Adapting Interventions to Diverse Populations

Purpose: Interventions to promote health and health behavior change in minority/ immigrant communities have been developed primarily from Western cultural perspectives. With the surge in research addressing underserved population outcomes, interventions have been adapted for these diverse population groups with inconsistent results. When individuals are asymptomatic, and combined with beliefs about health that are embedded in cultural and spiritual mores, stimulating behavior change is challenging. In this presentation, we describe methods of adapting interventions to minority/immigrant communities.

Methods: Using the social determinants of health model, three levels of health determinants are identified: proximal, intermediate, and distal, which encompass a wide range of variables from individual beliefs to health care system issues. Culture, race/ethnicity, and gender are interwoven into each level of determinant, often impacting how an individual reacts or adapts behavior.

Results: Types of health interventions—standardized, targeted and tailored are described, and factors that impact the design and adaptation of interventions (cost, delivery method, outcome of interest, expected or known variance in attributes to be manipulated, setting, etc.) are defined. Using exemplars from cancer screening and cardiovascular disease risk reduction, a decision model is presented for designing interventions.

Conclusions: A culturally-based intervention that only incorporates language or traditional beliefs cannot change health behavior. Researchers must proactively identify areas where a cultural intervention can improve behaviors, and actively implement the solution leveraging cultural practices, products, philosophies, or environments as vehicles that facilitate behavior change of patients and practitioners. Although, time-intensive and requiring rigorous formative research, this process will lead to enhanced and sustainable health interventions.