Contextual approach to emotional and psychological support for Malaysian adolescents: Feasibility and pilot outcomes

Abstract

The call to action to develop and implement a culturally appropriate prevention program has become an important goal to remedy Malaysia's growing number of emotionally distressed adolescents. Contextual behavioural-based interventions are progressively favoured to support adolescents and young people. The present study primarily investigates the feasibility of implementing a prevention program for Malaysian adolescents using a culturally adapted Discoverer, Noticer, Advisor and Values (DNA-V) protocol. The study consisted of two phases. In Phase 1, the content and ecological validity of the culturally adapted protocol, the Time to ACT! (‘TTA’) protocol was examined by five experts using a concurrent transformative mixed-methods design. The content validity was evaluated using Lawshe's Content Validity Index, and the ecological validity was assessed using Bernal's Ecological Validity Model. In Phase 2, nineteen Malaysian secondary students were recruited for the pilot to test its feasibility and acceptability by assessing anxiety, stress, and psychological flexibility levels pre- and post-program, number of dropouts, and participants' receptiveness. Further refinement and finalisation of the protocol were made post-program. In Phase 1, recommendations by the experts were made to improve the importance and clarity criteria of the major components of language (i.e. translation of terms from English to Bahasa Malaysia), metaphor (i.e. symbolism in Malaysian context) and concepts (i.e. uses of DNA-V concepts and terminologies in the Malaysian context) to enhance the content validity and ecological sensitivity of the protocol. The results in Phase 2 showed no statistically significant differences in the reduction of anxiety, stress and psychological inflexibility. Nevertheless, participants' and experts' high endorsement of its application and content showed the program's feasibility and acceptability as a prevention program for Malaysian adolescents. Most contents remained in the final versions of the ‘TTA’ protocol, with few refinements of the terminologies in the Bahasa Malaysia version of the ‘TTA’ protocol. Main findings, strengths, limitations and future directions were discussed. This study acts as a stepping stone toward future improved trials which will benefit Malaysian adolescents' mental health.