Gender differences in the knowledge, attitude and practice towards mental health illness in a rapidly developing Arab society

Adaptation and translation of mental health interventions in Middle Eastern Arab countries: a systematic review of barriers to and strategies for effective treatment implementation

AIM

All too often, efficacious psychosocial evidence-based interventions fail when adapted from one culture to another. International translation requires a deep understanding of the local culture, nuanced differences within a culture, established service practices, and knowledge of obstacles and promoters to treatment implementation. This research investigated the following objectives to better facilitate cultural adaptation and translation of psychosocial and mental health treatments in Arab countries: (1) identify barriers or obstacles; (2) identify promoting strategies; and (3) provide clinical and research recommendations.

METHODS

This systematic review of 22 psychosocial or mental health studies in Middle East Arab countries identified more barriers (68%) than promoters (32%) to effective translation and adaptation of empirically supported psychosocial interventions.

RESULTS

Identified barriers include obstacles related to acceptability of the intervention within the cultural context, community and system difficulties, and problems with clinical engagement processes. Whereas identified promoter strategies centre on the importance of partnering and working within the local and cultural context, the need to engage with acceptable and traditional intervention characteristics, and the development of culturally appropriate treatment strategies and techniques.

CONCLUSIONS

Although Arab cultures across the Middle East are unique, this article provides a series of core clinical and research recommendations to assist effective treatment adaptation and translation within Arab communities in the Middle East.

The relationship between awareness of intellectual disability, causal and intervention beliefs and social distance in Kuwait and the UK

Evidence on lay beliefs and stigma associated with intellectual disability in an Arab context is almost non-existent. This study examined awareness of intellectual disability, causal and intervention beliefs and social distance in Kuwait. These were compared to a UK sample to examine differences in lay conceptions across cultures. 537 university students in Kuwait and 571 students in the UK completed a web-based survey asking them to respond to a diagnostically unlabelled vignette of a man presenting with symptoms of mild intellectual disability. They rated their agreement with 22 causal items as possible causes for the difficulties depicted in the vignette, the perceived helpfulness of 22 interventions, and four social distance items using a 7-point Likert scale. Only 8% of Kuwait students, yet 33% of UK students identified possible intellectual disability in the vignette. Medium to large differences between the two samples were observed on seven of the causal items, and 10 of the intervention items. Against predictions, social distance did not differ. Causal beliefs mediated the relationship between recognition of intellectual disability and social distance, but their mediating role differed by sample. The findings are discussed in relation to cultural practices and values, and in relation to attribution theory. In view of the apparent positive effect of awareness of the symptoms of intellectual disability on social distance, both directly and through the mediating effects of causal beliefs, promoting increased awareness of intellectual disability and inclusive practices should be a priority, particularly in countries such as Kuwait where it appears to be low.