More than translation: an exploratory case study of culturally-responsive modifications in digital mental health for multilingual families

Preliminary Evidence of Feasibility, Acceptability, and Potential Benefit of a Culturally Responsive Mental Health Engagement Program for Hispanic Adults, Pensamientos y Pláticas

Background/Objectives: Hispanic adults in the United States seek and access professional mental health services at a disproportionately lower rate than non-Hispanic White adults, despite having similar rates of mental health challenges. Community focus groups held in El Paso, Texas, in 2022 revealed both systemic and individual-level factors that serve as barriers to help-seeking and access. Participant recommendations for overcoming these barriers included increasing mental health education and improving the cultural responsiveness and navigability of mental health services. Stemming from these findings and informed by the literature on trauma-informed practice, culturally responsive interventions, and evidence-informed practices, we developed and pilot-tested a 4-week closed group community-grounded mental health engagement program called Pensamientos y Pláticas. Methods: The program was offered to 82 participants. Paired-sample t-tests were used to analyze differences between pre- and post-intervention data for the outcome variables assessed: stigma and emotional well-being. Analysis was limited to the 39 participants who completed at least half of the modules and had intact pre- and post-intervention data. Results: Data analysis revealed a statistically significant reduction in stigma related to help-seeking with a small-to-moderate effect size, while no statistically significant increase in emotional well-being was supported by the data. Conclusions: Findings from this pilot study reflect preliminary evidence of feasibility, acceptability, and potential benefit at reducing stigma related to seeking help in Hispanic communities and support Pensamientos y Pláticas as a promising culturally responsive stigma-reduction intervention.

Barriers and facilitators to tele-support psychotherapy versus standard in-person mental health services for youth (15–30 Years) with depression in Kampala District, Uganda

Depression remains a critical mental health challenge among young people in low-resource settings, where financial, structural, and social barriers frequently limit care access. Digital approaches, including Tele-Support Psychotherapy (TSP), have emerged as promising, scalable alternatives to Standard in-person Mental Health Services (SMHS), yet evidence comparing their implementation remains limited. This study explored facilitators and barriers influencing the feasibility, acceptability and engagement of youths with TSP versus SMHS for depression treatment in Kampala District, Uganda. A qualitative phenomenological study was conducted among youth aged 15–30 years enrolled in a randomized controlled trial evaluating both interventions. Data were collected through semi-structured key informant interviews and focus group discussions with participants and lay counselors and analyzed using deductive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR). In the parent trial, 95 of 154 participants (61.69%) in the TSP arm and 15 of 146 (10.27%) in the SMHS arm engaged with their assigned intervention; these figures provide contextual background for these qualitative findings. Key facilitators for both interventions included strong social support networks and higher income levels. Technological challenges, such as unreliable mobile phone connectivity, hindered TSP, while high costs and limited awareness were barriers to SMHS. Government policies both supported trust in digital interventions and, in some cases, constrained access while lay-counselor attributes, including on-phone session flexible scheduling and rapport-building skills facilitated TSP. TSP presents a viable alternative to SMHS, particularly for youth facing financial and logistical barriers to accessing facility-based mental health services. However, optimizing its delivery requires addressing technological constraints, ensuring consistent government support, and integrating mental health literacy initiatives. Findings underscore the need for flexible and contextually tailored models that leverage technology and address individual and systemic barriers to enhance mental health service access in resource-constrained settings.

Centering Multilingual Patient Voices in the Co-Design of a Health-Related Social Needs Screening Tool in an Urban Safety-Net Hospital.

Technology Matters: From innovation to implementation - Nationwide self-referral for digital mental healthcare is possible.

Digital mental health interventions for children are developing rapidly, yet a persistent gap remains between demonstrating that they work and making them available to families in routine care. This article describes Iceland's national rollout of the Online Support and Intervention for Child Anxiety (OSI) programme, a government-funded digital mental health intervention for parents of children aged 5-12 with common anxiety difficulties, adapted for Icelandic primary care. Its broader importance, we argue, rests not only on the intervention content but also on the service model through which it was delivered. We describe three features: a deliberately simple self-referral pathway that retains clinical oversight, delivery embedded within existing primary care services and national rollout achieved through collaboration across seven health institutions. We argue that scaling digital mental healthcare demands substantial organisational, technical and governance infrastructure and is rarely simpler than face-to-face provision. While Iceland's context may not be directly replicable in other countries, the implementation principles it illustrates may be informative for clinicians, service leaders and policymakers internationally. Improving access depends on implementation as much as innovation.

Culturally and linguistically adapted digital diabetes health applications improve self-management and clinical outcomes in racialized immigrants: a systematic scoping review.

BACKGROUND Despite public health efforts, the prevalence of diabetes has quadrupled since 1990, disproportionately impacting marginalized communities including immigrants and refugees. Immigrants and refugees face access, education and management inequities as the prevalence and cost of chronic disease management escalates in host countries. Digital health applications may offer effective and equitable solutions to support self-management and empower immigrants. OBJECTIVE This study systematically scoped published evidence on digital health applications tailored for type 2 diabetes management among racialized immigrants, addressing an important intersection of digital innovation and health equity. METHODS Searching multiple databases (2010-March 2025), 14 primary studies and 15 reviews were identified, featuring culturally adapted, multimodal interventions with human (peer or provider) support across patient-matched languages and cultures such as Arabic, Chinese, Spanish, and Vietnamese. The 15 reviews on mainstream digital education allowed us to contextualize digital features, outcomes, and practice mediators and challenges. RESULTS Primary studies found that tailored digital health interventions significantly enhanced engagement, self-efficacy, health literacy and motivation for self-management, and most clinically significantly lowered HbA1c levels (moderate-high risk of bias). Tailoring included cultural food advice, education framed around family and faith, and apps in patients' native language. In comparing digital application features and type 2 diabetes outcomes with our review of reviews results, we were able to show successful replication in racialized immigrant populations, demonstrating health equity opportunities. CONCLUSION These results demonstrate the importance of adapting, personalizing, creating a trusted environment, and integrating human supports to ensure long-term engagement and equitable health outcomes.

'Families are Intimidated…Really Confused…Afraid': Healthcare Service Disparities for Spanish-Speaking Patients Witnessed by their Language Interpreters.

Spanish-speaking individuals represent one of the fastest growing populations in the United States. Spanish-speaking patients with limited English proficiency (LEP) face a range of structural, cultural, and financial barriers within U.S. healthcare systems. Language barriers are closely linked to challenges in healthcare access and quality, contributing to persistent disparities in health outcomes. Medical interpreters serve as a critical link between Spanish-speaking patients and healthcare providers. This study uses a social determinant of health (SDoH) framework to examine medical interpreters' experiences, with a focus on identifying opportunities to improve care quality for Spanish-speaking patients. Twelve medical interpreters in the southwestern U.S. from a range of healthcare contexts were interviewed for this study. Virtual interviews were recorded and transcribed for qualitative analysis. A reflexive thematic analysis approach was used to analyze data in multiple rounds of collaborative coding to produce themes from participant narratives. Four interrelated themes emerged that were linked to patient experience, organizational practices, and health outcomes: (1) lack of prioritization of interpretation services; (2) rushed clinical interactions; (3) failure to center patient understanding; and (4) manifestation of bias at the system level. Findings highlight the need for healthcare system changes to improve care quality for Spanish-speaking patients. Improving the availability and integration of interpretation services, along with expanding time for interpreted encounters and strengthening collaboration between interpreters and providers, may enhance patient understanding and engagement. Policy and training efforts that support culturally responsive care and reimbursement for language services are also needed to address persistent disparities.