Adapting brief problem-solving therapy for
pregnant women experiencing depressive
symptoms and intimate partner violence in rural
Ethiopia

The seventh issue of ‘Evidence Bits’ draws from the findings of a study conducted by Roxanne C. Keynejad and co-authors, which sought to adapt an evidence-based psychological intervention to address depressive symptoms and IPV among pregnant women in rural Ethiopia. The adaptation was guided by the UK MRC/NIHR ADAPT framework, in order to develop a model was culturally relevant, feasible, and safe.

The current study systematically reports the process of implementing the latest guidance on contextual consideration, adaptation and theoretical explication of a complex intervention in rural Ethiopia, with piloting a randomised controlled trial in mind. This study is one of few which carefully describes the participatory process by which an evidence-based psychological intervention was adapted from a different setting for the Ethiopian context.

Women expressed both value and concern regarding the prospect of antenatal psychological therapy. They welcomed “the opportunity to share problems and feel understood,” but feared breaches of confidentiality and stigma. Antenatal care providers highlighted the importance of “training, referral systems, and manageable workloads.” Trust, privacy, and empathy were consistently cited as critical conditions for engagement.

The study demonstrates that adapting psychological interventions requires systematic consideration of cultural, systemic and ethical domains. By documenting the process in detail, the authors provide a replicable methodology for tailoring complex interventions in low- and middle-income countries.