Heim Eva, Burchert Sebastian, Shala Mirëlinda, Hoxha Anna, Kaufmann Marco, Cerga Pashoja Arlinda, Morina Naser, Schaub Michael P, Knaevelsrud Christine, Maercker Andreas
Institute of Psychology, University of Lausanne, Lausanne, Switzerland.
Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany.
Clin Psychol Eur. 2024 Jun 28;6(2):e2743. doi: 10.32872/cpe.2743. eCollection 2024 Jun.
Research on cultural adaptation of psychological interventions indicates that a higher level of adaptation is associated with a higher effect size of the intervention. However, direct comparisons of different levels of adaptations are scarce.
This study used a smartphone-based self-help programme called Step-by-Step (Albanian: Hap-pas-Hapi) for the treatment of psychological distress among Albanian-speaking immigrants in Switzerland and Germany. Two levels of cultural adaptation (i.e., surface vs. deep structure adaptation) were compared. We hypothesised that the deep structure adaptation would enhance the acceptance and efficacy of the intervention.
We conducted a two-arm, single-blind randomised controlled trial. Inclusion criteria were good command of the Albanian language, age above 18, and elevated psychological distress (Kessler Psychological Distress Scale score above 15). Primary outcome measures were the total score of the Hopkins Symptom Checklist and the number of participants who completed at least three (out of five) sessions. Secondary outcomes were global functioning, well-being, post-traumatic stress, and self-defined problems.
Two-hundred-twenty-two participants were included, of which 18 (8%) completed the post-assessments. The number of participants who completed the third session was equal in both conditions, with N = 5 (5%) and N = 6 (6%) respectively.
Drop-out rates were high in both conditions, and no group difference was found regarding the acceptance of the intervention. The high drop-out rate stands in contrast with other trials testing Step-by-Step. Future research should examine cultural factors impacting recruitment strategies, as insights could help to reduce participant drop-out rates in clinical trials.
心理干预的文化适应研究表明，更高水平的适应与干预的更大效应量相关。然而，对不同适应水平的直接比较很少。
本研究使用了一个名为“步步为营”（阿尔巴尼亚语：Hap-pas-Hapi）的基于智能手机的自助项目，用于治疗瑞士和德国讲阿尔巴尼亚语的移民中的心理困扰。比较了两个文化适应水平（即表面适应与深层结构适应）。我们假设深层结构适应会提高干预的可接受性和效果。
我们进行了一项双臂、单盲随机对照试验。纳入标准是阿尔巴尼亚语熟练、年龄在18岁以上以及心理困扰程度较高（凯斯勒心理困扰量表得分高于15）。主要结局指标是霍普金斯症状清单的总分以及完成至少三（共五）次疗程的参与者人数。次要结局是整体功能、幸福感、创伤后应激和自我定义的问题。
纳入了222名参与者，其中18名（8%）完成了后测。在两种情况下完成第三次疗程的参与者人数相同，分别为N = 5（5%）和N = 6（6%）。
两种情况下的退出率都很高，在干预的可接受性方面未发现组间差异。高退出率与其他测试“步步为营”项目的试验形成对比。未来的研究应该考察影响招募策略的文化因素，因为相关见解可能有助于降低临床试验中的参与者退出率。
