Early developmental screening relies heavily on U.S.-standardized normative benchmarks, raising questions about cross-cultural stability and the relative influence of biological vs. contextual factors during infancy. This study examined Ages and Stages Questionnaire (ASQ-3) outcomes at six months in a Bulgarian infant cohort in comparison with established U.S. norms. In this cross-sectional study, 155 infants (six months chronological or corrected age) were assessed using the ASQ-3 during routine pediatric visits. One-sample t-tests were used to compare domain scores with U.S. normative means. Effect sizes (Cohen's d), 95% confidence intervals, and post hoc power sensitivity analyses were calculated. Secondary analyses evaluated the effects of birth weight, gestational age, and sex. Cross-cultural comparisons showed statistically significant differences in Gross Motor (d = -0.28) and Problem Solving (d = 0.30); however, all effect sizes were small (|d| ≤ 0.30), with no moderate or large deviations observed. In contrast, infants with birth weight <2,500 g demonstrated moderate-to-large effects across multiple domains (d = -0.63 to -0.88), particularly in Gross Motor and Personal-Social functioning. Differences related to gestational age were not clinically meaningful after correction for age. A small female advantage was observed in Communication (d = 0.37). ASQ-3 outcomes at six months suggest a high degree of cross-cultural similarity in this Southeastern European infant cohort. Variability in developmental outcomes in the present cohort appeared more strongly associated with biological risk factors than with cross-cultural contextual variation during early infancy. These findings support the use of ASQ-3 in the Bulgarian clinical context and highlight the importance of integrating perinatal risk factors into early developmental surveillance.
Parental quality of life (QoL) and stress are strongly linked to behavioural, emotional, and cognitive differences in autistic children. However, these relationships have rarely been examined with a cross-cultural lens, despite the potential influence of sociocultural contexts on assessment and interpretation. To address this knowledge gap, this study employed multinational data to investigate the cross-cultural associations between emotional/behavioural and cognitive/adaptive differences in autistic children and parental wellbeing. Data were obtained from 219 autistic children aged up to 18 years across five countries (Australia, Singapore, Hungary, Romania, and the United Kingdom). Standardised instruments were used to assess four key domains of parental QoL, parental stress, child's behavioural/emotional difficulties, and adaptive/cognitive differences. Since different standardised instruments were used across countries, all measures were dichotomised according to established clinical cut-offs for each instrument. Multivariable logistic regression models were used to examine associations between children's autistic difficulties and parental wellbeing accounting for country- and measure-level variations. Across countries, children experiencing higher emotional/behavioural difficulties were significantly associated with lower parental QoL (QoLA Part A: AOR = 0.36, 95% CI 0.11-0.97) and twice higher odds of parental stress (AOR = 2.11, 95% CI 1.08-4.54). However, the association between cognitive/adaptive difficulties and parental QoL and parental stress did not reach statistical significance. Additionally, there were no evidence of country- or measure-level heterogeneity for parental wellbeing outcomes (ICC = 0.00), indicating consistent associations across cultural contexts and assessment tools. Emotional and behavioural difficulties in autistic children are significantly associated with poorer parental quality of life and increased stress across diverse cultures, suggesting that the challenges faced by parents are largely universal. These findings highlight the importance of early identification and family-centred, culturally responsive supports to improve wellbeing for both autistic children and their parents.
The perception of emotional expression is influenced by cultural background and individual personality traits. This study examined whether the personality trait, shyness, moderated the relation between the intensity of facial emotional expressions and their perceived intensities from a cross-cultural perspective. The study included 160 young adult participants from Canada (White and East Asian) and Mainland China. Participants completed the Cheek and Buss Shyness Scale and rated the emotional intensity of same-race facial expressions (happiness, anger, fear, and sadness) at different intensity levels. Using multilevel structural equation modeling, results indicated that shyness significantly moderated the relation between expressed and perceived intensity only among participants from Mainland China (β = 0.118, p = .001), where higher levels of shyness were associated with stronger perceived emotional intensity across all emotions. However, no significant moderating effect was found in both White Canadian and East Asian Canadian groups. Findings suggest that cultural norms regarding emotional expression, particularly the emphasis on emotional restraint in Chinese culture, may amplify the role of shyness in emotional perception. Implications for clinical practice, cross-cultural communication, and psychological research on emotion recognition are discussed.
The growing use of large language model-supported companion robots in later-life care warrants closer scrutiny beyond conversational performance alone. While the original cross-cultural study offers valuable qualitative insights from the United Kingdom and Japan, its findings also expose unresolved questions regarding cross-cultural generalisability, sustained relational value, and the ethical implications of embedding generative AI in companionship technologies. Meaningful support for loneliness in older adults cannot be inferred from dialogue fluency alone, because loneliness is a multidimensional condition shaped by social context, identity, and care environment. This commentary therefore argues for a more context-sensitive and longitudinal research agenda that prioritises adaptive memory, culturally attuned interaction design, and human oversight within hybrid care models. By reframing companion robots as supportive tools rather than substitutes for human relationships, the discussion advances a critical perspective on how relational AI should be developed, evaluated, and governed in psychogeriatric care.
Nursing handoff is critical for patient safety but faces challenges like unstructured communication. While standardized assessment tools exist internationally, China lacks such a tool for evaluating handoff competency. This study aimed to translate and validate the Nursing Handoff Competency Scale (NHCS) for use in China. A methodological study comprising cross-cultural adaptation and psychometric validation. Following the Brislin model, the NHCS was translated and cross-culturally adapted via Delphi expert consultation (18 experts) and pilot testing (10 nurses). Psychometric evaluation involved 285 nurses from tertiary hospitals. Content validity, construct validity, internal consistency (Cronbach alpha and McDonald omega), and split-half reliability were assessed. The final 23-item, four-dimensional scale showed acceptable content validity (S-CVI = 0.961, modified kappa = 0.833-1.000), internal consistency (Cronbach's α = 0.977, McDonald's ω = 0.979), and a four-factor structure explaining 84.639% of variance. CFA indicated acceptable fit (χ2/df = 2.666, RMSEA = 0.077, CFI = 0.958, TLI = 0.952). The Chinese NHCS demonstrated satisfactory psychometric properties, providing initial evidence for assessing nursing handoff competency in China. Further validation in diverse settings is recommended.
The aim of this study was to translate and cross-culturally adapt the Raynaud-Specific Quality of Life Questionnaire (RQLQ) into Turkish, and to evaluate the psychometric properties of the Turkish version of RQLQ in patients with Raynaud's phenomenon. Patients with Raynaud's phenomenon completed the Turkish RQLQ and several validated questionnaires including the WHO-5 Well-being Index, Brief Illness Perception Questionnaire (B-IPQ), Short Form-12 (SF-12), Health Assessment Questionnaire-Disability Index (HAQ-DI), Hospital Anxiety and Depression Scale (HADS), Disabilities of the Arm, Shoulder, and Hand (DASH), and Jenkins Sleep Evaluation Scale (JSS). Construct validity was examined using correlation analyses between the Turkish RQLQ and related outcome measures. Structural validity was assessed using exploratory factor analysis (EFA). Regarding reliability, internal consistency was evaluated using Cronbach's alpha and test-retest reliability was assessed using the intraclass correlation coefficient (ICC). The study included 88 patients with a mean age of 50.8 ± 12.2 years and RQLQ total score of 94.8 ± 28.1. The Turkish RQLQ demonstrated excellent internal consistency (Cronbach's α = 0.95) and high test-retest reliability (ICC = 0.90, 95% CI 0.81-0.95; p < 0.001). Exploratory factor analysis supported a five-factor structure consistent with the original questionnaire, explaining 69.6% of the total variance (Kaiser-Meyer-Olkin = 0.875; Bartlett's test p < 0.001). Significant correlations (p < 0.001) between the Turkish RQLQ and B-IPQ (r =  - 0.646), SF-12 Physical Component Summary (r = 0.676), WHO-5 (r = 0.381), HAQ-DI (r =  - 0.490), DASH (r =  - 0.607), HADS-A (rho =  - 0.470), and HADS-D (rho =  - 0.460) supported construct validity. No substantial floor or ceiling effects were observed for the RQLQ total score (< 15%). The Turkish version of the RQLQ is a valid and reliable instrument for assessing disease-specific quality of life in patients with Raynaud's phenomenon. Key Points • The RQLQ was successfully translated and culturally adapted into Turkish. • The Turkish RQLQ showed excellent internal consistency and high test-retest reliability in patients with Raynaud's phenomenon. • The questionnaire demonstrated acceptable construct validity and factor analysis supported a five-factor structure consistent with the original questionnaire. • The Turkish RQLQ is a reliable and valid tool for assessing quality of life in patients with Raynaud's phenomenon.
The growing demand for palliative care (PC) services and the need for standardized approaches to patient identification highlight the importance of having validated tools available in Brazilian Portuguese. The absence of culturally adapted instruments may hinder appropriate patient assessment, delay referral to PC services, and ultimately compromise the quality of care delivered. This study aims to translate and adapt the Identification des patients nécessitant des soins PALLiatifs généraux et spécialisés (ID-PALL©) instrument into Brazilian Portuguese. Herdman's recommendations were followed, which include conceptual, item, and semantic validation stages. After authorization from the ID-PALL© developers, the translation, synthesis of the translated versions, and back-translation of the instrument were performed. Subsequently, a committee of 11 experts evaluated the semantic, idiomatic, conceptual, and cultural equivalence between the versions, resulting in the development of the pre-final version. To validate the instrument's content, this version was pre-tested (n = 30) with the participation of physicians and nurses. For statistical analyses, the content validity coefficient (CVC) was calculated. The cross-cultural adaptation demonstrated the suitability of the translated versions after semantic and cultural adjustments. The pre-final version showed satisfactory comprehension and semantic (CVC), idiomatic (CVC), conceptual (CVC), and cultural (CVC) equivalence, which enabled the development of the final version, named IDPALL-BR. The data obtained in the pre-test demonstrated content validity among the target audience, with a CVC = 0.909. The Brazilian Portuguese version of this instrument has semantic validity and, therefore, shows potential for screening general and specialized PC needs.
Transferability of questionnaires across languages and cultures requires a systematic process to preserve content integrity and ensure validity and reliability. The aim of this study was to translate, culturally adapt and face validate the US-developed patient-reported outcome (PRO) measure 'Type 1 Diabetes and Life' (T1DAL) for use in a Danish population of parents of children under the age of 11 years living with type 1 diabetes. The process followed the 10-step International Society for Pharmacoeconomics and Outcomes Research good practice principles for the translation and cultural adaptation of PRO measures, thereby establishing content validity and cross-cultural validity in accordance with COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations. Following approval from the developer of the original questionnaire, two independent forward translations were conducted by bilingual native Danish speakers. These translations were then synthesised into a reconciled version, which were then back translated by two bilingual native English speakers. Discrepancies between the original and the reconciled versions were reviewed, leading to small linguistic and cultural adjustments. This process included discussions around the response categories on the Likert-scale and items reflecting the US healthcare context-particularly those related to insurance-dependent access, which are less relevant in Denmark.Cognitive debriefings regarding the updated Danish version with 12 parents resulted in a Danish version demonstrating strong semantic, conceptual and experiential equivalence. Additionally, minor linguistic and cultural adjustments were made to enhance clarity and contextual appropriateness. Cognitive debriefing confirmed the questionnaire's acceptability and comprehensibility across a diverse range of respondents. Applying ISPOR principles emphasised the importance of cultural adaptation that extends beyond linguistic translation to preserve the original questionnaire's integrity and meaningfulness and resulted in a conceptually equivalent and culturally adapted Danish version of the original T1DAL questionnaire, suitable for use in Danish clinical and research settings. H-25016032.
Self-blame is a common psychological response after cancer diagnosis. It can impair patients' emotional adjustment and thereby increase their need for supportive care and psychological interventions. This study aimed to translate the Self-Blame Attribution for Cancer Scale (SBAC) into Chinese and to conduct a preliminary psychometric evaluation of the Chinese version (SBAC-C) in patients with gynecologic cancer. This methodological study was conducted in three phases: translation using the Brislin model, cross-cultural adaptation through two rounds of expert consultation and pilot testing, and psychometric evaluation in a convenience sample of 132 patients with gynecologic cancer. Item analysis, content validity, preliminary dimensional analysis using exploratory factor analysis with principal axis factoring, internal consistency, split-half reliability, and test-retest reliability were assessed. The final SBAC-C contained 11 items across two dimensions: behavioral self-blame and characterological self-blame. Item-level content validity indices ranged from 0.89 to 1.00, and the scale-level content validity index was 0.82. Exploratory factor analysis using principal axis factoring suggested a preliminary two-factor pattern, explaining 74.818% of the extracted variance, with factor loadings ranging from 0.460 to 0.932. Cronbach's alpha for the total scale was 0.905. Split-half reliability was 0.945, and test-retest reliability over a 3-week interval was 0.833. The SBAC-C demonstrated acceptable reliability and initial evidence of validity in patients with gynecologic cancer. The SBAC-C may serve as a preliminary tool for research use. Large-scale, multicenter validation including confirmatory factor analysis is warranted to firmly establish the factor structure.
Beliefs about childbirth shape women's expectations, decisions, and experiences. Although several tools assess related constructs such as fear or self-efficacy, few instruments focus specifically on childbirth beliefs. The Birth Beliefs Scale (BBS) addresses this gap by measuring 2 dimensions: beliefs in childbirth as a natural event and as a medical event. We sought to adapt the BBS to the Portuguese context and evaluate its psychometric properties. This methodological study involved cross-cultural adaptation and psychometric testing. The adaptation followed internationally recognized guidelines, including translation, synthesis, back-translation, expert review, and pretesting. Psychometric evaluation included exploratory and confirmatory factor analysis. The sample comprised 241 pregnant women enrolled in childbirth preparation programs in central Portugal. The original two-factor structure was partially confirmed following the removal of 3 items with low psychometric performance, including 2 related to labor pain. The Portuguese version (BBS-pt) demonstrated acceptable internal consistency for the Natural subscale (α = 0.68) and lower consistency for the Medical subscale (α = 0.58), suggesting cultural and contextual nuances in how birth beliefs are expressed. The BBS-pt is a promising instrument for assessing birth beliefs among Portuguese women. While further refinement is needed, particularly regarding pain-related items, the scale provides a valuable foundation for both research and clinical practice. It may assist nurse-midwives and other maternity care providers in tailoring antenatal education and intrapartum support to women's individual belief patterns, thereby contributing to more personalized and woman-centered care.
Late-life depression often extends to the marital partner, yet mechanisms of dyadic interdependence and their cross-cultural generalizability remain unclear. We analyzed harmonized longitudinal data from couples in the China Health and Retirement Longitudinal Study (CHARLS; n = 3,532; 5 waves, 2011-2020), the Health and Retirement Study (HRS; n = 2,332; 8 waves, 2006-2020), and the English Longitudinal Study of Ageing (ELSA; n = 1,895; 9 waves, 2002-2018). Depressive symptoms (CES-D) and activities of daily living (ADL)/instrumental ADL (IADL) limitations were measured at every wave. Complementary actor-partner interdependence models (APIM) and random-intercept cross-lagged panel models (RI-CLPM) were applied, with multiplicity adjustment, full-information maximum likelihood (FIML), and 20-imputation triangulation. Within-couple correlations of depressive symptoms were positive in every cohort (r = 0.34-0.43 in CHARLS, 0.14-0.20 in HRS, 0.23-0.29 in ELSA). APIM partner effects were robust in CHARLS but sparse elsewhere. After partialling out stable between-couple similarity, RI-CLPM within-person cross-spouse associations were attenuated, reaching consistent significance under FIML and multiple imputation only in ELSA. Four-variable RI-CLPMs showed bidirectional depression-disability coupling, strongest in HRS and ELSA, with cross-spouse function-to-depression effects in Western cohorts but not in CHARLS. Sex distinguishability was not supported, and half-longitudinal mediation through ADL/IADL did not survive multiplicity correction. Concordance in late-life depressive symptoms replicates across three major aging cohorts; in CHARLS, it primarily reflects stable between-couple similarity, whereas modest within-person prospective coupling persists in ELSA and in the multiple-imputation HRS estimates. Bidirectional depression-disability coupling in Western cohorts is the most replicable within-person signal, supporting combined depression management and functional rehabilitation for older couples.
Digital workplace transformation has created new psychological challenges for employees, particularly information anxiety encompassing information overload, fear of missing out (IFoMO), technostress, and digital presenteeism. However, cross-cultural research on these phenomena remains limited. This study examines how information anxiety affects employee mental health across Chinese and Western contexts, testing the mediating role of job stress and moderating effects of job autonomy and organizational support. We conducted a cross-sectional comparative study using large-scale datasets (N = 7,773; China n = 2,936, West n = 4,837) from technology workers. Validated scales measured information anxiety dimensions, job stress, mental health outcomes (anxiety, depression, wellbeing), and work resources. Data were analyzed using hierarchical regression, mediation analysis, moderated regression, and multigroup structural equation modeling with measurement invariance testing. Chinese employees reported significantly higher information anxiety (d = 0.38-0.60) and worse mental health outcomes compared to Western counterparts. Information anxiety explained 19%-26% of mental health variance. Job stress mediated 35%-39% of these relationships. Job autonomy (β = -0.12) and organizational support (β = -0.15) significantly buffered negative effects, with moderation effects present in both cultural groups; organizational support showed stronger buffering in Western samples, while job autonomy effects were numerically larger in the Chinese sample. Multigroup SEM revealed culturally-specific patterns: anxiety-stress relationships were stronger in China, while protective effects of work resources were more pronounced in the West. Information anxiety represents a universal but culturally-moderated occupational health risk. Organizations should implement culturally-adapted interventions: proactive information management and enhanced support in collectivistic cultures, while maintaining autonomy and organizational support in individualistic contexts.
Stigma is a major psychosocial problem for women with breast cancer during both treatment and survivorship. Assessing stigma is critical for developing supportive care strategies. This study aims to adapt the "Breast Cancer Stigma Assessment Scale (BCSAS)" into Turkish and to evaluate its psychometric properties. This methodological study included 352 women with breast cancer and its survivors. Translation and adaptation, content, construct, validity, and reliability of the "BCSAS" were examined. In the Exploratory Factor Analysis, the factor structure of the original scale, which consists of 7 factors and 28 items, was composed of 6 factors and 23 items in the Turkish version of BCSAS. The variance explained by these six factors was 64.371%. CFA confirmed the six-factor model determined in EFA with acceptable fit indices and factor loadings. The adapted Turkish version of the BCSAS was found to be a valid and reliable measurement tool for the Turkish population.
The Patient-Rated Ulnar Nerve Evaluation (PRUNE) is a validated, condition-specific instrument designed to assess symptoms and functional limitations in individuals with ulnar nerve disorders. However, no Persian adaptation has been developed to date. The present study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Persian version of the PRUNE among patients with Cubital Tunnel Syndrome (CuTS). Following international guidelines, the PRUNE was translated and culturally adapted into Persian. A total of 106 patients with clinically diagnosed Cubital Tunnel Syndrome (CuTS) were enrolled in the study. Internal consistency was evaluated using Cronbach's alpha, and test-retest reliability was determined with the Intraclass Correlation Coefficient (ICC) over a two-week interval. Construct validity was examined through an exploratory factor analysis (EFA) using principal component extraction and Varimax rotation. Convergent validity was examined by assessing the correlations between PRUNE scores and those of established instruments, including the QuickDASH, DASH, and Visual Analog Scale (VAS). The Persian version of the PRUNE demonstrated excellent internal consistency (Cronbach's α = 0.889) and strong test-retest reliability (ICC = 0.886). Exploratory factor analysis confirmed a multidimensional factor structure consistent with that of the original instrument. Significant positive correlations were observed between the PRUNE and the QuickDASH (r = 0.768), DASH (r = 0.699), and VAS (r = 0.664), supporting its convergent validity. The Persian version of the PRUNE proved to be a reliable and valid instrument for assessing symptoms and functional limitations in Persian-speaking patients with Cubital Tunnel Syndrome. It can be confidently applied in both clinical practice and research contexts.
Making a measure of orofacial pain available for use among Arabic-speakers might contribute to the development of prevention and therapeutic programs that consider psychosocial and behavioral determinants of the Lebanese population. This study aimed to translate, culturally adapt, and validate the Arabic version of the Orofacial Awakening Symptoms Questionnaire (OFASQ) among Lebanese adults. A cross-sectional web-based survey was conducted during August-September 2025 and included 427 participants (mean age = 27.5 ± 10.6 years; 56% women). The OFASQ was translated to Arabic using the forward-backward translation protocol. Confirmatory Factor Analysis (CFA) supported a single-factor structure with good fit indices (χ2/df = 2.67, Comparative Fit Index (CFI) = 0.970, Tucker-Lewis Index (TLI) = 0.941, Root Mean Square Error of Approximation (RMSEA) = 0.144 (90% Confidence Interval (CI): 0.086-0.207), and Standardized Root Mean Square Residual (SRMR) = 0.033). Internal consistency was good (Cronbach's α = 0.85). Measurement invariance across gender was established, with females scoring higher than males on the OFASQ. For criterion validity, higher OFASQ scores were significantly associated with worse sleep quality, more insomnia severity, and higher migraine. The Arabic OFASQ displayed reliability, validity, and cultural appropriateness for evaluating orofacial awakening indicators of bruxism and temporomandibular disorders in Arabic-speaking populations, validating its use in both clinical and research settings.
To translate, culturally adapt, and validate the Thai Hot Flash-related Daily Interference Scale for assessing interference from vasomotor symptoms. In this cross-sectional psychometric validation study, the Hot Flash-related Daily Interference Scale was translated using forward-backward translation, expert review, and cognitive debriefing. Women in the menopause transition or postmenopause at the menopause clinic in Bangkok completed the Thai Hot Flash-related Daily Interference Scale, the Thai Menopause Rating Scale, and the Thai Menopause-Specific Quality of Life questionnaire. Psychometric evaluation included content validity, structural validity, internal consistency, test-retest reliability using the intraclass correlation coefficient, construct validity evidence, floor and ceiling effects, and exploratory receiver operating characteristic analyses to support score interpretation. Of 336 enrolled women, 330 were analyzed (164 symptomatic and 166 asymptomatic controls). Content validity was high (scale-level content validity index=0.960). Reliability was excellent (Cronbach's alpha=0.963; intraclass correlation coefficient=0.981; 95% CI: 0.971-0.987). Factor analyses supported a predominantly unidimensional structure. Construct validity evidence was supported by a strong correlation with the vasomotor domain of the Thai Menopause-Specific Quality of Life Questionnaire (Spearman's correlation coefficient=0.716; P<0.001) and by known-groups differences between symptomatic and asymptomatic women (mean, 3.67 vs. 0.43; P<0.001). In exploratory supplementary analyses, scale scores showed good discrimination between Menopause Rating Scale-defined symptom-burden groups. The Thai Hot Flash-related Daily Interference Scale demonstrated reliability and validity and provides a brief measure of vasomotor symptom-related interference for Thai-speaking women in clinical practice and research.
To translate, revise and evaluate the Chinese-version Nursing Leaders' Readiness for Artificial Intelligence Scale and assess Chinese nursing leaders' AI readiness. Cross-sectional survey. The research team conducted translation, cognitive interviews, a pilot survey and psychometric evaluation. Survey participants were 762 nursing managers. The reliability and validity of the Chinese-version scale were examined. The status and influencing factors of AI readiness among Chinese nursing managers were investigated. The translated scale comprises 20 items. Cronbach's α was 0.824. Regarding validity, the three-factor model demonstrated a good fit. The square roots of the average variance extracted, absolute values of correlation coefficients among dimensions and content validity index values were acceptable. The mean AI readiness score was 65.27 ± 9.78. Of the participants, 624 scored above 60 points, 136 scored 40-60 points and 2 scored below 40 points. Scores differed significantly by hospital type, hospital level, department, training participation, prior AI tool or system use and frequency of AI usage. The Chinese-version scale demonstrated good reliability and validity and can effectively assess AI readiness among Chinese nursing managers. Nursing leaders generally demonstrated a favourable level of AI readiness; however, factors such as hospital type and level remain significant determinants influencing nursing leaders' AI readiness. This study provides a standard measurement tool for Chinese hospitals to check how ready their nursing managers are for AI. These findings help us understand the current state of AI readiness among nursing managers in China. The results can help improve AI use strategies. In addition, they can help bring AI into nursing practice more smoothly. This study has important value for moving forward with digital change and smart nursing in China.
Despite clinical advances, breast cancer screening adherence remains stagnant in Japan (<50%) compared with the United States (>70%). Understanding distinct cross-cultural barriers is essential; however, traditional methodologies often fail to capture visceral, real-world individual experiences and hidden deterrents to screening. This study aims to characterize and compare cross-cultural informatics profiles of barriers to breast cancer screening across Japanese-language and English-language social media discourse. We developed an automated natural language processing pipeline on a cloud-based informatics platform to analyze 46,823 screening-related posts (30,027 in Japanese and 16,796 in English) from X (formerly Twitter) collected in 2025, derived from an initial 76,955 posts after noise exclusion. The methodology integrated large language model-assisted sentiment polarity scoring with strict negation-handling, co-occurrence network topology analysis, and advanced distributional visualizations, including raincloud and ridgeline plots. Subgroup comparisons (prescreening vs postscreening and ultrasound with vs without mammography) were evaluated. Among the 46,823 screening-related posts, overall sentiment distributions showed no practically meaningful cross-cultural divergence (Cohen d=0.049); however, domain-specific analyses revealed sharp disparities in barrier prevalence. Within the English-language cohort containing 16,796 posts, discourse exhibited a concentrated, moderate negative sentiment regarding systemic barriers, featuring "Cost" as the primary barrier (n=1239, 7.4%), while "Pain" ranked considerably lower (n=842, 5.0%). In contrast, the Japanese-language cohort containing 30,027 posts was heavily bottlenecked by psychosomatic barriers, governed by a tightly interconnected network of "Pain," "Fear," and "Appointment." "Pain" emerged as the overwhelmingly dominant barrier (n=5788, 19.3%). In the English-language cohort, "Dense" breasts emerged as a prominent clinical topic due to elevated public awareness, distinct from the financial narrative. The Japanese subgroup analyses identified a temporal transition from anticipatory psychological anxiety ("Fear," 739/3805, 19.4%) and logistical concerns ("Appointment," 1556/3805, 40.9%) before screening to a strong persistence of the discomfort memory of "Pain" (1160/7419, 15.6%). Furthermore, sentiment scores for mammography were significantly more negative than those for ultrasound alone (P<.001, Cohen d=0.264), and pain-related descriptors for ultrasound spiked from 5.0% (106/2110, ultrasound alone) to 18.2% (733/4017) when performed concurrently with mammography. Despite comparable overall emotional equilibrium, a fundamental dichotomy emerged. The English-language discourse predominantly reflects US-specific systemic financial burdens, whereas the Japanese experience is characterized by emotional volatility transitioning from anticipatory anxiety to a tightly interconnected "Pain-Fear-Appointment" network. Physical discomfort of mammography dominates the screening narrative, overshadowing concurrent painless modalities like ultrasound. Improving adherence in Japan requires individualized pain-mitigating compression protocols and optimized clinical workflows to decouple mammographic discomfort from supplemental screening, thereby preventing pain-associated defensive avoidance and reducing logistical hurdles to improve equitable access.