title: Effects of culture-sensitive adaptation of patient information material on usefulness in migrants: a multicentre, blinded randomised controlled trial.
abstract: To evaluate the usefulness of culture-sensitive patient information material compared with standard translated material.
  
  
  
  Multicentre, double-blind randomised controlled trial.
  
  
  
  37 primary care practices.
  
  
  
  435 adult primary care patients with a migration background with unipolar depressive disorder or non-specific chronic low back pain were randomised. Patients who were unable to read in the language of their respective migration background were excluded. Sufficient data were obtained from 203 women and 106 men. The largest group was of Russian origin (202 patients), followed by those of Turkish (52), Polish (30) and Italian (25) origin.
  
  
  
  Intervention group: provision of culture-sensitive adapted material.
  
  
  
  provision of standard translated material.
  
  
  
  Primary outcome: patient-rated usefulness (USE) assessed immediately after patients received the material.
  
  
  
  patient-rated usefulness after 8 weeks and 6 months, symptoms of depression (PHQ-9), back pain (Back Pain Core Set) and quality of life (WHO-5) assessed at all time points.
  
  
  
  Usefulness was found to be significantly higher (t=1.708, one-sided p=0.04) in the intervention group (USE-score=65.08, SE=1.43), compared with the control group (61.43, SE=1.63), immediately after patients received the material, in the intention-to-treat analysis, with a mean difference of 3.65 (one-sided 95% lower confidence limit=0.13). No significant differences were found for usefulness at follow-up (p=0.16, p=0.71). No significant effect was found for symptom severity in depression (p=0.95, p=0.66, p=0.58), back pain (p=0.40, p=0.45, p=0.32) or quality of life (p=0.76, p=0.86, p=0.21), either immediately after receiving the material, or at follow-up (8 weeks; 6 months). Patients with a lower level of dominant society immersion benefited substantially and significantly more from the intervention than patients with a high level of immersion (p=0.005).
  
  
  
  Cultural adaptation of patient information material provides benefits over high quality translations. Clinicians are encouraged to use culture-sensitive material in their consultations, particularly with low-acculturated patients.
  
  
  
  German Register for Clinical Trials: DRKS00004241, Universal Trial Number: U1111-1135-8043, Results.
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Freiburg, Germany.
authors.forename: Lars P
authors.initials: LP
authors.lastname: Hölzel
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Freiburg, Germany.
authors.forename: Zivile
authors.initials: Z
authors.lastname: Ries
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Levente
authors.initials: L
authors.lastname: Kriston
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Dirmaier
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jördis M
authors.initials: JM
authors.lastname: Zill
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.|German Depression Foundation, Depression Research Center, Leipzig, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Rummel-Kluge
authors.affiliation: Department of General Practice, Medical Center-University of Freiburg, Freiburg, Germany.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Niebling
authors.affiliation: Staff Unit Board of Directors, Medical Center-University of Freiburg, Freiburg, Germany.
authors.forename: Isaac
authors.initials: I
authors.lastname: Bermejo
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Härter
mesh_terms: D000328:Adult; D000368:Aged; D054521:Cultural Competency; D003865:Major Depressive Disorder / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D017144:Focus Groups; D057220:Health Literacy; D006801:Humans; D007558:Italy; D007802:Language; D017116:Low Back Pain / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation; D011044:Poland; D011788:Quality of Life; D012426:Russia; D014171:Transients and Migrants; D014175:Translating; D014421:Turkey
keywords: culture sensitive; depression; low back pain; migrants; patient information; randomized