Transcreation and Feasibility of Spanish-Language Pediatric Post-Transplant Adherence App (BMT4me©): Insights from a...

Poor medication adherence for children receiving hematopoietic stem cell transplant (HCT) leads to increased risk for infection and fatal complications. Mobile health (mHealth) interventions improve adherence across multiple chronic diseases, yet only 20% of medication apps offer alternative languages. Therefore, it is imperative mHealth interventions are expanded for diverse populations; thus, we aimed to trans-create BMT4me©, an mHealth adherence app, for Spanish-speaking families undergoing HCT.

Community Advisory Board focus group members were recruited from Nationwide Children's Hospital Hispanic employee resource group. Purposive sampling was used to select six interested members (age: M=38.83 years; SD=9.39) representing diverse backgrounds: Puerto Rican, Peruvian, Venezuelan, Costa Rican, Colombian, and Mexican. Three focus groups were conducted using an iterative app revision process. Upon study completion, members completed the System Usability Scale (SUS) and Reaction Card for app evaluation.

Focus group feedback revealed 4 major qualitative themes: 1) user interface strengths (eg, visuals, legibility); 2) usability improvements (eg, navigation issues, confusing elements); 3) clinical implications (eg, client/provider communication); 4) evaluating content pertinence (eg, socio-cultural appropriateness, comprehension). Notably, members identified mistranslated words and made suggestions to make essential aspects align with Spanish-speaking countries: "There's not a Spanish word for reset, pero es reiniciar [but it is restart]".

Overall, the focus groups provided essential feedback regarding visual appeal, usability, clinical relevance, and socio-cultural appropriateness to trans-create the app, leading to an intuitive and useful Spanish version of the mHealth tool. This work underscores the importance of including community partners in transcreation to achieve culturally appropriate digital interventions.