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Objective <p>Fear of cancer recurrence (FCR) is a common concern among breast cancer survivors in Turkiye. Despite its clinical relevance, culturally adapted interventions are scarce. This study aimed to adapt the Fear of Recurrence Therapy (FORT), a structured group-based intervention, for Turkish breast cancer survivors using the Ecological Validity Model (EVM).</p> Methods <p>This study used a multi-phase mixed methods design conducted between February and September 2024. The cultural adaptation process included contextual literature review, translation and back-translation, ecological validity assessment by an expert panel (<i>n </i>= 6), cognitive interviews through focus groups with professionals and survivors (<i>n</i> = 6), and an adaptation workshop. A total of 12 participants contributed to the study, with no overlap between stages. Quantitative evaluations were analyzed using Gwet’s AC1 to assess inter-rater agreement across EVM domains. Qualitative feedback was analyzed through content analysis and used to guide manual revisions.</p> Results <p>Gwet’s AC1 scores indicated moderate to very good agreement across sessions and components, especially in content, context, and metaphors. Revisions addressed technical language, culturally inappropriate metaphors (e.g., funeral imagery), and unclear therapeutic exercises. Visual and structural improvements included consistent formatting, color-coded infographics, and a glossary of key terms. Focus groups helped ensure linguistic clarity, emotional appropriateness, and cultural fit. The final six-session manual was rated highly acceptable by both experts and survivors.</p> Conclusion <p>This study presents one of the first culturally adapted interventions targeting FCR in Turkiye. The participatory process emphasized ecological validity and cultural sensitivity, resulting in a clinically coherent and contextually appropriate manual. The adapted FORT program is now ready for pilot testing and provides a model for adapting evidence-based psycho-oncological interventions in other cultural settings.</p>

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Cultural adaptation of the fear of cancer recurrence therapy (FORT) for Turkish breast cancer survivors

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月15日

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  • Aslı Eyrenci,
  • Levent Ertuna,
  • Ozan Bahcivan

摘要

Objective

Fear of cancer recurrence (FCR) is a common concern among breast cancer survivors in Turkiye. Despite its clinical relevance, culturally adapted interventions are scarce. This study aimed to adapt the Fear of Recurrence Therapy (FORT), a structured group-based intervention, for Turkish breast cancer survivors using the Ecological Validity Model (EVM).

Methods

This study used a multi-phase mixed methods design conducted between February and September 2024. The cultural adaptation process included contextual literature review, translation and back-translation, ecological validity assessment by an expert panel (n = 6), cognitive interviews through focus groups with professionals and survivors (n = 6), and an adaptation workshop. A total of 12 participants contributed to the study, with no overlap between stages. Quantitative evaluations were analyzed using Gwet’s AC1 to assess inter-rater agreement across EVM domains. Qualitative feedback was analyzed through content analysis and used to guide manual revisions.

Results

Gwet’s AC1 scores indicated moderate to very good agreement across sessions and components, especially in content, context, and metaphors. Revisions addressed technical language, culturally inappropriate metaphors (e.g., funeral imagery), and unclear therapeutic exercises. Visual and structural improvements included consistent formatting, color-coded infographics, and a glossary of key terms. Focus groups helped ensure linguistic clarity, emotional appropriateness, and cultural fit. The final six-session manual was rated highly acceptable by both experts and survivors.

Conclusion

This study presents one of the first culturally adapted interventions targeting FCR in Turkiye. The participatory process emphasized ecological validity and cultural sensitivity, resulting in a clinically coherent and contextually appropriate manual. The adapted FORT program is now ready for pilot testing and provides a model for adapting evidence-based psycho-oncological interventions in other cultural settings.