A systematic review of acceptance and commitment therapy in sub-Saharan Africa: Understanding the cultural adaptations

Acceptance and Commitment Therapy (ACT) is being applied globally (Lim et al., 2024) and shows potential for addressing the significant mental health treatment gap in sub-Saharan Africa (WHO, 2022). This review examined the current evidence on the implementation, reported outcomes, and cultural adaptation of ACT in this region.

Following PRISMA guidelines, a systematic search was conducted across four databases: PsycINFO, PubMed, ProQuest, and Scopus. We conducted a narrative synthesis, including descriptive comparison of study characteristics, reported outcomes, and effect sizes where available.

Nineteen studies met the inclusion criteria. ACT interventions were implemented across diverse populations, including adolescents, university students, healthcare providers, and clinical groups, and were delivered in school, university, community, and healthcare settings. Interventions varied in format, duration, and targeted outcomes, with studies reporting improvements in psychological symptoms, performance-related outcomes, and psychological flexibility. Cultural adaptations were reported in some studies, primarily involving language, delivery structure, or contextual framing, although reporting often lacked specificity. Adaptations were made to language, delivery formats, and contextual factors. Interventions were applied equally among youth and adults, often in group-based settings. Acceptance emerged as the most frequently targeted ACT process. Cultural modifications enhanced both feasibility and acceptability. However, all studies relied on assessment tools developed in Western contexts.

The evidence provides preliminary supportl for the implementation of ACT in SSA across diverse populations and settings. The review highlights the importance of clearer reporting of adaptation processes and greater attention to construct validity and cultural relevance in future research.