Table 2.

Definitions of eight dimensions and example adaptations reviewed.

Dimension	Definition	Example adaptations	Example quotes
Language	Use of culturally appropriate, syntonic language	• Translation to Spanish by native speakers • Involves an element of persons as people who are both linguistically and culturally bilingual are considered more culturally relevant	“Both the men and the providers we interviewed felt strongly that alcohol screening and brief intervention should be provided by someone the men could relate to and spoke their language, such as a community health worker. Language was cited as a common barrier to care, and men preferred to discuss their alcohol use in Spanish.” (Ornelas et al., 2015)
Persons	Acknowledgement of the role of ethnic/racial similarities and differences between client and therapist	• Use of bilingual and bicultural therapists • Bilingual research staff, promotores, community health workers or entrenadores (coaches)	“All facilitators were fluent in Spanish and English. Facilitators consisted of three males and five females; all were of Latinx descent.” (Estrada et al., 2017) “Promotores were Spanish-speaking Latino immigrants selected based on their previous experience with health education, research, and working with Latino communities.” (Ornelas et al., 2019)
Metaphors	Symbols and concepts shared with the group's sayings or “dichos” in treatment	• Telenovelas • Interactive exercises	“The e-parent group sessions consisted of three components: simulated parent group discussions, a culturally syntonic telenovela series (i.e., soap opera), and interactive exercises. The simulated parent group discussions featured a group of Latinx parents who in real life were also the parents of adolescents. During the simulated discussions, parents discussed personal struggles associated with their adolescent, offered support, and provided suggestions on how to prevent adolescent risk behaviors.” (Estrada et al., 2019)
Content	Cultural knowledge, values, customs, and traditions; Uniqueness of groups (social, economic, historical, political)	• Taking steps to build rapport • Asking about cultural context and experiences • Providing examples, e.g. culturally relevant norms on drinking behavior	“First, a MI element, establishing rapport, was augmented by inviting participants to discuss their social contexts, including reasons for U.S. immigration. Second, culturally relevant content, including ethnic-specific drinking norms, that is, information on how the participant's weekly alcohol consumption compared with Latinxs of the same gender and age. Feedback on consequences specific to heavy drinking for Latinxs, that is, higher rates of cirrhosis mortality and of motor vehicle crashes, was also provided.” (Lee et al., 2019)
Concepts	Utilization of treatment concepts that resonate with the culture and context of the group (e.g., individualistic versus collectivistic)	• Adapting concepts and strategies to better reflect gender and interpersonal norms • Using scenarios that are more culturally appropriate	“Data from the students' focus groups revealed the salience of changing gender norms around substance use and substance use offers. Both boys and girls reported finding it challenging to resist peer pressure from a friend of the same gender. In addition, the students (particularly boys) wanted depictions and scenarios where girls were offering to use a substance.”Marsiglia, Ayers, et al., 2019) “Study therapists were trained to use a MI-based approach, Elicit-Provide Information–Elicit (Rollnick, Heather, & Bell, 1992), to elicit and then to discuss stressful events, such as feeling discriminated against, feeling misunderstood by close family members as a result of different values, or hassles attributable to the language barrier, that prompted thoughts about drinking.”(Lee et al., 2019)
Goals	Supporting values within the intervention that are from the culture of origin and are adaptive/positive	• Creating a module specifically aimed at increasing awareness and development of cultural values (e.g., ethnic identity)	“A new module was created for the A-CBT titled Ethnic Identity and Adjustment that was consistent with the principles of cognitive–behavioral therapy it focused on identity awareness and development for Latina/o adolescents. (Burrow-Sanchez et al., 2019)
Methods	Implementing culturally adapted treatment methods that are consistent with traditions from the group	• Use of CBPR • Culturally related measures • Modeling, cultural reframing, cultural hypothesis testing • Parental involvement	“The CAB also reviewed the thematic analysis of individual interviews, which confirmed the need to address particular risk and protective factors endorsed by men of Mexican-origin who engaged in at risk drinking prior to medical treatment for a serious injury. In addition, the CAB supported the translation of ‘Alcohol and the Latinx Community,’ (National Institute on Alcohol Abuse and Alcoholism 2015) and inclusion of information pertaining to relevant cultural risk (e.g., acculturative stress) and protective factors (e.g., familism).”(Field et al., 2019)
Contexta	Integrating changing contexts in assessment and treatment to the intervention	• Community history or historical aspects mentioned are integrated into the intervention • Acculturative stress migration phases developmental interconnectedness and family separation • Economic and social context of the intervention • Delivery of intervention at local community center or schools	“These modifications included the use of Spanish names in examples implementation of culturally relevant role-plays (e.g., problem solving a situation that involved racism or discrimination) and providing opportunities to discuss real-life stressors (e.g., translating for a parent).”(Burrow-Sanchez et al. 2019) “The CAMI also introduced a new treatment module that emphasized unique social risk factors for heavy drinking such as isolation marginalization discrimination acculturation stress economic disadvantage and lack of access to job opportunities.”(Lee et al. 2019) “Providing brief MI interventions for alcohol misuse in medical and community settings for Latinxs can also increase access to treatment by removing stigma related to seeking care for substance use issues a known barrier to care among Latinxs.”(Lee et al. 2019)

^aFor the purpose of this scoping review, context was broadened to include the physical setting in which the intervention was delivered as this was viewed to be inextricably linked to accounting for community context.