustrate the benefits of implementing differential cultural adaptation designs. Thus, the discussion will center on lessons learned from the cultural adaptation protocol and the ways in which differential designs can provide relevant data in cultural adaptation studies.