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On 24 Feb 2021, the Community of practice hosted a large online meeting on cultural adaptation. This topic is the space to continue the discussion and reflection that we started in the meeting. As we need it, members of the CoP can add new topics on specific issues or different topics.
You will find the questions and comments from the online meeting copied in below:01:35:51 Carol Sakr: is there any adaptation for implementing such activities remotely? eg online
01:38:13 David Nieuwe Weme – ARQ (the Netherlands): Question:
All panelists have experience with using PM+ in a specific cultural settings: can you give an example of what you had to adapt in PM+ or the delivery to make it suitable in your context?
01:38:35 chiara beguin: How much effort was put in the training on core competencies in terms of helping skills … as there are a lot of research showing that the skills of the helper is one key element for the success of the intervention
01:39:09 chiara beguin: For PM+, but even more I guess for group PM+ and even more when working with children
01:39:57 Felicity Brown: carol- this was something we considered doing in our trial, but we were not able to feasibly do it. Many other agencies in Lebanon had a lot of challenges in group online PSS activities during covid. i’d like to learn how we can do it, because it’s so important
01:40:32 chiara beguin: In some cultures breathing techniques are not at all usual, are there other apraoches been tried to reduce stress.
01:41:30 Felicity Brown: Chiara, it’s a really good question. Colleagues at War Child and George Washington University, WHO, and others are looking into common competencies for facilitators, how to use them in training, supervision, and assessments. War Child was specifically looking at core competencies for children. it’s called the EQUIP programme and WHO will be building a platform and training materials
01:41:34 Pernille Hansen – Danish Red Cross: Chiara a considerable part of the training was on helping skills
01:42:31 Pernille Hansen – Danish Red Cross: But additional skills are also needed, as you wrote, for the Group intervention, and for EASE
01:43:42 chiara beguin: Thanks Felicity, do you know when the EQUIP programme will be available ? Because for the time being in PM+ and other mhGAP interventions training on helping skills is very limited.
01:43:48 Edith van ‘t Hof: Part of the EQUIP materials is already online: https://www.who.int/mental_health/emergencies/equip/en/
01:44:33 Edith van ‘t Hof: With some online training materials already available: https://whoequipremote.org/en-gb?category=all
01:47:25 Clare Pain, University of Toronto, Ethiopia: Wonderful discussion+ as we hear about the necessity of complexity of cultural adaptions – will this inevitably change the actual PM plus content?
01:47:27 Federico Duarte: where has been implemented in Colombia ? border area or cities of social integration / durable solutions ? many thanks for share the experiences .
01:48:03 Abel Guerrero: In Colombia we had experience with PAHO in Bogotá
01:50:43 Dora Rebelo: Was the ethnographic study developed by local anthropologists?
01:50:53 Camila Perera Aladro: Hi Federico, we implemented in Arauca with the Colombian Red Cross – Salidos Abel!
01:51:21 Joel Montanez, MSF/ACF, Canada: What was the female/male ratio in Focus Groups and the Team Force working on the adaptations?
01:51:46 Peter Ventevogel, UNHCR (Switzerland): @Dora, I will share the reference
01:52:45 Hivine Ali, UNHCR (Kurdistan Region of Iraq): @joel For the adaptation I worked on, it was almost 50/50 male/female ratio as the MHPSS CWs ratio is like that in the refugee camps
01:54:21 Ana Andrade, MSF, OCG: is there a publication on this adatation for men in Kenya?
01:54:45 Federico Duarte: for how long are this process? for how long is the following ?
01:56:10 David Nieuwe Weme – ARQ (the Netherlands): Schafer, A., & Koyiet, P. (2018). Exploring links between common mental health problems, alcohol/substance use and perpetration of intimate partner violence: A rapid ethnographic assessment with men in urban Kenya. Global Mental Health, 5. https://doi.org/10.1017/gmh.2017.25
01:58:25 Christian Alama (UNICEF South Sudan): Group modality of PM + is very suitable in Africa, from my empirical observation. Individual approaches may not be always effective.. Likewise, I noticed also beneficiaries do not feel comfortable with breathing exercises. they prefer problem solving approaches
02:01:12 Martha Bird – IFRC Psychosocial Centre (Denmark): interesting @Christian Alama: why was the group format more appropriate? What made it work better? Andy why does the individual work less well?
02:01:23 jinane abi ramia: in Step-by-Step (Lebanon), we had to adapt stories and create special stories for men (married character and another younger single version) with activities and problems tailored for men and inspired by the focus group discussions
02:01:39 Yasemin Dinc – ASAM – TURKEY: Unfortunately we happen to know that there is a high number of sexual trauma victims among Syrian male (men & boys)! It is rather hard for them to speak up 🙁 but they do when they feel safe enough…
02:02:24 Aveen Hussein, WVI, Iraq: @Christian Alma At the beginning they face some difficult with breathing exercises but step by step they start to feel comfortable with it.
02:02:36 Samir Hamid: @ Phiona, good practice in including male participants. Similar modality for focus group discussion was implemented in Turkey, I found it useful also to include some representatives from the community as role models to break the ice, it allows opening discussions with many participants.
02:02:45 jinane abi ramia: we also targeted men in our social media communication and we then noticed an increase in adherence for men
02:04:06 jinane abi ramia: as for the focus group discussions, we approached gatekeepers in the community (old persons, leaders, mayors etc…) to invite men to attend
02:04:08 Hivine Ali, UNHCR (Kurdistan Region of Iraq): In Kurdistan region of Iraq, it was more of adaptation to ethnic diversity in Syrian refugees’ community.. As most of Syrian refugees in this area have a mother tongue and express themselves in a language other than Arabic.. We translated the manual to Kurdish language and adapted (and continue to work on that)
02:04:51 Shervin Shahnavaz, Karolinska Institutet, Sweden: The question of representativeness in qualitative and cognitive interviews. Who are appointed as representatives of a culture?
02:04:51 Ellen Minkenberg, I-psy, Netherlands: 5 sessions and each take 90 minutes
02:05:11 Aveen Hussein, WVI, Iraq: No I don’t have, thanks 🙂
02:06:29 Aveen Hussein, WVI, Iraq: @Ellen yeah and the follow up should be after a week for each session.
02:06:35 jinane abi ramia: same happened in Lebanon!
02:06:46 jinane abi ramia: we had to encourage people to do less:)
02:06:50 Felicity Brown: we found the same thing with the inactivity cycle, and i know Jinane’s study with step by step found the same!
02:07:09 Felicity Brown: people said ‘we don’t have the option to be inactive if we feel stressed’
02:08:19 Dora Rebelo: It would actually make more sense to “pause and slow down” for some communities where women are overburden
02:09:00 jinane abi ramia: yes, they needed more self care and rest
02:09:06 Hivine Ali, UNHCR (Kurdistan Region of Iraq): Yes, thank you Dora, slow down and get going in selfcare (?)
02:09:11 Christian Alama (UNICEF South Sudan): @Martha, culturally people are used to solve problems in group and not alone. an individual problem is always a community problem addressed through community solidarity, especially elderly. People do not solve their problems individually from an ethno-anthropological perspective. Of course the issue of confidentiality is topical here.
02:09:41 Ernest And: How does the adaptation take into account the online trainings alongside with COVID 19 context???
02:11:09 Christian Alama (UNICEF South Sudan): Local idioms should be handled very carefully because in some emergency ethnicity is very sensitive and could reactivate some wounds and antagonism among tribes
02:11:12 Berna Yuksek- MSYD Turkey: Good question; i also would like to ask that how does the adaptation take account the remote activities during pandemic outbreak?
02:11:42 Nkirote Muriithi: Could some colleagues share best practices on operationalizing PM+ online?
02:12:04 orione mwangi: Has anyone managed to use PM+ as main intervention as opposed to convectional methods such as CBT etc. How has it worked?
02:12:44 Peer van der Kreeft, HOGENT University College Ghent, Belgium: Adapting and maintaining fidelity with the Evidence Based Intervention implies a scrutinized comparison of proposed changed with the core components of the effective programme. But then the core components need to be concretely determined of course
02:12:49 Hivine Ali, UNHCR (Kurdistan Region of Iraq): @Berna, the PM+ helpers I know about are delivering them now over the phone, they are not doing one whole session per call.. but rather making them over 2 to 3 slots..
02:13:12 David Nieuwe Weme – ARQ (the Netherlands): Other interesting reads: Brown, F. L., Aoun, M., Taha, K., Steen, F., Hansen, P., Bird, M., Dawson, K. S., Watts, S., Chammay, R. el, Sijbrandij, M., Malik, A., & Jordans, M. J. D. (2020). The Cultural and Contextual Adaptation Process of an Intervention to Reduce Psychological Distress in Young Adolescents Living in Lebanon. Frontiers in Psychiatry, 11(March), 1–16. https://doi.org/10.3389/fpsyt.2020.00212
02:13:19 David Nieuwe Weme – ARQ (the Netherlands): Perera, C., Salamanca-Sanabria, A., Caballero-Bernal, J., Feldman, L., Hansen, M., Bird, M., Hansen, P., Dinesen, C., Wiedemann, N., & Vallières, F. (2020). No implementation without cultural adaptation: A process for culturally adapting low-intensity psychological interventions in humanitarian settings. Conflict and Health, 14(1), 1–12 https://doi.org/10.1186/s13031-020-00290-0
02:13:26 David Nieuwe Weme – ARQ (the Netherlands): Sangraula, M., Kohrt, B., Ghimire, R., Shrestha, P., Luitel, N., Van’t Hof, E., Dawson, K., Jordans, M. (2021). Development of the mental health cultural adaptation and contextualization for implementation (mhCACI) procedure: A systematic framework to prepare evidence-based psychological interventions for scaling. Global Mental Health, 8, E6. doi:10.1017/gmh.2021.5
02:13:37 David Nieuwe Weme – ARQ (the Netherlands): Sangraula, M., Turner, E. L., Luitel, N. P., Van’T Hof, E., Shrestha, P., Ghimire, R., Bryant, R., Marahatta, K., Van Ommeren, M., Kohrt, B. A., & Jordans, M. J. D. (2020). Feasibility of Group Problem Management plus (PM+) to improve mental health and functioning of adults in earthquake-affected communities in Nepal. Epidemiology and Psychiatric Sciences. https://doi.org/10.1017/S2045796020000414
02:13:47 David Nieuwe Weme – ARQ (the Netherlands): Van ’T Hof, E., Sangraula, M., Luitel, N. P., Turner, E. L., Marahatta, K., Van Ommeren, M., Shrestha, P., Bryant, R., Kohrt, B. A., & Jordans, M. J. D. (2020). Effectiveness of Group Problem Management plus (Group-PM+) for adults affected by humanitarian crises in Nepal: Study protocol for a cluster randomized controlled trial. Trials, 21(1), 1–16. https://doi.org/10.1186/s13063-020-04263-9
02:14:57 Aveen Hussein, WVI, Iraq: We are now using these interventions with a group of beneficiaries and there is a positive result from these interventions. Many people need this type of program, but they still need more awareness of the importance of mental health.
02:16:41 David Nieuwe Weme – ARQ (the Netherlands): Next webinar: Consultation to shape future CoP 24 March 2021, 3.00 – 5.00pm CET Register online https://community.pscentre.org/pm_plus/event/online-consultation-to-shape-the-future-community-of-practice-on-pm/
02:16:54 David Nieuwe Weme – ARQ (the Netherlands): Newsletter
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02:19:33 Franck Tsafack, World Vision DRC: I agree with Phiona. Every context is different and no matter how you are experienced you will certainly faced many challenges related to culture, political and religious influence and also the level of knowledge
02:20:00 koki@unhcr.org: In Dadaab we now trying to put up community safe homes for persons with mental illness but able to manage on their own with minimal support. do you have any support on this
02:20:50 Ana Andrade, MSF, OCG: can you say something about training in PM+
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