Client’s and Clinicians’ Experiences of the DSM-5 The Cultural Formulation Interview: A Mixed Method Study in Pakistani Outpatient Setting

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.