JMIR Publications

ABSTRACT

Background:

Health IT tools are increasingly used to help improve patient care. However, implementation of English-only Health IT tools could potentially worsen health disparities for non-English speakers.

Objective:

We describe the “trans-creation” process of developing linguistically and culturally appropriate Health IT tools through a detailed case analysis of a waiting room Health IT tool designed to help Spanish-speaking Latinos prepare for primary care visits.

Methods:

We adapted an English-language Visit Planner application for Spanish-speaking Latino patients. We applied culturally-defined themes derived from prior published research and from input by both skilled linguists and potential end-users. Initial changes were iteratively reviewed and edited by a team of writers, health care educators, subject matter experts, patients and providers.

Results:

The transcreation process resulted in the following key culturally-mediated changes to the tool: 1) Replacing the “provider” actors with “patient” actors; 2) Changing the choice of “Stress at Home or Work" (represented by an icon of a house) to “Mi Familia” (translation: My Family; icon = outline of family members holding hands); 3) Replacing the English terms “anxiety” and “depression” with “Me siento desanimado”(translation: I am feeling down) to avoid mental health stigma; 4) Using more concise text translation to ensure the wording fit the available on-screen space.

Conclusions:

The transcreation process of cultural and linguistic adaptation led to several design changes that would not have been implemented if we had simply translated the words from English to Spanish.