Using the ADAPT guidance to culturally adapt a brief intervention to reduce alcohol use among injury patients in Tanzania
Authors: Staton Catherine A. , Zimmerman Armand , Pesambili Msafiri , Phillips Ashley J , Tupetz Anna , de Souza João Vítor Perez , Boshe Judith , Pantalon Michael H , Swahn Monica , Vissoci Joao Ricardo Nickenig , Mmbaga Blandina 
Published: July 2021

BackgroundHarmful alcohol use is a leading risk factor for injury-related death and disability in low- and middle-income countries (LMICs). Brief negotiational interventions (BNIs) administered in emergency departments (EDs) to injury patients with alcohol use disorders (AUDs) are effective in reducing post-hospital alcohol intake and re-injury rates. However, most BNIs to date have been developed and implemented in high-income countries. The effectiveness of BNIs in LMICs is largely unknown as few studies have undertaken the rigorous task of culturally adapting these interventions to new settings. Given the high prevalence of alcohol-related injury in the Kilimanjaro region of Tanzania, we culturally adapted a BNI to reduce post-injury alcohol use for implementation in this patient population.MethodsFollowing the ADAPT guidance, we used an iterative, multiphase process to culturally adapt a high-income country BNI to the Tanzanian context. Our team consisted of local healthcare professionals with vast experience in counseling patients and an international team of academic and clinical professionals to integrate our extensive mixed-methods patient data to adapt this intervention. Design group discussions were used to discuss research results, interpret findings, discuss the goals of the intervention, and identify and suggest areas of adaptation of the intervention as well as specific adaptations to the BNI protocol. Objective assessments of our BNI protocol as well as a BNI assessment scale was developed to guide intervention fidelity.ResultsWe developed the Punguza Pombe Kwa Afya Yako (PPKAY); a one-time, 15-minute nurse-led BNI that encourages safe alcohol use and motivates change in alcohol use behaviors among injury patients in the Kilimanjaro region of Tanzania. Adaptations to the original intervention protocol include changes regarding the interventionist, how a patient is greeted, how the topic of alcohol use is raised, how a patient is informed of their harmful alcohol use, how graphics are visualized within the intervention protocol, how behavior change is motivated, and which behavior changes are encouraged. Similarly, we developed a BNI assessment scale to accompany the PPKAY which evaluates adherence to the protocol and motivational interviewing tenants. ConclusionsThe PPKAY intervention is the first alcohol BNI which was culturally adapted for delivery to injury patients in an African ED. Our study demonstrates our approach to adapting substance use interventions for use in low resource settings and shows that cultural adaptation of alcohol use interventions is feasible, beneficial and empowering for our team. Our study lays a framework and method for other low resourced settings to integrate cultural adaptation into the implementation of a BNI in low resource EDs.