Design and Implementation of a Culturally-Tailored Randomized Pilot Trial: Puerto Rican Optimized Mediterranean-Like Diet.

Background: Adhering to a Mediterranean Diet (MedDiet) is associated with a healthier cardiometabolic profile. However, there are limited studies on the MedDiet benefits for non-Mediterranean racial/ethnic minorities, for whom this diet may be unfamiliar and inaccessible and who have a high risk of chronic diseases. Objectives: To describe the study design of a pilot trial testing the efficacy of a MedDiet-like tailored to adults in Puerto Rico (PR). Methods: The Puerto Rican Optimized Mediterranean-like Diet (PROMED) was a single-site 4-mo parallel two-arm randomized pilot trial among a projected 50 free-living adults (25-65 y) living in PR with at least two cardiometabolic risk factors (clinicaltrials.gov registration #NCT03975556). The intervention group received 1 individual nutritional counseling session on a portion-control culturally-tailored MedDiet. Daily text messages reinforced the counseling content for 2 mo, and we supplied legumes and vegetable oils. Participants in the control group received cooking utensils and one standard portion-control nutritional counseling session that was reinforced with daily texts for 2 mo. Text messages for each group were repeated for two more months. Outcome measures were assessed at baseline, 2 and 4 m. The primary outcome was a composite cardiometabolic improvement score; secondary outcomes included individual cardiometabolic factors; dietary intake, behaviors, and satisfaction; psychosocial factors; and the gut microbiome. Results: PROMED was designed to be culturally appropriate, acceptable, accessible, and feasible for adults in PR. Strengths of the study include applying deep-structure cultural components, easing structural barriers, and representing a real-life setting. Limitations include difficulty with blinding and with monitoring adherence, and reduced timing and sample size. The COVID-19 pandemic influenced implementation, warranting replication. Conclusions: If PROMED is proven efficacious in improving cardiometabolic health and diet quality, the findings would strengthen the evidence on the healthfulness of a culturally-appropriate MedDiet and support its wider implementation in clinical and population-wide disease-prevention programs.

Perceptions of the Sense of Security, Belonging, and Acculturative Stress among International Students in China during COVID-19 Outbreak-An Empirical Analysis.

Understanding the cross-cultural adaptation of students studying in foreign countries by exploring acculturative stress factors is crucial to ensure the smooth academic performance of the students and, in turn, to enhance the global reputation of their universities. Therefore, it is an area of interest for the authorities (Ministry) and the corresponding management of universities. Using a random sample of 138 international students in China, descriptive and logistic regressions were conducted to assess the levels and influence of acculturative stress factors on cross-cultural adaptation, specifically on international students' sense of security and belonging during the COVID-19 pandemic outbreak. The results revealed that students were most concerned about homesickness, which obtained the highest mean score. The regression results indicated that the perception of fear and discrimination significantly impacted international students' sense of security. The perception of fear, guilt, and how long the student stayed in China also significantly affected the sense of belonging. We argue that the reflections provided herein are essential for universities to improve how they manage and handle international students to mitigate the effects of acculturative stress, particularly when additional stressful conditions are present, such as the COVID-19 pandemic.

Popping the "bubble” metaphor: separation and integration of expatriate communities

PurposeThis paper aims to discuss multiple uses of the concept of "bubble” as a metaphor to refer to different experiences of foreign working communities and suggests a more flexible and comprehensive approach.Design/methodology/approachBased on ethnographic fieldwork conducted at different locations, the authors propose changing the use of the bubble metaphor from an analogy of living in isolation to a way of conceptualising the changing contexts and characteristics that impact the porosity and permeability of communities.FindingsThe paper suggests that when using the metaphor as a concept, the following considerations need to be taken into account: (1) the conventional thinking that "expat-bubbles” are isolated places, (2) any simplistic notion that different internationally mobile workers will be less or more immersed in the local community and (3) the use of the bubble metaphor without a careful delineation and reference to its permeability and porosity.Originality/valueThe paper helps to visualise a different dimension of the traditional taken-for-granted representation of the bubble. The bubble emerges as a rich analogical concept not to explain binomial representations of integration-separation. Rather than a simple "open” or "closed”, bubbles became more or less porous and permeable depending on the experiences of foreign working communities.

Cross-cultural validation of 'Students' knowledge and use of digital technology during the COVID-19 pandemic' questionnaire to the Peruvian context

To obtain useful, valid, and reliable results, it is essential to carry out a cross-cultural adaptation process when using measurement instruments developed in other cultures, contexts, and populations with a different language from the original one. An instrumental study was conducted to determine the validity and reliability of the 'Students' knowledge and use of digital technology during the COVID-19 pandemic' questionnaire, developed in another context and different culture from the original one. The participants were 139 students of the Communications program of a private higher education institute in Lima, selected by non-probabilistic convenience sampling. The study presents a proposal consisting of eight factors and 56 items, as opposed to the original structure composed of seven factors and 77 items. The analyses show that the instrument is valid and reliable among the population under study. © 2022 IEEE.

Development of mental health first-aid guidelines for depression: a Delphi expert consensus study in Argentina and Chile.

BACKGROUND: Depression is one of the most common mental health problems worldwide and, while prevalence rates in Latin America are relatively high, most people who meet the criteria for diagnosis do not receive treatment. Family and friends of a person with depression can play an important role in supporting a person to seek and engage with treatment. However, many people do not have the necessary skills or confidence to help. English-language mental health first aid guidelines have been developed to support people to provide such help. The aim of this study was to culturally adapt these guidelines for Chile and Argentina. METHODS: A Delphi expert consensus study was conducted with two expert panels, one of people with lived experience of depression (either their own or as a carer; n = 26) and one of health professionals (n = 29). Overall, 172 statements from the English-language guidelines were translated and compiled into a questionnaire. Participants were asked to rate statements based on how essential or important those statements were for Chile and Argentina and to suggest new statements if necessary. RESULTS: Data were obtained over two survey rounds. Consensus was achieved on 172 statements. A total of 137 statements were adopted from the English-language guidelines, whereas 35 new endorsed statements were generated from panel suggestions. There were similarities between the English-language guidelines and those for Chile and Argentina. The adapted guidelines did not include some of the items from the English-language guidelines related to commenting on a person's strengths or making judgements about their character, and also incorporated new items related to the incorporation of sociocultural considerations as causes of depression and attention to inequities in mental health. CONCLUSIONS: The significant number of new items underscores the importance of undertaking a careful process of cultural adaptation. Further research on dissemination and incorporation of the guidelines into the Mental Health First Aid training course for Chile and Argentina is still required.

Finding voice in a year of collective trauma: Case study of an online photovoice project with youth.

In this article, we share findings from a qualitative case study of a virtual youth photovoice program implemented across three regions of the United States. The purpose of the program was to engage youth in research on a social issue relevant to them during an unprecedented year marked by two public health crises, COVID-19 and anti-Black racial violence. Results of an analysis of curriculum and archival program materials lend support for online strategies for youth engagement including individualized support and online audiovisual presentations with avatars. Racial justice and trauma-informed adaptations were designed to be responsive to youth needs for flexible programming and safe spaces. Themes captured in the first online gallery of youth photos include (1) tools for mental health, (2) meaningful connection, and (3) community advocacy, bringing attention to structural issues as well as family and community strengths. Findings suggest photovoice can be thoughtfully adapted for youth researchers and support individual and group storytelling in response to collective trauma.

Cross-cultural adaptation and validation of the Hospital Survey on Patient Safety Culture 2.0 - Brazilian version.

BACKGROUND: Patient safety culture concerns the values, beliefs and standards shared by an organisation's health staff and other personnel which influence their care provision actions and conduct. Several countries have made a priority of strengthening patient safety culture to improve the quality and safety of health care. In this direction, measuring the patient safety culture through validated instruments is a strategy applied worldwide. The purpose of this study was to adapt transculturally and validate the HSOPSC 2.0 to Brazilian Portuguese and the hospital context in Brazil. METHODS: Of the various validated scales for measuring safety culture, the instrument most used internationally is the Hospital Survey on Patient Safety Culture (HSOPSC) developed by the United States Agency for Healthcare Research and Quality in 2004 and revised in 2019, when version 2.0 was released. Adaptation was conducted on a universalist approach and the adapted instrument was then applied to a sample of 2,702 respondents (56% response rate) comprising staff of a large general hospital in the city of São Paulo. Construct validity was investigated by Exploratory Structural Equation Modelling-within-Confirmatory Factor Analysis (ESEM-within-CFA) and reliability was measured in each dimension by means of Cronbach alpha coefficients. RESULTS: ESEM fit indexes showed good data fit with the proposed model: χ2 = 634.425 df = 221 χ2/df ratio = 2.9 p-value < 0.0000; RMSEA = 0.045 (90% C.I. = 0.041-0.050) and probability RMSEA < = .05 = 0.963; CFI = 0.986; TLI = 0.968. However, ten items had loads lower than 0.4. Cronbach alpha values were 0.6 or more for all dimensions, except Handoffs and information exchange ([Formula: see text]= 0.50) and Staffing and work pace ([Formula: see text] = 0.41). CONCLUSION: The psychometric properties of the Brazilian version were found to be satisfactory, demonstrating good internal consistency and construct validity as expressed by estimates of reliability and indexes of model fit. However, given factor loadings smaller than 0.4 observed in ten items and considering that the scale translated and adapted to Portuguese was tested on a single sample during the Covid-19 pandemic, the authors recognize the need for it to be tested on other samples in Brazil to investigate its validity.

Key performance measurement capabilities for managing distributed teams

Distributed teams are a reality for several companies nowadays, many authors covered their benefits and problems, and the rate of adoption of such team's structure by companies is growing fast. Since these teams are more present in companies, a performance measurement system must get adapted to fulfill the gap of not having a vast theory about the subject. To fill that gap, this paper brings results from previous steps in the research (Systematic Literature Review and Qualitative analysis of the data). It presents to a group of experts to reach a consensus on which capabilities are essential to managing/developing distributed teams' performance. The experts were exposed to the information following a Delphi Panel format and provided output that reached consensus and refined the list. The experts indicated that a group of six capabilities (engagement, development of a culture of performance measurement, organizational learning, alignment between planning and execution, accurate information and consistency) are essential to have their performance measurement system working correctly and reaching all functions. The work also identified the success factors for virtual teams, providing directions for the adoption and the monitoring of this kind of team that gained importance during the COVID-19 pandemic.

Translation and Cross-Cultural Adaptation of the Cancer Health Literacy Test for Portuguese Cancer Patients: A Pre-Test.

Assuming the multidimensionality of health literacy, new complex and comprehensive approaches are more adequate to specific disease contexts, such as cancer. Assessing cancer literacy levels is a priority, since it entails potential serious implications for disease outcomes and patient's quality of life. This article reports on the translation and cultural adaptation of the Cancer Health Literacy Test to measure cancer literacy in Portuguese cancer patients. A multidisciplinary team of experts ensured the translation and cultural adaptation of the CHLT-30. A pre-test was conducted in two stages to evaluate the Portuguese version (CHLT-30 PT) in a sample of cancer patients (n = 71). Descriptive statistics were used to characterize the sample. Reliability (test-retest and internal consistency) and construct validity of CHLT-30 PT were assessed. The results obtained show a good internal consistency of the tool, respectively (Cronbach's alpha = 0.86 in the test and 0.80 in the retest). Patients' raw score mean in both test (23.96) and retest (25.97) and the distribution of scores categories are not statistically different. A suggestive association between higher education level and better total score was found compared to the results reported in CHLT-30-DKspa. The results obtained in the pre-test are favorable, and the instrument is now suitable for the next steps of the validation process. A Portuguese version of this tool will allow outlining patients' cancer literacy along the cancer care continuum, enabling the identification and implementation of adequate socio-educational strategies with highly positive impacts on health outcomes.

Adapting and Implementing Apps for Mental Healthcare.

PURPOSE OF REVIEW: To describe examples of adapting apps for use in mental healthcare and to formulate recommendations for successful adaptation in mental healthcare settings. RECENT FINDINGS: International examples are given to explore implementation procedures to address this multitude of challenges. There are only few published examples of adapting apps for use in mental healthcare. From these examples and from results of studies in implementation science in general clinical settings, it can be concluded that the process of adapting apps for mental healthcare needs to address clinician training and information needs, user needs which include cultural adaptation and go beyond mere translation, and organizational needs for blending app use into everyday clinical mental healthcare workflows.

Socio-cultural adaptation of migrants in Russia

Social, economic and political changes in society have actualized the problem of human migration. However, migration processes are not a new phenomenon, since they accompany human development constantly. It was in the second half of the 19th century that European countries began to keep records of people who migrated. At the same time, the COVID-19 pandemic has stirred up the world today, which, of course, has stopped the pace of migration processes, and the situation with the course of this disease in the world is very different, which can cause a new wave of migration of people to safer countries. In our opinion, it is relevant to pay attention to the effect of socio--cultural factors on the migrant's personality, which is reflected in adaptation and identification processes.

Family Strengthening in the Context of COVID-19: Adapting a Community-Based Intervention from Kenya to the United States.

COVID-19 led to widespread disruption of services that promote family well-being. Families impacted most were those already experiencing disparities due to structural and systemic barriers. Existing support systems faded into the background as families became more isolated. New approaches were needed to deliver evidence-based, low-cost interventions to reach families within communities. We adapted a family strengthening intervention developed in Kenya ("Tuko Pamoja") for the United States. We tested a three-phase participatory adaptation process. In phase 1, we conducted community focus groups including 11 organizations to identify needs and a community partner. In phase 2, the academic-community partner team collaboratively adapted the intervention. We held a development workshop and trained community health workers to deliver the program using an accelerated process combining training, feedback, and iterative revisions. In phase 3, we piloted Coping Together with 18 families, collecting feedback through session-specific surveys and participant focus groups. Community focus groups confirmed that concepts from Tuko Pamoja were relevant, and adaptation resulted in a contextualized intervention-"Coping Together"-an 8-session virtual program for multiple families. As in Tuko Pamoja, communication skills are central and applied for developing family values, visions, and goals. Problem-solving and coping skills then equip families to reach goals, while positive emotion-focused activities promote openness to change. Sessions are interactive, emphasizing skills practice. Participants reported high acceptability and appropriateness, and focus groups suggested that most content was understood and applied in ways consistent with the theory of change. The accelerated reciprocal adaptation process and intervention could apply across resource-constrained settings.

Cultural adaptation of a diabetes self-management education and support (DSMES) programme for two low resource urban settings in Ghana, during the COVID-19 era.

BACKGROUND: Type 2 diabetes is a significant public health problem globally and associated with significant morbidity and mortality. Diabetes self-management education and support (DSMES) programmes are associated with improved psychological and clinical outcomes. There are currently no structured DSMES available in Ghana. We sought to adapt an evidence-based DSMES intervention for the Ghanaian population in collaboration with the local Ghanaian people. METHODS: We used virtual engagements with UK-based DSMES trainers, produced locally culturally and linguistically appropriate content and modified the logistics needed for the delivery of the self-management programme to suit people with low literacy and low health literacy levels. CONCLUSIONS: A respectful understanding of the socio-cultural belief systems in Ghana as well as the peculiar challenges of low resources settings and low health literacy is necessary for adaptation of any DSMES programme for Ghana. We identified key cultural, linguistic, and logistic considerations to incorporate into a DSMES programme for Ghanaians, guided by the Ecological Validity Model. These insights can be used further to scale up availability of structured DSMES in Ghana and other low- middle- income countries.

Black Kin Caregivers: Acceptability and Cultural Adaptation of the Family Check-Up/Everyday Parenting Program.

Black children join kinship care disproportionately and black kin caregivers often face financial, housing, mental health, and parenting challenges when caring for relative children. Few interventions have been developed specifically for kin caregivers, let alone Black kin caregivers. This study evaluated the initial acceptability of an evidence based parenting intervention and worked to culturally adapt it for Black kin caregivers. The intervention was delivered in a family camp format. Feedback from participant interviews were analyzed for this study. Participants felt that overall the intervention was culturally appropriate. However, they also proposed changes to the curriculum, as well as to the process and format of the intervention. This study experienced challenges in terms of participant recruitment and sample size, which was exacerbated by COVID-19-related safety concerns. Future steps regarding recruitment, content, and format are discussed. Implications for child welfare practice, policy, and research are also provided.

Development and Cultural Adaptation of Psychological First Aid for COVID-19 Frontline Workers in American Indian/Alaska Native Communities.

The coronavirus disease 19 (COVID-19) pandemic is broadly affecting the mental health and well-being of people around the world, and disproportionately affecting some groups with already pre-existing health inequities. Two groups at greater risk of physical and/or mental health detriments from COVID-19 and more profoundly impacted by the pandemic include frontline workers and American Indian/Alaska Native (AI/AN) communities. To provide support and prevent long-term mental health problems, we culturally adapted a psychological first aid guide specifically for COVID-19 frontline workers serving AI/AN communities. We engaged a diverse, collaborative work group to steer the adaptation content and process. We also held two focus group discussions with frontline workers in AI/AN communities to incorporate their perspectives into the adapted guide. Results from the group discussions and the collaborative work group were compiled, analyzed to extract themes and suggestions, and integrated into the adapted content of the guide. Main adaptations included updating language (i.e., to be more culturally appropriate, less prescriptive, and less text heavy), framing the guide from a harm-reduction lens, incorporating cultural activities, values, and teachings common across diverse AI/AN communities (e.g., importance of being a good relative), and validating feelings and experiences of frontline workers. The resulting adapted guide includes four modules and is available as a free online training. Our adaptation process may serve as a guiding framework for future adaptations of similar resources for specific groups. The adapted guide may stand as an enduring resource to support mental well-being, the prevention of mental health problems, and reduction of health inequities during the pandemic and beyond.

Inequality in Pulmonary Rehabilitation - The challenges magnified by the COVID-19 pandemic.

The COVID-19 pandemic has served to expose and amplify existing inequalities in chronic respiratory disease and the social determinants of health. In this article, we summarise evidence of existing disparities associated with chronic obstructive pulmonary disease and pulmonary rehabilitation; highlighting limitations of existing data. To reduce health inequalities in pulmonary rehabilitation, there is a need to identify and target factors influencing fair access and personal agency to engage. With consideration of the influence of culture on beliefs, expectations and health behaviours, we propose a renewed approach toward progressively achieving health equity in pulmonary rehabilitation based on principles of cultural safety and adaptation. This is a key priority in improving the quality of life of people living with chronic respiratory disease. Building comprehensive pulmonary rehabilitation service delivery models based on an understanding of the holistic needs of the local population should be a priority for service providers and researchers.

Cultural adaptation of a community-based advance serious illness planning decision aid to the Quebec context involving end-users.

INTRODUCTION: Traditional advance care planning focuses on end-of-life planning in the context of a certain or imminent death. It is not tailored for serious illness planning, where the 'death' outcome is uncertain. The Plan Well Guide™ (PWG) is a decision aid that empowers lay persons to better understand different types of care and prepares them, and their substitute decision-makers, to express both their authentic values and informed treatment preferences in anticipation of serious illness. A cultural adaptation was necessary to make the material suitable to the context of Quebec, a French-speaking Canadian province. METHODS: We engaged lay collaborators and experts in a panel, involving three phases of consultation and data collection. These included an online questionnaire, focused interviews and virtual focus groups that identified elements within the francophone PWG affecting its feasibility, adaptation and integration, as well as items that should be modified. RESULTS: We engaged 22 collaborators between April and September 2021. The majority (82%) ranked the first translation as good or very good; most (70%) stated that they would recommend the final adaptation. Both lay and expert panel members suggested simplifying the language and framing the tool better within the context of other advance medical planning processes in Quebec. Translation was considered in a cultural context; the challenges identified by the research team or by collaborators were addressed during the focus group. Examples of wording that required discussion include translating 'getting the medical care that's right for you' when referring to the PWG's goal. An equivalent expression in the French translation was believed to invoke religious associations. Using the term 'machines' to describe life-sustaining treatments was also deliberated. CONCLUSION: Our collaborative iterative adaptation process led to the first French advanced serious illness planning tool. How acceptable and user-friendly this French adaptation of the PWG is in various Canadian French-speaking environments requires further study. CONTRIBUTION: We organized a focus group inviting both lay collaborators and experts to contribute to the interpretation of the results of the previous phases. This choice allowed us to add more value to our results and to the final PWG in French.

Addressing Gender-Based Violence Using Evidence-Based Practices During COVID-19: The Case of Puerto Rico.

As gender-based violence (GBV) surged during the COVID-19 pandemic, the 65th session of the Commission on the Status of Women (CSW65) called for member states, civil, and other stakeholders to consider the specific needs of women and girls in COVID-19 response and recovery efforts. Psychology provides scientific knowledge to help answer this call. Despite existing global guidance and psychological research to mitigate GBV, COVID-19 presents new challenges for consideration. This article summarizes existing GBV guidance/research and COVID-19 considerations, uses an illustrative case study to describe Puerto Rico's application of GBV guidance/research during COVID-19, and provides preliminary policy and practice recommendations.

Arabic validation and cross-cultural adaptation of the 5C scale for assessment of COVID-19 vaccines psychological antecedents

Background: In the Arab countries, there has not been yet a specific validated Arabic questionnaire that can assess the psychological antecedents of COVID-19 vaccine among the general population. This study, therefore, aimed to translate, culturally adapt, and validate the 5C scale into the Arabic language. Methods: The 5C scale was translated into Arabic by two independent bilingual co-authors, and then translated back into English. After reconciling translation disparities, the final Arabic questionnaire was disseminated into four randomly selected Arabic countries (Egypt, Libya, United Arab Emirates (UAE), and Saudi Arabia). Data from 350 Arabic speaking adults (aged >= 18 years) were included in the final analysis. Internal consistency was assessed by Cronbach's alpha. Construct validity was determined by concurrent, convergent, discriminant, exploratory and confirmatory factor analyses. Results: Age of participants ranged between 18 to 73 years;57.14% were females, 37.43% from Egypt, 36.86%, from UAE, 30% were healthcare workers, and 42.8% had the intention to get COVID-19 vaccines. The 5 sub-scales of the questionnaire met the criterion of internal consistency (Cronbach's alpha >= 0.7). The predictors of intention to get COVID-19 vaccines (concurrent validity) were young age and the 5C sub-scales. Convergent validity was identified by the significant inter-item and item-mean score of the sub-scale correlation (P < 0.001). Discriminant validity was reported as inter-factor correlation matrix (< 0.7). Kaiser- Meyer-Olkin sampling adequacy measure was 0.80 and Bartlett's sphericity test was highly significant (P < 0.001). Exploratory factor analysis indicated that the 15 items of the questionnaire could be summarized into five factors. Confirmatory factor analysis confirmed that the hypothesized five-factor model of the 15-item questionnaire was satisfied with adequate psychometric properties and fit with observed data (RMSEA = 0.060, GFI = 0.924, CFI = 0.957, TLI = 0.937, SRMR = 0.076 & NFI = 906). Conclusion: The Arabic version of the 5C scale is a valid and reliable tool to assess the psychological antecedents of COVID-19 vaccine among Arab population. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Moral Distress in Healthcare Providers Who Take Care of Critical Pediatric Patients throughout Italy-Cultural Adaptation and Validation of the Italian Pediatric Instrument.

BACKGROUND: Although Moral Distress (MD) is a matter of concern within the Pediatric Intensive Care Unit (PICU), there is no validated Italian instrument for measuring the phenomenon in nurses and physicians who care for pediatric patients in Intensive Care. The authors of the Italian Moral Distress Scale-Revised (Italian MDS-R), validated for the adult setting, in 2017, invited further research to evaluate the generalizability of the scale to clinicians working in other fields. Our study aims to reduce this knowledge gap by developing and validating the pediatric version of the Italian MDS-R. METHODS: We evaluated the new instrument for construct validity, then we administered it in a multicenter, web-based survey that involved healthcare providers of three PICUs and three adult ICUs admitting children in northern, central, and southern Italy. Finally, we tested it for internal consistency, confirmatory factorial validity, convergent validity, and differences between groups analysis. RESULTS: The 14-item, three-factor model best fit the data. The scale showed good reliability (a = 0.87). Still, it did not correlate with the Emotional Exhaustion and Depersonalization sub-scales of the Maslach Burnout Inventory (MBI) or with the 2-item Connor-Davidson Resilience Scale (CD-RISC 2) or the Satisfaction with Life Scale (SWLS). A mild correlation was found between the Italian Pediatric MDS-R score and intention to resign from the job. No correlation was found between MD and years of experience. Females, nurses, and clinicians who cared for COVID-19 patients had a higher MD score. CONCLUSIONS: The Italian Pediatric MDS-R is a valid and reliable instrument for measuring MD among Italian health workers who care for critically ill children. Further research would be helpful in better investigating its applicability to the heterogeneous scenario of Italian Pediatric Critical Care Medicine.