title: Cognitive Processing Therapy for Spanish-speaking Latinos: A Formative Study of a Model-Driven Cultural Adaptation of the Manual to Enhance Implementation in a Usual Care Setting.
abstract: As part of a larger implementation trial for cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) in a community health center, we used formative evaluation to assess relations between iterative cultural adaption (for Spanish-speaking clients) and implementation outcomes (appropriateness and acceptability) for CPT.
  
  
  
  Qualitative data for the current study were gathered through multiple sources (providers: N = 6; clients: N = 22), including CPT therapy sessions, provider fieldnotes, weekly consultation team meetings, and researcher fieldnotes. Findings from conventional and directed content analysis of the data informed refinements to the CPT manual.
  
  
  
  Data-driven refinements included adaptations related to cultural context (i.e., language, regional variation in wording), urban context (e.g., crime/violence), and literacy level. Qualitative findings suggest improved appropriateness and acceptability of CPT for Spanish-speaking clients.
  
  
  
  Our study reinforces the need for dual application of cultural adaptation and implementation science to address the PTSD treatment needs of Spanish-speaking clients.
authors.affiliation: Massachusetts General Hospital.|Harvard Medical School.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Valentine
authors.affiliation: Massachusetts General Hospital.|Harvard Medical School.
authors.forename: Christina P C
authors.initials: CP
authors.lastname: Borba
authors.affiliation: University of California Los Angeles.
authors.forename: Louise
authors.initials: L
authors.lastname: Dixon
authors.affiliation: Massachusetts General Hospital.
authors.forename: Adin S
authors.initials: AS
authors.lastname: Vaewsorn
authors.affiliation: University of Monterrey.
authors.forename: Julia Gallegos
authors.initials: JG
authors.lastname: Guajardo
authors.affiliation: Duke University Medical Center.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Resick
authors.affiliation: Palo Alto Veterans Affairs Health Care System.|Stanford University.
authors.forename: Shannon
authors.initials: S
authors.lastname: Wiltsey Stirman
authors.affiliation: Massachusetts General Hospital.|Harvard Medical School.
authors.forename: Luana
authors.initials: L
authors.lastname: Marques
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000592:standards*; D065246:Culturally Competent Care / Q000379:methods / Q000592:standards*; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D008297:Male; D008370:Manuals as Topic / Q000592:standards*; D008875:Middle Aged; D036301:Qualitative Research; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D055815:Young Adult
keywords: Latinos; cognitive processing therapy; cultural adaptation; implementation; posttraumatic stress disorder