Translation of a tobacco survey into Spanish and Asian languages: the Tobacco Use Supplement to the Current Population Survey

Cultural Adaptation of Child Discipline Measures for Puerto Rican Mothers: Enhancing the Cultural Sensitivity of Parenting Assessments

BACKGROUND/OBJECTIVES

Puerto Ricans (PRs) face significant challenges in accessing essential parenting resources and support due to language barriers and lack of culturally appropriate healthcare services, perpetuating health disparities. Cultural adaptation of psychosocial measurement tools is crucial for promoting health equity and improving health outcomes. This study describes the cultural adaptation of two parenting discipline assessment measures for use with Spanish-speaking PR mothers of 2-4-year-old children.

METHODS

We used a community-engaged, mixed-methods approach to measurement adaptation that involved independent translations (n = 2), back-translations (n = 2), and an adaptation committee (n = 6, including all translators) who reviewed, appraised, and modified survey versions. We conducted cognitive interviews (n = 20) to pretest the semi-finalized Spanish measures and assess mothers' understanding of survey items.

RESULTS

Mothers had a mean age of 28.6 years. Most were married/cohabitating (70%), had a high school diploma or GED (90%), and a household income of less than $40,000 (68%). Indexed children's mean age was 2.9 years, with most identified by mothers as female (60%). Feedback from the adaptation committee and pretesting participants led to specific changes like rephrasing culturally specific terms and adjusting examples to better fit the daily experiences of PR mothers. Most mothers found the Spanish version of the measures to be clear and culturally relevant. This cultural adaptation process addressed translation inconsistencies and design issues, and better captured culturally relevant discipline practices.

CONCLUSIONS

Engaging communities in measurement adaptations ensures culturally and linguistically tailored measures that respect participant preferences, strengthen partnerships, and enable interventions to address health disparities, thereby promoting child health.

Development of the Canadian Food Intake Screener to assess alignment of adults' dietary intake with the 2019 Canada's Food Guide healthy food choices recommendations

NOVELTY

The Canadian Food Intake Screener was developed to rapidly assess alignment of adults' dietary intake over the past month with the Food Guide's healthy food choices recommendations. The screener was developed and evaluated through an iterative process that included three rounds of cognitive interviews in each of English and French, along with ongoing feedback from external advisors and face and content validity testing with a separate panel of content experts. The 16-question screener is intended for use with adults, aged 18-65 years, with marginal and higher health literacy in research and surveillance contexts in which comprehensive dietary assessment is not possible.

The Nutrition Literacy Assessment Instrument for Brazilians, NLit-Br: An Exploratory Cross-Cultural Validity Study

This study aimed to test the validity of the cross-cultural adapted Nutrition Literacy Assessment Instrument for Brazilians (NLit-Br). An observational cross-sectional study was performed in chronic disease clinics from the Brazilian Public Health System in two phases: (1) linguistic and cultural adaptation and (2) validity testing. Six registered dietitians and thirty adult patients diagnosed with at least one chronic disease participated in the study using the nutrition literacy assessment instrument (NLit-Br) and the short assessment of health literacy for Portuguese-speaking adults (SAHLPA-18). Sample descriptive variables: age, sex, race, income, education, and occupation. To adapt the instrument to the Brazilian Portuguese and Brazilian culture, we tested cognitive interviewing and the Scale Content Validity Index (S-CVI) with a group of dietitians and patients. To test the tool’s validity, health literacy (SAHLPA-18) was used as a construct that presents similarities and differences with nutrition literacy (NLit-Br). The correlation of NLit-Br and the SAHLPA-18 was tested (Spearman’s Rho). Internal consistency was measured by Kuder−Richardson Formula 20 (KR-20). The NLit-Br content validity (S-CVI = 0.85) and internal consistency (KR-20 = 0.868) were confirmed. Additionally, NLit-Br presented a significant and robust correlation with SAHLPA-18 (r = 0.665, p < 0.001). Therefore, the NLit-Br was considered a linguistic, cultural, and valid instrument to measure Brazilian’s nutrition literacy.

Improving Translation and Cultural Appropriateness of Spanish-Language Consent Materials for Biobanks

A growing proportion of prospective research participants in the United States speak limited or no English. We conducted cognitive interviews with native Spanish speakers to test Spanish-language translations of simplified and traditional biobank consent forms. Comprehension was generally high and did not differ by form. Most of those who received the simplified form felt it contained the right amount of information, compared with fewer than half of those who received the traditional form. Qualitative results allowed us to identify overarching issues related to tone, formality, and voice that may affect prospective participants' trust and willingness to participate. Certain characteristics of written Spanish are seemingly at odds with recommended actions to simplify consent forms; thus, even when significant empirical effort has been expended to develop simplified consent materials in English, additional work is needed to ensure the accuracy, comprehensibility, and cultural-congruence of Spanish-language translations.

Measuring Nutrition Literacy in Spanish-Speaking Latinos: An Exploratory Validation Study

Nutrition is important for preventing and treating chronic diseases highly prevalent among Latinos, yet no tool exists for measuring nutrition literacy among Spanish speakers. This study aimed to adapt the validated Nutrition Literacy Assessment Instrument for Spanish-speaking Latinos. This study was developed in two phases: adaptation and validity testing. Adaptation included translation, expert item content review, and interviews with Spanish speakers. For validity testing, 51 participants completed the Short Assessment of Health Literacy-Spanish (SAHL-S), the Nutrition Literacy Assessment Instrument in Spanish (NLit-S), and socio-demographic questionnaire. Validity and reliability statistics were analyzed. Content validity was confirmed with a Scale Content Validity Index of 0.96. Validity testing demonstrated NLit-S scores were strongly correlated with SAHL-S scores (r = 0.52, p < 0.001). Entire reliability was substantial at 0.994 (CI 0.992-0.996) and internal consistency was excellent (Cronbach's α = 0.92). The NLit-S demonstrates validity and reliability for measuring nutrition literacy among Spanish-speakers.

Translation and adaptation of skin cancer genomic risk education materials for implementation in primary care

Genomic medicine has revolutionized disease risk identification and subsequent risk reduction interventions. Skin cancer risk genomic feedback is a promising vehicle to raise awareness and protective behaviors in the general population, including Hispanics who are largely unaware of their risks. Yet, personalized genomics currently has limited reach. This study is the initial phase of a randomized controlled trial investigating the personal utility and reach of genomic testing and feedback for melanoma. Semi-structured cognitive interviews (N = 28), stratified across education level, were conducted to assess the comprehension and acceptability of translated skin cancer genomic risk education materials with Spanish-speaking Hispanic primary care patients. Overall, materials were comprehensible and acceptable with 33 of 246 terms/concepts identified as difficult. Common problems included translation challenges (e.g., peeling from sunburn), ambiguous concepts (e.g., healthcare system), and problematic terms (e.g., risk version). Aiming to expand the reach of genomic medicine across subpopulations that may benefit from it, necessary modifications were made to education materials to improve comprehensibility, acceptability, and cultural relevance.

Examining Intuitive Cancer Risk Perceptions in Haitian-Creole and Spanish-Speaking Populations

BACKGROUND

There is a developing emphasis on intuition and affect in the illness risk perception process, yet there have been no available strategies to measure these constructs in non-English speakers. This study examined the comprehensibility and acceptability of translations of cancer risk beliefs in Haitian-Creole and Spanish.

METHOD

An established, iterative, team-based translation process was employed. Cognitive interviews (n = 20 in Haitian-Creole speakers; n = 23 in Spanish speakers) were conducted in an inner-city primary care clinic by trained interviewers who were native speakers of each language. Use of an established coding scheme for problematic terms and ambiguous concepts resulted in rewording and dropping items.

RESULTS

Most items (90% in the Haitian-Creole version; 87% in the Spanish version) were highly comprehensible.

DISCUSSION

This work will allow for further research examining health outcomes associated with risk perceptions across diverse, non-English language subgroups, paving the way for targeted risk communication with these populations.

Using cognitive interviewing for the semantic enhancement of multilingual versions of personality questionnaires

We discuss the use of cognitive interviewing with bilinguals as an integral part of cross-cultural adaptation of personality questionnaires. The aim is to maximize semantic equivalence to increase the likelihood of items maintaining the intended structure and meaning in the target language. We refer to this part of adaptation as semantic enhancement, and integrate cognitive interviewing within it as a tool for scrutinizing translations, the connotative meaning, and the psychological impact of items across languages. During the adaptation of a work-based personality questionnaire from English to Arabic, Chinese (Mandarin), and Spanish, we cognitively interviewed 12 bilingual participants about 136 items in different languages (17% of all items), of which 67 were changed. A content analysis categorizing the reasons for amending items elicited 11 errors that affect 2 identified forms of semantic equivalence. We provide the resultant coding scheme as a framework for designing cognitive interviewing protocols and propose a procedure for implementing them. We discuss implications for theory and practice.

Validation of the Health-Promoting Lifestyle Profile II for Hispanic male truck drivers in the Southwest

The aims of the study were to validate the English and Spanish Versions of the Health-Promoting Lifestyle Profile II (HPLP II) with Hispanic male truck drivers and to determine if there were any differences in drivers' responses based on driving responsibility. The methods included a descriptive correlation design, the HPLP II (English and Spanish versions), and a demographic questionnaire. Fifty-two Hispanic drivers participated in the study. There were no significant differences in long haul and short haul drivers' responses to the HPLP II. Cronbach's alpha for the Spanish version was .97 and the subscales alphas ranged from .74 to .94. The English version alpha was .92 and the subscales ranged from .68 to .84. Findings suggest the subscales of Health Responsibility, Physical Activities, Nutrition, and Spirituality Growth on the HPLP II Spanish and English versions may not adequately assess health-promoting behaviors and cultural influences for the Hispanic male population in the southwestern border region.

Cultural adaptation of physical activity self-report instruments

CONTEXT

The validity of physical activity (PA) self-report measures can be a problem when using these measures with target populations that differ from the population for which the measures were originally developed.

OBJECTIVES

Describe an approach to further tailor PA self-report measures to a target community, and report on focus group and cognitive interview findings.

PROCESS

Topics relevant to culturally tailoring measures are discussed, including translation, focus groups, and cognitive interviews. We describe examples from our own work, including focus groups and cognitive interviews conducted to assess Latinos' interpretations of PA questions derived from various epidemiological surveys that were developed in White communities.

FINDINGS

Findings from focus groups and cognitive interviews provide valuable information about the comprehension, interpretation, and cultural relevance of the PA questions to Latino communities.

CONCLUSIONS

It is recommended that investigators collect formative data to better assess the equivalence of items being applied to a different cultural group. Guidelines for cultural attunement of self-report instruments are described to promote more uniform and rigorous processes of adaptation and facilitate cross-cultural investigations.

Using Cognitive Interviewing and Behavioral Coding to Determine Measurement Equivalence across Linguistic and Cultural Groups: An Example from the International Tobacco Control Policy Evaluation Project

The present study aimed to examine and compare results from two questionnaire pretesting methods (i.e., behavioral coding and cognitive interviewing) in order to assess systematic measurement bias in survey questions for adult smokers across six countries (USA, Australia, Uruguay, Mexico, Malaysia and Thailand). Protocol development and translation involved multiple bilingual partners in each linguistic/cultural group. The study was conducted with convenience samples of 20 adult smokers in each country. Behavioral coding and cognitive interviewing methods produced similar conclusions regarding measurement bias for some questions; however, cognitive interviewing was more likely to identify potential response errors than behavioral coding. Coordinated survey qualitative pretesting (or post-survey evaluation) is feasible across cultural groups, and can provide important information on comprehension and comparability. Cognitive interviewing appears a more robust technique than behavioral coding, although combinations of the two might be even better.

Cognitive testing of physical activity and acculturation questions in recent and long-term Latino immigrants

Background

We ascertained the degree to which language (English versus Spanish), and residence time in the US influence responses to survey questions concerning two topics: self-reported acculturation status, and recent physical activity (PA). This topic is likely to be of general interest because of growing numbers of immigrants in countries worldwide.

Methods

We carried out qualitative (cognitive) interviews of survey items on acculturation and physical activity on 27 Latino subjects from three groups: (a) In Spanish, of those of low residence time (less than five years living in the U.S.) (n = 9); (b) In Spanish, of those of high residence time (15 or more years in the U.S) (n = 9); and (c) in English, of those of high residence time (n = 9).

Results

There were very few language translation problems; general question design defects and socio-cultural challenges to survey responses were more common. Problems were found for both acculturation and PA questions, with distinct problem types for the two question areas. Residence time/language group was weakly associated with overall frequency of problems observed: low residence time/Spanish (86%), high residence time/Spanish (67%), and English speaking groups (62%).

Conclusions

Standardized survey questions related to acculturation and physical activity present somewhat different cognitive challenges. For PA related questions, problems with such questions were similar regardless of subject residence time or language preference. For acculturation related questions, residence time/language or education level influenced responses to such questions. These observations should help in the interpretation of survey results for culturally diverse populations.