Cultural adaptation of a psychosocial screening tool for adolescents living with HIV/AIDS attending antiretroviral therapy program in Malawi

Abstract

Background Adolescents living with HIV (ALHIV) face a higher risk of mental health problems than adolescents without HIV yet culturally appropriate mental health screening tools are lacking in settings like Malawi. This study aimed to culturally adapt the HEADSS (Home, Education, Activities, Drugs, Sexuality, Suicide/Depression) psychosocial screening tool for the Malawian context, as the original was previously found to be inappropriate. Methods The study was conducted between December 2021 and May 2022. We employed an adapted Heuristic Framework for cultural adaptation translations. Data was collected with Mental Health experts (n = 4), focus group discussions with ALHIV (n = 20), in-depth interviews with health care providers (HCPs) (n = 6) and key informants (n = 4). An iterative process of piloting and feedback guided the adaptation. Results The adaptation addressed conceptually difficult, unacceptable, or stigmatizing items. HCPs reported that the adapted HEADSS tool may effectively guide the examination of ALHIV challenges and simplify the identification of high-risk behaviors (e.g., early sexual debut, self-harm and substance abuse). The tool’s language was culturally accepted by ALHIV, as the screening questions were available in both the local language and English, and accurately reflected their daily challenges. Conclusions Developing easy-to-use, comprehensible, and locally appropriate mental health screening tools is crucial for detecting high-risk behaviors and psychosocial issues among ALHIV. To effectively meet ALHIVs’ needs within HIV services, mental health interventions are essential for improving adherence to antiretroviral therapy (ART). Therefore, training HCPs to address sensitive risk issues during routine care is highly recommended.