An evaluation of the linguistic and cultural validity of the Spanish language version of the children with special health care needs screener

Objectives: The 2001 National Survey of Children with Special Health Care Needs (CSHCN) used the CSHCN Screener, a 5-item survey based tool, to identify children with special health care needs. The prevalence of special health care needs for Hispanic children was lower than that reported for all other ethnic and racial groups, with the exception of Asian children. To better understand the reasons for the lower prevalence rate, this study examined variations in CSHCN prevalence for Hispanic children according to whether parents responded to the National Survey of CSHCN screening interview in Spanish or English. The Spanish translation of the CSHCN Screener was further evaluated through a series of face-to-face interviews with parents with limited English proficiency (LEP). Methods: The 2001 National Survey of CSHCN screened 372,174 children ages 0-17 years for special health care needs. Bivariate and multivariate analyses were conducted to examine the effects of interview language on the CSHCN prevalence rates for Hispanic children (n = 47,371). Using a standardized protocol, cognitive interviews were conducted in Spanish with 19 LEP parents to elicit their comprehension of and reactions to the screening questions. Results: When parents wereinterviewed in English, 11.7% of Hispanic children were identified as CSHCN. When parents were interviewed in Spanish, 5.1% of Hispanic children were identified as CSHCN. Lower prevalence of the need for or use of prescription medications for chronic conditions made the largest contribution to the observed difference in CSHCN prevalence. Cognitive interviews with parents did not identify any linguistic or cultural deficiencies in the Spanish translation of the CSHCN Screener. Parents did express disinclination toward sharing details of their children's health in the context of a typical telephone survey.