A heuristic framework for the cultural adaptation of interventions

What conditions justify cultural adaptations to evidence-based treatments, and how might those adaptations be developed? Lau's (2006) analysis brought considerable clarity to these questions. We place Lau's insights and those of others within an elaborated framework that proposes tests of three types of cultural equivalence to determine when evidence-based treatments might merit adaptations: equivalence of (a) engagement, (b) action theory, and (c) conceptual theory. Extrapolating from Lau's examples and recommendations of others, we describe a sequence for developing adaptations that consists of the following phases: (a) information gathering, (b) preliminary adaptation design, (c) preliminary adaptation tests, and (d) adaptation refinement.