Cultural adaptation
self-harm
Before the exploratory study, a group of mental health professionals translated the content of the manual into Urdu (Pakistan’s national language). A focus group with multidisciplinary health professionals (mental health professionals, general physicians, nurses) was conducted to discuss cultural adaptations, and special consideration was given to phrases and concepts to reflect Pakistani culture. Additionally, culturally appropriate case scenarios were incorporated and a consensual view to addressing cultural factors such as gender role, family conflicts and financial difficulties was taken. Issues related to substance misuse were replaced with more emphasis on family conflicts (culturally sensitive training in assertiveness and conflict management) as these conflicts usually lead to a self-harm episode in Pakistan.