Co-Creation, Translation, and Localisation of Sentinel: A Protocol for Testing a Digital Mental Health App in Diverse Socio-Economic Contexts (Preprint)

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BACKGROUND Digital mental health interventions have emerged as scalable tools to support psychological wellbeing and reduce acute stress among frontline and trauma-exposed occupational groups. However, many existing interventions lack cultural adaptation, contextual sensitivity, and linguistic inclusivity, factors that are critical for sustained user engagement, particularly in low-resource and non-Western settings. Barriers such as stigma, lack of local relevance, language mismatch, and digital inequity often limit the accessibility and effectiveness of these tools across diverse socio-economic and geopolitical environments. OBJECTIVE This protocol outlines a participatory, multi-country research study focused on the co-creation, translation, and localisation of Sentinel, a trauma-informed digital mental health intervention designed for frontline workers. The aim is to evaluate usability, acceptability, feasibility, and perceived psychological impact of localised versions of Sentinel in three international settings, South Africa, Saudi Arabia, and Ukraine, each representing distinct cultural, linguistic, and occupational landscapes. METHODS The study employs a four-phase, mixed-methods, participatory research design. Phase 1 involves stakeholder engagement and cultural insight workshops with frontline professionals to guide adaptation of app content and interface. Phase 2 focuses on professional translation and linguistic validation into Arabic, isiXhosa, Afrikaans, and Ukrainian, following forward–backward translation and cognitive testing protocols. Phase 3 involves iterative localisation and adaptation of the app interface and content through user feedback. In Phase 4, a six-week feasibility pilot will be conducted in each country, with 100 participants per site using the localised app version. Data collection will include validated quantitative outcome measures, in-app usage analytics, and post-intervention qualitative interviews to explore cultural fit, usability, and psychological impact. RESULTS The study will generate linguistically and culturally adapted versions of Sentinel and yield comparative data across three diverse global contexts. Outcomes will offer insights into engagement patterns, user preferences, and the role of cultural adaptation in shaping perceived utility and psychological outcomes. The research will also produce practical guidance for future localisation of digital health tools, with a focus on trauma-informed care. CONCLUSIONS This protocol addresses a critical gap in the localisation and ethical deployment of digital mental health interventions for underserved and trauma-exposed populations. By embedding co-creation, linguistic validation, and cultural adaptation into each phase, the study advances best practices for the equitable and sustainable implementation of digital mental health tools in LMIC and crisis-affected settings. Findings will contribute to global mental health research and support the scaling of culturally intelligent interventions that are responsive to local contexts and frontline needs.

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