Skip to main content
Journal cover image

Cross-cultural adaptation of motivational interviewing for use in rural Nepal.

Publication ,  Journal Article
Rimal, P; Khadka, S; Bogati, B; Chaudhury, J; Rawat, LK; Bhat, KC; Manandhar, P; Citrin, D; Maru, D; Ekstrand, ML; Swar, SB; Aryal, A ...
Published in: BMC Psychol
April 1, 2021

BACKGROUND: Motivational Interviewing (MI) has a robust evidence base in facilitating behavior change for several health conditions. MI focuses on the individual and assumes patient autonomy. Cross-cultural adaptation can face several challenges in settings where individualism and autonomy may not be as prominent. Sociocultural factors such as gender, class, caste hinder individual decision-making. Key informant perspectives are an essential aspect of cross-cultural adaptation of new interventions. Here, we share our experience of translating and adapting MI concepts to the local language and culture in rural Nepal, where families and communities play a central role in influencing a person's behaviors. METHODS: We developed, translated, field-tested, and adapted a Nepali MI training module with key informants to generate insights on adapting MI for the first time in this cultural setting. Key informants were five Nepali nurses who supervise community health workers. We used structured observation notes to describe challenges and experiences in cross-cultural adaptation. We conducted this study as part of a larger study on using MI to improve adherence to HIV treatment. RESULTS: Participants viewed MI as an effective intervention with the potential to assist patients poorly engaged in care. Regarding patient autonomy, they initially shared examples of family members unsuccessfully dictating patient behavior change. These discussions led to consensus that every time the family members restrict patient's autonomy, the patient complies temporarily but then resumes their unhealthy behavior. In addition, participants highlighted that even when a patient is motivated to change (e.g., return for follow-up), their family members may not "allow" it. Discussion led to suggestions that health workers may need to conduct MI separately with patients and family members to understand everyone's motivations and align those with the patient's needs. CONCLUSIONS: MI carries several cultural assumptions, particularly around individual freedom and autonomy. MI adaptation thus faces challenges in cultures where such assumptions may not hold. However, cross-cultural adaptation with key informant perspectives can lead to creative strategies that recognize both the patient's autonomy and their role as a member of a complex social fabric to facilitate behavior change.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

BMC Psychol

DOI

EISSN

2050-7283

Publication Date

April 1, 2021

Volume

9

Issue

1

Start / End Page

52

Location

England

Related Subject Headings

  • Rural Population
  • Nepal
  • Motivational Interviewing
  • Humans
  • Family
  • Cross-Cultural Comparison
  • 5203 Clinical and health psychology
  • 5202 Biological psychology
  • 5201 Applied and developmental psychology
  • 1701 Psychology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Rimal, P., Khadka, S., Bogati, B., Chaudhury, J., Rawat, L. K., Bhat, K. C., … Acharya, B. (2021). Cross-cultural adaptation of motivational interviewing for use in rural Nepal. BMC Psychol, 9(1), 52. https://doi.org/10.1186/s40359-021-00557-y
Rimal, Pragya, Sonu Khadka, Bhawana Bogati, Jamuna Chaudhury, Laxmi Kumari Rawat, Kumari Chhaya Bhat, Pramita Manandhar, et al. “Cross-cultural adaptation of motivational interviewing for use in rural Nepal.BMC Psychol 9, no. 1 (April 1, 2021): 52. https://doi.org/10.1186/s40359-021-00557-y.
Rimal P, Khadka S, Bogati B, Chaudhury J, Rawat LK, Bhat KC, et al. Cross-cultural adaptation of motivational interviewing for use in rural Nepal. BMC Psychol. 2021 Apr 1;9(1):52.
Rimal, Pragya, et al. “Cross-cultural adaptation of motivational interviewing for use in rural Nepal.BMC Psychol, vol. 9, no. 1, Apr. 2021, p. 52. Pubmed, doi:10.1186/s40359-021-00557-y.
Rimal P, Khadka S, Bogati B, Chaudhury J, Rawat LK, Bhat KC, Manandhar P, Citrin D, Maru D, Ekstrand ML, Swar SB, Aryal A, Kohrt B, Shrestha S, Acharya B. Cross-cultural adaptation of motivational interviewing for use in rural Nepal. BMC Psychol. 2021 Apr 1;9(1):52.
Journal cover image

Published In

BMC Psychol

DOI

EISSN

2050-7283

Publication Date

April 1, 2021

Volume

9

Issue

1

Start / End Page

52

Location

England

Related Subject Headings

  • Rural Population
  • Nepal
  • Motivational Interviewing
  • Humans
  • Family
  • Cross-Cultural Comparison
  • 5203 Clinical and health psychology
  • 5202 Biological psychology
  • 5201 Applied and developmental psychology
  • 1701 Psychology