Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study

PLOS ONE RESEARCH ARTICLE Cultural and contextual adaptation of mental health measures in Kenya: An adolescentcentered transcultural adaptation of measures study Vincent Nyongesa1*, Joseph Kathono1,2, Shillah Mwaniga2,3, Obadia Yator1, Beatrice Madeghe4, Sarah Kanana ID2, Beatrice Amugune5, Naomi Anyango6, Darius Nyamai2, Grace Nduku Wambua7, Bruce Chorpita ID8, Brandon A. Kohrt9, Jill W. Ahs ID10,11, Priscilla Idele12, Liliana Carvajal13,14, Manasi Kumar ID1,15 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Nyongesa V, Kathono J, Mwaniga S, Yator O, Madeghe B, Kanana S, et al. (2022) Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study. PLoS ONE 17(12): e0277619. https://doi.org/10.1371/ journal.pone.0277619 Editor: Caroline Kingori, Ohio University, UNITED STATES Received: May 2, 2022 Accepted: October 31, 2022 Published: December 15, 2022 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0277619 Copyright: © 2022 Nyongesa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Relevant focus group discussions, cognitive interview transcripts, and a 1 Department of Psychiatry, University of Nairobi, Nairobi, Kenya, 2 Nairobi Metropolitan Services, Nairobi, Kenya, 3 Vrije University, Amsterdam, Netherlands, 4 Department of Food and Nutrition Sciences, University of Nairobi, Nairobi, Kenya, 5 School of Pharmacy, University of Nairobi, Nairobi, Kenya, 6 Department of Mental Health, Ministry of Health, Kenya, 7 Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, 8 University of California, Los Angeles, United States of America, 9 Division of Global Mental Health, Department of Psychiatry and Behavioral Science, The George Washington University, Washington, District of Columbia, United States of America, 10 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden, 11 Department of Health Care Sciences, Swedish Red Cross University College, Huddinge, Sweden, 12 UN Secretariat, New York, New York, United States of America, 13 Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York, United States of America, 14 Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden, 15 Brain and Mind Institute, Aga Khan University, Nairobi, Kenyau * Abstract Introduction There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Children’s Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents. Materials and methods Using a qualitative approach, we explored adolescent participants’ views on cultural acceptability, comprehensibility, relevance, and completeness of specific items in these tools through an adolescent-centered approach to understand their psychosocial needs, focusing on gender and age-differentiated nuances around expression of distress. Forty-two adolescents and 20 caregivers participated in the study carried out in two primary care centers where we conducted cognitive interviews and focused group discussions assessing mental health knowledge, literacy, access to services, community, and family-level stigma. PLOS ONE | https://doi.org/10.1371/journal.pone.0277619 December 15, 2022 1 / 18 PLOS ONE summary table are within the Supporting information files. Funding: MK received Fogarty International Centre’s Emerging global leadership award (grant no K43 TW010716-04). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: he authors have declared that no competing interests exist. Cultural and contextual adaptation of mental health measures in Kenya Results We reflect on process and findings of adaptations of the tools, including systematic identification of words adolescents did not understand in English and Kiswahili translations of these scales. Some translated words could not be understood and were not used in routine conversations. Response options were changed to increase comprehensibility; some statements were qualified by adding extra words to avoid ambiguity. Participants suggested alternative words that replaced difficult ones and arrived at culturally adapted tools. Discussion Study noted difficult words, phrases, dynamics in understanding words translated from one language to another, and differences in comprehension in adolescents ages 10–19 years. There is a critical need to consider cultural adaptation of depression and anxiety tools for adolescents. Conclusion Results informed a set of culturally adapted scales. The process was community-driven and adhered to the principles of cultural adaptation for assessment tools. Introduction Why is it important to consider cultural adaptation of mental health tools? Assessment of prevalence of mental health issues among adolescents, evaluation of interventions, and determination of cost-effectiveness of programs in low and middle-income countries (LMICs) proves difficult due to the lack of culturally adapted and validated tools for child and adolescent mental health (CAMH) [1]. Several mental health aspects, such as perception of health and illness, help-seeking behavior, practitioner and patient attitudes, are impacted by cultural diversity [2]. Culture influences what is considered a problem, how it is understood, and the kind of practical solutions considered [3]. To generate more data on adolescent mental health in LMICs, there is a need to consider cross-cultural issues also due to the high level of ethno-diversity in these contexts [4]. Of great concern is that mental health tools developed for populations in high-income countries may fail to accurately assess and identify the mental health issues in LMICs [5], which calls for considering an adaptation of tools to fit the specificity of diverse contexts. Additionally, assessing a tool against a gold st (...truncated)