Food Insecurity and Diet Quality Among Low-Income Women in Dhaka City Amidst COVID-19 and the Ukraine Crisis: A Cross-Sectional Study.

Cultural sensitivity is essential for digital mental health research, our work on the CMHDS prompted us to reflect on how this is conceptualised and operationalised in practice. It involves recognition and awareness of how factors such as ethnicity, religion, gender and socioeconomic status influence a person's perception of their health and illness, as well as the behaviours that might ensue from those perceptions. Cultural awareness is increasingly understood to be important not only in fostering better communication, better patient-centred care and better outcomes, but also in addressing inequalities resulting from culturally insensitive practices and poor patient engagement. Through our work, we became aware of the tension between standardised data collection approaches and the need for culturally responsive design. Adopting a culturally sensitive approach within digital mental health research can improve patient satisfaction and enhance the skills and knowledge of healthcare providers, ensuring outputs are both relevant and accessible to the target population (). The American Psychological Association (APA) guidelines (), emphasise the ethical responsibility of researchers to conduct culturally appropriate and ecologically embedded research. Despite this, we recognise that health research may inadvertently overlook the needs of diverse and vulnerable populations, potentially exacerbating health disparities (, ). A range of challenges undermine the validity and ethical integrity of studies involving diverse populations (–). Digital health approaches have the potential to enhance accessibility, personalisation, and inclusivity in research () and to become an essential tool in developing strategies that enhance the quality of research findings, while also preventing further marginalisation of diverse communities (). This commentary reflects on our lessons learned through the co-development of the Core Mental Health Dataset (CMHDS). In co-developing the CMHDS, we identified the challenges of implementing culturally sensitive approaches in digital mental health research where stigma and unrepresentative sampling risk findings not being applicable across diverse populations. Our National Institute for Health and Care Research (NIHR)-funded project (NIHR201104) co-developed the CMHDS to embed routine collection of mental health data in physical health research. The CMHDS consists of two psychometrically robust and globally validated self-report questionnaires for common mental health symptoms (PHQ-8 () and GAD-7 ()), alongside novel questionnaires about mental health diagnoses, support sought and the experience of childhood or other forms of trauma. While these measures are widely used, we became aware of assumptions about the use of standardised measures, prompting us to consider their cultural appropriateness. Consent is stepped, allowing participants to complete some, or all questions. The aim of the CMHDS is to safely, securely, acceptably, and easily collect mental health information from participants in physical health research and thereby to grow understanding of the links between physical and mental health. The CMHDS was culturally adapted in 2023 through a separate project funded by the NIHR Applied Research Collaboration Greater Manchester. The cultural adaption of the CMHDS followed an iterative and agile design process () employed in previous cultural adaptation and co-development projects (, ). Throughout this process, we sought to remain attentive to how the assumptions and priorities of the study team could be shaping the methodological choices, recognising adaptation is not a neutral process.