Cross-Cultural Adaptation of Generationpmto for Post-Conflict and Resettled Refugee Communities

Significance: Effective family-focused preventive interventions often do not benefit the most underserved and under-resourced communities around the world. While an increasing number of preventive interventions have been designed and tested within non-white, non-western communities, there is a continual need for cultural adaptation to meet the unique needs and circumstances of each community. In the US, the population is continually becoming more diverse. Around the world, immigrants and refugees face unique challenges in parenting after migration. In developing nations and post-war communities, the burden of psychological trauma and mental health needs are high. In this presentation, we describe our innovative approach to adapting GenerationPMTO to the needs of mothers in northern Uganda and Karen refugee mothers.

Innovation: In separate but related lines of research, we adapted the content, materials, and metaphors in GenerationPMTO to the needs of these two communities. Our innovative, multistep approach to cultural adaptation included visually representing all major concepts in a printed manual to account for illiteracy and cultural fit. For example, a comic-style sequence illustrated the steps to giving an effective direction or using timeouts. The illustrated families were culturally appropriate and the images integrated local metaphors.

Approach: Our process and the breadth of the adaptations were informed by Bernal et al.’s (1995) model of cultural adaptation, which suggests making adaptations in 8 areas: language, persons, metaphors, content, concepts, goals, methods, and context. These projects began with foundational ethnographic work and relied on community collaborators and informants throughout. The visual manual involved a back-and-forth process of illustrating concepts and editing based on feedback from community members. In each community, the adaptation work culminated in feasibility studies.

Results/Implications for Optimizing Prevention Science: Cultural adaptation has been shown to improve the effectiveness of interventions in communities with which they were not originally tested. Our studies illustrate that significant cultural adaptation can be completed without altering the principles of an intervention’s core components. Family-focused preventive interventions should be a significant component of support for communities following war, conflict, migration, or other significant community-wide stressors. To effectively provide this support, innovations in adaptation will continue to be needed.