Introduction: Digital technologies and pictorial screeners are increasingly used to enhance access to care and monitor mental health, yet most are designed in Western contexts. Although the concept of pictorial or emoji-based screeners may appear universal, their meaning can differ across cultural settings. When applied to diverse cultural contexts, evidence-based adaptations must be incorporated to enhance the rigor and validity of such tools.





Purpose: The purpose of this study was to utilize an evidence-based process to adapt WellCheq, a digital, emoji-based screening tool, developed in the United States, that captures wellbeing states of youth to be culturally responsive to the Chinese youth population within a larger global wellbeing study.





Methods: Adults from mainland China (n=105) completed a survey to assess emoji preferences of affective states. Participants were presented with six emojis: three Apple emojis and three WeChat emojis (Chinese emoji dictionary) for the ten states used in WellCheq. Participants selected the emoji that they believed best represented each affective state.





Results: Chi-squared tests confirmed that the leading emoji for each emotion was chosen far more often than expected (χ² = 11.6-165.1, all p < .05), with 7 of 10 top selections belonging to WeChat. Although the overall 7-3 split between platforms was not statistically significant (χ² = 1.6, p = .21), the consistent per-emotion preferences highlight that even pictorial tools assumed to be universal require cultural adaptation to ensure validity and relevance.





Conclusion: Cultural adaptation of well-being assessments is necessary to ensure accuracy across populations. Integrating culturally familiar symbols strengthens validity, promotes inclusivity, and improves accessibility. Such adaptation helps psychologists capture experiences of groups often overlooked in mainstream research, including Asian populations and those with lower education levels. By reducing cultural blind spots in measurement, this work contributes to addressing inequalities and advancing global mental health.