Cultural adaptation of an internet-based self-help app for grieving Syrian refugees in Switzerland

Abstract

Background: Loss and grief pose significant challenges for victims of armed conflicts, such as Syrian refugees. Internet-based interventions (IBIs) present a promising solution to address this treatment gap and provide adequate support. However, research on grief, grief support, and IBIs remain largely limited to Western cultural contexts, and culturally adapted IBIs for grief are needed. Following the Reporting Cultural Adaptation in Psychological Trials (RECAPT) framework, this study aimed to develop and further adapt a culturally sensitive IBI for bereaved Syrian refugees in Switzerland.

Methods: The study employed qualitative methods. Initially, formative research was conducted to create a first version of the intervention, including semi-structured interviews with 10 experts to identify necessary cultural adaptations. The preliminary version of the intervention was then presented to six potential users and three experts to gather feedback on additional cultural adaptations through two iterative feedback rounds. The first round involved semi-structured interviews using a "paper version" of the intervention, followed by a second round with a walk-through think-aloud protocol with a beta version. Data were analyzed using framework analysis.

Results: The input from various key informants at different stages of development provided valuable feedback on surface and deep structure adaptation, which may enhance treatment adherence, acceptance, and motivation.

Conclusions: These findings provide important insights and recommendations for the cultural adaptation of interventions and may help address the treatment gap for bereaved Syrian refugees.

Keywords: Bereaved; Cultural adaptation; Mobile mental health; RECAPT; Refugees; Self-help; Syrian.

Fig. 1

Overview of the chapters of the IBI in German and Arabic

Fig. 2

Screenshots of the IBI in Arabic and German

Fig. 3

Examples of Intervention Components Note. (1) Vignette; (2) List exercise; (3) Interactive exercise (Resource-Lifeline); (4) Mindfulness audio-exercise

Fig. 4

Adaptation of illustrations according to feedback Note. (1) Depiction of Yasmin with headscarf and Yusef with beard. (2) Adapted version of the illustration after feedback

Fig. 5

Fictional vignette characters Amir and Yasmin