Cultural adaptation of the facial emotion perception test for use in Zimbabwe: A pilot study

Abstract

Background: In African countries, including Zimbabwe, about half of those with depression respond to first-line therapies like problem-solving therapy. Predicting who needs more intensive treatment is challenging. In the US and Europe, tools like the Facial Emotion Perception Test (FEPT) help match treatments to likely responders. However, its applicability in Zimbabwe is unexplored. Aim: To develop a racially diverse adaptation of the FEPT for Shona-speaking Zimbabweans. Setting: Outpatient primary healthcare clinics at Marondera Provincial Hospital and Chitungwiza Central Hospital, Zimbabwe. Methods: Facial Emotion Perception Test was adapted using the Ecological Validity Model’s eight constructs through a four-step process: expert consultation, preliminary content adaptation, iterative content adaptation, and finalising adaptation. Three focus groups and 12 cognitive interviews assessed cultural appropriateness, suitability, usability and acceptability of FEPT for Zimbabwean Shona speakers. Fifteen participants, including graduates, primary healthcare workers and individuals with lived experience of depression, took part. Results: Key adaptations of FEPT-Multiple-Races (MR)-Shona include: (1) added 20 black and 20 Asian face stimuli for cultural relevance; (2) improved stimuli resolution for clarity; (3) extended test duration from 6 to 10 minutes for repeatable tutorials; (4) provided bilingual instructions in Shona and English; (5) shifted to a low-cost touchscreen tablet, familiar to Zimbabwean participants. Conclusion: The adaptation shows promising cultural relevance and usability for Shona speakers. Further testing with diverse educational and contextual backgrounds is needed to enhance cross-cultural and ecological validity. Contribution: This study highlights the importance of culturally adapting cognitive performance tools that can potentially improve depression treatment outcomes in low-income countries.