# Cultural adaptation of a psychosocial screening tool for adolescents living with HIV/AIDS attending antiretroviral therapy program in Malawi

## TL;DR

This study adapted a mental health screening tool for adolescents with HIV in Malawi to better fit local cultural needs and improve identification of high-risk behaviors.

## Contribution

The paper introduces a culturally adapted version of the HEADSS tool tailored for Malawian adolescents living with HIV.

## Key findings

- The adapted HEADSS tool was found to be culturally acceptable and effective in identifying high-risk behaviors among adolescents with HIV.
- Healthcare providers reported that the tool simplifies the identification of issues like early sexual debut and substance abuse.

## Abstract

Adolescents living with HIV (ALHIV) face a higher risk of mental health problems than adolescents without HIV yet culturally appropriate mental health screening tools are lacking in settings like Malawi. This study aimed to culturally adapt the HEADSS (Home, Education, Activities, Drugs, Sexuality, Suicide/Depression) psychosocial screening tool for the Malawian context, as the original was previously found to be inappropriate.

The study was conducted between December 2021 and May 2022. We employed an adapted Heuristic Framework for cultural adaptation translations. Data was collected with Mental Health experts (n = 4), focus group discussions with ALHIV (n = 20), in-depth interviews with health care providers (HCPs) (n = 6) and key informants (n = 4). An iterative process of piloting and feedback guided the adaptation.

The adaptation addressed conceptually difficult, unacceptable, or stigmatizing items. HCPs reported that the adapted HEADSS tool may effectively guide the examination of ALHIV challenges and simplify the identification of high-risk behaviors (e.g., early sexual debut, self-harm and substance abuse). The tool’s language was culturally accepted by ALHIV, as the screening questions were available in both the local language and English, and accurately reflected their daily challenges.

Developing easy-to-use, comprehensible, and locally appropriate mental health screening tools is crucial for detecting high-risk behaviors and psychosocial issues among ALHIV. To effectively meet ALHIVs’ needs within HIV services, mental health interventions are essential for improving adherence to antiretroviral therapy (ART). Therefore, training HCPs to address sensitive risk issues during routine care is highly recommended.