Flexible Interview for ICD-11 (FLII-11): Cultural Adaptation and Translation for India

The Flexible Interview for ICD-11 (FLII-11) is a new structured diagnostic interview developed by the World Health Organization (WHO) for diagnosing mental disorders based on the ICD-11's clinical descriptions and diagnostic requirements. The instrument is to be used for India's National Mental Health Survey-2 as the primary assessment instrument for mental health morbidity. This paper outlines the systematic process of culturally adapting the FLII-11 for India. Given India's immense cultural and linguistic diversity, this was deemed a crucial step to ensure a valid and reliable data collection process. Key steps included: preliminary evaluation by experts for language and cultural congruence; ascertaining the adaptation's effectiveness in clinical settings; interim analysis, followed by modifications and retesting; and incorporating feedback from both Indian and international collaborators. It also describes the protocol for translating the instrument into 22 recognized Indian languages, ensuring that it can be administered in each state's language. This project was an international collaboration involving teams from India, South Africa, the UK and the USA. Almost all of the changes made from this study were also incorporated into the current version of the FLII-11, which is being tested in other countries, representing the study's global contribution of the study.