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A Model for Adapting Evidence-based Behavioral Interventions to a New Culture: HIV Prevention for Psychiatric Patients in Rio de Janeiro, Brazil

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Abstract

As in other countries worldwide, adults with severe mental illness in Brazil have elevated rates of HIV infection relative to the general population. However, no HIV prevention interventions have been tested for efficacy with psychiatric patients in Brazil. We conducted participatory research with local providers, community leaders, patient advocates, and patients using an intervention adaptation process designed to balance fidelity to efficacious interventions developed elsewhere with fit to a new context and culture. Our process for adapting these interventions comprised four steps: (1) optimizing fidelity; (2) optimizing fit; (3) balancing fidelity and fit; and (4) pilot testing and refining the intervention. This paper describes how these steps were carried out to produce a Brazilian HIV prevention intervention for people with severe mental illness. Our process may serve as a model for adapting existing efficacious interventions to new groups and cultures, whether at a local, national, or international level.

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References

  • Almeida, R., & Pedroso, E. (2004). Vulnerability and exposure to serologic markers to HIV, Hepatitis B and C viruses, human T cell lymphotropic virus and syphilis in in-patients from a public hospital. Revista Médica de Minas Girais, 14, 244–250. Retrieved July 28, 2006 from http://www.coopmed.com.br/index.php?arquivo=editora&arquivo2=revista_materia&codigo=17&codigoX=111.

  • Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215.

    Article  PubMed  CAS  Google Scholar 

  • Bauman, L. J., Stein, R. E., & Ireys, H. T. (1991). Reinventing fidelity: The transfer of social technology among settings. American Journal of Community Psychology, 19, 619–639.

    Article  PubMed  CAS  Google Scholar 

  • Bayer, R. (1995–1996). AIDS prevention vs. cultural sensitivity. Responsive Community, 6, 20–27.

    Google Scholar 

  • Bellack, A. S., & Hersen, M. (1979). Research and practice in social skills training. New York: Plenum Press.

    Google Scholar 

  • Boal, A. (1974). Theater of the oppressed and other political poetics. Buenos Aires: Ediciones de la Flor.

    Google Scholar 

  • Carey, M. P., Carey, K. B., Maisto, S. A., Gordon, C. M., Schroder, K. E. E., & Vanable, P. A. (2004). Reducing HIV-risk behavior among adults receiving outpatient psychiatric treatment: Results from a randomized controlled trial. Journal of Consulting and Clinical Psychology, 72, 252–268.

    Article  PubMed  Google Scholar 

  • Carvalho, C. M. L., Braga, V. A. B., & Galvão, M. T. G. (2004). AIDS and mental health: Bibliographical review. Journal Brasileiro de Doenças Sexualmente Transmissíveis, 16(4), 50–55. Retrieved July 10, 2006, from http://www.uff.br/dst/revista16-4-2004/9.pdf.

    Google Scholar 

  • Castro, F. G., Barrera, M., & Martinez, C. R. (2004). The cultural adaptation of prevention interventions: Resolving tensions between fidelity and fit. Prevention Science, 5, 41–45.

    Article  PubMed  Google Scholar 

  • Catania, J. A., & Kegeles, S. M. (1990). Towards an understanding of risk behavior: An AIDS risk reduction model (AARM). Health Education Quarterly, 17, 53–72.

    PubMed  CAS  Google Scholar 

  • Collins, P. Y. (2001). Dual taboos: Sexuality and women with severe mental illness in South Africa. Perceptions of mental health care providers. AIDS and Behavior, 5, 151–161.

    Article  Google Scholar 

  • Cornwall, A., & Jewkes, R. (1995). What is participatory research? Social Science and Medicine, 41(12), 1667–1676.

    Article  PubMed  CAS  Google Scholar 

  • Daniel, H., & Parker, R. (1993). Sexuality, politics and AIDS in Brazil: In another world? London, England: Falmer Press.

    Google Scholar 

  • Devieux, J. G., Malow, R. M., Rosenberg, R., & Dyer, J. G. (2004). Context and common ground: Cultural adaptation of an intervention for minority HIV infected individuals. Journal of Cultural Diversity, 11, 49–57.

    PubMed  Google Scholar 

  • Devieux, J. G., Malow, R. M., Rosenberg, R., Jean-Gilles, M., Samuels, D., Ergon-Perez, E., & Jacobs, R. (2005). Cultural adaptation in translational research: Field experiences. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 82(Suppl 3), iii82–iii91.

    Article  Google Scholar 

  • Fishbein, M., Bandura, A., & Triandis, H. C. (1991). Factors influencing behavior and behavior change: Final report to NIMH. Rockville, MD: NIMH.

    Google Scholar 

  • Fisher, J. D., & Fisher, W. A. (1992). Changing AIDS risk behavior. Psychological Bulletin, 111, 455–474.

    Article  PubMed  CAS  Google Scholar 

  • Freier, M. C., McBride, C., Hopkins, G. Babikian, T., Richardson, L., & Helm, H. (2005). The process of research in international settings: From risk assessment to program development and intervention. Journal of Urban Health, 82(3 Suppl 4), iv9–iv15.

    PubMed  Google Scholar 

  • Henriques, H. (1996). Country watch: Brazil. AIDS STD Health Promotion Exchange, 4, 5–6.

    Google Scholar 

  • Kalichman, S., Sikkema, K., Kelly, J., & Bulto, M. (1995). Use of a brief behavioral skills intervention to prevent HIV infection among chronic mentally ill adults. Psychiatric Services, 46, 275–280.

    PubMed  CAS  Google Scholar 

  • Kelly, J. A., McAuliffe, T. L., Sikkema, K. J., Murphy, D. A., Somlai, A. M., Mulry, G., Miller, J. G., Stevenson, L. Y., & Fernandez, M. I. (1997). Reduction in risk behavior among adults with severe mental illness who learned to advocate for HIV prevention. Psychiatric Services, 48, 1283–1288.

    PubMed  CAS  Google Scholar 

  • Kelly, J.A., Heckman, T.G., Stevenson, L.Y., Williams, P.N., Ertl, T., Hays, R.B., Leonard, N.R., O’Donnell, L., Terry, M.A., Sogolow, E.D., & Neuman, M.S. (2000). Transfer of research-based HIV prevention interventions to community service providers: Fidelity and adaptation. AIDS Education and Prevention, 12(5 Suppl), 87–98.

    PubMed  CAS  Google Scholar 

  • Kumpfer, K. L., Alvarado, R., Smith, P., & Bellamy, N. (2002). Cultural sensitivity and adaptation in family-based prevention interventions. Prevention Science, 3, 241–246.

    Article  PubMed  Google Scholar 

  • Liberman, R. P., Mueser, K. T., Wallace, C. J., Jacobs, H. E., Eckman, T., & Massel, H. K. (1986). Training skills in the psychiatrically disabled: Learning coping and competence. Schizophrenia Bulletin, 12, 631–647.

    PubMed  CAS  Google Scholar 

  • Marin, G. (1993). Defining culturally appropriate community interventions: Hispanics as a case study. Journal of Community Psychology, 21, 149–161.

    Article  Google Scholar 

  • McCann, B. (2004). Hello, hello Brazil: Popular music and the making of modern Brazil. Durham: Duke University Press.

    Google Scholar 

  • McKinnon K., Cournos F., Herman R., & Le Melle S. (2005). HIV and people with serious and persistent mental illness. In K. Citron, M.-J. Brouillette, & A. Beckett (Eds.), HIV and psychiatry: A training and resource manual (pp. 138–152). Cambridge: Cambridge University Press.

    Google Scholar 

  • Ministry of Health of Brazil, National Coordination for STD and AIDS (1996). Epidemiological profile of HIV infection in the psychiatric hospitals of Bahia. Research on HIV/AIDS sponsored by Brazilian Ministry of Health (p. 19). Brasília, Brazil: Ministry of Health of Brazil.

  • Ministry of Health of Brazil, National Coordination for STD and AIDS. (2000). The Brazilian response to HIV/AIDS: Best practices. Brasília, Brazil: Ministry of Health of Brazil. Retrieved July 23, 2006, from http://www.aids.gov.br/data/documents/storedDocuments/%7BB8EF5DAF-23AE-4891-AD36–1903553A3174%7D/%7B27CC537A-85D5–406B-934F-54B652819451%7D/resp_ingles.pdf.

  • Ministry of Health of Brazil. (2001). AIDS: Epidemiological newsletter. Retrieved August 26, 2006 from http://www.aids.gov.br/final/biblioteca/bol_htm/boletim.htm.

  • Ministry of Health of Brazil, National Coordination for STD and AIDS. (2005a). Epidemiologic Newsletter—AIDS and STD, Year II, n. 1-01ª-26ª. Brasília, Brazil: Ministry of Health of Brazil. Retrieved July 23, 2006, from http://www.aids.gov.br/main.asp?View={C0A0AADB-861D-4F1D-B7EC-A15D14B530DB}.

  • Ministry of Health of Brazil, National Coordination for STDs and AIDS. (2005b). Positive response: Experiences of the Brazilian AIDS program. Brasília, Brazil: Ministry of Health of Brazil. Retrieved July 23, 2006, from http://www.aids.gov.br/final/biblioteca/resposta/resposta_2005.pdf.

  • Otto-Salaj, L., Kelly, J., Stevenson, L., Hoffmann, R., & Kalichman, S. (2001). Outcomes of a randomized small-group HIV prevention intervention trial for people with serious mental illness. Community Mental Health Journal, 37, 123–144.

    Article  PubMed  CAS  Google Scholar 

  • Paiva, V. (2003). Beyond magic solutions: Prevention of HIV and AIDS as a process of psychosocial emancipation. Divulgação em Saúde para Debate, 27, 192–203. Retrieved July 26, 2006, from http://www.scholar.google.com/url?sa=U&q=http://www.abiaids.org.br/media/Artigo%2520ing%2520Vera%2520Paiva%252003.pdf.

  • Parker, R. (2001). Sexuality, culture and power in HIV/AIDS research. Annual Review of Anthropology, 30, 163–179.

    Article  Google Scholar 

  • Patton, M. (1990). Humanistic psychology and humanistic research. Special Issue: Human inquiry and the person-centered approach. Person-Centered Review, 5, 191–202.

    Google Scholar 

  • Pinto, D. (1997). A linguistic analysis of the Brazilian adaptation of the Beck Scale for depression. Jornal Brasileiro de Psiquiatria, 46, 249–253.

    Google Scholar 

  • Rogler, L. H. (1999). Methodological sources of cultural insensitivity in mental health research. American Psychologist, 54, 424–433.

    Article  PubMed  CAS  Google Scholar 

  • Schensul, S. L., Natasi, B. K., & Verma, R. K. (2006). Community-based research in India: A case example of international and transdisciplinary collaboration. American Journal of Community Psychology, [Epub ahead of print] Retrieved July 12, 2006 from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16838073&query_hl=1&itool=pubmed_docsum.

  • Sivaram, S., Srikrishnan, A. K., Latkin, C. A., Johnson, S. C., Go, V. F., Bentley, M. E., Solomon, S., & Celentano, D. D. (2004). Development of an opinion-leader led HIV prevention intervention among alcohol users among Chennai in India. AIDS Education and Prevention, 16, 137–149.

    Article  PubMed  Google Scholar 

  • Strauss, A., & Corbin, J. (1994). Grounded theory methodology: An overview. In N. K. Denzin, & Y. S. Lincoln (Eds.), Handbook of qualitative research (pp. 273–285). Thousand Oaks, CA: Sage Publications Inc.

    Google Scholar 

  • Susser, E., Valencia, E., Berkman, A., Sohler, N., Conover, S., Torres, J., Betne, P., Felix, A., & Miller, S. (1998). Human immunodeficiency virus sexual risk reduction in homeless men with mental illness. Archives of General Psychiatry, 55, 266–272.

    Article  PubMed  CAS  Google Scholar 

  • Wainberg, M., Gonzalez, M. A., McKinnon, K., Elkington, K. S., Pinto, D., Mann, C. G., & Mattos, P. E. (under revision). Targeted ethnography as a critical step to inform cultural adaptations of HIV prevention interventions for adults with severe mental illness. Social Science and Medicine.

  • Weinhardt, L. S., Carey, M. P., Carey, K. B., & Verdecias, R. N. (1998). Increasing assertiveness skills to reduce HIV risk among women living with a severe and persistent mental illness. Journal of Consulting and Clinical Psychology, 66, 680–684.

    Article  PubMed  CAS  Google Scholar 

  • Wilson, B. D., & Miller, R. L. (2003). Examining strategies for culturally grounded HIV prevention: A review. AIDS Education and Prevention, 15, 184–202.

    Article  PubMed  Google Scholar 

  • Yerushalmi, H. (1999). The roles of group supervision of supervision. Psychoanalytic Psychology, 16, 426–447.

    Article  Google Scholar 

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Acknowledgments

This research was supported by Grant R01 MH65163 (Milton L. Wainberg, M.D.) from the National Institute of Mental Health and a center grant from the National Institute of Mental Health to the HIV Center for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University (P30-MH43520; Principal Investigator: Anke A. Ehrhardt, Ph.D.). The authors gratefully acknowledge the enormous contributions made to the PRISSMA Project by people receiving care at IPUB and PINEL and by mental health care providers and other staff at these institutions. PRISSMA team members: Denise Feijó, Tatiana Dutra, Carlos Linhares, Alfredo Gonzalez, André Nunes, Fernanda Gomes, Abmael de Sousa Alves, Alexander Ramalho, Débora Salles, Denise Corrêa, Erínia Belchior, Márcia Silviano, Maria Tavares, Vandré Matias Vidal. We also thank Patricia A. Warne, Ph.D., and Jennifer Higgins, Ph.D., M.P.H., for their invaluable editorial input.

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Authors and Affiliations

  1. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 112, New York, NY, 10032, USA

    Milton L. Wainberg, Robert H. Remien, Katherine S. Elkington & Francine Cournos

  2. New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 112, New York, NY, 10032, USA

    Karen McKinnon

  3. Psychiatric Institute of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Paulo E. Mattos, Claudio Gruber Mann & Suely Broxado de Oliveira

  4. PRISSMA (Projeto Interdisciplinar em Sexualidade, Saúde Mental e Aids - Interdisciplinary Project in Sexuality, Mental Health and AIDS), Rio de Janeiro, Brazil

    Milton L. Wainberg, Karen McKinnon, Paulo E. Mattos, Diana Pinto, Claudio Gruber Mann, Claudia Simone dos Santos de Oliveira, Suely Broxado de Oliveira, Robert H. Remien, Katherine S. Elkington & Francine Cournos

  5. UNIRIO-Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

    Diana Pinto

  6. CTO-Rio-Centro do Teatro do Oprimido (Theater of the Oppressed Center of Rio de Janeiro), Rio de Janeiro, Brazil

    Claudia Simone dos Santos de Oliveira

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  1. Milton L. Wainberg
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  2. Karen McKinnon
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  3. Paulo E. Mattos
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  4. Diana Pinto
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  8. Robert H. Remien
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  9. Katherine S. Elkington
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  10. Francine Cournos
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PRISSMA Project

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Correspondence to Milton L. Wainberg.

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Wainberg, M.L., McKinnon, K., Mattos, P.E. et al. A Model for Adapting Evidence-based Behavioral Interventions to a New Culture: HIV Prevention for Psychiatric Patients in Rio de Janeiro, Brazil. AIDS Behav 11, 872–883 (2007). https://doi.org/10.1007/s10461-006-9181-8

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