Table 3.
Guidelines for General BIP Adaptation Process
| Step | Description | Example / Nonexample | Social Validity | |
|---|---|---|---|---|
| 1. | Information gathering | Review the literature to gain information on cultural trends of the population, cultural implications for presenting behavioral challenges, and enablers and barriers to treatment, before creating the BIP. It is important for the practitioner to be humble and acknowledge that personal experiences are a glimpse from a single perspective and that additional information from the perspective of the target population is needed. This can include interviews, surveys, focus groups and other means of information gathering (Barrera et al., 2013). |
Example: Creating parent training materials for autistic children after reviewing the literature on enablers and barriers to treatment for the relevant cultural group and interviewing population representatives to see what their priorities and needs are. Nonexample: When creating parent training materials for autistic children, use your own insight, past experiences, and current understanding of the population to create materials without doing additional information gathering. |
To understand and plan for the specific cultural beliefs, values and needs of your clients. |
| 2. | Preliminary design | Start by creating comprehensible empirical interventions based on the function and topography of the behavior, environmental constraints, and client preferences (see “Comprehensibility” section for specifics). Next, adapt the evidence-based procedures to represent the cultural beliefs and values of the client, while maintaining the core content and procedural integrity of the prescribed protocols (see “Cultural Adaptation of Deep Structure” section). It is important not to diminish the preciseness of the procedures when culturally adapting protocols as this would weaken the empiricism and likely efficacy of the intervention (Bernal & Adames, 2017). Use subject matter experts, representative focus groups, questionnaires and/or surveys about your materials (Barrera et al., 2013). |
Example: Creating parent training materials based on empirical recommendations after adapting steps of the procedure for comprehensibility and cultural appropriateness, and asking subject matter experts and representative individuals to rate them for appropriateness and consistency. Nonexample: Creating parent training materials based on the procedures that you always recommend for a given problem, tweaking phrases to replace jargon with lay terms, and distributing them for use with parents. |
To get input from the representative population and ensure that materials are likely to be culturally representative without being offensive. |
| 3. | Preliminary testing | Pilot materials with a small sample of representative participants and take data on qualitative and quantitative dimensions (Barrera et al., 2013). Qualitative dimensions could include things like ease of application, challenges with content or activities, the extent to which the materials helped solve the problem, preference for these materials compared to others, overall satisfaction with the program, and acceptability of the intervention. It would be advisable to ask about the acceptability of cost, time requirements, flexibility, whether the training felt supportive and professional (Raulston et al., 2019), goodness of fit for the family and community, whether parents think the intervention will work, and whether parents think they can perform the intervention (Moore & Symons, 2011). Quantitative measures could include fidelity of using the materials compared to standard materials (Barrera et al., 2013). This could be through percentage of steps performed correctly, trials to criterion; or other quantitative analysis of efficacy, maintenance and generalization. |
Example: Before giving the new materials to parents, have a small group of staff test out the materials to test comprehensibility and usefulness. Role play that you are the learner and the staff member is the parent implementing the strategy. Collect basic fidelity measures on staff performance of each step of the procedure. Solicit feedback on goodness of fit from staff familiar with the family. Adjust materials to be clearer and more precise if needed. Nonexample: Complete an initial draft of your materials and bring it to the target family for a test run. If the parent is offended or confused, make revisions. |
To make sure procedures are a good fit, culturally appropriate, and solve the problem they are intended for. |
| 4. | Refinement | Once case studies and or pilot studies end, use information gathered to refine materials and intervention protocols. |
Example: Based on feedback, adjust brightness, contrast, and sharpness of images. Zoom in or change images for clarity. Edit and revise text to reflect language that would be most easily understood by the target family. Remove distracting or confusing contents. Nonexample: Change technical terms to lay terms while maintaining all original information and tips. |
To revise the materials so that they are clear and precise before presenting them to the client’s family. |
| 5. | Final trial tailoring | When you are ready to conduct your final trial or use with your client’s family, be sure to use tools to tailor interventions to individual participants (Halder et al., 2008). Because you may have been creating templates for family BIPS up to this point, it would be important to further individualize the materials at this point. Tailoring will require you to use a survey or questionnaire that can be used to measure the extent to which the participant identifies with the cultural themes you identified during information gathering. For example, you can use the CIFA (Tanaka-Matsumi et al., 1996) to inform the type and extent of cultural surface and deep structure adaptations that you will embed for individual participants (see “Cultural Adaptation of Deep Structure” section for more information on how to use cultural domains to adapt deep structure). Specific instructions by Halder et al., (Halder et al., 2008) may be a good place to start for practitioners new to tailoring. |
Example: After creating parent training protocols and material samples that have been adapted to include themes that are common to Black American culture, you create a survey for each family to rate their agreement with the cultural themes displayed. Then you adapt each participant’s materials to reflect individual cultural tendencies before using them with clients. Nonexample: After creating parent training protocols and material samples that have been adapted to include themes that are common to Black American culture, you distribute them to all of your families assuming that the cultural themes will more-or-less fit all families and will work better than no adaptation. |
To further individualize the materials to fit the family culture. |
Guidelines for adapting behavior intervention materials are described using a focus on cultural differences related to ethnicity and through the perspective of materials created for parents of autistic children for illustrative purposes.