Seeking Models and Methods for Cultural Adaptation of Interventions: Commentary on the Special Section.

Early in the literature on developing and adapting psychosocial interventions for Hispanic groups, Rogler, Malgady, Costantino, and Blumenthal (1987) suggested three approaches. The first one was to make traditional treatments more accessible to Hispanics. Another was to select available therapies according to their proximity to Hispanic cultures and apply them to this population group. And a third was to extract elements from Hispanic culture to modify traditional treatments. These approaches are not mutually exclusive. In fact, they may work together very effectively in the selection and use of empirically supported therapies for Latinos. After all, there is a growing literature on adapting and tailoring therapies to diverse Latino groups in different parts of the U.S. and across the life span. The collective efforts in cultural-adaptation research have been to improve accessibility of tested interventions for Latinos and use critical Hispanic cultural elements to enhance the utility of these treatments. In many ways, Rogler et al.'s classification of approaches is perhaps more relevant today than when the paper first appeared. As someone who began in the mental health field when little if any attention was paid to race and ethnicity—and, when included, race and ethnicity were often framed as sources of pathology rather than as sources of strengths—I am impressed by the progress we have made in placing culture at its rightful place for ensuring treatment use and success. But I am fully aware that we still have a good distance to go to incorporate cultural factors stemming from a common ethnicity to make interventions relevant and effective with Hispanics. Our progress may have been limited by the lack of empirical substantiation of the specific features that reflect Hispanic cultures. Many cultural concepts that are associated with Latinos, such as respeto, familismo, marianismo, and personalismo, have appeared in the literature (and reappeared as they do in the papers in this section) with such regularity that they are now found in the common lexicon of researchers and clinicians working with Latinos. The general operating assumption has been that Latinos will be better engaged and served if we observe these cultural features when we design and implement our interventions. This assumption, however, has not stood up to critical scrutiny. In a recent review of the literature on Latino cultural values, Melanie Domenech Rodriguez, Ana Baumann, Audrey Schwartz, and I are finding that there is some definitional consensus that has gradually coalesced around the cultural values. Still, many of these concepts have not been operationalized or operationalized with sufficient uniformity that we can comfortably say they can be or have been used in intervention-adaptation research. Dumka, Lopez, and Carter (2002), for example, found in their review of 21 parenting interventions for Latino families that most studies identified one or more pan-Latino values but few citations or other information were presented “to substantiate the validity of these values” (p. 215). This is certainly a cause of concern and should steel our determination to get a better handle on culture and how culture fits in the adaptation and implementation of empirically derived treatments and interventions.