Marshall Sarah, Taki Sarah, Love Penny, Laird Yvonne, Kearney Marianne, Tam Nancy, Baur Louise A, Rissel Chris, Wen Li Ming
Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia.
Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia.
BMC Public Health. 2021 Feb 4;21(1):284. doi: 10.1186/s12889-021-10270-5.
BACKGROUND: Behavioural interventions for the early prevention of childhood obesity mostly focus on English-speaking populations in high-income countries. Cultural adaptation is an emerging strategy for implementing evidence-based interventions among different populations and regions. This paper describes the initial process of culturally adapting Healthy Beginnings, an evidence-based early childhood obesity prevention program, for Arabic and Chinese speaking migrant mothers and infants in Sydney, Australia. METHODS: The cultural adaptation process followed the Stages of Cultural Adaptation theoretical model and is reported using the Framework for Reporting Adaptations and Modifications-Enhanced. We first established the adaptation rationale, then considered program underpinnings and the core components for effectiveness. To inform adaptations, we reviewed the scientific literature and engaged stakeholders. Consultations included focus groups with 24 Arabic and 22 Chinese speaking migrant mothers and interviews with 20 health professionals. With input from project partners, bi-cultural staff and community organisations, findings informed cultural adaptations to the content and delivery features of the Healthy Beginnings program. RESULTS: Program structure and delivery mode were retained to preserve fidelity (i.e. staged nurse calls with key program messages addressing modifiable obesity-related behaviours: infant feeding, active play, sedentary behaviours and sleep). Qualitative analysis of focus group and interview data resulted in descriptive themes concerning cultural practices and beliefs related to infant obesity-related behaviours and perceptions of child weight among Arabic and Chinese speaking mothers. Based on the literature and local study findings, cultural adaptations were made to recruitment approaches, staffing (bi-cultural nurses and project staff) and program content (modified call scripts and culturally adapted written health promotion materials). CONCLUSIONS: This cultural adaptation of Healthy Beginnings followed an established process model and resulted in a program with enhanced relevance and accessibility among Arabic and Chinese speaking migrant mothers. This work will inform the future cultural adaptation stages: testing, refining, and trialling the culturally adapted Healthy Beginnings program to assess acceptability, feasibility and effectiveness.
背景:早期预防儿童肥胖的行为干预措施大多聚焦于高收入国家的英语人群。文化调适是在不同人群和地区实施循证干预措施的一种新兴策略。本文描述了对“健康开端”(一项循证的幼儿肥胖预防项目)进行文化调适的初始过程,该调适针对澳大利亚悉尼讲阿拉伯语和汉语的移民母亲及其婴儿。 方法:文化调适过程遵循文化调适阶段理论模型,并使用增强版的调适与修改报告框架进行报告。我们首先确立调适的基本原理,然后考虑项目的基础以及有效性的核心要素。为了为调适提供依据,我们查阅了科学文献并与利益相关者进行了交流。咨询活动包括与24位讲阿拉伯语和22位讲汉语的移民母亲进行焦点小组讨论,以及对20名卫生专业人员进行访谈。在项目合作伙伴、双语工作人员和社区组织的参与下,研究结果为“健康开端”项目的内容和实施特点的文化调适提供了依据。 结果:保留了项目结构和实施模式以确保保真度(即按阶段安排护士进行电话回访,传达关键项目信息,涉及可改变的与肥胖相关行为:婴儿喂养、积极玩耍、久坐行为和睡眠)。对焦点小组和访谈数据的定性分析得出了描述性主题,涉及讲阿拉伯语和汉语的母亲们与婴儿肥胖相关行为以及儿童体重认知有关的文化习俗和观念。基于文献和当地研究结果,在招募方式、人员配备(双语护士和项目工作人员)以及项目内容(修改后的电话脚本和文化调适后的书面健康促进材料)方面进行了文化调适。 结论:“健康开端”的这种文化调适遵循了既定的过程模型,产生了一个在讲阿拉伯语和汉语的移民母亲中相关性和可及性更强的项目。这项工作将为未来的文化调适阶段提供信息:测试、完善和试用文化调适后的“健康开端”项目,以评估其可接受性、可行性和有效性。
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