JMIR Publications

ABSTRACT

Background:

The aging and caregiving population is becoming increasingly diverse in the U.S., leading to a growing need for culturally adapted interventions to address the unique needs of underrepresented groups, such as Asian Americans. However, interventions targeting Asian Americans and exploring cultural adaptation strategies remain limited in dementia caregiving research.

Objective:

This report describes the cultural adaptation process of an evidence-based intervention for Chinese and Korean American dementia caregivers, called the New York University Caregiver Intervention–Enhanced Support (NYUCI-ES).

Methods:

We conducted a deductive content analysis and categorized our adaptation strategies into five elements: content, context, relationship fidelity and core elements, engagement, and cultural competence. Timing and types of response to each adaptation strategy were also observed. Two authors conducted the initial analysis, and additional team members finalized the synthesis through discussion. The Standards for Reporting Qualitative Research checklist and Template for Intervention Description and Replication checklists were used to guide the methodological rigor.

Results:

A total of 24 major adaptations were identified and categorized. For content, we translated materials, used culturally relevant terms, incorporated ethnic-specific surveys and resources, created social media support groups on platforms widely used by the targeted population, and extended the time allocated to complete the six counseling sessions. Context adaptation included expanding the range of individuals eligible for family counseling sessions to include fictive kin, using online and social media apps for communication, cultural matching and training of staff, and partnerships with relevant community organizations. Relationship fidelity and core elements involved consulting with community experts, conducting focus group interviews with caregivers, having regular meetings with the developer of the original intervention and an experienced NYUCI clinician as well as experts in Chinese and Korean culture, and continuing regular counseling supervision. To enhance engagement, we provided clear explanations of the study procedure, which emphasized benefits in participants’ native languages and matched participants with social workers who shared the same cultural backgrounds. We also employed a step-by-step contact approach and prolonged communication, explained staff roles to build rapport, and offered participant compensation. Lastly, cultural competence was reflected in tailoring counseling techniques with respect for cultural beliefs, the use of euphemistic language for taboo subjects, and culturally appropriate refreshments to show respect and build interpersonal relationships.

Conclusions:

We systemically adjusted a counseling-based intervention, an approach that is less familiar among Asian Americans, to fit the cultural characteristics of the target population. A contribution of this study is using an integrated, theory-driven approach that combines two cultural adaptation frameworks while also capturing real-time adaptations informed by external feedback and self-reflection. This work provides a practical model for adapting evidence-based interventions to serve Chinese and Korean American dementia caregivers and may inform future adaptations for other East Asian populations. Clinical Trial: ClinicalTrial.gov (NCT05461495); https://clinicaltrials.gov/study/NCT05461495