Adaptation of community health worker-delivered behavioral activation for torture survivors in Kurdistan, Iraq
Background. Growing evidence supports the use of Western therapies for the treatment of depression, trauma, and stress delivered by community health workers (CHWs) in conflict-affected, resource-limited countries. A recent randomized controlled trial (Bolt...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2015-01-01
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| Series: | Cambridge Prisms: Global Mental Health |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2054425115000229/type/journal_article |
| _version_ | 1827994776232787968 |
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| author | J. F. Magidson C. W. Lejuez T. Kamal E. J. Blevins L. K. Murray J. K. Bass P. Bolton S. Pagoto |
| author_facet | J. F. Magidson C. W. Lejuez T. Kamal E. J. Blevins L. K. Murray J. K. Bass P. Bolton S. Pagoto |
| author_sort | J. F. Magidson |
| collection | DOAJ |
| description |
Background.
Growing evidence supports the use of Western therapies for the treatment of depression, trauma, and stress delivered by community health workers (CHWs) in conflict-affected, resource-limited countries. A recent randomized controlled trial (Bolton et al. 2014a) supported the efficacy of two CHW-delivered interventions, cognitive processing therapy (CPT) and brief behavioral activation treatment for depression (BATD), for reducing depressive symptoms and functional impairment among torture survivors in the Kurdish region of Iraq.
Methods.
This study describes the adaptation of the CHW-delivered BATD approach delivered in this trial (Bolton et al. 2014a), informed by the Assessment–Decision–Administration-Production–Topical experts–Integration–Training–Testing (ADAPT–ITT) framework for intervention adaptation (Wingood & DiClemente, 2008). Cultural modifications, adaptations for low-literacy, and tailored training and supervision for non-specialist CHWs are presented, along with two clinical case examples to illustrate delivery of the adapted intervention in this setting.
Results.
Eleven CHWs, a study psychiatrist, and the CHW clinical supervisor were trained in BATD. The adaptation process followed the ADAPT–ITT framework and was iterative with significant input from the on-site supervisor and CHWs. Modifications were made to fit Kurdish culture, including culturally relevant analogies, use of stickers for behavior monitoring, cultural modifications to behavioral contracts, and including telephone-delivered sessions to enhance feasibility.
Conclusions.
BATD was delivered by CHWs in a resource-poor, conflict-affected area in Kurdistan, Iraq, with some important modifications, including low-literacy adaptations, increased cultural relevancy of clinical materials, and tailored training and supervision for CHWs. Barriers to implementation, lessons learned, and recommendations for future efforts to adapt behavioral therapies for resource-limited, conflict-affected areas are discussed.
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| first_indexed | 2024-04-10T04:46:15Z |
| format | Article |
| id | doaj.art-868fc30100b74692ac451f3e78fda0b4 |
| institution | Directory Open Access Journal |
| issn | 2054-4251 |
| language | English |
| last_indexed | 2024-04-10T04:46:15Z |
| publishDate | 2015-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Cambridge Prisms: Global Mental Health |
| spelling | doaj.art-868fc30100b74692ac451f3e78fda0b42023-03-09T12:35:33ZengCambridge University PressCambridge Prisms: Global Mental Health2054-42512015-01-01210.1017/gmh.2015.22Adaptation of community health worker-delivered behavioral activation for torture survivors in Kurdistan, IraqJ. F. Magidson0C. W. Lejuez1T. Kamal2E. J. Blevins3L. K. Murray4J. K. Bass5P. Bolton6S. Pagoto7Department of Psychiatry, Massachusetts General Hospital (MGH)/Harvard Medical School, Boston, MA, USADepartment of Psychology, Center for Addictions, Personality, and Emotion Research (CAPER), University of Maryland, College Park, MD, USAFine Arts Institute, University of Sulaimani, Kurdistan Region, IraqDepartment of Psychology, Center for Addictions, Personality, and Emotion Research (CAPER), University of Maryland, College Park, MD, USADepartment of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USADepartment of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USACenter for Refugee and Disaster Response and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USADivision of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA Background. Growing evidence supports the use of Western therapies for the treatment of depression, trauma, and stress delivered by community health workers (CHWs) in conflict-affected, resource-limited countries. A recent randomized controlled trial (Bolton et al. 2014a) supported the efficacy of two CHW-delivered interventions, cognitive processing therapy (CPT) and brief behavioral activation treatment for depression (BATD), for reducing depressive symptoms and functional impairment among torture survivors in the Kurdish region of Iraq. Methods. This study describes the adaptation of the CHW-delivered BATD approach delivered in this trial (Bolton et al. 2014a), informed by the Assessment–Decision–Administration-Production–Topical experts–Integration–Training–Testing (ADAPT–ITT) framework for intervention adaptation (Wingood & DiClemente, 2008). Cultural modifications, adaptations for low-literacy, and tailored training and supervision for non-specialist CHWs are presented, along with two clinical case examples to illustrate delivery of the adapted intervention in this setting. Results. Eleven CHWs, a study psychiatrist, and the CHW clinical supervisor were trained in BATD. The adaptation process followed the ADAPT–ITT framework and was iterative with significant input from the on-site supervisor and CHWs. Modifications were made to fit Kurdish culture, including culturally relevant analogies, use of stickers for behavior monitoring, cultural modifications to behavioral contracts, and including telephone-delivered sessions to enhance feasibility. Conclusions. BATD was delivered by CHWs in a resource-poor, conflict-affected area in Kurdistan, Iraq, with some important modifications, including low-literacy adaptations, increased cultural relevancy of clinical materials, and tailored training and supervision for CHWs. Barriers to implementation, lessons learned, and recommendations for future efforts to adapt behavioral therapies for resource-limited, conflict-affected areas are discussed. https://www.cambridge.org/core/product/identifier/S2054425115000229/type/journal_articleAdaptationbehavioral activationdepressiontask shiftingtrauma |
| spellingShingle | J. F. Magidson C. W. Lejuez T. Kamal E. J. Blevins L. K. Murray J. K. Bass P. Bolton S. Pagoto Adaptation of community health worker-delivered behavioral activation for torture survivors in Kurdistan, Iraq Cambridge Prisms: Global Mental Health Adaptation behavioral activation depression task shifting trauma |
| title | Adaptation of community health worker-delivered behavioral activation for torture survivors in Kurdistan, Iraq |
| title_full | Adaptation of community health worker-delivered behavioral activation for torture survivors in Kurdistan, Iraq |
| title_fullStr | Adaptation of community health worker-delivered behavioral activation for torture survivors in Kurdistan, Iraq |
| title_full_unstemmed | Adaptation of community health worker-delivered behavioral activation for torture survivors in Kurdistan, Iraq |
| title_short | Adaptation of community health worker-delivered behavioral activation for torture survivors in Kurdistan, Iraq |
| title_sort | adaptation of community health worker delivered behavioral activation for torture survivors in kurdistan iraq |
| topic | Adaptation behavioral activation depression task shifting trauma |
| url | https://www.cambridge.org/core/product/identifier/S2054425115000229/type/journal_article |
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