Task 5
Bron: Groen, Richters, Laban & Devillé
● Cultural formulation
○ Systematic method for eliciting and evaluating cultural information during a
clinical encounter
○ Aims to help clinicians who provide care to patients from diverse ethno-cultural
backgrounds
■ To assess the impact of cultural factors on all items of psychiatric illness
■ To render a culturally sensitive diagnosis
■ To formulate treatment plans that are acceptable to the patient and to the
family
● Outline for cultural formulation (OCF)
○ Focus: Cultural definition of mental health problems
■ Inventory cultural background
○ Components
■ Cultural identity of the individual
■ Cultural explanations of individual’s illness
■ Cultural factors related to the psychosocial environment and levels of
functioning
■ Cultural elements of the relationship between the individual and the
clinician
● The cultural interview (CI)
○ Focus: Cultural identity of person
○ Intended for use as a tool in the construction of a cultural formulation in
psychiatric practice
■ 48 questions
● First 4 components of OCF
● Half are open-ended
○ Provide detailed information
○ At the end of the interview → report generated
■ Summary of
● Personal background & medical history
● Answers given to CI questions
● Observations made by interviewer
● Translation of answers into assessment of cultural elements
● Research setting: A Dutch centre for transcultural psychiatry
○ De Evenaar: Centre for transcultural psychiatry
■ Offers metnal health care services to people from range of cultural
backgrounds
● E.g. refugees, migrant workers, asylum seekers etc.
■ Both inpatient and outpatient care
● Inpatient: biweekly day-treatment programmes
○ Orientation and observation group, treatment groups,
, rehabilitation groups
● Outpatient
○ Individual consultations with psychiatric nurse
○ Consultations with psychiatrist
● Background of research
○ “Help us understand them better”
○ 2 versions of CI
■ Older version
● To long → difficulty for patients
● Only partly comprehension of all CI questions
■ Newer version
● Aimed at facilitating an anthropological encounter and reducing
the time needed to administer a CI
Results
● Feasibility: Time needed and comprehensibility
○ Time needed
■ 80 minutes BCI
■ 2 hours CI
○ Comprehensibility
■ 14 questions not understood BCI
■ 112 questions not understood CI
● Acceptability
○ More acceptability for BCI
○ No differences in term of willingness to participate
● Utility
○ Most domains were considered more useful in the BCI than in CI, except for
gender, religion and stigma
Conclusion
● BCI offers higher feasibility than the longer CI
○ Without losing its usefulness for the sake of valid diagnosis
● Possible for mental health institutes to implement the OCF
Bron: Leong & Kalibatseva
Concept of cultural validity
● Ethnic validity model
○ Refers to the “recognition, acceptance, and respect for the presence of
communalities and differences in psychosocial development and experiences
among people with different ethnic or cultural heritages”
→ broaden this concept into cultural validity
● Concept of cultural validity
○ Refers to the effectiveness of a measure or the accuracy of a clinical diagnosis to
Bron: Groen, Richters, Laban & Devillé
● Cultural formulation
○ Systematic method for eliciting and evaluating cultural information during a
clinical encounter
○ Aims to help clinicians who provide care to patients from diverse ethno-cultural
backgrounds
■ To assess the impact of cultural factors on all items of psychiatric illness
■ To render a culturally sensitive diagnosis
■ To formulate treatment plans that are acceptable to the patient and to the
family
● Outline for cultural formulation (OCF)
○ Focus: Cultural definition of mental health problems
■ Inventory cultural background
○ Components
■ Cultural identity of the individual
■ Cultural explanations of individual’s illness
■ Cultural factors related to the psychosocial environment and levels of
functioning
■ Cultural elements of the relationship between the individual and the
clinician
● The cultural interview (CI)
○ Focus: Cultural identity of person
○ Intended for use as a tool in the construction of a cultural formulation in
psychiatric practice
■ 48 questions
● First 4 components of OCF
● Half are open-ended
○ Provide detailed information
○ At the end of the interview → report generated
■ Summary of
● Personal background & medical history
● Answers given to CI questions
● Observations made by interviewer
● Translation of answers into assessment of cultural elements
● Research setting: A Dutch centre for transcultural psychiatry
○ De Evenaar: Centre for transcultural psychiatry
■ Offers metnal health care services to people from range of cultural
backgrounds
● E.g. refugees, migrant workers, asylum seekers etc.
■ Both inpatient and outpatient care
● Inpatient: biweekly day-treatment programmes
○ Orientation and observation group, treatment groups,
, rehabilitation groups
● Outpatient
○ Individual consultations with psychiatric nurse
○ Consultations with psychiatrist
● Background of research
○ “Help us understand them better”
○ 2 versions of CI
■ Older version
● To long → difficulty for patients
● Only partly comprehension of all CI questions
■ Newer version
● Aimed at facilitating an anthropological encounter and reducing
the time needed to administer a CI
Results
● Feasibility: Time needed and comprehensibility
○ Time needed
■ 80 minutes BCI
■ 2 hours CI
○ Comprehensibility
■ 14 questions not understood BCI
■ 112 questions not understood CI
● Acceptability
○ More acceptability for BCI
○ No differences in term of willingness to participate
● Utility
○ Most domains were considered more useful in the BCI than in CI, except for
gender, religion and stigma
Conclusion
● BCI offers higher feasibility than the longer CI
○ Without losing its usefulness for the sake of valid diagnosis
● Possible for mental health institutes to implement the OCF
Bron: Leong & Kalibatseva
Concept of cultural validity
● Ethnic validity model
○ Refers to the “recognition, acceptance, and respect for the presence of
communalities and differences in psychosocial development and experiences
among people with different ethnic or cultural heritages”
→ broaden this concept into cultural validity
● Concept of cultural validity
○ Refers to the effectiveness of a measure or the accuracy of a clinical diagnosis to
