Trauma web-based psychoeducational programme: systematic cultural adaptation and protocol for a feasibility-acceptability study

<b>Background:</b> Trauma exposure in Indonesia is high despite the fact that there is limited accessibility to mental healthcare. <i>Pulihkan Luka (PL)</i> is a web-based trauma psychoeducation intervention that aims to provide a practical solution to overcome barriers to accessing mental healthcare. <b>Objectives:</b> This article aimed to (1) describe the cultural adaptation process of PL for Indonesian students and (2) describe the design of the pilot randomised controlled trial (RCT) that examines the feasibility and acceptability of <i>PL</i>. <b>Methods:</b> First, we describe the cultural adaptation process of <i>PL</i> following the 5-phase Formative Method for Adapting Psychotherapy (FMAP) approach: (1) knowledge generation, (2) information integration, (3) review and revision, (4) mini-testing, and (5) finalisation. Focus Group Discussion (FGD) was conducted to gather the views of 15 stakeholders on psychoeducation material and trauma-related mental health problems. Based on the outcomes, we decided to utilise the informal Indonesian language, incorporate practical worksheets and infographics, which include illustrations that reflect Indonesia’s cultural diversity, and provide guidance on seeking help that aligns with the mental health system in Indonesia. Second, we describe the design of a pilot RCT. Undergraduate students (<i>N</i> = 130) will be randomised to (1) four to seven sessions of <i>PL</i> + Enhanced Usual Care (<i>PL</i> + EUC; <i>n</i> = 65) or (2) Enhanced Usual Care only (EUC only; <i>n</i> = 65). Assessments will be conducted at baseline, post-intervention, and three and six-month follow-up. Additionally, 20 participants will be invited for an FGD to explore their experiences with the intervention. Quantitative data will be analysed using linear mixed-effect models, and qualitative data will be analysed using thematic analysis. <b>Discussion:</b> Cultural adaptation is crucial for optimally developing and assessing the feasibility and acceptability of a web-based trauma psychoeducation intervention in Indonesia. The outcomes of the RCT will inform the feasibility and acceptability of web-based trauma psychoeducation in the Indonesian undergraduate student population. Studies examining trauma-based psychoeducation in low and middle-income countries (LMICs) are scarce.Web-based psychoeducation may be a promising intervention for trauma-affected people in a country like Indonesia, with high exposure and limited healthcare.Cultural adaptation might improve intervention’s feasibility and effectiveness. Studies examining trauma-based psychoeducation in low and middle-income countries (LMICs) are scarce. Web-based psychoeducation may be a promising intervention for trauma-affected people in a country like Indonesia, with high exposure and limited healthcare. Cultural adaptation might improve intervention’s feasibility and effectiveness.

<b>研究背景：</b>尽管印度尼西亚的创伤暴露率居高不下，但该国精神卫生服务可及性却严重不足。<i>Pulihkan Luka（PL）</i>是一款基于网页的创伤心理教育干预项目，旨在为破解精神卫生服务获取障碍提供切实可行的解决方案。<b>研究目标：</b>本文旨在实现两项核心目标：（1）阐述面向印度尼西亚学生群体的PL项目文化适配流程；（2）描述试点随机对照试验（randomised controlled trial, RCT）的设计方案，该试验旨在评估PL项目的可行性与可接受性。<b>研究方法：</b>首先，本研究遵循心理治疗适应形成性方法（Formative Method for Adapting Psychotherapy, FMAP）的五阶段框架，阐述PL项目的文化适配流程：（1）知识生成；（2）信息整合；（3）评审与修订；（4）小型测试；（5）最终定稿。本研究通过焦点小组讨论（Focus Group Discussion, FGD），收集了15名利益相关者对心理教育材料及创伤相关精神卫生问题的观点与看法。基于上述调研结果，我们最终确定采用印尼日常用语、增设实用工作手册与信息图表（其中包含能体现印尼文化多样性的插画），并提供契合印尼精神卫生系统的求助指引。其次，本文阐述了试点RCT的设计方案：将130名本科生（总样本量<i>N</i> = 130）随机分配至两组：（1）PL+增强常规护理（Enhanced Usual Care, EUC）组（PL+EUC；<i>n</i> = 65），接受4至7次PL干预；（2）仅增强常规护理组（仅EUC组；<i>n</i> = 65）。评估将在基线、干预后、3个月随访及6个月随访四个时间点开展。此外，我们将邀请20名参与者参与焦点小组讨论，以探究其对本次干预的体验与感受。定量数据将采用线性混合效应模型进行分析，定性数据则采用主题分析法进行编码与解读。<b>讨论：</b>文化适配对于在印度尼西亚优化开发并评估基于网页的创伤心理教育干预项目的可行性与可接受性至关重要。本次RCT的研究结果将为印度尼西亚本科生群体中基于网页的创伤心理教育的可行性与可接受性提供研究依据。目前针对中低收入国家（low and middle-income countries, LMICs）创伤相关心理教育的研究仍较为匮乏。在印度尼西亚这类创伤暴露率高、医疗资源有限的国家，基于网页的心理教育或可为受创伤影响的人群提供颇具前景的干预方案。文化适配或可提升干预项目的可行性与有效性。目前针对中低收入国家（LMICs）创伤相关心理教育的研究仍较为匮乏。在印度尼西亚这类创伤暴露率高、医疗资源有限的国家，基于网页的心理教育或可为受创伤影响的人群提供颇具前景的干预方案。文化适配或可提升干预项目的可行性与有效性。