JMIR Publications

ABSTRACT

Background:

Spanish-speaking populations in the United States face significant barriers to accessing mental health care, including language discordance, cultural mismatch, and limited availability of bilingual providers. Although digital mental health tools offer scalable solutions, most are not culturally or linguistically adapted, limiting their effectiveness and engagement among Spanish-speaking users.

Objective:

This study describes the translation and cultural adaptation of the Digital Clinic (DC) manual and associated digital tools for Spanish-speaking populations, with the goal of improving accessibility, engagement, and equity in digital mental health care.

Methods:

Guided by the Ecological Validity Framework (Bernal et al., 2009), the translation process addressed eight dimensions: language, persons, metaphors, content, concepts, goals, methods, and context. A stepwise approach was implemented, including initial translation by a bilingual clinician, secondary translation of digital and clinician-facing materials, and collaborative review to ensure linguistic accuracy, cultural relevance, and clinical fidelity. Existing Spanish-language clinical resources, including the Unified Protocol, were used to guide terminology and conceptual alignment.

Results:

The adapted manual preserved the core therapeutic components of the original model while incorporating culturally relevant language, tone, and examples. Key challenges included translating complex clinical terms and ensuring cross-regional comprehensibility. The final version improved clarity, cultural resonance, and usability for both clinicians and patients, while maintaining flexibility within a structured, short-term care model.

Conclusions:

Culturally and linguistically adapting digital mental health interventions is essential for equitable care. The Spanish-language Digital Clinic manual demonstrates a scalable approach to improving engagement and access for underserved populations. Future efforts should focus on multilingual infrastructure, clinician training, and region-specific adaptations to expand the reach and impact of digital mental health care.