Translation, Adaptation and Implementation of FRIENDS For Life with Pakistani Children

Abstract

Background: Pakistan being in the list of lower- and-middle income countries lack in mental health interventions. The high prevalence of mental health disorders in Pakistan signifies the need of culturally sensitive adapted intervention programs. Intervention applied early is the right fit for the prevention of mental health disorders and to reduce the associated disease burden. For children, schools are the first formal exposure of the world and can serve as a suitable place to begin with early interventions. Objective: This study aimed to translate and adapt the Friends for Life Program activity book to Urdu language. Moreover, study also aimed to assess the efficacy of the program in school setting. Method: The efficacy of the Urdu version of Friends for Life program was assessed by comparing the intervention group with control group using quasi experimental design (N=79). Random assignment of participants was made to intervention and control group. School was chosen based on convenience. Culturally adapted Urdu language versions of outcome measures were used to evaluate level of participant’s anxiety, behavioral problems, fear, anxiety, social skills and social problem-solving. The social validity and fidelity of the program was also assessed. Results: The results have shown a decrease behavioral issues, anxiety symptoms and fear while improvement in social skills and social problem-solving was observed. A significant decrease in behavioral problems (F=1.78, p<.01), peer problems (F=5.99, p<.01), externalizing symptoms (F=4.01, p<.05), internalizing symptoms (F=7.01, p<.05) as assessed by Strengths and Difficulty Questionnaire- Parent version (SDQ-P). Similarly, significant differences were found between intervention and control group for Generalized Anxiety Disorder (F=6.35, p<.05) and social anxiety (F=6.13, p<.05) as assessed by Screen for Child Anxiety Related Disorders (SCARED). On secondary outcome measures, significant reduction in overall fear (F=4.27, p<.05), fear of failure and criticism (F=4.28, p<.05), fear of unknown (F=9.69, p<.01) and fear of danger of death (F=5.36, p<.05) was observed as assessed by Fear Survey Schedule for Children- Revised (FSSC-R). Moreover, as hypothesized, significant improvement in social skills was also observed (F=4.47, p<.05) and social problem-solving skills (F=6.35, p<.05). The statistically significant findings indicate the usefulness of the program for school children. Conclusion: The study provided a preliminary evidence of Friends for Life program in school setting in Pakistan. Participants reported that program was beneficial and enjoyable. The Implementation of the program provided children the opportunity to learn new skills and build resilience.