Integrating Nonpharmacologic Strategies for Pain with Inclusion, Respect, and Equity (INSPIRE): Cultural and linguistic tailoring for a digital health intervention.

Chronic pain (CP) disproportionately affects underserved populations who often experience barriers to evidence-based nonpharmacologic treatments. Digital health interventions can address these barriers by providing scalable and accessible CP management resources. However, culturally and linguistically tailored digital interventions are rare, which may limit engagement and effectiveness. The Integrating Nonpharmacologic Strategies for Pain with Inclusion, Respect, and Equity (INSPIRE) intervention combines a tailored mobile app with culturally and linguistically concordant health coaching to deliver cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), and movement-focused interventions (MFI) for CP management. This manuscript describes the process of linguistically and culturally tailoring the INSPIRE app for three target adult populations-African American/Black, Spanish-speaking Latinx, and Cantonese-speaking Chinese. Iterative tailoring was driven by multiple rounds of stakeholder focus groups followed by generative artificial intelligence (GenAI) and expert review to ensure accuracy and cultural congruence while optimizing limited resources. After initial GenAI content generation in English, the adaptation process began with surface-level adjustments in language translation and cultural representation in visual and audio elements. Deep-level adaptations incorporating culturally rooted values and beliefs about CP were made to address culturally specifically experiences with stigma and bias relevant to CP. This study highlights a replicable, efficient framework for adapting digital health interventions to improve equity and inclusion in CP management by combining AI-driven tools with human expertise to achieve optimal cultural and linguistic adaptations. Future research will evaluate the effectiveness of the INSPIRE intervention in a randomized controlled trial to assess engagement, acceptability, and improved pain outcomes across diverse populations.