As I have ongoing conversations with colleagues about digitally mediated mental health interventions, a continuous theme that comes up is how to customize interventions for diverse audiences based on criteria like gender, socio-economic status, ethnicity, regionality, technographics, etc. As I read studies ongoing, I am always looking for examples that address this question, and appreciate your sharing if you are aware of or are working on related research and implementations.
Earlier this year, I came across a 2019 study in The Journal of Interpersonal Violence by Regan Stewart, Isha Metzger and others, at Medical University of South Carolina (USA). The title of the article is Leveraging Technology and Cultural Adaptations to Increase Access and Engagement Among Trauma — Exposed African American Youth Exploratory Study of School-Based Telehealth Delivery of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This study executed a TF-CBT telehealth intervention in a school setting with 3 African American children, their families and schools. This research examined barriers related to treatment, telehealth factors and cultural tailoring (what I like to call indigenization, and others have labeled as acculturation).
This study has a nice result showing a significant reduction in PTSD symptoms related to this tailored telehealth intervention. In this post, I want to highlight this study’s savvy use of “cultural tailoring” elements. Its execution is considerable and worth replication.
Cultural Tailoring: Its Benefits & Types
Quoting the study article, “Research suggests that cultural tailoring leads to enhanced treatment engagement and improved treatment effectiveness (Griner & Smith, 2006; Jackson-Gilfort, Liddle, Tejeda, & Dakof, 2001).” Cultural tailoring involves use of relevant topics like: a) “system” mistrust, b) parental beliefs about corporal punishment, c) the importance of extended family in child-rearing, and d) stigma associated with seeking mental health care (McKay & Bannon, 2004; Stevenson, 1994).
There is even research showing that racial socialization and transmission of cultural behaviors, attitudes, and values prepare youth for life stressors as an ethnic minority, and may be important in increasing engagement in TFTs (Coard et al., 2004; Metzger, Cooper, Flory, & Zarrett, 2013).
Socialization Content Categories
The author further cites examples of racial socialization categories for use, and these can be adapted for other group criteria than race. They are:
a) pride messages to promote group unity and combat negative majority opinions;
b) barrier messages, which teach about discrimination and highlight the complexities of social interactions between minority and majority populations;
c) equality messages, which emphasize the importance of egalitarian virtues, peace, and multi-ethnic coexistence;
d) achievement messages emphasizing academic and individual achievement; and
e) spiritual/religious messages to cope with difficult life situations in which individuals feel they have little control.
I found these content categories powerful as a content strategy. It makes so much sense it’s a wonder this isn’t a more standard approach. In an environment where so many mentaltech users either do not engage or do not complete engagement with CBT content, to a therapeutically effective level, one can imagine how such customizations can benefit outcomes. Just the effect of increased engagement means that more use of developed programs will make for both improved returns on investment and health outcomes.
The skeptic in me knows that this will not work in every situation and for every situation as there are always exceptions, but that does not discount the value of cultural tailoring as we know that “nothing works with everyone but many things work with enough to have a redeeming effect”.
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- Stewart, R. W., Orengo-Aguayo, R., Wallace, M., Metzger, I. W., & Rheingold, A. A. (2019). Leveraging Technology and Cultural Adaptations to Increase Access and Engagement Among Trauma-Exposed African American Youth: Exploratory Study of School-Based Telehealth Delivery of Trauma-Focused Cognitive Behavioral Therapy. Journal of Interpersonal Violence. https://doi.org/10.1177/0886260519831380
- Griner, D., & Smith, T. B. (2006). Culturally adapted mental health interventions: A meta-analytic review. Psychotherapy: Theory, Research, Practice, and Training, 43, 531–548.
- Jackson-Gilfort, A., Liddle, H. A., Tejeda, M. J., & Dakof, G. A. (2001). Facilitating engagement of African American male adolescents in family therapy: A cultural process study. Journal of Black Psychology, 27, 321–340.
- Coard, S. I., Wallace, S. A., Stevenson, H. C., Jr., & Brotman, L. M. (2004). Towards culturally relevant preventive interventions: The consideration of racial socialization in parent training with African American families. Journal of Child and Family Studies, 13, 277–293.
- Metzger, I., Cooper, S. M., Flory, K., & Zarrett, N. (2013). Culturally sensitive risk- behavior prevention programs for African American adolescents: A systematic analysis. Clinical Child and Family Psychology Review, 16, 187–212.