Efficacy testing of the DSM-5 Cultural Formulation Interview for patients in vocational rehabilitation in Norway

Patients with work-related musculoskeletal disorders risk becoming outsiders of society due to the complexity of their health and life situations. Chronic pain is often predominant, and the comorbidity rate is high, with anxiety and depression as the most common disorders. Due to the high prevalence and multidimensional character of chronic pain, there has been a call for person-centered and comprehensive approaches that include cultural aspects and an existential dimension. The DSM-5 Cultural Formulation Interview (CFI) is person-centered and was developed to explore all patients' perceptions of illness, health and support in relation to their life contexts. The study forms part of a larger mix-methods project testing the efficacy of the core CFI (16 questions) in various Norwegian clinical contexts. The objective was to efficacy test the core CFI with patients in vocational rehabilitation treatment.

The design was inspired by field trials for efficacy testing of the core CFI in the United States. In Norway, the efficacy design went beyond conducting the core CFI in order to follow the use of the CFI information throughout the treatment process. This was referred to as the CFI process. Six consecutive patients were interviewed at three stages: the core CFI on day 1 of treatment, T2 interviews 5-7 days later, and T3 interviews at completion of treatment. Deductive content analysis, following Elo and Kyngäs, was used. Fidelity analysis for conducting the core CFI evidenced high scores.

The main results were: 1) T1-core CFI: Eliciting complex and broad understandings of pain-related problems affecting daily life, 2) T2: The core CFI as a holistic experience, facilitating reflections and hope for the treatment, and 3) T3: The treatment as a significant learning arena with the core CFI as a reflexive basis for treatment processes and expectations.

Patients found the CFI process to be complex, positive, and holistic, leading to reflections and expectations for their treatment. This was evidenced further by results from the Debriefing Instrument for Patients (DIP). Future clinical implementation of the core CFI should build on a person-centered foundation, incorporating accountable integration of patients' treatment expectations and illness/health narrative information.