Adele Pacini is a clinical-academic with a background in clinical psychology and mindfulness based approaches. She has a particular interest in adaptation of mental health interventions in LMICs, and hold academic affiliations with the Open University and UCL.
Global dissemination of western mental health interventions across widely diverse cultures leaves a potentially large implementation gap for non-Caucasian people1. Central to the uptake of mental health interventions are the extent to which they align with the cultural and personal values of local cultures, organisations, staff, individuals and their families which are key contextual factors influencing implementation science.
We explore the potential of integrating components of the Pragmatic Robust Implementation and Sustainability Model (PRISM)2 within a dynamic system of cultural adaptation3. We model the complementary and contradictory perspectives on cultural concepts of distress and healing, highlighting how successful implementation depends on navigating the ‘best fit’ between these concepts and evidence based psychological techniques
Figure 1 shows the resulting model for the implementation of culturally adapted psychological interventions. We model the dynamic nature of the overlap between an individual’s coping mechanisms, their family’s, alongside organizational capacity to implement interventions and existing cultural and evidence based practices to support mental health.
Integrating components of PRISM within a dynamic system model of cultural adaptation allows us to represent the uncertainty and unpredictability of adapting mental health interventions more accurately in non-western cultures. Importantly, it also models the tension between self, other and organizational values, which may be particularly critical in collectivist cultures, or across generations in countries experiencing rapid development. Our case example suggests how we might navigate these uncertainties and complexities through a lens of ‘best fit’ rather than input-output.
1. Rose D, Kalathil J. Power, privilege and knowledge: the untenable promise of co-production in mental “health”. Frontiers in Sociology. 2019:57.
2. Feldstein AC, Glasgow RE. A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. The Joint Commission Journal on Quality and Patient Safety. 2008 Apr 1;34(4):228-43.
3.Braithwaite J, Churruca K, Long JC, Ellis LA, Herkes J. When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC medicine. 2018 Dec;16(1):1-4.