Nittas Vasileios, Chavez Sarah J, Daniore Paola
Department of Behavioral and Social Sciences, Brown University, 121 South Main Street, Providence, RI, 02912, United States, 1 6944624408.
Brown University Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States.
JMIR Mhealth Uhealth. 2025 Jul 18;13:e59965. doi: 10.2196/59965.
Some people are less likely to benefit from digital health interventions (DHIs) than others. Culture, along with other factors, contributes to these differences. DHIs that do not address a population's cultural norms or concerns are likely to be less effective. One way to create culturally sensitive DHIs is through cultural adaptations. Yet, there is currently little evidence-based guidance on when and how to adapt DHIs.
We aimed to capture the experiences of experts to understand the (1) current practices, (2) challenges, and (3) recommendations around culturally adapting DHIs.
We conducted semistructured interviews (n=15) via Zoom (Zoom Video Communications, Inc) between May and August 2023, with academic experts who have previously undertaken cultural adaptations of DHIs. Experts were identified through publications and snowball sampling. We used a thematic analytical approach, beginning with a preliminary deductive codebook and then following a three-stage analysis. All transcripts were coded with the MAXQDA (VERBI Software GmbH) software. Codes were reviewed, and similar or related codes were categorized into broader themes, consolidating one or multiple codes into a single topic.
Our analysis produced 30 codes, which were categorized into (1) defining culture, (2) justifying the adaptation, (3) choosing the adaptation elements, (4) implementing the adaptation, (5) understanding the challenges, and (6) recommendations. Based on their experiences, experts recommended that (1) the adaptation team is multiprofessional, digitally competent, and culturally sensitive; (2) DHI users and (3) all other relevant stakeholders are continuously involved; and (4) the adaptations incorporate evaluations and knowledge exchange. They further emphasized that culturally adapted DHIs must be understandable, relatable, appealing, and easy to adhere to, ensuring that health technology and content reflect the target population's lived experiences, sociodemographic characteristics, and digital literacy. When asked which elements of cultural DHI adaptations, the most common responses were language, lived experience, and technology. Responses revealed five common DHI-relevant challenges, including (1) technology, (2) uncertainty, (3) user involvement, (4) communication, and (5) evaluation and sustainability.
The cultural adaptation of DHIs was described as an iterative, often unstructured, and resource-intensive process that requires careful justification and a solid understanding of the culture and the specific cultural group for which it is implemented. Our interviews confirmed the absence of technology-specific frameworks to guide the cultural adaptations of DHIs. Based on our findings, such a framework should guide the choice of the correct definition of culture and the criteria for assessing the need to adapt. It should also offer tools to drive stakeholder engagement, prioritize adaptation elements, and address common challenges.
与其他人相比，有些人从数字健康干预措施（DHI）中获益的可能性较小。文化与其他因素共同导致了这些差异。未考虑人群文化规范或担忧的DHI可能效果较差。创建具有文化敏感性的DHI的一种方法是进行文化调适。然而，目前关于何时以及如何调适DHI的循证指南很少。
我们旨在了解专家的经验，以理解（1）当前围绕DHI进行文化调适的做法、（2）挑战和（3）建议。
2023年5月至8月期间，我们通过Zoom（Zoom Video Communications公司）对15位学术专家进行了半结构化访谈，这些专家此前曾对DHI进行过文化调适。通过出版物和滚雪球抽样确定专家。我们采用了主题分析方法，首先使用初步的演绎编码手册，然后进行三阶段分析。所有访谈记录均使用MAXQDA（VERBI Software GmbH）软件进行编码。对编码进行审查，将相似或相关的编码归类为更广泛的主题，将一个或多个编码合并为一个单一主题。
我们的分析产生了30个编码，分为（1）定义文化、（2）证明调适的合理性、（3）选择调适要素、（4）实施调适、（5）理解挑战和（6）建议。基于他们的经验，专家建议：（1）调适团队应具备多专业背景、数字能力和文化敏感性；（2）让DHI用户和（3）所有其他相关利益相关者持续参与；（4）调适应纳入评估和知识交流。他们进一步强调，经过文化调适的DHI必须易于理解、相关、有吸引力且易于坚持，确保健康技术和内容反映目标人群的生活经历、社会人口特征和数字素养。当被问及文化DHI调适的哪些要素时，最常见的回答是语言、生活经历和技术。回答揭示了五个与DHI相关的常见挑战，包括（1）技术、（2）不确定性、（3）用户参与、（4）沟通以及（5）评估和可持续性。
DHI的文化调适被描述为一个迭代的、通常无结构的且资源密集的过程，需要仔细论证并深入了解其实施所针对的文化和特定文化群体。我们的访谈证实缺乏指导DHI文化调适的特定技术框架。基于我们的研究结果，这样一个框架应指导对文化的正确定义的选择以及评估调适需求的标准。它还应提供工具以促进利益相关者的参与、确定调适要素的优先级并应对常见挑战。
