JMIR Publications

ABSTRACT

Background:

Some people are less likely to benefit from digital health interventions than others. Together with other factors, culture contributes to these differences. Digital health interventions that do not address the cultural norms or concerns of a population are likely to be effective. One way to create culturally sensitive digital health interventions is through cultural adaptations. Yet, there is currently little no frameworks to inform when and how to adapt digital health interventions.

Objective:

We aimed to capture expert experiences to better understand (a) current practices, (b) challenges, and (c) recommendations around culturally adapting digital health interventions.

Methods:

We conducted semi-structured online interviews, conducted via Zoom between May and August 2023 with academic experts who have previously undertaken cultural adaptations of digital health interventions. Experts were identified through publications and snowball sampling. We used a thematic analytical approach starting with preliminary deductive codebook and followed by a 3-stage analysis. All transcripts were coded using MAXQDA. Codes were reviewed and similar or related codes categorized into broader themes, capturing one or multiple codes into a single topic.

Results:

We interviewed 17 experts. Our analysis yielded 30 codes, which were categorized into: (1) justifying the adaptation and defining culture, (2) choosing the adaptation elements, (3) implementing the adaptation, (4) understanding the challenges, and (5) recommendations. Based on their experiences, experts recommended that (a) the adaptation team is multi-professional, digitally competent, and culturally sensitive, (b) that DHI users and (c) all other relevant stakeholders are continuously involved, and (d) the adaptations integrate 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 lived experience, socio-demographic characteristics, and digital literacy of the target population. 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.

Conclusions:

The cultural adaptation of digital health interventions was described as an iterative, often unstructured, and resource-intensive process, that needs careful justification and a good understanding of culture and the cultural group it is conducted for. Our interviews confirmed the lack of technology-specific systematic approaches to guide cultural adaptations of digital health interventions. Future research should focus on thoroughly evaluating adapted DHIs and explore systematic ways to mitigate core challenges.