Table 1.

Examples of Cultural Factors That Were Considered When Adapting the Cognitive-Behavioral Stress Management Intervention for Black Breast Cancer Survivors

Cultural Factor	Culture-Specific Definition	Intervention Adaptation
Interpersonal orientation	The group or collective is emphasized over the individual.	The concept of sisterhood is woven throughout the intervention as a means of creating lasting bonds and empowering women to make healthy choices for themselves.
Spirituality and religiosity	There exists a force greater than oneself, and faith in God is an important aspect of daily life.	There are explicit discussions about the role of spirituality and religion in the intervention, and women are encouraged to view religiosity and spirituality as naturally derived strengths to bolster them during challenging times.
Harmony	All aspects of one’s life are connected and must be balanced.	Guided by the notion that all individuals are embedded in, and affected by, larger social and cultural spheres of influence, stress is presented as a facet of life that must be balanced. Too much stress creates tension, whereas too little stress may result in a situation in which a person feels unmotivated. Stress can affect individuals internally and externally, which has an impact on larger social units.
Time as a social phenomenon	Time is not an entity in itself but is created as a consequence of interpersonal interaction.	Groups do not begin on time.
Negativity to positivity	Value is placed on being able to turn bad situation into something good.	Women are encouraged to find balance between viewing situations as inherently “good” or “bad” but that all events are an opportunity for growth and empowerment.

Source: Adapted from Belgrave, Brome, and Hampton (2000).