Mayo Test Drive Español: A model of digital cognitive test adaptation

Objective: Test adaptations for Spanish are typically 1:1 translations of traditional paper-and-pencil tests that prioritize the fidelity of the original measure and have not undergone cross-cultural adaptation. Mayo Test Development through Rapid Iteration, Validation, and Expansion-Español (Mayo Test Drive-Español) is an adaptation of digital cognitive tests (Stricker Learning Span, Symbols Test) for and by heterogeneous Spanish speaking populations via a mixed methods approach. Method: Participants who spoke Spanish as a first and/or primary language, living in or outside of the United States, were recruited for the Mayo Test Drive-Español registry to complete surveys assessing linguistic background, familiarity with cognitive testing, cognitive diagnoses, and technological accessibility. A subsample completed additional questionnaires and virtual focus groups including cognitive interviewing and direct feedback on test instructions/stimuli. Iterative adaptations and alternative sets of stimuli/instructions were presented to subsequent focus groups and underwent team review. Saturation was determined by team consensus. Professional transcriptions of focus groups were analyzed qualitatively. Results: A subsample of Mayo Test Drive-Español registry participants (n = 85) were enrolled into 10 focus groups (n = 38, 1-7 per group). 8 iterative revisions of test stimuli (including 54/92 words) and 9 iterative revisions of instructions were made based on focus group feedback, team meetings, and quality control procedures. Transcribed sessions were analyzed for themes related to the platform, paradigms/construct, instructions, and content. Conclusions: Mayo Test Drive-Español demonstrates the importance of early input from stakeholders (professionals, patients, community members) from various regions to improve the adaptation of cognitive measures for different languages and contexts.  .