Cultural Adaptation

What is Cultural Adaptation?

The process of cultural adaptation is a defining feature of our project. Community partners are encouraged to adapt the manual to suit their communities' cultures and needs, and to add their respective cultural content, such as traditional stories, land-based activities and language to the program. By placing a strong emphasis on cultural adaptation, culture is affirmed as an important determinant of health and wellbeing. Cultural adaptation can promote better participation and engagement with a program. It can also create a better sense of ownership and control over a project, because those using the program are also the ones adapting the material. More importantly, incorporating culture into an intervention transforms the intervention into one that reflects the strengths and values of a community.

Why Culturally-Adapt?

Cultural adaptation involves a comprehensive and collaborative process that often includes the participation of community partners for whom the adaptation is being developed. Knowledge keepers, such as Elders in Indigenous contexts, are also involved and contribute greatly to the adaptation process. In the LTOA project, there are certain key elements such as community values, language, stories, traditional crafts and land activities that are often incorporated into the program, as part of the adaptation process. This adaptation process will differ in every community, and what a community adds as cultural content to a program will vary, leaving every community with their own unique version of the program.

The process of cultural adaptation looks like this:

• A partnership is formed between our research team and an Indigenous health/social organization that services one or several Indigenous communities.

• The Indigenous health/social organization assembles a steering committee—made up of community Elders, leaders, and knowledge holders—to guide the cultural adaptation process. The steering committee receives all the program materials and adapts the materials over the course of several workshops.

• Changes to the program material are verified through an iterative process in collaboration with the research team. This iterative process ensures that the program retains core elements of the evidence-based curriculum, while incorporating values of each community.

• Our research team formats all changes to the program materials in the facilitator's manual, and youth & adult program booklets.

• The steering committee reviews the formatted materials and approves them for use in their communities.

• Partnered First Nations deliver the culturally adapted materials and generate comments that create feedback for future program revisions.

• Throughout the entire adaptation process, we work with local agencies, social service providers, band government, and schools to identify community organizations who would be interested in sustaining the program.

The following documents were assembled to guide steering committees through the process of cultural adaptation:

Start here: File Cultural Adaptation: First Steps

PDF icon Cultural Adaptation Step-by-Step Guide PDF Version
File Cultural Adaptation Step-by-Step Guide Word Version

PDF icon 7 Workshop Cultural Adaptation Guide PDF Version
File 7 Workshop Cultural Adaptation Guide Word Version

Overview of the Cultural Adaptation process within the LTOA Program
Key Principle As described by Kirmayer et al. As described through the LTOA program
1. Follow a systematic process 
  • Adaptation is an iterative, circular process, and community feedback must be built into all steps.
  • Adaptation timelines vary. Sufficient time to review feedback and incorporate any changes to the intervention is necessary.
  • Changes made during the adaptation process should be documented in order to guide subsequent adaptation work.

An Indigenous health or social organization supports the lead facilitator throughout the adaptation. Additionally, the National Coordinator and research team at McGill also offer support.

  • Different communities choose to adapt the program differently. The level of language translation, and addition of new stories and activities, varies among communities.
  • The adaptation process and steps are documented by the lead facilitator to update the general LTOA team and research team with progress and challenges encountered.
  • If research is ongoing with the community, the adaptation process is also followed on this end.
  • Facilitators may also adapt “on the fly,” tweaking sessions to fit the immediate needs of the participants.
2. Balance fit and fidelity
  • Fidelity is necessary to ensure that original components associated with efficacy are retained, while fit is critical for the successful delivery of the intervention.
  • Balancing fit and fidelity requires flexibility, and too rigid of an emphasis on fidelity may be perceived as disparaging local Indigenous knowledge.
  • Each change made to the intervention should be considered in terms of impact on 1) the core components of the intervention and 2) cultural congruence.

Adaptation recommendations are offered to the community by the National Coordinator, highlighting main areas of adaptation.

  • The facilitators decide the type and level of adaptations needed to make the program culturally-relevant for their community.
  • Each session may be adapted to meet the needs of the community, the core objectives and themes are retained to insure fidelity of the intervention.
  • Ongoing check-ins with the National Coordinator and research team give opportunities to discuss the adaptation process, ask and resolve questions, and ensure that key aspects of the program are retained while it is adapted.
3. Evaluate and refine adaptations

Evaluation is necessary in understanding the effectiveness of modified interventions, especially because cultural adaptation may inadvertently exclude key elements of the original intervention. Evaluation can also increase the understanding of underlying mechanisms or processes of effective interventions, opening up possibilities for improving the intervention.

  • Evaluation should be discussed from the beginning of a project so a plan can be developed.
  • The evaluation process should be culturally safe, by choosing methods and goals in partnership with Indigenous communities.

After the first round of implementation:

  • Facilitators continue to adapt their manuals and materials with support from the Elder.
  • Feedback is incorporated into the program. New materials, stories and additional activities may be added.

4. Promote knowledge exchange and sustainability

  • Sharing early findings with community partners encourages discussion, knowledge exchange, and stakeholder engagement.
  • Community partners should be consulted on how to best disseminate results. Research summaries and reports should be available and accessible in plain language.
  • Other avenues for sharing results may be through photos, video, and story-telling. Developing a community of practice is also a means to building networks of knowledge exchange.
  • If the program is to be delivered in different communities, additional adaptations may be necessary in order to make the program more relevant and specific to other communities.
  • Future adaptations in different communities are done in collaboration with the regional coordinator/facilitator, new facilitators, and Elders.
  • Facilitators are encouraged to record their adaptation steps and methods to share with other facilitators, and new facilitators at training sessions and LTOA gatherings
  • When a community is interested in delivering the LTOA program, or is in the process of doing so, community members involved in the program are invited to join our community of practice, by staying up-to-date with LTOA news and events, participating in meetings and gatherings, and sharing updates with the LTOA team regarding the program.
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