Beyond input‑output: Applying dynamic systems theory to the complexity of implementing mental health interventions in non‑western cultures

Pacini, Adele and Shrestha, Prithvi (2022). Beyond input‑output: Applying dynamic systems theory to the complexity of implementing mental health interventions in non‑western cultures. In: Proceedings of the 5th UK Implementation Science Research Conference, 14-15 Jul 2022, London, pp. 18–19.

Abstract

Background

Global dissemination of western mental health interventions across widely diverse cultures leaves a potentially large implementation gap for non-Caucasian people [1]. Central to the uptake of mental health interventions are the extent to which they align with the cultural and personal values of local cultures, organisations, staff, individuals and their families.

Method

We explore the potential of integrating components of the Pragmatic Robust Implementation and Sustainability Model (PRISM) [2] within a dynamic system of cultural adaptation [3]. We model the complementary and contradictory perspectives on cultural concepts of distress and healing, highlighting how successful implementation depends on navigating the ‘best fit’ between these concepts and evidence based psychological techniques.

Results

Figure 1 shows the resulting model for the implementation of culturally adapted psychological interventions. We model the dynamic nature of the overlap between an individual’s coping mechanisms, their family’s, alongside organizational capacity to implement interventions and existing cultural and evidence-based practices to support mental health.

Conclusion

Integrating components of the PRISM within a dynamic system model of cultural adaptation allows us to represent the uncertainty and unpredictability of adapting mental health interventions more accurately in non-western cultures. Importantly, it also models the tension between self, other and organizational values, which may be particularly critical in collectivist cultures, or across generations in countries experiencing rapid development. Our case example suggests how we might navigate these uncertainties and complexities through a lens of ‘best fit’ rather than input-output.

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