TABLE 4.
Culturally Sensitive Strategies Used in Included Interventions (n = 23)
| Author (Year) | Cultural Terms Used | Constituent Strategies | Evidential Strategies | Linguistic Strategies | Peripheral Strategies | Sociocultural Strategies |
|---|---|---|---|---|---|---|
| Arauz Boudreau et al27 (2013) | Sensitive, relevant | Not described | Not described | Not described | Not described | Tailored sessions to be family centered to cater to participants’ sense of familismo |
| Bender et al28 (2013) and Bender et al29 (2014) | Sensitive, relevant, appropriate, adapted, tailored, competent, suitable, modified | Preprogram stakeholders’ input, incorporated to develop the culturally relevant intervention; an experienced promotora was recruited from the health center and trained by investigators | Not described | Study materials were forward- and back-translated into Spanish by 2 independent translators, according to Eremenco and colleagues’ guidelines.74 Surveys were linguistically tailored to participant education and literacy levels | Program materials included pictures of Hispanic children and families. Meetings were at familiar community locations and incorporated common cultural foods | Program materials and curriculum were designed with special attention to culture. Program attendance was extended to family members, and child care as well as supplemental health and social services assistance was provided |
| Chen et al30 (2019) | Appropriate, tailored | Not described | Not described | Not described | Presented opportunities for participants to sample healthy Chinese and Western foods | Modules discussed common Chinese and Western dietary practices, concepts, and beliefs regarding promoting balance in health |
| Cronk et al31 (2011) | Tailored, specific, familiar | The primary staff delivering the program were culturally Latino, usually born in a Latin American country, and native Spanish speakers with proficiency in English | Not described | The primary staff delivering the program were Spanish speakers with proficiency in English. Materials adapted and translated for use with Latino participants | Not described | Sessions were family centered and child focused, focusing on culturally familiar and acceptable approaches to increasing activity and decreasing caloric intake, rather than wt loss |
| D’Angelo et al32 (2009) | Sensitive, relevant, adapted, aware | A multidisciplinary, multiethnic group of researchers, including bilingual and/or bicultural preventionists, developed the adaptation; feedback from focus groups was incorporated | Information was provided to mothers about the similarities and differences about raising children in the United States versus their country of origin | Scales and interview questions were offered in both Spanish and English | Not described | Several modifications were made to better align with the target population’s values, such as placing more emphasis on respeto (respect) and confianza (trust) |
| Falbe et al33 (2015) and Falbe et al34 (2017) | Sensitive, relevant, tailored, specific, congruent | A promotora was involved in each intervention session. Feedback was incorporated on the basis of focus groups and interviews with parents | Not described | Promotoras and the dietician were bilingual native Spanish speakers. One of the 2 physicians was fluent in Spanish, and the other spoke basic Spanish | Module on immigration, focused on foods and recipes common in the target population | Targeted cultural perceptions and practices, such as viewing children with obesity as healthy. It was also designed to be family centered, with a focus on parenting |
| Feutz and Andresen35 (2013) | Appropriate, based, acceptable | Not described | Not described | Used culturally and linguistically appropriate materials and activities that relate Hispanic cultural values | Used music and videos relevant to the population | Emphasizes the Latino cultural beliefs of familismo, machismo, marianismo, respeto, and personalismo |
| Hamilton et al36 (2013) | Competent, effective | A parent advisory group that meets monthly provides a mechanism for families to participate in the development of the program | Not described | The family liaison is bilingual in English and Spanish | Not described | Not described |
| Herbst et al37 (2019) | Sensitive, appropriate, tailored | Not described | Not described | Handouts were written at a lower literacy level to facilitate greater understanding | Not described | Handouts were tailored to address common patient barriers associated with social determinants of health |
| La Roche et al38 (2006) | Competent | Not described | Framed patients’ asthma symptoms and problems within a historical and socioeconomic context in which health disparities are aggravated by social and economic force | Not described | Not described | Discussed topics in groups in a manner consistent with the allocentric orientation |
| Landback et al39 (2009) | Relevant | Preliminary tests in 2 clinics were done, which generated feedback from adolescents, which was used to adjust the intervention design | Not described | Not described | At the completion of each module, there was an Internet-based reward, which directed the adolescent to an Internet site on which they could play a game or listen to music | Each module lesson included teenager stories, skill-building exercises, and behavior change assignments |
| Lewin et al40 (2015) | Sensitive, appropriate, adapted | To inform the adaptation, focus groups and interviews were conducted with teen-aged fathers and mothers | Not described | Not described | Not described | Sessions were adapted to be more experiential and active than didactic to be more engaging for the teen-aged parents. Homework assignments were eliminated because of a negative connotation |
| López et al41 (2018) | Sensitive, relevant, adapted, tailored, competent, specific | The intervention was delivered by a clinic-employed promotora to help enhance trust between the clinic and participants | Not described | The PACE program was translated into Spanish and the promotora spoke Spanish with participants | Included videotapes, posters, and handouts as part of the intervention | The program specifically targeted traditional engagement barriers, such as child care, transportation, and food, to help ensure participation. The intervention of the program incorporated cultural differences in parenting |
| Mazzeo et al42 (2014) | Sensitive | Not described | Not described | Not described | Not described | Allowed all participants to consider how culture influences their behaviors and beliefs; the intervention was not exclusively tailored to African American participants |
| Mirza et al43 (2013) | Appropriate, adapted, competent | Not described | Not described | Not described | Not described | Hypothesized that a low-glycemic-load diet might be particularly useful for Hispanic children; the authors note that they adapted this intervention for the Hispanic culture but do not otherwise specify how this was done |
| Nitsos et al44 (2017) | Appropriate, adapted, tailored, acceptable, targeted | Not described | Not described | Materials were translated to Spanish for LEP participants | Educational handouts were provided to accompany intervention teaching | Not described |
| O’Connor et al45 (2020) | Adapted, centered | Not described | Not described | All facilitators were bilingual in Spanish and English. Families were given the option to participate in English or Spanish | Foods and games were modified to be common ones known to Hispanic families, and the program material’s reading level was lowered | The curriculum was enhanced with cultural values and addressed barriers for participation and engagement for Hispanic fathers; engaged mothers more by inviting them to a closed Facebook group for the program and sending them weekly videos of that week’s content |
| Reavy et al46 (2012) | Appropriate, safe, competent | Clinic peer health advisors were hired from refugee communities; used focus groups and individual interviews to elicit feedback from stakeholders | Not described | Peer health advisors and certified medical interpreters were available for the following languages: Arabic, Burmese, Dari, Farsi, French, Karen, Kirundi, Lingala, Nepali, Pashtu, Russian, Somali, Swahili, and Uzbek | The clinic is decorated with art from refugees’ native countries. A large map noting the native homes of all refugees hangs on a prominent wall | For the positions to be culturally safe, only women can apply for the position of health advisor for the prenatal and pediatric C.A.R.E. Clinic because refugee women in the C.A.R.E. Clinic have experienced trauma in their home countries |
| Rice et al47 (2003) | Appropriate | Incorporated feedback from stakeholders in 4 pilot focus groups, a pilot intervention, clinic, and school trials | Project TNT discusses epidemiology of tobacco-related diseases and prevalence of smoking and other tobacco use among youth and risk factors related to tobacco use. Participants were given smoking data tailored to Arab countries | Materials were provided in Arabic as well as English | Not described | Participants requested same-sex intervention sessions and a same-sex health educator |
| Ryan et al48 (2020) | Sensitive, relevant, tailored | The research team built a partnership with a local Baltimore public charter school and engaged youth in creating the content and filming | Not described | Not described | Not described | Not described |
| Serpas et al49 (2013) | Sensitive, appropriate, accurate | Met with community leaders and conducted focus groups to help inform strategy; adapted questionnaires were piloted with community representatives to ensure cultural and linguistic accuracy | Not described | The San Diego Healthy Wt Collaborative Web site was accessible in both English and Spanish, as were educational materials provided by the primary care clinic; translated health education in examination rooms | Not described | Not described |
| Svetaz et al50 (2016) | Sensitive, appropriate, competent, inclusive | Cultural concordance between patient and provider was a key element. Parents attended focus groups | Not described | Handouts are available in both English and Spanish; bilingual intervention facilitators | Not described | Interventions take into consideration Latino values and preferences, cultural navigation, and challenges related to immigration. Confidentiality was emphasized |
| Valdez et al51 (2013) | Sensitive, adapted, specific, equivalent, representative, centered | Focus groups were led by bilingual facilitators after delivery of the intervention for evaluation and future adaptation | Not described | Native Spanish speakers facilitated the adult groups in Spanish. Facilitators in the youth groups were trained graduate students in counseling psychology and social work who were bilingual in English and Spanish | A culturally representative meal was offered at each session | The 4 following sociocultural concepts were added: (1) acculturative and immigration stressors, (2) parental involvement and monitoring of children’s activities outside the home, (3) marital relationships in the context of acculturative stress and maternal depression, and (4) cultural assets, such as traditions, support from extended family, and ethnic socialization (ie, cultural pride and coping with discrimination) |
C.A.R.E., Culturally Appropriate Resources and Education; LEP, limited English proficiency; PACE, Parenting Our Children to Excellence; TNT, Toward No Tobacco Use.