Issues and methods in disparities research: the Rhode Island-Puerto Rico asthma center.

BACKGROUND: Epidemiologic studies have documented higher rates of asthma prevalence and morbidity in minority children compared to non-Latino white (NLW) children. Few studies focus on the mechanisms involved in explaining this disparity, and fewer still on the methodological challenges involved in rigorous disparities research. OBJECTIVES AND METHODS: This article provides an overview of challenges and potential solutions to research design for studies of health disparities. The methodological issues described in this article were framed on an empirical model of asthma health disparities that views disparities as resulting from several factors related to the healthcare system and the individual/community system. The methods used in the Rhode Island-Puerto Rico Asthma Center are provided as examples, illustrating the challenges in executing disparities research. RESULTS: Several methods are described: distinguishing ethnic/racial differences from methodological artifacts, identifying and adapting culturally sensitive measures to explain disparities, and addressing the challenges involved in determining asthma and its severity in Latino and other minority children. The measures employed are framed within each of the components of the conceptual model presented. CONCLUSIONS: Understanding ethnic and/or cultural disparities in asthma morbidity is a complicated process. Methodologic approaches to studying the problem must reflect this complexity, allowing us to move from documenting disparities to understanding them, and ultimately to reducing them.

Translation and cultural adaptation of a mental health outcome measure: the BASIS-R(c).

Culturally and linguistically appropriate outcome measures are needed to address the needs of Latino consumers of mental health services. The revised Behavior and Symptom Identification Scale (BASIS-R(c)) is an English-language consumer self-report measure designed to assess outcome of behavioral health or substance abuse treatment. This study sought to develop a culturally and linguistically appropriate version of the BASIS-R(c) for Spanish-speaking Latinos. To achieve this goal, the English instrument was translated and adapted into Spanish by an international bilingual committee and tested in four focus groups and 45 cognitive interviews with Puerto Ricans, Dominicans, and Mexicans living in the United States and Puerto Rico. Focus groups and cognitive interviews provided qualitative and quantitative information about the instrument's content and format, and respondents' understanding of the instructions, questionnaire items, time frame, and response options. Respondents' ratings of the clarity and importance of each item were also obtained. Analyses of focus group and cognitive interview data identified items that were confusing or difficult for participants. Findings suggest that the Spanish version of the BASIS-R(c) incorporated the cultural diversity of the three groups of Latinos in this study without compromising the validity of the English version of the BASIS.

A study of disruptive behavior disorders in Puerto Rican youth: I. Background, design, and survey methods.

OBJECTIVE: This is the first of two related articles on a study carried out between 2000 and 2003 designed to assess the prevalence, associated comorbidities, and correlates of disruptive behavior disorders in two populations of Puerto Rican children: one in the Standard Metropolitan Areas of San Juan and Caguas in Puerto Rico, and the other in the south Bronx in New York City. METHOD: This article provides the study's background, design, and methodology. Probability samples of children ages 5 to 13 years were drawn at the two sites (n = 2,491). Subjects and their primary caretakers were interviewed using the Diagnostic Interview Schedule for Children-IV and a wide array of risk factor measures. The samples were weighted to correct for differences in the probability of selection resulting from sample design and to adjust for differences from the 2000 U.S. Census in the age/gender distribution. RESULTS: The samples are representative of the populations of Puerto Rican children in the south Bronx and in the Standard Metropolitan Areas in Puerto Rico. Of the 2,940 children identified as eligible for the study, 2,491 participated for an overall compliance rate of 85%. CONCLUSIONS: The study results, to be described in an accompanying report, are generalizable to the two target populations.

Cultural relevance and equivalence in the NLAAS instrument: integrating etic and emic in the development of cross-cultural measures for a psychiatric epidemiology and services study of Latinos.

This paper describes the development, translation and adaptation of measures in the National Latino and Asian American Study (NLAAS). We summarize the techniques used to attain cultural relevance; semantic, content and technical equivalency; and internal consistency of the measures across languages and Latino sub-ethnic groups. We also discuss some of the difficulties and thallenges encountered in doing this work. The following three main goals are addressed in this paper: (1) attaining cultural relevance by formulating the research problem with attention to the fundamental cultural and contextual differences of Latinos and Asians as compared to the mainstream population; (2) developing cultural equivalence in the standardized instruments to be used with these populations; and (3) assessing the generalizability of the measures - i.e., that the measures do not fluctuate according to culture or translation. We present details of the processes and steps used to achieve these three goals in developing measures for the Latino population. Additionally, the integration of both the etic and emic perspectives in the instrument adaptation model is presented.