Culture in Ibero-America: A Neglected Issue in Behavioral and Cognitive Randomized Control Trial Interventions

ABSTRACT. The purpose of this interpretative review study is to determine if researchers from the Ibero-American region are aware of culture and of cultural adaptations in psychological interventions and treatment. As a preliminary approach to examine these issues, the words «culture», «cultural factors», or «cultural adaptations» were searched within the text of cognitive behavioral randomized controlled trial (RCT) articles assessing clinical and health outcomes in children and adults in Ibero-American countries. International and regional databases were systematically searched for randomized controlled trials adhering to specified criteria. Results show that the word culture and cultural adaptations are absent from most descriptions of RCT studies from Ibero- America. Although the exploratory nature of this paper may limit its findings, researchers from this region might be attuning their interventions to their particular contexts without explicitly calling them culture adaptations. An explanatory concept, the Cultural Alliance Effect, is advanced to account for the inclusion of culture in the US literature and its exclusion in Ibero-America. It is recommended that efforts be undertaken by Ibero-American researchers to fully describe adaptations of intervention protocols so that their experiences can inform other scholars, particularly in developing countries.KEYWORDS. Culture. Cultural adaptations. Randomized controlled trials. Cultural alliance effect. Interpretative review study.RESUMEN. El proposito de este estudio de revision interpretativo es determinar si los investigadores iberoamericanos son conscientes de la cultura y adaptaciones culturales a tratamientos y programas de intervencion psicologica. Como una primera aproximacion para estudiar estos aspectos, se realizaron busquedas de las palabras «cultura», «factores culturales» o «adaptaciones culturales» en cualquier parte del texto de articulos cognitivo-conductuales de tipo ensayo controlado aleatorio (ECA) sobre temas clinicos, y de la salud en ninos y adultos de paises iberoamericanos. Se realizaron busquedas en bases de datos norteamericanas y regionales sobre ECAs que cumplieran con los criterios de inclusion. Los resultados muestran que las palabras cultura y adaptaciones culturales estan ausentes en la mayor parte de las descripciones de los estudios tipo ECA de Iberoamerica. A pesar de las limitaciones de este estudio exploratorio, los investigadores ibero-americanos estan probablemente ajustando sus intervenciones a los contextos particulares, sin explicitamente identificarlos como adaptaciones culturales. Se propone el concepto Efecto de Alianza Cultural para explicar porque la cultura es reconocida en la literatura Norteamericana y desatendida en la iberoamericana. Se recomienda que las adaptaciones a manuales y protocolos clinicos iberoamericanos sean ampliamente descritas para facilitar su aplicacion por otros investigadores, particularmente de los paises en desarrollo.PALABRAS CLAVE. Cultura. Adaptaciones culturales. Ensayos controlados aleatorios. Efecto de alianza cultural. Estudio de revision interpretativo.The influence of culture on psychological interventions and treatment has been a subject of discussion in the mental health literature for many years (Lamkaddem, Spreeuwenberg, Deville, Foets, and Groenewegen, 2012; Ruiz, 2011). One area that has received worldwide attention is the use of tests and survey instruments to study psychological phenomena across cultures or countries (Berry et al., 2002). Crosscultural psychology has developed extensive protocols to ensure linguistic and cultural equivalency whenever survey instruments or psychological tests are used between cultures (Bartram, 2011).In contrast, there is less information about how to proceed when importing therapeutic techniques or program interventions across cultural contexts (Jacob and Kuruvilla, 2012). Assuming the validity of psychological interventions and simply replicating them across countries and cultural contexts may be questionable, particularly in developing countries (Lund et al. …