Correlates of expected eMental Health intervention uptake among Filipino domestic workers in China

'C'mon, let's talk: a pilot study of mental health literacy program for Filipino migrant domestic workers in the United Kingdom

PURPOSE

This pilot study of a culturally adapted online mental health literacy (MHL) program called 'Tara, Usap Tayo!' (C'mon, Let's Talk) aims to assess the acceptability, appropriateness, feasibility, and potential effectiveness in improving the help-seeking behavior of Filipino migrant domestic workers in the United Kingdom (UK).

METHODS

Using mixed methods, we conducted a non-randomized single-group study of the online MHL program with 21 participants. The development of this intervention was guided by the Medical Research Council Framework for developing complex interventions and utilized Heim & Kohrt's (2019) framework for cultural adaptation. Content materials from the WHO Mental Health Gap Action Program (mhGAP), WHO Problem Management Plus (PM +) and Adult Improving Access to Psychological Therapies (IAPT) were modified and translated into the Filipino language. The MHL program was delivered online in three sessions for two hours each session. Data were collected at three time points: (T1) pretest; (T2) posttest; and (3) follow-up test. Quantitative data on participants' attitudes towards help-seeking and level of mental health literacy as outcome measures of potential intervention effectiveness were collected at T1, T2 and T3, while focus group discussions (FGDs) to assess participants' feedback on the acceptability, feasibility, and appropriateness of the online MHL program were conducted immediately at T2. Data analysis was done using a thematic approach for qualitative data from the FGDs and descriptive statistics and repeated-measures ANOVA were used to assess the difference in the T1, T2, and T3 tests. Both quantitative and qualitative results were then integrated and triangulated to answer the research questions.

RESULTS

The online MHL program is generally acceptable, appropriate, and feasible for use among Filipino migrant domestic workers. Preliminary findings lend support for its possible effectiveness in improving mental health literacy and help-seeking propensity. The cultural adaptation made in the content, form, and delivery methods of the intervention was acceptable and feasible for this target subcultural group.

CONCLUSION

By improving their mental health literacy and help-seeking propensity, this online MHL program has the potential to provide support to the mental health and well-being of Filipino migrant domestic workers in the UK. Further feasibility study or large-scale randomized controlled trial is needed to confirm the preliminary findings of this study.

Factors influencing attitudes toward cyber-counseling among China's Generation Z: A structural equation model

Information technology developments have combined traditional face-to-face counseling with online- or cyber-counseling. As digital natives, Generation Z has easy access to cyber-counseling. However, their attitudes toward cyber-counseling remain unknown. This study explored these attitudes and relevant influencing factors among 1216 Chinese adolescents using self-report questionnaires. Descriptive analyses and structural equation modeling were used for data analysis. The model explained 27.7 % of the total variance, attitudes toward psychological help was the most influential, followed by attitudes toward the Internet and perceived behavioral control. The model was effective in explaining attitudes toward cyber-counseling, emphasizing the influence of attitudes toward psychological help.

Strategies for Implementing Occupational eMental Health Interventions: Scoping Review

BACKGROUND

The implementation of eMental health interventions, especially in the workplace, is a complex process. Therefore, learning from existing implementation strategies is imperative to ensure improvements in the adoption, development, and scalability of occupational eMental health (OeMH) interventions. However, the implementation strategies used for these interventions are often undocumented or inadequately reported and have not been systematically gathered across implementations in a way that can serve as a much-needed guide for researchers.

OBJECTIVE

The objective of this scoping review was to identify implementation strategies relevant to the uptake of OeMH interventions that target employees and detail the associated barriers and facilitation measures.

METHODS

A scoping review was conducted. The descriptive synthesis was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and the Consolidated Framework for Implementation Research.

RESULTS

A total of 31 of 32,916 (0.09%) publications reporting the use of the web-, smartphone-, telephone-, and email-based OeMH interventions were included. In all, 98 implementation strategies, 114 barriers, and 131 facilitators were identified. The synthesis of barriers and facilitators produced 19 facilitation measures that provide initial recommendations for improving the implementation of OeMH interventions.

CONCLUSIONS

This scoping review represents one of the first steps in a research agenda aimed at improving the implementation of OeMH interventions by systematically selecting, shaping, evaluating, and reporting implementation strategies. There is a dire need for improved reporting of implementation strategies and combining common implementation frameworks with more technology-centric implementation frameworks to fully capture the complexities of eHealth implementation. Future research should investigate a wider range of common implementation outcomes for OeMH interventions that also focus on a wider set of common mental health problems in the workplace. This scoping review's findings can be critically leveraged by discerning decision-makers to improve the reach, effectiveness, adoption, implementation, and maintenance of OeMH interventions.

Evaluating the Implementation of a Mental Health App for Overseas Filipino Workers in Macao China: A Mixed-Methods Study of Stakeholders' Perspectives

BACKGROUND

Overseas Filipino workers (OFWs) is one of the largest communities of international migrant workers. They face systemic barriers to fulfilling their health needs. The COVID-19 pandemic worsened this condition and provided a context to evaluate the utility of a digital mental health intervention delivered within a stepped-care model to address OFW mental health. Using an implementation science framework, this study aimed to evaluate stakeholders' perspectives on the implementation of Kumusta Kabayan, a mobile phone-based mental health app, for OFWs in Macao.

METHODS

A mixed-methods convergent design was used by conducting two parallel steps, including quantitative and qualitative measures. The quantitative data was collected from Filipino team members and local non-governmental organization (NGO) staff members (N = 12). The qualitative data were gathered from interviews with OFWs in Macao who used the app (N = 25; 80% females, 76% domestic workers).

RESULTS

From the online survey, the staff members of the local partner NGO and the Filipino team members strongly perceived that their organization could adapt Kumusta Kabayan to their program and generally evaluated that Kumusta Kabayan achieved its goal and was received well by OFWs. In the interviews, the OFW app users shared their experiences in using Kumusta Kabayan, which was thematically organized into six aspects of the participants' experience: (1) promotional channel and expectation; (2) when to use the app and in what language; (3) lessons learnt; (4) memorable aspects; (5) key facilitators and barriers; and (6) suggestions.

CONCLUSION

Kumusta Kabayan was well accepted and shows potential to be integrated into the existing support services for OFWs in Macao. This app has the promise of being scaled-up for OFWs in other countries by collaborating with local and overseas stakeholders. Lessons learnt from this evaluation could also be implemented in wider digital mental health services in different settings.

Knowledge and awareness of COVID-19 among Indonesian migrant workers in the Greater China Region

OBJECTIVES

Migrant workers are one of the most vulnerable population groups during the coronavirus disease 2019 (COVID-19) pandemic. This study investigated knowledge and awareness of COVID-19 among Indonesian migrant workers (IMWs) in Macao (SAR), Hong Kong (SAR), and Taiwan.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Data were collected through an online survey in February and March 2020 to gain information on (1) participants' sociodemographic characteristics, (2) experience and awareness regarding COVID-19 information, and (3) knowledge and understanding of COVID-19. A series of Chi-squared, t-test, and logistic regression analyses were conducted.

RESULTS

The survey was completed by 491 participants (92.1% female). Knowledge of COVID-19 was obtained from multiple sources, including a large proportion from online social media. However, participants who obtained information from their employer, local social networks, and migrant organisations answered a greater number of questions correctly. One-third of participants reported receiving hoax, fake news, and incorrect information and obtained information from unverified sources. Participants were most interested in information about how to cure COVID-19, and 57.8% knew that no specific drug or vaccine was currently available. Almost all participants correctly identified fever and wearing a facemask as the main COVID-19 symptom and prevention strategy, respectively. Participants with senior high school or higher education and who worked as domestic or care workers had a greater knowledge of COVID-19 than their counterparts.

CONCLUSIONS

Public health communication strategies using multiple channels, including employers and community organisations, would help to minimise COVID-19 knowledge gaps. In addition, it is recommended that digital literacy content is added to public health campaigns.

Crowdsourcing to design a marketing package to promote a WHO digital mental health intervention among Chinese young adults

BACKGROUND

Digital mental health is an emerging field that can leverage technology and mobile apps to deliver mental health treatment to populations in areas with limited mental health services. Despite widespread availability of these apps, uptake remains low. Enhanced marketing is necessary to increase public engagement. There is growing recognition that mental health intervention beneficiaries should be engaged in all phases of treatment development, adaptation, and delivery. Crowdsourcing - consulting the public to solve problems and sharing the solutions - can foster community-informed ideas for public health, but has yet been applied to digital mental health marketing.

OBJECTIVE

With the goal of engaging potential intervention beneficiaries in digital mental health dissemination, the current project implemented a digital mental health crowdsourcing designathon for Chinese college students in Macao SAR, China and evaluated the feasibility of the contest and the products. The contest asked participants to design marketing packages for Step-by-Step, a scalable WHO digital mental health intervention focusing on depression.

METHODS

Designathon participants, recruited from a global health class, were sorted into teams with balanced areas of expertise. Two judging panels - one of experts in relevant fields and another of Chinese college students - evaluated the marketing packages and selected finalists. The designathon was held in-person over four days and involved debriefing, workshops, a contest, and an awards ceremony. A parallel mixed-methods approach was applied, including qualitative feedback from judges and participants alongside quantitative data on participant satisfaction and depressive symptoms to enrich our understanding of the event. Additionally, based on judges' feedback given to participants, the communication packages of the contest were ranked.

RESULTS

49 participants (8 teams of 6-7 members each) were involved in the designathon. Using a cutoff score of 10 on the Patient Health Questionnaire-9 (PHQ-9), 11.4% of participants had moderate or higher depressive symptoms. All teams successfully produced complete digital mental health marketing packages. Four finalists' packages were selected quantitatively with judges' scores and the top finalist's package was described by judges' comments as simple, thoughtful, and appealing, although not informative enough. Participants were overall satisfied with the designathon, but some mentioned that time was insufficient and that organization/instruction clarity could have been improved.

CONCLUSIONS

The designathon is a novel, feasible strategy to collect crowd input for the dissemination of a mental health intervention. Compared with traditional communication strategies, this bottom-up approach included and engaged potential intervention beneficiaries to take an active role in creating digital mental health marketing communication. Future contests should allow participants more time and reconsider aspects of event organization.

Prevalence of Depression, Anxiety, and Stress Among Repatriated Indonesian Migrant Workers During the COVID-19 Pandemic

Introduction: Repatriated Indonesian migrant workers are vulnerable to developing serious mental health problems during the COVID-19 pandemic. This study aimed to assess the prevalence and associated factors of depression, anxiety, and stress among these populations during the COVID-19 pandemic.

Methods: Guided by the health belief model, a cross-sectional study design was employed among 335 participants, and primary data were collected through an online survey. Measured using DASS-21, anxiety, depression, and stress were the dependent variables. We performed descriptive and inferential statistical analyses—logistic regression was used to predict independently associated variables. STATA was used to execute all data analyses.

Results: The prevalence of depression, anxiety, and stress among repatriated Indonesian migrant workers were 10.15, 9.25, and 2.39%, respectively. The risk of anxiety and depression was low among those aged 21–30 years old, who had completed a university degree, were married, and had quarantined for 14 days. Conversely, the risk of anxiety and depression was high among those who had bad perceived health status, high perceived susceptibility, and negative stigma perception.

Conclusion: The prevalence of depression, anxiety, and stress among repatriated Indonesian migrant workers was relatively low compared to the general population. The risk of anxiety and depression was low among young people, educated people, and those under effective quarantine, but the risk was high among those who had negative perceptions about their health, stigma, and susceptibility to the disease.

Exploring correlates of depression, quality of life and alcohol misuse: a nationwide cross-sectional study of international migrants during the COVID-19 epidemic in China

OBJECTIVES

The COVID-19 pandemic has overwhelmed health systems globally. With the increase of global migration, quantifying the health needs and key correlates of these outcomes is a global health priority. This study assessed migration characteristics, COVID-19 attitudes and the postmigration social environment as key correlates of depression, quality of life and alcohol misuse among international migrants in China.

DESIGN

A nationwide cross-sectional online survey was conducted from 17 February and 1 March 2020.

SETTING

Links to the online survey were disseminated by migrant-focused community-based organisations through WeChat.

PARTICIPANTS

English speaking international migrants who met the inclusion criteria. Inclusion criteria were being born in a country outside of China, aged 18 years or over, cumulatively living in China for 1 month or more and staying in China between December 2019 and February 2020.

OUTCOME MEASURES

Depression, quality of life and alcohol misuse.

RESULTS

Regression models indicated that planning or considering leaving China due to COVID-19, lacking the confidence to protect themselves and not being confident that the epidemic would end soon was associated with greater depression, lower quality of life and greater levels of alcohol misuse. Worry about contracting COVID-19 and feeling helpless to prevent infection were associated with greater depression and lower quality of life. General perceived social support, and trust in Chinese people, institutions and systems were protective factors for depression and associated with higher reported quality of life.

CONCLUSIONS

This study identifies key correlates that, if adequately addressed through public health outreach, may safeguard migrant well-being during a public health emergency. Trust in people and systems within the postmigration environment is an important consideration for future public health planning efforts.

Structural validation of The Patient Health Questionnaire-9 (PHQ-9) among Filipina and Indonesian female migrant domestic workers in Macao: STRUCTURAL VALIDATION OF PHQ-9

Within diverse global populations, validated tools are needed to assess common mental disorders. The Patient Health Questionnaire-9 (PHQ-9) is one of the most commonly used depression screeners. However, the PHQ-9 has not been structurally validated among female migrant domestic workers (MDWs). Female MDWs constitute a population numbering 11.5 million, and commonly report depression. This study aimed to structurally validate the PHQ-9 among Filipina and Indonesian female MDWs in Macao Special Administrative Region of China. Participants were recruited using respondent driven sampling. Participants were adult female MDWs from The Philippines (N=1375) or Indonesia (N=367) and legally working in Macao. We used confirmatory factor analysis (CFA) to test five structural models of depression using all PHQ-9 items with the Filipina and Indonesian samples. We applied multi-group CFA to test measurement invariance across samples. A two-factor (cognitive/affective, somatic) model yielded the best fit within both samples, and the multi-group CFA demonstrated invariance across samples. The two-factor model best represents the factor structure of the PHQ-9 among Filipina and Indonesian female MDWs.

A digital mental health intervention to reduce depressive symptoms among overseas Filipino workers: protocol for a pilot hybrid type 1 effectiveness-implementation randomized controlled trial

BACKGROUND

The current pilot randomized controlled trial (RCT) protocol will comprehensively describe the implementation of a culturally adapted Filipino version of the World Health Organization Step-by-Step (SbS-F) program, unguided online psychological intervention for people with depression based on behavioral activation, among overseas Filipino workers (OFWs) in Macao (Special Administrative Region). The main objective of this pilot study is to explore the preliminary effectiveness of the SbS-F program to decrease participant-reported depressive symptoms compared to enhanced care as usual (ECAU); and the secondary objectives are to explore the preliminary effectiveness of the SbS-F to decrease participant-reported anxiety symptoms and improve wellbeing, and to evaluate the potential for SbS-F implementation in real-world settings.

METHODS

This trial will follow an effectiveness-implementation hybrid type 1 trial design and utilize the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to accelerate the translation of clinical research into more effective implementation strategies and policies. Participants will be randomized 1:1 to control and treatment groups. Control group participants will receive ECAU that consists of brief depression psychoeducation and referral to local community partners. Treatment group participants will receive a 5-session of digital intervention through a mobile phone application. The primary outcome (depression) and psychological secondary outcomes (anxiety symptoms and wellbeing) will be measured using validated instruments. To evaluate study implementation, an embedded mixed-methods design will be used to collect data from various stakeholders. Data then will be analyzed using intention to treat principle and reported following the Consolidated Standards of Reporting Trials (CONSORT) guideline.

DISCUSSION

This study will provide important new knowledge about the preliminary effectiveness of SbS-F, a mobile application, as a digital mental health intervention and its scalability. If SbS-F shows positive results among OFWs in Macao, it has strong potential to be used by OFWs in other countries that may also experience depression and difficulty accessing mental health services.

TRIAL REGISTRATION

Prospective registration, Chinese Clinical Trial Registry (ChiCTR2000034959) on 26/07/2020.

The network structure of posttraumatic stress disorder among Filipina migrant domestic workers: comorbidity with depression

BACKGROUND

Labour migrants are exposed to potentially traumatic events throughout the migration cycle, making them susceptible to developing mental disorders. Posttraumatic stress disorder (PTSD) is often comorbid with depression. Comorbidity worsens the course of illness, prognosis, treatment response, and increases suicidal risk. Using network analysis, this study examined the structure of PTSD and depression in a sample of migrant domestic workers, an especially vulnerable community of labour migrants. This study sought to derive the central or most important symptoms, strongest edges or relationships among symptoms, and bridge symptoms between PTSD and depression.

METHODS

Data were obtained from 1,375 Filipina domestic workers in Macao SAR, China. Data from a subsample of 1,258 trauma-exposed participants were analysed using R software.

RESULTS

Most of the strongest edges were within the same disorder and, for PTSD, within the same symptom cluster. Highest node centrality were PCL-5's 'avoid thoughts', 'lose interest', 'negative emotions', and 'not concentrate', and PHQ-9's 'sleep difficulties'. The bridge symptoms were PHQ-9's 'sleep difficulties,' 'psychomotor agitation/retardation,' and 'fatigue,' PCL-5's 'not concentrate', and PHQ-9's 'worthlessness' and 'anhedonia'.

LIMITATIONS

Results may not generalize to Filipino migrant workers in other occupations and to male migrant workers. Potentially relevant symptoms like somatic symptoms and fear of somatic and mental symptoms were not included.

CONCLUSIONS

Central and bridge symptoms are the most important nodes in the network. Developing interventions targeting these symptoms, particularly depression symptoms, is a promising alternative to PTSD treatment given substantial barriers to specialist care for this population.

Coronavirus pandemic (COVID-19) and its natural environmental impacts

Coronavirus Disease 2019 (COVID-19) is the official name of a respiratory infectious disease caused by a new coronavirus that started first in Wuhan, China, and outspread worldwide with an unexpectedly fast speed. Flights have been canceled worldwide and transportation has been closed nationwide and across international borders. As a consequence, the economic activity has been stopped and stock markets have been dropped. The COVID-19 lockdown has several social and economic effects. Additionally, COVID-19 has caused several impacts on global migration. On the other hand, such lockdown, along with minimal human mobility, has impacted the natural environment somewhat positively. Overall carbon emissions have dropped, and the COVID-19 lockdown has led to an improvement in air quality and a reduction in water pollution in many cities around the globe. A summary of the existing reports of the environmental impacts of COVID-19 pandemic are discussed and the important findings are presented focusing on several aspects: air pollution, waste management, air quality improvements, waste fires, wildlife, global migration, and sustainability.

Coronavirus pandemic (COVID-19) and its natural environmental impacts

Coronavirus Disease 2019 (COVID-19) is the official name of a respiratory infectious disease caused by a new coronavirus that started first in Wuhan, China, and outspread worldwide with an unexpectedly fast speed. Flights have been canceled worldwide and transportation has been closed nationwide and across international borders. As a consequence, the economic activity has been stopped and stock markets have been dropped. The COVID-19 lockdown has several social and economic effects. Additionally, COVID-19 has caused several impacts on global migration. On the other hand, such lockdown, along with minimal human mobility, has impacted the natural environment somewhat positively. Overall carbon emissions have dropped, and the COVID-19 lockdown has led to an improvement in air quality and a reduction in water pollution in many cities around the globe. A summary of the existing reports of the environmental impacts of COVID-19 pandemic are discussed and the important findings are presented focusing on several aspects: air pollution, waste management, air quality improvements, waste fires, wildlife, global migration, and sustainability.

Migrant Workers and Psychological Health: A Systematic Review

Migrant workers show an increase in the incidence of serious, psychotic, anxiety, and post-traumatic disorders due to a series of socio-environmental variables, such as loss of social status, discrimination, and separations from the family. The purpose is to elaborate a systematic review and highlight the prevailing psychological pathologies of these workers and categories most at risk. Our research included articles published from 2009 to 2019 on the major databases (Pub Med, Cochrane Library, and Scopus) using a combination of some keywords. The online search indicated 1.228 references. Using inclusion and exclusion criteria, we analyzed 127 articles, in particular 12 reviews and 115 original articles. Principal emerging disorders from the research are depressive syndrome (poor concentration at work, feeling down, or anger and somatization), anxiety, alcohol or substance abuse, and poor sleep quality. This causes low life conditions, which is also due to marginalization from the social context and strenuous work; in fact, migrant workers may suffer verbal or physical abuse, and they are often employed in dangerous, unhealthy jobs. It is therefore essential to increase the role of occupational medicine and promote wellbeing for this vulnerable job category.

Psychometric Validation of PHQ-9 and GAD-7 in Filipino Migrant Domestic Workers in Macao (SAR), China

There are 500,000 female Filipino domestic workers worldwide. However, there are no validated instruments to assess common mental disorders in this population. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) are brief measures that could be effective screeners for depression and anxiety in domestic workers. This study aims to establish reliability and validity of the Filipino versions of the PHQ-9 and GAD-7. In Study 1, 131 domestic workers completed the PHQ-9, GAD-7, and other questionnaires with a test-retest interval of 10 days. Convergent validity was examined using measures of posttraumatic stress disorder, direct exposure to traumatic events, and rumination. Discriminant validity was assessed using measures of discrimination, pain, social support, and indirect exposure to traumatic events. In Study 2, criterion validity was established with another sample of domestic workers (N = 100) using clinician-administered Mini International Neuropsychiatric Interviews. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic efficiency. Results showed acceptable and high internal consistency for PHQ-9 and GAD-7, respectively. Both had acceptable test-retest reliability. Convergent and discriminant validity were also established. ROC curve results demonstrated that optimal cut scores for PHQ-9 and GAD-7 are 6 and 7, respectively. The Filipino versions of PHQ-9 and GAD-7 are reliable and valid for use among Filipino domestic workers.

Exploring comorbidity between anxiety and depression among migrant Filipino domestic workers: A network approach

BACKGROUND

Depression and anxiety are comorbid. From the network model perspective, comorbidity is due to direct interactions between depression and anxiety symptoms. These interacting symptoms are called bridge symptoms, suppression of which is expected to halt other symptoms. This study investigates the network structure of depression, anxiety, and bridge symptoms in a sample of migrant domestic workers, who are among the most vulnerable and marginalized groups of workers.

METHOD

Data were collected from 1375 Filipino domestic workers in Macao Special Administrative Region, China. Data from a subsample of 355 consisting of participants who met criteria for depression and anxiety were used in analysis. R software was used to estimate the network.

RESULTS

The eight strongest edges were between items from the same disorder. Six were between depression symptoms, like "concentration difficulties" and "psychomotor agitation/retardation," and "psychomotor agitation/retardation" and "thoughts of death." Two were between anxiety symptoms, including "worry too much" and "trouble relaxing." For centrality indices, "fatigue" had highest strength and closeness, and "restlessness" had highest betweenness. Results revealed three bridge symptoms: "fatigue," "depressed mood," and "anhedonia."

LIMITATIONS

The results may not generalize to the entire Filipino population. Further, while the centrality index of strength had adequate stability, it was not highly stable.

CONCLUSIONS

The current study highlighted critical transdiagnostic bridge symptoms as specific candidates for intervention. "Psychomotor agitation/retardation" was identified as key priority due to its association with suicidal ideation. Systemic multilevel interventions at the person-level (e.g., cognitive therapy and behavioral activation), and at the structural and policy-level to alleviate psychosocial stressors, could be applied to address disorder comorbidity in this population.

Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers

Background

Electronic mental (e-mental) health interventions can address mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish a better fit with the cultural group and to achieve better treatment outcomes.

Objective

This study aimed to describe the cultural adaptation of the World Health Organization’s e-mental health program Step-by-Step for overseas Filipino workers. We used a framework which posits that cultural adaptation should enhance (1) relevance, wherein the cultural group can relate with the content; (2) acceptability, where the cultural group will not find any element offensive; (3) comprehensibility, where the program is understandable; and (4) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino and male and female versions.

Methods

Overall, 3 experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for overseas Filipino workers. We then adapted the program and obtained feedback from 28 overseas Filipino workers from diverse industries through focus group discussions. We conducted 7 and 9 focus group discussions with male and female participants, respectively. Per discussion, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided iterative program adaptations, which were again shown to participants for validation and improvement.

Results

Several issues were raised by participants about the generic version of Step-by-Step. There were elements deemed irrelevant, like unfitting characters, lack of Filipino values, and unsuitable problems and activities. There were unacceptable components that were stigmatizing, political, inappropriate to context or subgroups, and too feminine for male users. Some elements were incomprehensible, unclear, or complicated. To address these issues, we made key adaptations. To enhance relevance, we adapted the narrative to match the experiences of overseas Filipino workers, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), political or unacceptable content was removed, and the program was made suitable for overseas Filipino workers from different sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms, and ensured that text and illustrations matched. We also used Taglish (ie, merged English and Filipino) when participants deemed pure Filipino translations sounded odd or incomprehensible. Finally, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness.

Conclusions

This study showed the utility of a 4-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. Moreover, we achieved a culturally appropriate adapted version of the Step-by-Step program for overseas Filipino workers. We discuss lessons learned in the process to guide future cultural adaptation projects of e-mental health interventions.

Psychometric validation of the PTSD Checklist-5 among female Filipino migrant workers

Migrant populations are at increased risk for exposure to traumatic life events. Presently, there are no reliable and valid screening instruments for posttraumatic stress disorder (PTSD) among Filipino migrant workers, a population that numbers over 2.3 million worldwide. This study evaluated the psychometric properties of the PTSD Checklist for DSM-5 (PCL-5) in a sample of female Filipino migrant workers in Macao (SAR), China, in two studies. The first examined the reliability (internal and test-retest), convergent validity (with depression, anxiety, and rumination), and discriminant validity (with pain and social support) in a sample of 131 participants. The second study established criterion validity of the PCL-5 using the PTSD module of the Mini-International Neuropsychiatric Interview (MINI), delivered by a female Filipino psychologist as the criterion, in a sample of 100 participants. Results indicated excellent internal consistency (Cronbach's alpha = 0.95) and moderate 10-day test-retest reliability (ρ = 0.58, p < .001). PCL-5 scores correlated strongly with scores on measures of depression (ρ = 0.71, p < .001), anxiety (ρ = 0.61, p < .001), and rumination (ρ = 0.68, p < .001), supporting convergent validity. Discriminant validity was demonstrated by a weaker association with scores on measures of pain (ρ = 0.33, p < .001) and social support (ρ = -0.11, p = .22). The diagnostic accuracy of the scale was good (AUC = 0.87). The optimal cutoff score of 25 optimized sensitivity (0.89) while maintaining adequate specificity (0.73), with a weighted Kappa of κ[1]) = 0.82. Our results demonstrated that the PCL-5 is a reliable and valid screening instrument for use among female Filipino migrant workers.

The effect of discrimination on depression and anxiety symptoms and the buffering role of social capital among female domestic workers in Macao, China

Foreign migrant domestic workers experience an increased burden of mental disorders. Discrimination contributes to this burden. Social resources may buffer migrants from the effects of this discrimination. The present study explored the relationship between discrimination and common mental disorder (CMD) symptoms, anxiety and depression, and examined whether social capital (cognitive and structural) modified this association. A total of 131 female migrant Filipina domestic workers in Macao, China (M_age = 39.7) were sampled using snowball methods. Self-report data were obtained using tablet devices. Correlation analyses demonstrated that discrimination was significantly associated with depression (r_s = 0.43) and anxiety (r_s = 0.42). Mulitvariable regressions showed that cognitive, but not structural, social capital was significantly negatively associated with depression (β = -0.30) and anxiety (β = -0.32). Cognitive social capital modified the association between discrimination and depression (β = 0.39) and anxiety (β = 0.53). Contrary to predictions, as discrimination increased, compared to those with no cognitive social capital, those with moderate or high levels of cognitive social capital experienced worsening CMD symptoms. This finding provides greater nuance to our understanding of how and under what circumstances social resources are protective for mental health for migrant workers.