A framework for culturally adapting mental mHealth apps

Mobile health (mHealth) apps are increasingly deployed for evidence-based mental health interventions, broadening access to care. While effective, Internet-based Cognitive Behavioural Therapy, delivered via web or app, frequently overlooks ethnic minority and migrant populations. Effective cultural adaptation of mHealth apps is critical to their impact and accessibility; however, existing frameworks often lack specific guidance for digital contexts, relying on superficial adjustments or omitting the explicit integration of religious factors. Our novel framework fundamentally departs from prior models by embedding cultural responsiveness throughout the entire digital development lifecycle of mHealth apps, rather than treating it as a peripheral concern. This comprehensive approach is structured across four interconnected layers: adapting the therapeutic foundation (explicitly incorporating religious considerations), culturally grounding features and reframing standard tools, tailoring content and messaging, and optimizing UX/UI design. Central to this framework is a participatory co-design and prototyping methodology that ensures deep cultural insights, including religious and spiritual dimensions, are profoundly integrated from the earliest stages of development. This framework thus offers a practical, inclusive, and ethical blueprint for designing culturally relevant digital health products and can be applied and tested in future work through iterative co-design workshops, user-centred prototyping, and the development of culturally tailored digital interventions, with ongoing evaluation of their effectiveness and acceptability in diverse populations.