A Quantitative Systematic Review to Evaluate the Favorability of the DSM-5 Cultural Formulation Interview (CFI) on the Acceptability, Feasibility, and Clinical Utility for Clinicians, Patients, and Relatives

Abstract

The Cultural Formulation Interview (CFI) is a semi-structured interview in the DSM-5 comprised of three parts: a core-16-item questionnaire, an informant version for relatives or relevant others, and 12 supplementary modules placing culture and context at the center of patient assessment and treatment to clarify diagnosis and treatment and ensure patients feel understood. The paper aims to synthesize the current quantitative evidence on CFI’s favorability (i.e., whether it is feasible, acceptable, and valuable) for patients, clinicians, and relatives. A mixed-methods synthesis methodology was used to assess the impact of the favorability of the CFI for patients, clinicians and relatives, and clinicians’ cultural competence. The synthesis included 10 studies on the clinician’s competency, attitudes, training, and diagnosis, three studies on the views of the patients and clinicians about the CFI, and five studies with 34 estimates ( n = 581) on the favorability of the CFI for patients, clinicians and relatives. Clinicians reported that the CFI increased their cultural knowledge across research, training, and practice settings. Patients reported that the CFI prioritized their perspective and increased rapport-building. A quantitative estimate from the five studies on the acceptability, utility, and feasibility of CFI from patients, relatives, and clinicians was favorable, suggesting that patients, relatives, and clinicians were satisfied with using the CFI. A protocol for standardizing CFI training and practice to inform future research using mixed-methods designs that include randomized control trials (RCTs) to examine the effect of the CFI on the clinician’s cultural competence, working alliance, and patient’s level of functioning was recommended.