Table 1.

Key findings from cultural adaptation of web-based trauma psychoeducation intervention in Indonesia.

Cultural Elements	Indonesian cultural elements	Justification for Cultural Adaptations according to Stakeholders’ suggestions	Cultural Adaptation Result
Language	Bahasa Indonesia (Indonesian) is the official and national language of Indonesia and has been used as the lingua franca among multi-ethnic-lingual groups in Indonesia.	The utilisation of informal Bahasa Indonesia is deemed the optimal approach for the intervention, compared to the formal style, given its widespread usage and its acceptability to the target users. Positive phrasing tends to resonate well and feels more encouraging for Indonesian readers. The gap in mental health literacy among the Indonesian population should be taken into consideration.	The intervention is delivered in informal (colloquial) Bahasa Indonesia. Negative and command sentences are rephrased into more positive sentences. Clinical and technical terminology is accompanied by explanations in plain language and concrete examples.
Persons	Participants are Indonesian undergraduate students with trauma experience and mental health problems	Utilising illustrations that depict the socio-cultural diversity and mental health problems in Indonesia would be more widely embraced by the intended participants and increase participant’s engagement.	The intervention incorporates images, illustrations, stories, and examples that represent the young generation, the sociocultural diversity, and mental health problems in Indonesia.
Metaphors	Among Indonesians, there is a notable tendency to express mental health issues through somatic symptoms. Indonesian young generation also own their unique cultural metaphors, which are shared among their population to reflect their experience with mental health issues.	It is important to include somatic symptoms as cultural metaphors and other population-based-metaphors in the intervention to foster participants’ familiarity, self-understanding, and motivation.	Psychoeducation material includes examples and explanations related to somatic symptoms and other population-based metaphors. Worksheets are provided to facilitate the tracking of sleep disturbances and somatic complaints as well as to facilitate the recognition of the interrelation between emotions, thoughts, behaviours, and physical sensations.
Content	Indonesian cultural beliefs and traditions (e.g. collectivist culture, family & community-oriented, religious celebrations).	Indonesian cultural beliefs and traditions could serve as risk and protective factors for mental health issues, help-seeking behaviour, and trauma recovery. Introducing and incorporating these cultural elements are essential as they facilitate participants in recognising the source of risks and protective factors, learning the coping strategy, and optimising their potential.	Integrated cultural elements into the psychoeducation material, such as the examples and explanations related to identifying trauma triggers and coping strategies and seeking help.
	There is a strong belief among Indonesians that mental health issues are associated with and caused by supernatural phenomena.	This perception could potentially result in delayed and improper treatment and other more serious (mental) health consequences. Therefore, it is imperative to encourage the participants to seek help from (mental) health professionals and emphasize the material on the scientific fact behind trauma-mental health issues.	Adding information to the material related to the importance and strategies to seek help from (mental) health professionals, and elaborate material with the scientific facts related to mental health issues.
Concept	Simple, affordable, and non-intimidating mental health intervention is preferable for Indonesians. Young Indonesian generations, including undergraduate students, are more interested in internet/technological-based intervention.	Web-based psychoeducation interventions provide a secure and less stigmatising environment for target users and have benefits in the economic aspect. Straightforward, pragmatic, and concise mental health interventions are likely to enhance participants’ adherence. The intervention’s accessibility and flexibility enhance its scalability for potential implementation across population contexts.	The concept of the intervention has been justified by stakeholders.
Goals	Mental health issues remain overlooked and are considered taboo subjects in Indonesia, thus increasing the stigmatisation and preventing help-seeking behaviour. On the other hand, there is a growing mental health awareness among the young Indonesian generation, including undergraduate students. It is a valuable and gratifying moment for the young generation to be mentally healthy, have higher mental health literacy, and be a valid resource for peers and society.	Enhancing mental health literacy has the potential to foster help-seeking behaviour and promote psychological well-being among undergraduate students. As they become advocates for their peers and society at large, they also experience a greater sense of integration of society.	The goal of the intervention is to increase mental health literacy, help-seeking intention, and psychological well-being, helping the participants to feel more empowered and be more integrated into society.
Method	Because of the social stigma targeting individuals with disability in Indonesia, they have often been overlooked in mental health services despite their heightening risk of suffering mental health issues. Within the context of undergraduate students, motivation to participate in the intervention might be hindered because of personal circumstances and academic as well as non-academic loads.	Individuals with a disability should be facilitated to ensure equality in accessing mental health care. Ensuring intervention adherence is crucial to achieving intervention outcomes.	Zoom-in and zoom-out buttons are integrated into the website to facilitate visually impaired users. The intervention incorporates weekly reminders to help maintain participant adherence.
Context	The majority of Indonesians, including undergraduate students, have limited access to mental health interventions and are not familiar with internet-based interventions as well as mental health systems in Indonesia. Along with the increasing rate of inaccurate and misleading mental health information on the internet, the young population of Indonesia often shows a tendency to formulate inaccurate self-diagnoses without the guidance of professionals.	The availability of web-based psychoeducation, which is affordable, practical, and understandable, would increase access to care and participant adherence. Self-diagnosis could be dangerous, leading to false diagnoses, delayed and improper treatment, and other more serious (mental) health consequences. Therefore, it is crucial to encourage undergraduate students to avoid self-diagnosis, access credible mental health information, and seek help from (mental) health professionals.	Psychoeducation material is enriched with practical examples, infographics, supportive quotes, and stories with interesting illustrations that resonate with participants’ cultural backgrounds to make it easy to follow and more appealing. The material also incorporates information related to seeking help that is in accordance with the mental health system in Indonesia and accessible to students. A clear and detailed user manual (in written form and video clip) is provided for the participants, allowing them to access the intervention independently. It is accompanied by Frequently Asked Questions (FAQ) embedded on the website. Material related to the negative impact of self-diagnosis and the importance and strategies to find credible mental health information and seek help from (mental) health professionals is added to the website.