Motivational Interviewing (MI) has a robust evidence base in facilitating behavior change for several health conditions. MI focuses on the individual and assumes patient autonomy. Cross-cultural adaptation can face several challenges in settings where individualism and autonomy may not be as prominent. Sociocultural factors such as gender, class, caste hinder individual decision-making. Key informant perspectives are an essential aspect of cross-cultural adaptation of new interventions. Here, we share our experience of translating and adapting MI concepts to the local language and culture in rural Nepal, where families and communities play a central role in influencing a person’s behaviors. We developed, translated, field-tested, and adapted a Nepali MI training module with key informants to generate insights on adapting MI for the first time in this cultural setting. Key informants were five Nepali nurses who supervise community health workers. We used structured observation notes to describe challenges and experiences in cross-cultural adaptation. We conducted this study as part of a larger study on using MI to improve adherence to HIV treatment. Participants viewed MI as an effective intervention with the potential to assist patients poorly engaged in care. Regarding patient autonomy, they initially shared examples of family members unsuccessfully dictating patient behavior change. These discussions led to consensus that every time the family members restrict patient's autonomy, the patient complies temporarily but then resumes their unhealthy behavior. In addition, participants highlighted that even when a patient is motivated to change (e.g., return for follow-up), their family members may not “allow” it. Discussion led to suggestions that health workers may need to conduct MI separately with patients and family members to understand everyone’s motivations and align those with the patient’s needs. MI carries several cultural assumptions, particularly around individual freedom and autonomy. MI adaptation thus faces challenges in cultures where such assumptions may not hold. However, cross-cultural adaptation with key informant perspectives can lead to creative strategies that recognize both the patient’s autonomy and their role as a member of a complex social fabric to facilitate behavior change.

中文翻译：

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动机访谈的跨文化适应在尼泊尔农村的应用

动机访谈 (MI) 在促进多种健康状况的行为改变方面拥有坚实的证据基础。MI 注重个人并承担患者的自主权。在个人主义和自主性可能不那么突出的环境中，跨文化适应可能会面临一些挑战。性别、阶级、种姓等社会文化因素阻碍个人决策。关键知情人的观点是新干预措施跨文化适应的一个重要方面。在这里，我们分享将 MI 概念翻译并适应尼泊尔农村当地语言和文化的经验，在那里，家庭和社区在影响一个人的行为方面发挥着核心作用。我们与关键信息提供者一起开发、翻译、实地测试和改编了尼泊尔语 MI 培训模块，以产生有关在这种文化环境中首次调整 MI 的见解。关键信息提供者是五名负责监督社区卫生工作者的尼泊尔护士。我们使用结构化的观察笔记来描述跨文化适应中的挑战和经验。我们开展这项研究是一项更大规模研究的一部分，该研究旨在利用 MI 来提高 HIV 治疗的依从性。参与者认为 MI 是一种有效的干预措施，有可能帮助护理工作不佳的患者。关于患者自主权，他们最初分享了家庭成员未能成功指导患者行为改变的例子。这些讨论得出的共识是，每当家人限制患者的自主权时，患者都会暂时服从，但随后又恢复了不健康的行为。此外，参与者强调，即使患者有动力改变（例如返回进行随访），他们的家人也可能不会“允许”。讨论提出，卫生工作者可能需要与患者和家属分开进行 MI，以了解每个人的动机并使这些动机与患者的需求保持一致。MI 带有多种文化假设，特别是围绕个人自由和自治。因此，在这种假设可能不成立的文化中，MI 适应面临着挑战。然而，跨文化适应与关键信息提供者的观点可以带来创造性的策略，认识到患者的自主性和他们作为复杂社会结构成员的角色，以促进行为改变。