# Development of culturally-appropriate text message booster content to follow a brief intervention focused on reducing alcohol related harms for injury patients in Moshi, Tanzania

## TL;DR

This study created culturally appropriate text messages in Swahili to support alcohol reduction efforts for injury patients in Tanzania.

## Contribution

The study developed and culturally adapted text message boosters for a brief intervention targeting alcohol use in a Tanzanian emergency department.

## Key findings

- Nearly 50 text messages were developed in English, but only 29 were successfully translated and adapted into Swahili.
- Themes of Self-awareness, Goal setting, and Motivation were central to the text message content.
- Culturalization is critical to ensure interventions are effective and relevant to the target population.

## Abstract

Alcohol use is a risk factor for death and disability and is attributed to almost one-third of injury deaths globally. This highlights the need for interventions aimed at alcohol reduction, especially in areas with high rates of injury with concurrent alcohol use, such as Tanzania. The aim of this study is to create a culturally appropriate text messages as a booster to a brief negotiational intervention (BNI), to in the Emergency Department of the Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Creation of text message boosters for an ED-based intervention expands the window of opportunity for alcohol use reduction in this high-risk population. The study followed a two-step approach to create the text message content in English and then translate and culturally adapt to Tanzanian Swahili. The culturalization process followed the World Health Organization’s process of translation and adaptation of instruments. Translation, back translation, and qualitative focus groups were used for quality control to ensure text message content accuracy and cultural appropriateness. In total, nearly 50 text messages were initially developed in English, yet only 29 text messages were successfully translated and adapted; they were focused on the themes of Self-awareness, Goal setting and Motivation. We developed culturally appropriate text message boosters in Swahili for injury patients in Tanzania coupled with a BNI for alcohol use reduction. We found it important to evaluate content validation for interventions and measurement tools because the intended text message can often be lost in translation. The process of culturalization is critical in order to create interventions that are applicable and beneficial to the target population.

Trial registration: Clinical Trials Registration Number: NCT02828267, NCT04535011