Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study

Vincent Nyongesa; Joseph Kathono; Shillah Mwaniga; Obadia Yator; Beatrice Madeghe; Sarah Kanana; Beatrice Amugune; Naomi Anyango; Darius Nyamai; Grace Nduku Wambua; Bruce Chorpita; Brandon A. Kohrt; Jill W. Ahs; Priscilla Idele; Liliana Carvajal; Manasi Kumar

doi:10.1371/journal.pone.0277619

Peer Review History

Original SubmissionMay 2, 2022
20 Jul 2022 Decision Letter - Caroline Kingori, Editor PONE-D-22-12888Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures studyPLOS ONE Dear Dr. Kumar, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Sep 03 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. You indicated that you had ethical approval for your study. In your Methods section, please ensure you have also stated whether you obtained consent from parents or guardians of the minors included in the study or whether the research ethics committee or IRB specifically waived the need for their consent. 3. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 4. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. 5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: • This was a very good and enjoyable manuscript. The need for culturally appropriate measurement scales is a logical point and well explained in the introduction section. My feedback is really on structure and writing to make sure it is readable and findings easy to review. • Introduction section – provides a good overview of what the TAA process is and the importance of using a participatory method to improve measurement scales. In the objective, you mention only FGDs (no mention of C.Is). • Box 1 – restructure/reformat table another way as the words seems to scatter off making it difficult to identify the 3 different columns (Domains, FGD & CD findings). Same applies for Table 3 • Page 31 – 3rd sentence “there are dual roles…” --- reconsider that sentence, reads a bit unclear • Study implications are very well discussed though the latter discussion read a bit disconnected from the overall scope of the study. This last paragraph focuses, though accurate, the need for support services. The study findings tended to focus on the actual adaptation of the scales and not on the lived experience/challenges of the youth. Though important, in order for this to connect with this last paragraph, maybe providing some findings on that so that we can get context on what the service needs are. • Writing – a few scattered grammatical errors noted (either missing a word or have an extra work somewhere. Be sure to review entire document to catch those hidden errors. Reviewer #2: This study described the process of culturally adapting mental health assessment measures for adolescents in Kenya. This article is important because it highlights the lack of culturally tailored mental health tools for this population. The strength of this article is that authors used a thorough multi-stage adaptation process. To improve this article, I suggest that authors should focus on reducing some redundancy in the text and clarifying the methods that were used in the adaptation process. Introduction Page 6, Paragraph 1: This paragraph is quite redundant. The following four sentences say very similar things and can be combined. • In addition, multi-stakeholder inquiries involving representatives from different groups in the society are crucial as they bring different views that help tailor the tools to meet specific needs of the target group (13). • Global mental health emphasizes multistakeholder engagement and recognizes the need for linguistic and cultural adaptation of mental health tools (15,16). • Therefore, involvement of service consumers or community members in making decisions during cultural adaptations and letting experts make sure final changes and decisions are inclusive helps maintain touch with the local realities (17). • Checking with subject experts and end-users from time to time ensures relevance of the adapted tool. Methods • The paragraphs for study setting and study site should be combined • It was hard to follow all of the data collection activities that were conducted and how they were ordered. To clarify this section, clearly define what the TTA approach is. Additionally, provide greater details about the protocols for each data collection activity . • In analysis section, describe how data from body mapping and free listing activity were analyzed if differently from CI and FGD transcripts. Results • It is mentioned that pregnant and parenting adolescents were included as participants, however the extent to which their responses differed from non-parenting adolescents isn’t included in the results section. • It was helpful to see the table with all of the adjustments that were made, but the table was hard to follow. This is partially due to formatting. It may be more useful to have that table as an appendix and include the final items in Kiswahili and English in the main text. • Page 28-29: The section, “Age and gender differences around idioms used to express mental health difficulties and distress” is interesting, but it is unclear which parts of data collection the findings come from. It seems like a mixture of observations and the body mapping exercise. Additionally, parts of this section also are more appropriate for the discussion than the results section. For example, the sentences explaining what Sheng is should be in the discussion section. Discussion • The discussion notes that the study sought to gain an improved understanding of the “UNICEF mental health module for adolescents,” or “MMA protocol” yet that was not described in the methods and results. Include information in the methods describing what the module was, the methods for assessing the module, and participants assessment of the module. • Include a paragraph where you describe any study limitations and strengths. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Elizabeth Wachira Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0277619.r001
Revision 1
26 Sep 2022 Author Response 30th August 2022 To The Editor PLOS ONE Re: Resubmission of paper ‘PONE-D-22-12888 Cultural and contextual adaptation of mental health measures in Kenya: an adolescent-centered transcultural adaptation of measures study’ Dear Dr. Caroline Kingori We want to thank you for reviewing our manuscript and we have spent some time editing the paper and have provided point- by-point response given here below. We are grateful to the reviewers for their comments and feedback. We hope you the edited paper will meet your expectation. Regards Vincent Nyongesa Manasi Kumar Response to reviewers Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response: we thank you and have now edited the manuscripts per guidance. 2. You indicated that you had ethical approval for your study. In your Methods section, please ensure you have also stated whether you obtained consent from parents or guardians of the minors included in the study or whether the research ethics committee or IRB specifically waived the need for their consent. Response: Thank you, we have added this statement (Please see page 9) 3. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. Response: we thank for noticing this inconsistency and we have now addressed this. The senior author was funded by Fogarty and the costs of activities were partially covered by UNICEF. 4. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. Response: We have attached focus group discussion, and cognitive interview transcripts, and a table as supplementary information 5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. Response: Thank you, we have corrected this now. 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: • This was a very good and enjoyable manuscript. The need for culturally appropriate measurement scales is a logical point and well explained in the introduction section. My feedback is really on structure and writing to make sure it is readable and findings easy to review. • Introduction section – provides a good overview of what the TAA process is and the importance of using a participatory method to improve measurement scales. In the objective, you mention only FGDs (no mention of C.Is). Response: Thank you, we have now mentioned Cognitive interviews under this section • Box 1 – restructure/reformat table another way as the words seems to scatter off making it difficult to identify the 3 different columns (Domains, FGD & CD findings). Same applies for Table 3 Response: Thank you, we have added table grids to make it readable • Page 31 – 3rd sentence “there are dual roles…” --- reconsider that sentence, reads a bit unclear Response: Thank you, we have cut down and restructured this sentence • Study implications are very well discussed though the latter discussion read a bit disconnected from the overall scope of the study. This last paragraph focuses, though accurate, the need for support services. The study findings tended to focus on the actual adaptation of the scales and not on the lived experience/challenges of the youth. Though important, in order for this to connect with this last paragraph, maybe providing some findings on that so that we can get context on what the service needs are. Response: Thank you for pointing at this, we have clarified this section (See page 32) • Writing – a few scattered grammatical errors noted (either missing a word or have an extra work somewhere. Be sure to review entire document to catch those hidden errors. Response: Thank you for pointing to this, we have checked this on Grammarly software and edited the work Reviewer #2: This study described the process of culturally adapting mental health assessment measures for adolescents in Kenya. This article is important because it highlights the lack of culturally tailored mental health tools for this population. The strength of this article is that authors used a thorough multi-stage adaptation process. To improve this article, I suggest that authors should focus on reducing some redundancy in the text and clarifying the methods that were used in the adaptation process. Introduction Page 6, Paragraph 1: This paragraph is quite redundant. The following four sentences say very similar things and can be combined. • In addition, multi-stakeholder inquiries involving representatives from different groups in the society are crucial as they bring different views that help tailor the tools to meet specific needs of the target group (13). • Global mental health emphasizes multistakeholder engagement and recognizes the need for linguistic and cultural adaptation of mental health tools (15,16). • Therefore, involvement of service consumers or community members in making decisions during cultural adaptations and letting experts make sure final changes and decisions are inclusive helps maintain touch with the local realities (17). • Checking with subject experts and end-users from time to time ensures relevance of the adapted tool. Methods Response: Thank you, we have combined and edited the sentences per your suggestion (See page 6) • The paragraphs for study setting and study site should be combined Response: Thank you for pointing to this, we now have merged them (Please see page 7) • It was hard to follow all of the data collection activities that were conducted and how they were ordered. To clarify this section, clearly define what the TTA approach is. Additionally, provide greater details about the protocols for each data collection activity. Response: Thank you, we have elaborated the steps, and this work has been explained in the following publications we have now added more information here (Please see page 8). Joseph Hayes, Liliana Carvajal, Zeinab Hijazi, Jill Witney Ahs, P. Murali Doraiswamy, Fatima Azzahra El Azzouzi, Cameron Fox, Helen Herrman, Charlotte Petri Gornitzka, Brandon Staglin, Miranda Wolpert,You Can’t Manage What You Do Not Measure - Why Adolescent Mental Health Monitoring Matters, Journal of Adolescent Health, 2021, ISSN 1054-139X, https://doi.org/10.1016/j.jadohealth.2021.04.024.(https://www.sciencedirect.com/science/article/pii/S1054139X21002214) Carvajal L, Ottman K, Ahs JW, Li GN, Simmons J, Chorpita B, Requejo JH, Kohrt BA. Translation and Adaptation of the Revised Children's Anxiety and Depression Scale: A Qualitative Study in Belize. J Adolesc Health. 2022 Aug 4:S1054-139X(22)00494-3. doi: 10.1016/j.jadohealth.2022.05.026. Epub ahead of print. PMID: 35934586. Liliana Carvajal, Jill W. Ahs, Jennifer Harris Requejo, Christian Kieling, Andreas Lundin, Manasi Kumar, Nagendra P. Luitel, Marguerite Marlow, Sarah Skeen, Mark Tomlinson, Brandon A. Kohrt, Measurement of Mental Health Among Adolescents at the Population Level: A Multicountry Protocol for Adaptation and Validation of Mental Health Measures, Journal of Adolescent Health,2022,ISSN 1054-139X,https://doi.org/10.1016/j.jadohealth.2021.11.035. (https://www.sciencedirect.com/science/article/pii/S1054139X21006935) • In analysis section, describe how data from body mapping and free listing activity were analyzed if differently from CI and FGD transcripts. Response: Thank you, the data from body mapping and free listing were part of FGDs, thus analyzed together Results • It is mentioned that pregnant and parenting adolescents were included as participants, however the extent to which their responses differed from non-parenting adolescents isn’t included in the results section. Response: Thank you for pointing to this, however, their responses were not so different from the non-parenting ones, they expressed more problems that come with conceiving at a younger age and challenges associated with continuation of education. • It was helpful to see the table with all of the adjustments that were made, but the table was hard to follow. This is partially due to formatting. It may be more useful to have that table as an appendix and include the final items in Kiswahili and English in the main text. Response: Thank you, we have added table grids for easy readability, we have also provided supplementary material with final wording. • Page 28-29: The section, “Age and gender differences around idioms used to express mental health difficulties and distress” is interesting, but it is unclear which parts of data collection the findings come from. It seems like a mixture of observations and the body mapping exercise. Additionally, parts of this section also are more appropriate for the discussion than the results section. For example, the sentences explaining what Sheng is should be in the discussion section. Response: Thank you, we have now clarified this on page 29, we have also moved part of this paragraph to discussion per your suggestions Discussion • The discussion notes that the study sought to gain an improved understanding of the “UNICEF mental health module for adolescents,” or “MMA protocol” yet that was not described in the methods and results. Include information in the methods describing what the module was, the methods for assessing the module, and participants assessment of the module. Response: the UNICEF publications came after the submission were made. We have now annotated those and reflected on some of these issues in the methods section. • Include a paragraph where you describe any study limitations and strengths. Response: Thank you for this suggestion, we have included this section (See page 32) Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0277619.r002
1 Nov 2022 Decision Letter - Caroline Kingori, Editor Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study PONE-D-22-12888R1 Dear Dr. Kumar, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Caroline Kingori Academic Editor PLOS ONE Additional Editor Comments (optional): Authors address a topic of great concern in the public health arena. Mental health is still a challenge across the globe and does not receive adequate resources. I was glad to see authors discuss the importance of cross-cultural adaptation of mental health scales within a niche population of young people in Kenya. While many of the mental health scales readily used to measure burden and impact on the populace, cross-cultural adaptation of such scales within heterogeneous communities is not well studied. I commend the authors for taking on the task. I concur with the reviewers that the paper is ready for publication. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: (No Response) Reviewer #2: (No Response) ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) Reviewer #2: (No Response) ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: (No Response) Reviewer #2: (No Response) ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: (No Response) Reviewer #2: (No Response) ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0277619.r003
Formally Accepted
1 Dec 2022 Acceptance Letter - Caroline Kingori, Editor PONE-D-22-12888R1 Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study Dear Dr. Kumar: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Caroline Kingori Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0277619.r004

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