Table 5.
Guidelines for Applying Cultural Adaptations to BIPs
| Step | Description | Example / Nonexample | Social Validity | |
|---|---|---|---|---|
| 1. | Include culturally appropriate images | Visuals should be familiar to your audience and avoid items and symbols that would not be easily understood (CDC, 2009; Nierkens et al., 2013; Osmar & Webb, 2015; Singelis et al., 2018). If the client has physical challenges, such as medically necessary equipment or support, this can be included in visuals to help the reader relate to the image. Be sure that all components of the image such as skin tone, facial features, clothing style, food or other items, and background scenes are culturally appropriate to your target audience (Nierkens et al., 2013; Singelis et al., 2018). Photographed people should portray interactions that are in line with cultural norms (Singelis et al., 2018). Each scene depends on the unique culture of the target family and be specific all the way down to the type of food on the table (Houts et al., 2006; Resnicow et al., 1999). |
Example: Including a photograph for meal preparation featuring a Chinese American family dressed in casual Southern California style clothing seated at the dinner table, to be used with a Chinese American family in Los Angeles, living in a multigenerational home similar to the image and wearing clothing similar to the image. Nonexample: Including a photograph for meal preparation featuring images from a thematic Broadway play depicting several Chinese children in embroidered costumes on a set with golden embellishments hanging in the background; to be used to be used with a Chinese-American family in Los Angeles, California. |
To be relatable to the reader in order to facilitate comprehension and buy-in. |
| 2. | Avoid stereotypes | It is important to avoid stereotypes and derogatory images when selecting CS visuals (Singelis et al., 2018). For example, including a photograph of a child of the matching ethnicity but located in an impoverished or inappropriate background environment could be considered offensive. In some cases, with consent it may be best to create photographs of the client and parent performing the actions of interest for use in the individualized behavioral documents. When visuals are needed to represent diverse audiences, photographs should feature a variety of ages, ethnicities, and racial groups (CDC, 2009). |
Example: Including a photograph featuring a Black woman and child wearing jeans and short-sleeve shirts, to be used for a Black child and his mother who live in San Antonio, Texas. Nonexample: Including images from a country music video depicting a Black man with a cowboy hat, to be used for a Black child and his mother who live in San Antonio, Texas. |
To maintain cultural humility, by approaching each interaction with consideration and respect; to contributing to the reader’s comprehension and buy-in. |
| 3. | Operationalize cultural themes | Before attempting to adapt text, operationalize cultural themes that will be included in the materials—these are the themes or domains that you identified during information gathering. This will allow text to be easily and reliably adapted. For example, some cultural themes that can affect diverse families with children with ASD are locus of control (Mendez-Luck & Anthony, 2016), acceptability of using behavioral interventions (Burkett et al., 2015), parental role and responsibility (Liao et al., 2018; Mendez-Luck & Anthony, 2016), and support systems (Goedeke et al., 2019; Gona et al., 2020). Cultural agreement within each of these domains can occur across a spectrum so materials may need to be adapted to best reflect individual beliefs in each domain, e.g.. external locus or internal locus, high to low acceptability, high to low feelings of responsibility for child behavior change, and high to low levels of support from family and friends. When attempting to operationalize a cultural domain, it should be clearly explained, include a guideline of how to adapt, and include examples and nonexamples. This will help to consistently adapt phrasing. Consider these operationalization examples of locus of control. |
Example: External Locus of Control: This a person’s perception of the determining factors for attaining reinforcers, or other outcomes, being widely attributed to external causes (Rotter, 1966). For example, a person may consider a reinforcer to be delivered in part due to an outside force such as chance, fate, luck, or other higher power. When events are interpreted as being heavily controlled by an outside source, this is referred to as external locus. When incorporating external locus, embed themes of outside sources of behavior change (such as parent support). Example: “You can practice these steps many times to teach your child to stay engaged.” Nonexample: “These steps can be practiced many times so your child learns to stay engaged.” Nonexample: External Locus of Control: When incorporating external locus, embed themes of outside sources of behavior change (such as parent support). For example, write, “help him learn.” |
To be relatable to the reader in order to facilitate understanding and buy-in. |
| 4. | Embed lay terms and cultural themes | Once you have a list of protocol steps and operationalized cultural themes, adapt your recommendations to better align with cultural themes, being careful not to reduce the preciseness of the procedures. When simplifying procedures, conversational language should be chosen over technical language (Jarmolowicz et al., 2008; Neuman, 2018). For example, when using technical language, it would be appropriate to say, “reinforce the behavior.” When using conversational language, it would be appropriate to say, “reward the child.” Notice that these are conceptually different messages, yet both specify the delivery of a desired item after a behavior. When the goal of intervention materials is to quickly change parent behavior, it is important to choose phrases that the parent is likely to quickly understand and respond to—remember, additional education on behavioral principles can always be taught at a later date (Neuman, 2018). The statements chosen should be clear, concise and reflect the client’s cultural beliefs. When intermixing precise, technological, and conversational language, it is important not to confuse word meanings because this breach of logic could contribute to added confusion (Neuman, 2018). |
Example: 1. “Reward the child.” 2. “Give a reward after he completes the task.” 3. “Reinforce this behavior so that he does it more in the future” (for readers with some behavioral training). Nonexample: 1. “Reward the behavior” (breach of logic). 2. “Reinforce the child” (breach of logic). 3. “Deliver reinforcers for compliance. (jargon and technical language). |
To increase comprehension and maintain precise instructions that are likely to be followed. |
It may be beneficial to use the guidelines in this section to create pictographs of common strategies for use by clients of various ethnic backgrounds. This would allow practitioners to readily create a basic BIP strategy that can then be adapted to each family.