Pilot Testing the Oh Happy Day Class:
A Culturally Adapted Depression Intervention
Earlise Ward, Ph.D.
Licensed Psychologist
Assistant Professor
ecward@wisc.edu
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Wisconsin: Depression
Age-Adjusted Hospital Admission
Rates Per 100,000 persons
180
171
160
145
140
120
125
95
113
100
Male
Female
80
67
60
40
20
0
Af Am
Am Ind
Asian
Latino
Cau
Wisc. Minority
Health Program 2
WWisconsin: Alcohol or Drug
Age-Adjusted Hospital Admission
Rates Per 100,000 persons
2,500
2,114; 935
2,000
1,500
1’280; 523
Male
Female
1,000
390;192
500
0
Af Am
Am Ind
Asian
Latino
Caucas
Wisc. Minority
Health Program 3
Culturally Adapted Interventions (CAIs)
• CAIs involve changes in approaches to service delivery,
nature of the therapeutic relationship, or in components of
the treatment to accommodate the cultural beliefs,
attitudes, and behaviors of the target population.7
• A recent meta-analysis of CAIs found CAIs were four
times more effective than interventions provided to mixed
groups of patients.8
• Literature review
No CAI developed specifically
for African American adults with depression.
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Addressing Depression Among
African American Adults
 The OHDC was developed to address this deficit.
Developing the OHDC
• Adapted the Coping with Depression Course CWD),9,10,11
• Conducted extensive preliminary research in which African
Americans’ beliefs about mental illness, stigma, preferred
and treatment preferences were identified,12,13,14
• Incorporated an Afrocentric paradigm; Nugzo Saba 7 life
principles (unity, self-determination, collective work and
responsibility, cooperative economics, purpose, creativity, and
faith)
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Oh Happy Day Class (OHDC)
• The OHDC is a cognitive behavioral group counseling
intervention, culturally adapted from the CWD.
• 2-hour weekly for 12 weeks.
• Community-based in churches, community & academic ctrs.
• Delivered jointly by 2 mental health therapist and a trained
paraprofessional community member.
• Uses a support group & psychoeducational approach
focusing on:
– Educating clients about depression & reducing
symptoms.
– increasing healthy coping behaviors.
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OHDC Weekly Topics
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Purpose of Pilot Study
• Test the feasibility and acceptability of the OHDC.
• Examine preliminary efficacy of the OHDC in
reducing symptoms of depression:
– Mid intervention (week 6)
– Immediately post-intervention (week 12)
– 3 months post-intervention (week 24)
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Methods
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•
•
•
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Design
– one-group pretest-posttest design
– Mixed method (qualitative and quantitative)
Pilot 1
16 African American women (community-dwelling)
Age range: 60-78 (M= 71 years)
Highest level of education- completed 8th grade
All retired
Pilot 2
19 African Americans (n=11 men; n=8 women)
Age range: 35 to 61 (M = 49 years)
Highest level of education- completed high school
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Methods
Data collection time points
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–
–
–
–
–
Screening
Baseline
Wee 6 (mid intervention)
Week 12 (immediate end of intervention)
Week 13 qualitative interview
Week 24 (3 months post-intervention
Data Analysis
– Descriptive statistics (mean scores) and T test for
comparison
– Qualitative analysis used dimensional analysis to
identify thems relevant to satisfaction and acceptability
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Results: Feasibility
• Pilot 1
– Enrolled 16 African-American women ages 60-78
(M = 71 years) within 2 months and retained
81%.
• Pilot 2
– Enrolled 19 African Americans [men n=11 and
women n=8] ages 35 to 61 (M = 49 years), within
3 months and retained 79%.
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Results - Acceptability
Is the OHDDI acceptable to participants?
Sample interview questions:
• Tell me about your experiences participating in OHDC.
• Tell me about your experiences participating in this
research study.
Analysis:
• Dimensional analysis: Identified relevant themes
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Results - Acceptability
 Staff willing to help
“And if something didn’t go well, they were willing to help and try to
solve the problem or come to a solution that we talked about. I
think it was great for me, it was. I don’t know about nobody else,
but it was beautiful to me because, I’m not a real talker with
people.”
 Talked and was comfortable
Oh, we talked about everything. We could soul with each other, you
know. We didn’t have to make up stuff, you know. It made me
feel comfortable. I felt at home. We become normal people, you
know. I wish that others could have that same feeling that we had.
 Trust
And we talked and we trusted one another. We didn’t go around
throwing stones or talking about each other. We talked about what
positive things are. We talked about that a lot. You know, and it
was just a nice group. I don’t think I could get a better group.
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Results: Efficacy
Was the OHDDI efficacious in reducing symptoms of depression?
Measure
• Center for Epidemiological Studies Depression Scale (CES-D)
– 20-items and self-administered
– Items scored 0-3, with a possible range of scores from 0-60.
– Standard cutoff score of 16 has been defined as indicating
clinical depression (Nguyen, Kitner-Triolo, Evans, & Zonderman, 2004).
– 16 to 24: borderline elevation of depressive symptoms.
– 24 and above: significant elevation of depressive symptoms.
Analysis:
• Descriptive statistics (mean scores) and T test for comparison
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Results: Efficacy of OHDC in reducing symptoms? P1
16 cutoff
16-24
borderline
elevation
24+ signif
elevation
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Results: Efficacy of OHDC in reducing symptoms? P2
16 cutoff
16-24
borderline
elevation
24+ signif
elevation
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Summary of Preliminary Results
• Study was feasible with trained staff and financial
resources.
• Participants found the OHDC acceptable and were
satisfied.
• Intervention was found to be efficacious in reducing
symptoms of depression.
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Application to Caribbean Populations
• Research
– Due to similar culture and health disparities it is feasible to
replicate current study in the Caribbean
• Possible Challenges
– Funding to conduct study
– Perceived stigma associated with mental illness
– Recruitment and retention
• Anticipated outcomes
– Reduction in symptoms of depression
Despite challenges, can it be done? Yes we can!!
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Future Research
• Secure funding (R01) to test the intervention in a
larger sample using RCT design
• Explore collaborations to replicate research in the
Caribbean
Acknowledgements
UW Institute of Clinical and Translational Research
UW School of Nursing
National Institute of Nursing Research
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