Development of a Cultural Adaptation Model of the South Asian Healthy Lifestyle Intervention (SAHELI): A Qualitative Approach

Abstract

Background: South Asians have increased risk for atherosclerotic cardiovascular disease (ASCVD) compared to other Asian groups and non-Hispanic whites. Cultural adaptations of evidence-based health education have been shown to improve health outcomes immigrant and minority populations when compared to usual care. Few studies have identified core elements to culturally adapt lifestyle interventions for South Asian immigrant populations in the US. Purpose: This study aims to describe how the SAHELI intervention culturally adapts the evidence-based Diabetes Prevention Program for a US-based South Asian immigrant population.Methods: Qualitative analysis of SAHELI health education audio recording transcripts from 5 cohorts across three community sites (health department, community center, school district). Following generation of thematic constructs from written transcript analysis, coding was applied to 32 English-speaking and 8 Urdu-speaking group education sessions.Results: SAHELI culturally adapts evidenced-based lifestyle interventions by applying both surface-level cultural knowledge (South Asian language, food, festivals, religion); deep-structure cultural knowledge (South Asian values, gender roles, health beliefs); and activation of cultural identity (shared ethnic background, SAHELI group identity).Conclusions: SAHELI utilizes both surface-level and deep-structural cultural knowledge and activation of cultural identity within a group motivational interviewing framework to promote health behavior change via lifestyle interventions grounded by South Asian sociocultural contexts.

Acknowledgements

I would like to thank all members of the SAHELI research study team for their invaluable support including Fatima Safi, MPH; Swapna Dave, MBBS; Himali Bharucha, Zohrab Mirza, MPH, Waqas Khan, Sarah Aziz Hussain, and Catherine Counard, MD, MPH. Without your welcoming kindness and translation skills, this project would not be possible.

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