A Netnographic Study of Cross-Cultural Miscommunication in Digital Mental Health Nursing and Telepsychiatry Among Online Communities

Authors

  • Bagus Dwi Cahyono Universitas Jember
  • Mareta Deka Paraswati Universitas Jember
  • Domingos Soares Health Trainer and researcher at Instituto Nacional de Saude Publica Timor-Leste (INSP-TL) Dili

DOI:

https://doi.org/10.62255/ijen.v2i1.261

Abstract


Background: A chatbot cannot ask about a patient's family before it asks about their symptoms, and in cultures where healing begins with relationship rather than data, that single omission may be where digital psychiatric care quietly loses the people it was built to reach. Telepsychiatry and tele-nursing platforms have expanded rapidly across Southeast Asia, yet whether these tools translate psychological distress across cultural boundaries, and not merely across language, remains poorly understood. This study explored how Indonesian- and Malay-speaking internet users described experiences of cross-cultural miscommunication with digital mental health providers.

Methods: A 20-week netnographic study was conducted across Indonesian- and Malay-language online communities discussing telepsychiatry, tele-nursing, and digital mental health applications. Publicly available discussion threads were analysed using an inductive, Braun-and-Clarke-informed thematic approach.

Results: Analysis of threads from participants who described a personal digital mental health encounter generated four interconnected themes: linguistic and semantic dissonance, relational asymmetry and digital etiquette mismatches, algorithmic cultural bias in screening, and an anonymity–trust paradox.

Conclusion: Cultural miscommunication in digital psychiatric nursing appears to cluster around the translation of idioms of distress and the compression of relational care into transactional data collection. Culturally responsive intake design and provider training may help narrow this gap, although the findings warrant confirmation in structured, representative samples.

 

Keywords:

Mental Health Services, Mobile Applications, Communication Barriers, Cultural Competency, Psychiatric Nursing, Telemedicine

References

Adade, A.E. et al. (2022) “Exposure to substance and current substance among school-going adolescents in Timor-Leste.,” PLOS global public health, 2(8), p. e0000797. Available at: https://doi.org/10.1371/journal.pgph.0000797.

Cohen, F. (2023) “Cultural idioms of distress among displaced populations: A scoping review.,” The International journal of social psychiatry, 69(1), pp. 5–13. Available at: https://doi.org/10.1177/00207640221114742.

Cork, C., Kaiser, B.N. and White, R.G. (2019) “The integration of idioms of distress into mental health assessments and interventions: a systematic review.,” Global mental health (Cambridge, England), 6, p. e7. Available at: https://doi.org/10.1017/gmh.2019.5.

Desai, G. and Chaturvedi, S.K. (2017) “Idioms of Distress.,” Journal of neurosciences in rural practice, 8(Suppl 1), pp. S94–S97. Available at: https://doi.org/10.4103/jnrp.jnrp_235_17.

Hall, T., Kakuma, R., Palmer, L., Martins, J., et al. (2019) “Are people-centred mental health services acceptable and feasible in Timor-Leste? A qualitative study.,” Health policy and planning, 34(Supplement_2), pp. ii93–ii103. Available at: https://doi.org/10.1093/heapol/czz108.

Hall, T., Kakuma, R., Palmer, L., Minas, H., et al. (2019) “Social inclusion and exclusion of people with mental illness in Timor-Leste: a qualitative investigation with multiple stakeholders.,” BMC public health, 19(1), p. 702. Available at: https://doi.org/10.1186/s12889-019-7042-4.

Jacob, K.S. (2019) “Idioms of distress, mental symptoms, syndromes, disorders and transdiagnostic approaches.,” Asian journal of psychiatry, 46, pp. 7–8. Available at: https://doi.org/10.1016/j.ajp.2019.09.018.

Jin, H. et al. (2024) “Molecular Confirmation of Taenia solium Taeniasis in Child, Timor-Leste.,” Emerging infectious diseases, 30(9), pp. 1964–1967. Available at: https://doi.org/10.3201/eid3009.240238.

Jones, B. et al. (2024) “NEARER SCAN (LENO BESIK) evaluation of a task-sharing echocardiographic active case finding programme for rheumatic heart disease in Australia and Timor-Leste: protocol for a hybrid type II effectiveness-implementation study.,” BMJ open, 14(10), p. e083467. Available at: https://doi.org/10.1136/bmjopen-2023-083467.

Kidron, C.A. and Kirmayer, L.J. (2019) “Global Mental Health and Idioms of Distress: The Paradox of Culture-Sensitive Pathologization of Distress in Cambodia.,” Culture, medicine and psychiatry, 43(2), pp. 211–235. Available at: https://doi.org/10.1007/s11013-018-9612-9.

Lauckner, C. and Whitten, P. (2016) “The State and Sustainability of Telepsychiatry Programs.,” The journal of behavioral health services & research, 43(2), pp. 305–318. Available at: https://doi.org/10.1007/s11414-015-9461-z.

Lichtenberg, A.A. et al. (2022) “Understanding mental distress in Arcahaie, Haiti: Heterogeneous uses of idioms of distress in communicating psychological suffering.,” Transcultural psychiatry, 59(4), pp. 479–491. Available at: https://doi.org/10.1177/13634615211000543.

Peltzer, K. and Pengpid, S. (2020) “Sexual risk behaviour and its correlates among adolescents in Indonesia, Laos, Thailand and Timor-Leste: results from national school surveys in 2015.,” International journal of adolescent medicine and health, 33(6), pp. 501–509. Available at: https://doi.org/10.1515/ijamh-2019-0230.

Smith, K. et al. (2020) “COVID-19 and Telepsychiatry: Development of Evidence-Based Guidance for Clinicians.,” JMIR mental health, 7(8), p. e21108. Available at: https://doi.org/10.2196/21108.

Tay, A.K. et al. (2017) “The factor structures and correlates of PTSD in post-conflict Timor-Leste: an analysis of the Harvard Trauma Questionnaire.,” BMC psychiatry, 17(1), p. 191. Available at: https://doi.org/10.1186/s12888-017-1340-0.

Victor, A.M. (2019) “Telepsychiatry and comprehensive mental health India.,” Perspectives in psychiatric care, 55(3), pp. 459–463. Available at: https://doi.org/10.1111/ppc.12342.

Wallace, H.J. et al. (2018) “What influences a woman’s decision to access contraception in Timor-Leste? Perceptions from Timorese women and men.,” Culture, health & sexuality, 20(12), pp. 1317–1332. Available at: https://doi.org/10.1080/13691058.2018.1433330.

West, N.S. et al. (2024) “Okweraliikirira and Okwenyamira: Idioms of Psychological Distress Among People Living with HIV in Rakai, Uganda.,” Research square [Preprint]. Available at: https://doi.org/10.21203/rs.3.rs-4656465/v1.

West, N.S. et al. (2025) “Okweraliikirira and Okwenyamira: Idioms of Psychological Distress Among People Living with HIV in Rakai, Uganda.,” Culture, medicine and psychiatry, 49(3), pp. 857–872. Available at: https://doi.org/10.1007/s11013-025-09912-9.

Wiley, A.N. (2026) “What’s in a Name? Psychiatric Concept Creep and the Moral Legibility of Student Suffering within the Canadian University Context.,” Medical anthropology quarterly, p. e70062. Available at: https://doi.org/10.1111/maq.70062.

Downloads

Published

2026-07-20

How to Cite

Cahyono, B. D. ., Paraswati, M. D. ., & Soares, D. (2026). A Netnographic Study of Cross-Cultural Miscommunication in Digital Mental Health Nursing and Telepsychiatry Among Online Communities. Interdisciplinary Journal of Ethnopsychiatric Nursing, 2(1), 30–41. https://doi.org/10.62255/ijen.v2i1.261