Cultural challenges for adapting behavioral intervention frameworks: A critical examination from a cultural psychology perspective

Ronald Fischer, Yuki Bailey, Megha Shankar, Nadia Safaeinili, Johannes A. Karl, Adam Daly, Finley Ngarangi Johnson, Taylor Winter, Hitaua Arahanga-Doyle, Ririwai Fox, Amina Abubakar, Donna Michelle Zulman

Research output: Contribution to journalReview articlepeer-review


We introduce the bias and equivalence framework to highlight how concepts, methods, and tools from cultural psychology can contribute to successful cultural adaptation and implementation of behavioral interventions. To situate our contribution, we provide a review of recent cultural adaptation research and existing frameworks. We identified 68 different frameworks that have been cited when reporting cultural adaptations and highlight three major adaptation dimensions that can be used to differentiate adaptations. Regarding effectiveness, we found an average effect size of zr = 0.24 (95%CI 0.20, 0.29) in 24 meta-analyses published since 2014, but also substantive differences across domains and unclear effects of the extent of cultural adaptations. To advance cultural adaptation efforts, we outline a framework that integrates key steps from previous cultural adaptation frameworks and highlight how cultural bias and equivalence considerations in conjunction with community engagement help a) in the diagnosis of behavioral or psychological problems, b) identification of possible interventions, c) the selection of specific mechanisms of behavior change, d) the specification and documentation of dose effects and thresholds for diagnosis, e) entry and exit points within intervention programs, and f) cost-benefit-sustainability discussions. We provide guiding questions that may help researchers when adapting interventions to novel cultural contexts.

Original languageEnglish
Article number102425
JournalClinical Psychology Review
Publication statusPublished - Jun 2024


  • Behavioral intervention
  • Cultural adaptation
  • Cultural universals
  • Culture-sensitive therapy
  • Equivalence and bias
  • Fidelity vs adaptation


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