Participatory cultural adaptation of a multigenerational mindfulness-based program for war-exposed families with refugee status.

BACKGROUND: Disseminating the details and processes involved in a participatory-based selection, adaptation, and implementation of evidence-based interventions (EBI) in support of refugee families in resettlement is paramount for an equitable, trauma-informed, public health approach to promoting family health and resilience. We describe the participatory cultural adaptation of EBIs to establish a multigenerational mindfulness-based and resilience enhancing family program for war-affected families with adolescent youth.

METHODS: The study team integrated conceptual and pragmatic approaches to the adaptation and implementation of an intervention program composed of two well-supported interventions to target intergenerational trauma in war-affected refugee families. The integration and adaptation of the program described in this report was conducted in partnership with members of the Karen refugee community (originating from Burma in Southeast Asia and resettled in the United States).

RESULTS: Based on three adaptation models and a FRAME-IS reporting structure, the process produced a focused set of contextual, content, and implementation adaptations. Most modifications were contextual, such as considering culturally responsive familial dynamics and selecting community-preferred delivery settings and facilitation. Content changes were limited and involved a careful examination of word choice and phrasing, and emphasized emotion-regulation and parenting strategies aligned with existing community practices. Implementation adaptations refined facilitator guidance and strengthened Community Health Worker Interventionist training. Iterative input from community experts enhanced relevance and feasibility while preserving the core intervention elements.

CONCLUSION: Engaging members of a Community Leadership Board and Community Health Worker Interventionists in training, practice and feedback sessions informed the adaptation of evidence-supported interventions into a mindfulness-based family intervention to disrupt intergenerational trauma transmission in war-affected Karen families. We provide transparent intervention and program development documentation and guidance for other teams considering adaptations of health and resilience oriented EBIs for refugee families. The adapted program has the potential to be translated to other refugee populations.