Using participatory design methodologies to co-design and culturally adapt the Spanish version of the Mental Health eClinic (Preprint)

BACKGROUND Populations who do not speak English and currently reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers; have weaker social support networks; and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically-diverse populations are limited. Having a Spanish version of the Mental Health eClinic (MHeC-S) would greatly benefit these students. OBJECTIVE Using participatory design (PD) methodologies with users (young people aged 16 to 30 years, supportive others and health professionals) the aims of this study were to: i) conduct workshops with users to co-design and culturally-adapt the MHeC; ii) inform the development of the MHeC-S alpha prototype; iii) perform usability testing of the MHeC-S alpha prototype; iv) translate, culturally-adapt and face-validate the MHeC-S self-report assessment; and v) collect information to inform its beta prototype. METHODS A research and development (R&D) cycle included several iterative PD phases: co-design workshops; knowledge translation; language translation and cultural adaptation; rapid prototyping and user testing of the MHeC-S alpha prototype. RESULTS Two co-design workshops were held with 17 users (young people n=10, health professionals n=7). A total of 15 participated in the one-on-one user testing sessions (young people n=7, health professionals n=5, supportive others n=3). 225 source documents were collected and thematic analysis resulted in five main themes (help-seeking barriers, technology platform, functionality, content, user interface). A random sample of 106 source documents were analyzed by two independent raters revealing an ‘almost perfect’ agreement for the functionality (kappa=0.86; P<0.001) and content (kappa=0.92; P<0.001); and, a ‘substantial’ agreement for the user interface (kappa=0.785; P<0.001). In this random sample, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to get medical or psychological services and smartphones were the most used device to access the Internet. There was adequate acceptability of the prototype’s five main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system and personalized well-being plan. The data also revealed gaps in the current alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities; and, a lack of Spanish language apps and etools as well as online mental health information was noted. CONCLUSIONS Through an iterative process of R&D, the MHeC-S was co-designed and culturally-adapted, developed and user-tested, as well as evaluated. By translating and culturally-adapting the MHeC to Spanish, we aimed to increase accessibility and availability of (e)mental health care to the developing world, and assist vulnerable populations that have migrated to English-speaking countries. CLINICALTRIAL The University of Sydney’s Human Research Ethics Committee approved the study Protocol No. 2014/689 and Protocol No. 2016/487