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      Cultural adaptation of an evidence-based intervention to address mental health among youth affected by armed conflict in Colombia: An application of the ADAPT-ITT approach and FRAME-IS reporting protocols

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          Abstract

          Background

          In Colombia, over 9 million people have been impacted by armed conflict, creating a significant need for mental health services. This study aimed to culturally adapt and pilot test the Youth Readiness Intervention (YRI), an evidence-based transdiagnostic mental health intervention, for conflict-affected Colombian youth aged 18-28 years.

          Methods

          The eight phases of the Assessment, Decision, Administration, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework were used to culturally adapt the YRI for conflict-affected Colombian youth. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to track the adaptations made. Qualitative and quantitative data were gathered and analyzed throughout the adaptation process.

          Results

          Data from the Assessment phase demonstrated a high need for mental health interventions among conflict-affected youth. The Testing phase revealed significant improvements in emotion regulation and functional impairment, suggesting the YRI is a promising intervention among conflict-affected Colombian youth. Qualitative data confirmed the intervention’s acceptability among youth and mental health providers.

          Conclusions

          The YRI was successfully adapted for conflict-affected Colombian youth. Future studies using randomized designs are needed to test the effectiveness of the YRI for improving mental health among larger samples of Colombian conflict-affected youth.

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          Most cited references46

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          Thematic networks: an analytic tool for qualitative research

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            The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions

            Background This paper describes the process and results of a refinement of a framework to characterize modifications to interventions. The original version did not fully capture several aspects of modification and adaptation that may be important to document and report. Additionally, the earlier framework did not include a way to differentiate cultural adaptation from adaptations made for other reasons. Reporting additional elements will allow for a more precise understanding of modifications, the process of modifying or adapting, and the relationship between different forms of modification and subsequent health and implementation outcomes. Discussion We employed a multifaceted approach to develop the updated FRAME involving coding documents identified through a literature review, rapid coding of qualitative interviews, and a refinement process informed by multiple stakeholders. The updated FRAME expands upon Stirman et al.’s original framework by adding components of modification to report: (1) when and how in the implementation process the modification was made, (2) whether the modification was planned/proactive (i.e., an adaptation) or unplanned/reactive, (3) who determined that the modification should be made, (4) what is modified, (5) at what level of delivery the modification is made, (6) type or nature of context or content-level modifications, (7) the extent to which the modification is fidelity-consistent, and (8) the reasons for the modification, including (a) the intent or goal of the modification (e.g., to reduce costs) and (b) contextual factors that influenced the decision. Methods of using the framework to assess modifications are outlined, along with their strengths and weaknesses, and considerations for research to validate these measurement strategies. Conclusion The updated FRAME includes consideration of when and how modifications occurred, whether it was planned or unplanned, relationship to fidelity, and reasons and goals for modification. This tool that can be used to support research on the timing, nature, goals and reasons for, and impact of modifications to evidence-based interventions.
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              Qualitative inquiry and research design: Choosing among five approaches:

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                Author and article information

                Journal
                Glob Ment Health (Camb)
                Glob Ment Health (Camb)
                GMH
                Cambridge Prisms: Global Mental Health
                Cambridge University Press (Cambridge, UK )
                2054-4251
                2024
                28 November 2024
                : 11
                : e114
                Affiliations
                [ 1 ] Boston College , School of Social Work, Chestnut Hill, MA, USA
                [ 2 ] Brown University , Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Providence, RI, USA
                [ 3 ] Universidad de Los Andes , Department of Economics, Bogotá, Colombia
                [ 4 ] Florida International University , Robert Stempel College of Public Health and Social Work, Miami, FL, USA
                [ 5 ] Boston College , Connell School of Nursing, Chestnut Hill, MA, USA
                Ponce Health Sciences University , Puerto Rico
                London School of Hygiene & Tropical Medicine , United Kingdom of Great Britain and Northern Ireland
                Ponce Health Sciences University , Puerto Rico
                London School of Hygiene & Tropical Medicine , United Kingdom of Great Britain and Northern Ireland
                Author notes
                Correspondence author: María Pineros-Leano; Email: maria.pinerosleano@ 123456bc.edu
                Author information
                https://orcid.org/0000-0001-7057-8316
                https://orcid.org/0000-0003-2392-0371
                https://orcid.org/0009-0002-2869-0608
                Article
                S2054425124001067
                10.1017/gmh.2024.106
                11704387
                d76ed7a3-c691-4157-9204-cccb8b1b20b0
                © The Author(s) 2024

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

                History
                : 18 April 2024
                : 12 July 2024
                : 05 September 2024
                Page count
                Tables: 9, References: 51, Pages: 14
                Funding
                Funded by: Bogota Mayor’s Office
                Categories
                Research Article
                Interventions
                Population Strategies
                Teaching and Learning
                Training Non-Mental Health Professionals

                evidence-based intervention,cultural adaptation,conflict-affected youth,mental health

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