Translation and Cross-Cultural Adaptation of the World Health Organization's Thinking Healthy Program into Persian for Implementation by Community Health Volunteers (Peers) in Iran's Health System.

BACKGROUND

The World Health Organization's (WHO) Thinking Healthy Program (THP), which targets prenatal depression, requires adaptation for diverse communities. This study aimed to translate, culturally adapt, and assess the feasibility of implementing THP through community health volunteers (peers).

MATERIALS AND

METHODS

Following WHO guidelines, bilingual experts translated the THP manual, which was subsequently reviewed by a multidisciplinary panel of psychiatrists, reproductive health specialists, and linguists. Content and face validity were assessed by experts and healthcare providers. Cultural adaptations were informed by a systematic review and refined through the nominal group technique. The adapted THP was piloted with seven pregnant women experiencing depression (Edinburgh Postnatal Depression Scale [EPDS] score ≥13) and five peers. Feedback was obtained through structured questionnaires.

RESULTS

Key adaptations included (1) culturally sensitive terminology (e.g., "health caregiver"), (2) contextually appropriate visuals, (3) the addition of a module on sexual health, and (4) training on natural childbirth to address the high prevalence of cesarean deliveries. Qualitative feedback demonstrated high acceptability: 85.7% of participating mothers found the program comprehensible, and all peers endorsed its feasibility. Participants highlighted the program's dual focus on psychological well-being and maternal health education.

CONCLUSIONS

The Persian adaptation of THP demonstrates strong cultural validity and feasibility within Iran's primary healthcare system. Peer-delivered implementation helps bridge gaps in mental health services, particularly in resource-limited settings. Future randomized controlled trials are warranted to evaluate its effectiveness in reducing perinatal depression on a larger scale.