Table 3 Conceptual framework for cultural adaptations

1. Community outreach and involvement

 a. Community needs assessment (e.g., outlining the issue from their perspective)

 b. Involvement in development of the adaptation

 c. Participation in the implementation/management/delivery of services

2. Changes in structure and process of service delivery

 a. Change in geography/location (e.g., location of center, home vs. office visits, etc.)

 b. Change made to the physical space (e.g., pictures, room or building design, etc.)

 c. Change in mechanism of service delivery (e.g., face-to-face, electronic, mailed, etc.)

 d. Changes to service provider/presenter (e.g., selection and training)

  i. Language matching to client

  ii. Race, gender, or cultural matching to client

 e. Change in manner of service delivery (e.g., interaction style, proximity to client, active or passive speech, intonation, rapport building, self-presentation, group composition, etc.)

 f. Provision of supplemental services, resources, or support

  i. Supplemental providers (e.g., traditional healer, patient navigators)

  ii. Funds for a specific service or resource

  iii. Supplemental services (e.g., child care, transportation, paid leave from work)

  iv. Translated materials (e.g., documents, signs, etc.)

  iv. Other

3. Adaptation of content

 a. Level of personal specificity

  i. Individualized

  ii. Targeted to subgroup

 b. Inclusion of cultural content

  i. Graphics

  ii. Cultural allusions (affect-free content with which the recipient may personally identify)

  iii. Culturally-relevant factual information

  iv. Targets or references negative-valence beliefs, values, or experiences (e.g., fatalism, stigmatization)

  v. Targets or references neutral or positive-valence beliefs, values, or experiences (e.g., familial involvement, time-orientation)