title: Cultural adaptations to augment health and mental health services: a systematic review.
abstract: Membership in diverse racial, ethnic, and cultural groups is often associated with inequitable health and mental health outcomes for diverse populations. Yet, little is known about how cultural adaptations of standard services affect health and mental health outcomes for service recipients. This systematic review identified extant themes in the research regarding cultural adaptations across a broad range of health and mental health services and synthesized the most rigorous experimental research available to isolate and evaluate potential efficacy gains of cultural adaptations to service delivery.
  
  
  
  MEDLINE, PsycINFO, CINAHL, EMBASE, and grey literature sources were searched for English-language studies published between January 1955 and January 2015. Cultural adaptations to any aspect of a service delivery were considered. Outcomes of interest included changes in service provider behavior or changes in the behavioral, medical, or self-reported experience of recipients.
  
  
  
  Thirty-one studies met the inclusion criteria. The most frequently tested adaptation occurred in preventive services and consisted of modifying the content of materials or services delivered. None of the included studies focused on making changes in the provider's behavior. Many different populations were studied but most research was concerned with the experiences and outcomes of African Americans. Seventeen of the 31 retained studies observed at least one significant effect in favor of a culturally adapted service. However there were also findings that favored the control group or showed no difference. Researchers did not find consistent evidence supporting implementation of any specific type of adaptation nor increased efficacy with any particular cultural group.
  
  
  
  Conceptual frameworks to classify cultural adaptations and their resultant health/mental health outcomes were developed and applied in a variety of ways. This review synthesizes the most rigorous research in the field and identifies implications for policy, practice, and research, including individualization, cost considerations, and patient or client satisfaction, among others.
authors.affiliation: Centre for the Study of Services to Children and Families, University of British Columbia, ASC 453, 3187 University Way, Kelowna, BC, V1V 1V7, Canada.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Healey
authors.affiliation: Centre for the Study of Services to Children and Families, University of British Columbia, ASC 453, 3187 University Way, Kelowna, BC, V1V 1V7, Canada.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Stager
authors.affiliation: Centre for the Study of Services to Children and Families, University of British Columbia, ASC 453, 3187 University Way, Kelowna, BC, V1V 1V7, Canada.
authors.forename: Kyler
authors.initials: K
authors.lastname: Woodmass
authors.affiliation: University of Houston Graduate College of Social Work, 3511 Cullen Blvd Room 110HA, Houston, TX, 77204-4013, USA.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Dettlaff
authors.affiliation: Centre for the Study of Services to Children and Families, University of British Columbia, ASC 453, 3187 University Way, Kelowna, BC, V1V 1V7, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vergara
authors.affiliation: University of British Columbia, Okanagan Campus Library, LIB 241, 3287 University Way, Kelowna, BC, V1V 1V7, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Janke
authors.affiliation: Centre for the Study of Services to Children and Families, University of British Columbia, ASC 453, 3187 University Way, Kelowna, BC, V1V 1V7, Canada. susan.wells@ubc.ca.
authors.forename: Susan J
authors.identifier: 0000-0001-5914-9350
authors.initials: SJ
authors.lastname: Wells
mesh_terms: D001741:Black or African American / Q000208:ethnology; D003376:Counseling; D054521:Cultural Competency; D003469:Culture; D005006:Ethnicity / Q000523:psychology; D006801:Humans; D001523:Mental Disorders / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D017060:Patient Satisfaction / Q000208:ethnology; D044469:Racial Groups / Q000208:ethnology
keywords: Cultural appropriateness; Cultural competence; Cultural safety; Ethnicity; Health; Mental health; Racial disparities