Abstract:
Cultural factors profoundly impact mental health perceptions and treatment, necessitating
culturally competent approaches in clinical practice. The Cultural Formulation Interview (CFI)
from DSM-5 provides a framework for integrating cultural contexts into mental health
assessments. However, its adaptation and efficacy in non-Western settings remain
underexplored. This study addresses this gap by translating and validating the CFI into Urdu
for use in Pakistan, a culturally diverse context with unique mental health perceptions. This
research aimed to translate the CFI and its supplementary modules into Urdu; to assess the
agreement in CFI ratings between clients, clinicians, and informants; to investigate changes in
clinicians’ ratings of the CFI with increased experience; and to analyze qualitative insights
from CFI assessments. The study was conducted in two phases. The first phase involved the
translation of the CFI using a structured process including forward translation, expert review,
back-translation, and cognitive interviewing. The final Urdu-adapted CFI was pre-tested with
clinicians for cultural relevance. The second phase utilized a mixed-method design.
Quantitatively, data was collected from 30 clients, 10 clinicians, and 10 informants in public
hospitals in Islamabad. Clinicians conducted multiple CFI interviews and rated its clinical
value, utility, feasibility, and acceptability. Qualitatively, 40 audio-recorded interviews were
analyzed to extract thematic insights. The study revealed significant differences in the utility
ratings of the CFI across groups. Clinicians rated the CFI’s clinical value and utility
significantly higher than clients and informants. The clinicians’ ratings of the CFI improved
with experience, showing increased utility and feasibility after repeated use. The qualitative
analysis highlighted cultural nuances and revealed varying perceptions of the CFI’s
effectiveness and relevance among different groups.
