No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings.

BACKGROUND: Despite the widely recognised importance of cultural adaptation to increase the effectiveness of psychological interventions, there is little guidance on its process. Developed based on existing theory, we applied a four-step process to culturally adapt a low-intensity psychological intervention for use in humanitarian settings. METHODS: The four-step process was applied to adapt a WHO low-intensity psychological intervention (i.e. Problem Management Plus, or PM+) for use with displaced Venezuelans and Colombians in Colombia. First, a rapid desk review was used as an (1) information gathering tool to identify local population characteristics. Next, the results were taken forward for the (2) formulation of adaptation hypotheses, whereby PM+ protocols were screened to identify components for adaptation, drawing on the Ecological Validity Model. Third, the elements flagged for adaptation were taken forward for (3) local consultation to firstly, verify the components identified for adaptation, to identify other areas in need of adaptation, and thirdly, to adapt the intervention protocols. Finally, the adapted intervention protocols were reviewed through (4) external evaluations with local experts. RESULTS: The information gathering phase yielded key information on the socioeconomic aspects of the groups targeted for intervention, the availability and need for mental health and psychosocial support, and existing barriers to accessing care. The adaptation hypotheses phase further identified the need for clearer explanations of key concepts, the need for sensitive topics to match local attitudes (e.g., domestic violence, thoughts of suicide), and the identification of culturally appropriate social supports. Building on these first two phases, local consultation subsequently resulted in revised PM+ protocols. The adapted protocols differed from the original format in their focus on the problems unique to these population groups, the way that psychological distress is expressed in this context, and the inclusion of locally available supports. The results of the external evaluation supported the adaptations made to the protocols. CONCLUSION: The proposed four-step process offers a useful guide for how to adapt low-intensity psychological intervention within humanitarian settings. Despite some limitations, we show that even when time and resources are scarce it is possible and necessary to culturally adapt psychological interventions. We invite further testing, replication, and improvements to this methodology.

Validación preliminar del cuestionario de estrés laboral (desbalance-esfuerzo/recompensa) en una muestra de trabajadores de la salud venezolanos / Preliminary evaluation of work stress questionnaire (effort-reward imbalance) in a sample of venezuelan health workers

Objetivo: El objetivo de este estudio fue validar en una muestra venezolana el Cuestionario de Estrés Laboral elaborado por Siegrist (Siegrist 1996) basado en el Modelo Desbalance Esfuerzo-Recompensa. Sujetos: se aplicó el cuestionario a una muestra de 296 trabajadores del área de la salud. Instrumento: La versión del cuestionario en castellano se obtuvo de la versión española de 23 ítems. Resultados: Luego de utilizar un análisis factorial exploratorio, se mantienen las tres dimensiones (Esfuerzo, Recompensa e Implicación) de la estructura factorial del instrumento original. En cuanto a la confiabilidad, para la consistencia interna de las dimensiones esfuerzo y recompensa se obtuvo valores superiores a 0.80. no así para la dimensión implicación, que dio por debajo de lo esperado. Conclusiones: La evaluación de estructura factorial del instrumento original queda corroborada en la versión venezolana.

Objective: The objective of this study was to validate in a Venezuelan sample the Work Stress Questionnaire developed by Siegrist (Siegrist 1996) and based on the Effort-Reward Imbalance Model. Subjects: The questionnaire was applied to a sample of 296 health workers. Instrument: The Spanish version of the questionnaire based on 23 items was used. Results: After using an exploratory Factorial Analysis, the three dimensions (Effort, Rewards and Overcommitment) of the factorial structure of the original instrument are maintained. As for reliability, for the internal consistency of the dimensions Effort and Reward, values higher than 0.80 were found. However, values lower than expected were obtained for the overcommitment dimension reliability. Conclusions: The evaluation of factorial structure of the original instrument is corroborated in the Venezuelan version.

Validación preliminar del cuestionario de estilos de humor en trabajadores y trabajadoras de la salud: caso Venezuela / Preliminary validation of the humor styles questionnaire in male and female health workers. The Venuzuela case

Desde hace algunas décadas se viene estudiando los beneficios del humor en la salud física y mental de las personas. Asimismo, se ha desarrollado un interés creciente de aplicaciones potenciales del humor en una variedad de ámbitos profesionales, en especial en los espacios de trabajo. La actual investigación presenta la validación en una muestra venezolana del Cuestionario de Estilos de Humor (HSQ). Para ello se utilizó la versión española adaptada por Lillo (Lillo 2006) y diseñada originalmente por Martin y Cols. (Martin et al. 2003), partiendo de una visión multidimensional y de rasgo del humor. La versión española utilizada consta de 29 ítemes. Para esta investigación se aplicó el cuestionario en una muestra de 273 trabajadores de la salud venezolanos, obteniéndose posterior al análisis factorial tres factores que explican el 33,666 por ciento de la varianza con un total de 27 ítemes distribuidos en Humor agresivo y autodescalificador (13 ítems), Humor Incrementador del sí mismo (8 ítems) y Humor afiliativo (6 ítems) con resultados válidos y fiables. Este cuestionario constituye un instrumento muy útil para el estudio de esta variable en el ambiente laboral.

For some decades one comes studying the benefits of the humor in the physical and mental health of the persons. Likewise there has developed an increasing interest of potential applications of the humor in a variety of professional areas, especially in the working places. The present study presents the validation in a Venezuelan sample of the questionnaire of Styles of Humor (HSQ). The Spanish version adapted by Lillo (Lillo 2006) was in use and designed originally by Martin and Cols. (Martin et al. 2003), considering a multidimensional approach and considering the humor as a trait. The Spanish used version consists of 29 items. For this research, the questionnaire was applied in a sample of 273 Venezuelan health workers. A factorial analysis was carried out and three factors that explained 33.666 percent of the variance were found with a whole of 27 items distributed in Aggressive Humor and Self Enhancing Humor (13 items), Self Enhancing Humor (8 items) and Affiliative Humor (6 items) with valid and trustworthy results. This questionnaire constitutes a very useful instrument for the study of this variable in the labor environment.

Relaciones trabajo-familia y salud en mujeres trabajadoras / Work-family relationships and health in working women

OBJETIVO: Estudiar la asociación existente entre las gratificaciones y las interferencias generadas en la relación trabajo-familia y su impacto en la salud de mujeres trabajadoras. MATERIAL Y MÉTODOS: Se utilizó un diseño no experimental correlacional. Se aplicó en Caracas, Venezuela, durante el año 2006, a un grupo de 402 mujeres trabajadoras con edades comprendidas entre 27 y 71 años, una batería de pruebas para medir relación trabajo-familia, autoestima, ansiedad, depresión, bienestar, percepción de salud y número de síntomas. RESULTADOS: Se encontró que las gratificaciones en la relación trabajo-familia están relacionadas con un mayor bienestar y autoestima, así como con menor depresión, ansiedad y síntomas reportados. Una mayor interferencia se asoció a una mayor depresión, ansiedad y número de síntomas. CONCLUSIONES: Los resultados permiten identificar algunos factores protectores y de riesgo para la salud de las mujeres con roles múltiples y sirven de base para el diseño de planes de intervención tanto en el plano individual como organizacional.

OBJECTIVE: To study the relationship between gratifications and interferences generated in the work-family relationship and its impact on working women's health. MATERIAL AND METHODS: A non-experimental, correlational design was used. A group of 402 working women between 27 and 71 years of age were tested in Caracas, Venezuela during 2006, to measure work-family relationship, self-esteem, anxiety, depression, wellbeing, health perception and number of symptoms. RESULTS: It was found that the gratifications in the work-family relationship are related to better wellbeing and self-esteem, less depression, anxiety and symptom report. Presence of more interferences was associated with more depression, anxiety and number of symptoms. CONCLUSIONS: These results give an indication of protective and risk factors for multiple-role women's health and could provide some guidelines for intervention programs.

[Work-family relationships and health in working women]. / Relaciones trabajo-familia y salud en mujeres trabajadoras.

OBJECTIVE: To study the relationship between gratifications and interferences generated in the work-family relationship and its impact on working women's health. MATERIAL AND METHODS: A non-experimental, correlational design was used. A group of 402 working women between 27 and 71 years of age were tested in Caracas, Venezuela during 2006, to measure work-family relationship, self-esteem, anxiety, depression, wellbeing, health perception and number of symptoms. RESULTS: It was found that the gratifications in the work-family relationship are related to better wellbeing and self-esteem, less depression, anxiety and symptom report. Presence of more interferences was associated with more depression, anxiety and number of symptoms. CONCLUSIONS: These results give an indication of protective and risk factors for multiple-role women's health and could provide some guidelines for intervention programs.

Relaciones entre estrés académico, apoyo social, salud mental y rendimiento académico en estudiantes universitarios venezolanos / Relationships between Academic Stress, Social Support, Mental Health and Academic Performance in Venezuelan University Students

El objetivo de la presente investigación fue evaluar el estrés académico, el apoyo social y su relación con la salud mental y el rendimiento académico en estudiantes universitarios. Trescientos veintiún estudiantes de carreras técnicas en Caracas, Venezuela, diligenciaron, durante el periodo académico de mayor tensión, instrumentos sobre estrés académico, apoyo social y salud mental. Los resultados indican que las condiciones favorables de salud mental están asociadas con un mayor apoyo social y un menor estrés académico. En las mujeres, la mayor intensidad del estrés se asoció al menor apoyo social de los amigos, mientras que en los hombres se relacionó con un menor apoyo social por parte de personas cercanas, y un menor apoyo en general. Ambos presentaron mejor rendimiento cuando el estrés académico percibido fue mayor y el apoyo social de las personas cercanas fue moderado. Los resultados se discuten en función de las implicaciones en la salud mental y el rendimiento académico de los estudiantes universitarios.

The objective of the present study was to evaluate academic stress, social support and their relationships with mental health and academic performance in university students. Three hundred and twenty one students from a technological university in Caracas, Venezuela, responded instruments on academic stress, social support and mental health during the most academically stressful period. The results indicate that favorable conditions of mental health were associated to more social support and less academic stress. In women, higher stress levels were associated to a lesser amount of social support from friends whereas in men stress was related to less social support coming from close people and general social support. Both displayed better performance when perceived higher levels of academic stress and the social support of the near people was moderate. Results are discussed in terms of their implications for academic life and mental health in university students.

Influencia de la cualidad del rol laboral y la rabia sobre la salud en mujeres trabajadoras / Influence of job-role quality and anger on health in working women

El objetivo del presente estudio fue analizar cómo la cualidad de rol laboral y la rabia o ira influyen directa e indirectamente sobre la presencia de síntomas de enfermedad, los hábitos inadecuados de salud y el colesterol (HDL/LDL), en 402 mujeres trabajadoras entre 27 y 71 años de edad. Se aplicó un conjunto de escalas que medían: reporte de síntomas, hábitos de riesgo de salud, rabia reprimida y expresada y cualidad de rol laboral. Se tomó una muestra de sangre para evaluar el perfil lipídico. Mediante un análisis de trayectorias, se encontró que poseer más hábitos de riesgo para la salud se asoció con mayor reporte síntomas. Se observó una relación directa entre las gratificaciones laborales y los niveles de colesterol, así como entre la rabia reprimida y el nivel de LDL. Las preocupaciones laborales influencian el nivel de LDL mediado por la rabia reprimida. Los hallazgos permiten verificar relaciones planteadas en el área de salud, emociones y cualidad de rol siendo estos hallazgos de mucha utilidad para programas de intervención en el área organizacional, específicamente en mujeres trabajadoras (AU)

The goal of the present study was to analyze the ways in which job-role quality and anger have direct or indirect influence on the reported presence of desease symptoms, risk habits of health and cholesterol (HDL/LDL), in a sample of 402 working women between 27 and 71 years of age. A set of scales were applied in order to measure: symptoms report, health risk habits, anger-in, anger-out and job-role quality. A blood sample was taken to evaluate the lipid profile. Using a Path analysis it was found that, health risk habits were associated with more symptoms reported. Direct relationship between job rewards and cholesterol levels were observed as well as between anger-in and LDL cholesterol. Job-role concerns have an effect on the LDL cholesterol mediated by anger-in. The findings allowed verifying relations in the health area, emotions and role quality in working women. These findings can be very useful for intervention programs in organizational settings

La satisfacción del paciente hospitalario: una propuesta de evaluación / Satisfaction among hospital inpatients: a proposal for evaluation

Objetivo: Diseñar y validar un instrumento para medir la satisfacción del paciente hospitalizado hacia la atención recibida. Material y método: A partir de dos fases de estudio, se construyó el cuestionario Cuidado de su Salud durante la Hospitalización (CSH). Se aplicó en una muestra piloto de 31 pacientes hospitalizados y luego se validó en una segunda muestra de 394 pacientes hospitalizados en el Hospital Universitario de Caracas-Venezuela, entre 2002 y 2004. Se realizó un análisis estadístico para la selección de los reactivos, un análisis factorial exploratorio de componentes principales con rotación varimax para la validez de constructo y el cálculo de consistencia interna (coeficiente alfa de Cronbach); se empleó el programa SPSS 10 para Windows. Resultados: Se seleccionaron 43 reactivos dicotómicos que miden elementos asociados a la satisfacción de los usuarios. El cuestionario (CSH) consta además de un reactivo final dicotómico que mide la satisfacción general de los pacientes y un apartado de datos sociodemográficos de 6 ítems. A partir del análisis factorial exploratorio se identificaron 6 aspectos asociados a la satisfacción del paciente hospitalizado hacia la atención recibida que explican un 38,0% de la varianza: evaluación de la labor y actitud del personal de enfermería, la labor y actitud del personal médico, las condiciones ambientales de la hospitalización, la mejoría física percibida, información médica proporcionada y valoración del rendimiento del servicio. Conclusiones: El cuestionario elaborado (CSH) se presenta como una herramienta promisoria para la medición válida y confiable de la satisfacción del paciente. Se plantea un conjunto de recomendaciones con la finalidad de fortalecer el instrumento en investigaciones futuras

Objective: To design and validate an instrument to measure satisfaction with the care received in hospitalized patients. Material and method: A questionnaire on "healthcare during hospitalization" was designed and tested in a pilot study with 31 hospitalized patients. The questionnaire was validated in a second sample of 394 patients hospitalized in the University Hospital of Caracas-Venezuela between 2002 and 2004. A statistical analysis for item selection, an exploratory principal components factor analysis with varimax rotation for construct validity and Cronbach's alpha coefficient for internal consistency were performed using SPSS 10 for Windows. Results: Forty-three dichotomic items were selected to measure elements associated with patient satisfaction. The questionnaire has a final dichotomic item evaluating the patient's overall satisfaction and six items on sociodemographic data. The exploratory factorial analysis identified six factors associated with hospitalized patients' satisfaction with the care received, explaining 38.0% of the variance: evaluation of the work and attitude of nursing staff, the work and attitude of medical staff, the environmental conditions of hospitalization, perceived physical improvement, medical information, and evaluation of the unit's performance

Las emociones en el ambiente laboral: un nuevo reto para las organizaciones / Emotions in the workplace: a new challenge for organizations

El presente artículo tiene por objetivo destacar el creciente interés y los nuevos retos que representa el estudio de las emociones en las organizaciones. A través de la revisión de los conceptos fundamentales, los enfoques teóricos más actuales, su evaluación y las técnicas de intervención para el manejo y control tanto a nivel individual, grupal y organizacional se pretende motivar en el estudio e investigación de esta temática que permitir  entender, explicar y abordar de manera más efectiva y eficiente como las emociones afectan la vida laboral y organizacional.

The aim of the present article is to emphasize the increasing interest and the new challenges of the study of the emotions in organizations. Across the review of the fundamental concepts, the most current theoretical approaches and models, the assessment and intervention strategies for management and control at individual, group and organizational levels, the target of the present article is to motivate in the study and research of this issue in a manner that will allow to understand in more effective and efficient way how emotions affects the labor and organizational life.

La diferencia de la sensibilidad emocional entre británicos y venezolanos / Differences in emotional sensitivity among british and venezuelan

En el presente estudio se comparan la sensibilidad emocional de dos grupos culturalmente disímiles, uno británico y el otro venezolano. Los participantes completaron la Escala de Sensibilidad Emocional (ESE) en sus versiones en inglés y en español. Se compararon inicialmente las estructuras factoriales de ambas escalas utilizando análisis factorial confirmatorio, para finalmente comparar los puntajes de los estudiantes, con el objeto de determinar diferencias culturales en su sensibilidad emocional. Los resultados indicaron que la estructura factorial de la versión anglosajona de la escala está compuesta por dos dimensiones de la sensibilidad, mientras que la escala en español arrojó una tercera dimensión que describía de manera más apropiada los datos. Por otro lado, los estudiantes británicos mostraron mayor sensibilidad emocional tanto negativa como positiva con respecto a los venezolanos, estableciéndose así una diferencia que contrasta con estereotipos culturales ampliamente aceptados

The present study reports on the results of a comparative analysis of de emotional sensitivity amongst two culturally dissimilar groups, one British and the other Venezuelan. Participants completed the Emotional Sensitivity Scale (ESS) in both English and Spanish versions. The factorial structure of both scales was compared using confirmatory factor analysis, and then the scores of the students were compared in order to determine cultural differences on their sensitivity. Results indicated that the factorial structure of the English version comprises two dimensions of sensitivity, while the Spanish scale yielded a third dimension, which better described the data. On the other hand, British students showed a higher emotional sensitivity, both negative and positive, compared with the Spanish group, thus imposing a difference that largely contrasts with well-established cultural stereotypes

Masculinity-femininity as a national characteristic and its relationship with national agoraphobic fear levels: Fodor's sex role hypothesis revitalized.

Hofstede's dimension of national culture termed Masculinity-Femininity [. Cultures and organizations: software of the mind. London: McGraw-Hill] is proposed to be of relevance for understanding national-level differences in self-assessed agoraphobic fears. This prediction is based on the classical work of Fodor [. In: V. Franks & V. Burtle (Eds.), Women in therapy: new psychotherapies for a changing society. New York: Brunner/Mazel]. A unique data set comprising 11 countries (total N=5491 students) provided the opportunity of scrutinizing this issue. It was hypothesized and found that national Masculinity (the degree to which cultures delineate sex roles, with masculine or tough societies making clearer differentiations between the sexes than feminine or modest societies do) would correlate positively with national agoraphobic fear levels (as assessed with the Fear Survey Schedule-III). Following the correction for sex and age differences across national samples, a significant and large effect-sized national-level (ecological) r=+0.67 (P=0.01) was found. A highly feminine society such as Sweden had the lowest, whereas the champion among the masculine societies, Japan, had the highest national Agoraphobic fear score.

Phobic anxiety in 11 nations. Part I: Dimensional constancy of the five-factor model.

The Fear Survey Schedule-III (FSS-III) was administered to a total of 5491 students in Australia, East Germany, Great Britain, Greece, Guatemala, Hungary, Italy, Japan, Spain, Sweden, and Venezuela, and submitted to the multiple group method of confirmatory analysis (MGM) in order to determine the cross-national dimensional constancy of the five-factor model of self-assessed fears originally established in Dutch, British, and Canadian samples. The model comprises fears of bodily injury-illness-death, agoraphobic fears, social fears, fears of sexual and aggressive scenes, and harmless animals fears. Close correspondence between the factors was demonstrated across national samples. In each country, the corresponding scales were internally consistent, were intercorrelated at magnitudes comparable to those yielded in the original samples, and yielded (in 93% of the total number of 55 comparisons) sex differences in line with the usual finding (higher scores for females). In each country, the relatively largest sex differences were obtained on harmless animals fears. The organization of self-assessed fears is sufficiently similar across nations to warrant the use of the same weight matrix (scoring key) for the FSS-III in the different countries and to make cross-national comparisons feasible. This opens the way to further studies that attempt to predict (on an a priori basis) cross-national variations in fear levels with dimensions of national cultures.

Responsabilidad en el hogar y salud de la mujer trabajadora / Home-making responsibilities and health in working woman

Objetivo. Analizar la relación existente entre la distribución de responsabilidades en el hogar y la salud física y mental percibida por un grupo de mujeres trabajadoras. Material y métodos. Estudio transversal realizado en Caracas, Venezuela, entre septiembre de 1994 y octubre de 1995. Se encuestó a 260 profesoras universitarias sobre administración o planificación de las tareas en el hogar y realización de las mismas. Se calcularon medidas de tendencia central y se realizó análisis de varianza y regresión múltiple jerárquica. Resultados. En cuanto a la distribución de responsa-bilidades en el hogar, se observó que existe una mayor participación de las mujeres en la planificación y gerencia de las tareas y que reciben ayuda de su pareja en el mantenimiento de la casa. Aquellas mujeres que informan una mayor carga en las tareas del hogar presentan ansiedad, depresión y baja autoestima. Conclusiones. Este hallazgo evidencia los efectos negativos que el trabajo del hogar puede tener sobre la salud mental en mujeres trabajadoras.