Alcántara Carmela, Giorgio Cosenzo Luciana, Diaz Sarah V, Arias Darwin, Schwartz Joseph E, Kronish Ian M, Moise Nathalie
School of Social Work, Columbia University, USA.
University of Alabama School of Social Work, USA.
Lancet Reg Health Am. 2025 Jul 1;48:101158. doi: 10.1016/j.lana.2025.101158. eCollection 2025 Aug.
Digital therapeutics represent an innovative and scalable means for addressing inequities in access to behavioural healthcare. However, the adaptation of digital health technologies for minoritised communities to promote equitable uptake remains elusive, and the procedures and outcomes are often not systematically detailed. Our aim was to describe the equity-centred, theory-informed process we undertook to culturally adapt, for Spanish-speaking Hispanic adults, the first Food and Drug Administration authorized, self-guided, prescription digital therapeutic for insomnia.
We used an integrated four-stage model of cultural adaptation to guide the process and a cultural adaptation taxonomy of common elements to report findings. A bilingual (Spanish/English) community advisory board provided critical input. In Stages 1-3, ten focus groups and 13 individual interviews were conducted to obtain feedback on cultural adaptations and digital components. In Stage 4, a pilot study was undertaken to assess usability of the adaptations. Qualitative data were analysed using thematic content analysis and coded by type of adaptation.
53 Hispanic adults with chronic insomnia were invited to participate in all stages; Mean age = 53.6 years (SD = 11.4), 64.2% women, 49% less than college, and 62.3% reported low technological confidence. Cultural adaptations were made in each taxonomy component (83 total); the adapted program had high usability (System Usability Scale = 95/100). Surface-level adaptations (34.9% of changes made based on observable characteristics), which included changes to the characters (storylines, images), activities, and content to reflect the within-Hispanic group heterogeneity. Deep-level adaptations (65.1% of changes made based on sociocultural factors) included the integration of sociocultural values () and environment/burdens (stressors, social determinants, immigrant status) into the intervention content, and more in-App guidance/instruction to facilitate navigation for low health and digital literacy.
We produced a digital therapeutic for insomnia for Hispanic adults across the digital literacy spectrum with high acceptability, usability, and potential to confer clinical benefits.
This project was supported by AHRQ HS024274 and a Provost Grant from Columbia University.
数字疗法是解决行为健康护理获取不平等问题的一种创新且可扩展的方式。然而，将数字健康技术应用于少数族裔社区以促进公平采用的情况仍然难以捉摸，其程序和结果往往没有系统地详细说明。我们的目标是描述我们为讲西班牙语的西班牙裔成年人进行文化适应所采用的以公平为中心、基于理论的过程，这是美国食品药品监督管理局授权的首个用于失眠症的自我引导式处方数字疗法。
我们使用了一个综合的四阶段文化适应模型来指导这一过程，并使用常见元素的文化适应分类法来报告研究结果。一个双语（西班牙语/英语）社区咨询委员会提供了关键意见。在第1至3阶段，进行了10个焦点小组和13次个人访谈，以获取关于文化适应和数字组件的反馈。在第4阶段，进行了一项试点研究以评估适应措施的可用性。定性数据采用主题内容分析法进行分析，并按适应类型进行编码。
邀请了53名患有慢性失眠症的西班牙裔成年人参与所有阶段；平均年龄 = 53.6岁（标准差 = 11.4），64.2%为女性，49%学历低于大学，62.3%表示技术信心较低。在每个分类法组件中都进行了文化适应（共83项）；改编后的程序具有很高的可用性（系统可用性量表 = 95/100）。表面层面的适应（基于可观察特征做出的改变占34.9%），包括对角色（故事情节、图像）、活动和内容的改变，以反映西班牙裔群体内部的异质性。深层次的适应（基于社会文化因素做出的改变占65.1%）包括将社会文化价值观（）和环境/负担（压力源、社会决定因素、移民身份）融入干预内容，以及在应用程序中提供更多指导/说明，以方便健康和数字素养较低的人群进行操作。
我们为不同数字素养水平的西班牙裔成年人开发了一种用于失眠症的数字疗法，具有较高的可接受性、可用性和提供临床益处的潜力。
本项目由美国医疗保健研究与质量局（AHRQ）HS024274资助以及哥伦比亚大学教务长奖资助。
