TY - JOUR

T1 - Cultural adaptation of internet interventions for refugees

T2 - Results from a user experience study in Germany

AU - Spanhel, Kerstin

AU - Schweizer, Johannes Samuel

AU - Wirsching, Dorothea

AU - Lehr, Dirk

AU - Baumeister, Harald

AU - Bengel, Juergen

AU - Sander, Lasse

N1 - Funding Information: We would like to thank our participants for sharing their knowledge and expertise with us, as well as all institutions that helped us contacting possible participants. Furthermore, we would like to thank the Studienstiftung des deutschen Volkes for financing the first author's PhD scholarship. KS and LS initiated this study. KS, HB, JB, and LS contributed to the design of this study. DL provided the original intervention GET.ON Recovery. KS, JSS, DW, and LS adapted the intervention content. KS, JSS, and DW largely contributed to the recruitment, data collection, and analyses. DL and HB provided expertise in Internet-based interventions. JB provided expertise in the cultural field. KS wrote the draft of the manuscript. All authors contributed to the further writing of the manuscript and approved the final version of it. Authors of the manuscript were partly involved in the development of eSano Sleep-e or its predecessor versions. DL is a stakeholder of the GET.ON Institute for Online Health Training, Hamburg, which aims to transfer scientific knowledge related to this field of research into routine mental health care in Germany. This institute is licensed to provide the original German version of the intervention from the Leuphana University, Lüneburg, as part of routine preventive services covered by health insurance companies in Germany. There are no other conflicts of interest. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Publisher Copyright: © 2019 The Authors

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Background: The estimated number of refugees worldwide resulting from persecution, conflict, violence, or human rights violations reached 25.4 million in 2017. An increased prevalence of mental disorders combined with language and socio-cultural barriers pose a challenge for healthcare systems. Internet-based interventions can help to meet this challenge. For the effective use of such interventions in refugees, cultural adaptations are necessary. The variety of their cultural backgrounds thereby is particularly challenging. Methods: We conducted this explorative qualitative study in order to identify elements of Internet-based interventions that need cultural adaptation to be suitable for refugees. Six refugees from Syria, Iran, Eritrea, Algeria, and Iraq, and six healthcare providers (two social workers, two psychologists, one physiotherapist, one physician) working with refugees went through an intervention for individuals with sleeping problems (eSano Sleep-e). Possible threats to user experience were identified using the Think Aloud method and semi-structured interviews. Statements were analysed based on the grounded theory method. Results: Results indicate the necessity to adapt the intervention to the specifics of refugees including aspects related to the flight (i.e., past and current stressors) and non-western characteristics (i.e., habits, disease and treatment concepts). Elements of adaptation should include pictures, role models, language, psychoeducational elements, structure of modules, and format of presentation. Conclusions: Cultural adaptation can be used to facilitate the identification with an intervention, which seems crucial to increase the acceptance among refugees. In spite of their diverse cultural backgrounds, it appears feasible to create interventions that allow identification by refugees from different home countries.

AB - Background: The estimated number of refugees worldwide resulting from persecution, conflict, violence, or human rights violations reached 25.4 million in 2017. An increased prevalence of mental disorders combined with language and socio-cultural barriers pose a challenge for healthcare systems. Internet-based interventions can help to meet this challenge. For the effective use of such interventions in refugees, cultural adaptations are necessary. The variety of their cultural backgrounds thereby is particularly challenging. Methods: We conducted this explorative qualitative study in order to identify elements of Internet-based interventions that need cultural adaptation to be suitable for refugees. Six refugees from Syria, Iran, Eritrea, Algeria, and Iraq, and six healthcare providers (two social workers, two psychologists, one physiotherapist, one physician) working with refugees went through an intervention for individuals with sleeping problems (eSano Sleep-e). Possible threats to user experience were identified using the Think Aloud method and semi-structured interviews. Statements were analysed based on the grounded theory method. Results: Results indicate the necessity to adapt the intervention to the specifics of refugees including aspects related to the flight (i.e., past and current stressors) and non-western characteristics (i.e., habits, disease and treatment concepts). Elements of adaptation should include pictures, role models, language, psychoeducational elements, structure of modules, and format of presentation. Conclusions: Cultural adaptation can be used to facilitate the identification with an intervention, which seems crucial to increase the acceptance among refugees. In spite of their diverse cultural backgrounds, it appears feasible to create interventions that allow identification by refugees from different home countries.

KW - Cultural sensitive psychotherapy

KW - eHealth

KW - Low-threshold intervention

KW - Mental health gap

KW - Stepped care

KW - Psychology

UR - http://www.scopus.com/inward/record.url?scp=85067309653&partnerID=8YFLogxK

U2 - 10.1016/j.invent.2019.100252

DO - 10.1016/j.invent.2019.100252

M3 - Journal articles

C2 - 31890608

AN - SCOPUS:85067309653

VL - 18

JO - Internet Interventions

JF - Internet Interventions

SN - 2214-7829

M1 - 100252

ER -