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Table 2 Adaptation hypotheses across the eight dimensions of the Ecological Validity Model

From: No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings

Dimensions Adaptation hypotheses
Language - Language should be simplified to match literacy level of providers and study populations
Persons - Material’s graphics should depict individuals from both populations
- Case examples should be adapted to reflect common problems and stressors, reactions and coping strategies among the population, as well as institutions and individuals providing support
- Consider culturally appropriate interaction between providers and beneficiaries (e.g., physical contact, ways of addressing each other).
Metaphors - Identify sayings and metaphors to express distress
- Identify somatic expressions of psychological distress
Content - Identify common and culturally appropriate social support and leisure activities
- Consider culturally appropriate ways of discussing sensitive topics (e.g., domestic violence, thoughts of suicide, grief)
- Intervention activities are understood and are appropriate in the cultural context
Concepts - Key concepts (e.g., confidentiality, consent, intervention) and titles are correctly interpreted by both populations
- Technical terms (e.g., distress, withdrawal, social isolation) match literacy level
Goals - Intervention goals match social and cultural values
Methods - Intervention delivered in a format that is acceptable to populations (e.g., including family, appropriate location, time between sessions)
- Instruments are validated with target population and revised by volunteers for comprehension
Context - Address barriers to participation (e.g., child-care, financial situation)
- Address barriers for providers (e.g., time of day of sessions, reaching participant’s house)
- Consider any issues unique to the populations context (e.g., family separation, migratory status)
- Conduct sessions in culturally appropriate locations
- Identify culturally and context appropriate referral pathways