Invisible Users in Digital Health: A Scoping Review of Digital Interventions to Promote Physical Activity Among CALD Women

Paper Title

Invisible Users in Digital Health: A Scoping Review of Digital Interventions to Promote Physical Activity Among CALD Women

Publication Info

• Topic area: Digital health interventions for culturally and linguistically diverse (CALD) women.
• Keywords: Physical activity, culturally diverse women, digital health, human-computer interaction, cultural adaptation, scoping review, behavior change, social support, long-term engagement, participatory design.

Background and Problem

• Problem / challenge: Digital health interventions often fail to sustain long-term engagement among CALD women due to surface-level cultural adaptations and reliance on techno-solutionist approaches. Social-support features are fragile in low-activity networks, and behavior-change theories are poorly implemented in culturally responsive ways.
• Significance: Addressing physical inactivity among CALD women is critical for reducing chronic disease risks such as diabetes, hypertension, and cardiovascular disease. Effective interventions can improve health equity and empower marginalized groups.
• Motivation and related work: Prior reviews have focused on usability and short-term efficacy but lack deep cultural adaptation and long-term strategies. Public health research highlights socio-cultural barriers but does not translate these insights into actionable design mechanisms. This paper aims to bridge the gap by examining design paradigms and proposing a culturally sustaining framework.

Solution

• Proposed approach: The Culturally Embedded Interaction Framework, a five-dimensional model for designing culturally sustaining digital health interventions.
• Novelty:
  1. Critical synthesis of design assumptions in digital health interventions, revealing structural shortcomings.
  2. Introduction of a five-dimensional framework addressing cultural and temporal adaptability, social weaving, and theory-guided design.
• Procedure and key techniques:
  • Systematic scoping review of 18 studies using PRISMA-ScR methodology.
  • Identification of dominant design paradigms and their limitations.
  • Inductive synthesis of strategies into five interconnected dimensions: culturally-grounded measurement, multi-modal interaction, embedded social weaving, theory-guided cultural adaptation, and contextual and temporal adaptability.

Results

• Concrete findings:
  • Surface-level cultural adaptations (e.g., translation, simplified interfaces) improve accessibility but fail to sustain engagement.
  • Deep cultural adaptations (e.g., family-centered framing, bicultural staff) align interventions with cultural values but are limited to a few programs.
  • Four systemic design tensions identified: cultural-temporal misalignment, scalability-sustainment trade-offs, fragile social support, and theory-implementation gaps.
• Advantage over baselines: The proposed framework integrates cultural values into interaction design, addressing long-term engagement challenges overlooked by existing interventions.
• Experiments / evaluation:
  • Reviewed studies included randomized controlled trials, pilot studies, and mixed-methods approaches targeting CALD women in the U.S., primarily Latina women.
  • Metrics focused on physical activity outcomes (e.g., steps, MVPA minutes) and qualitative feedback on cultural fit.
• Limitations and future work:
  • Limited geographical and cultural diversity in the reviewed studies, predominantly focused on U.S.-based Latina women.
  • Need for longitudinal validation of the framework across diverse contexts.
  • Future research should prioritize participatory and co-design methods to refine culturally embedded interaction mechanisms.

Summary

This scoping review identifies systemic shortcomings in digital health interventions for CALD women, including reliance on surface-level cultural adaptations and fragile social-support features. To address these issues, the authors propose the Culturally Embedded Interaction Framework, which integrates cultural values into five design dimensions: culturally-grounded measurement, multi-modal interaction, embedded social weaving, theory-guided cultural adaptation, and contextual and temporal adaptability. The framework provides actionable guidance for HCI researchers and practitioners to design long-term, culturally sustaining interventions. Future work should validate the framework across diverse cultural contexts and prioritize participatory design approaches to ensure equity and resonance.