Cultural adaptation of a complementary and alternative medicine use pattern survey instrument in puerto rico

Complementary and alternative medicine (CAM) has been defined as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. The use of CAM has become widespread, with expense in the U.S. equal to all out-of-pocket expenses for physician services. Patient safety and access issues, financial and cost considerations and the role of CAM practices in health promotion and prevention are primary concerns for patients, providers, insurers, policy makers and health care managers in Puerto Rico as well as in other countries. However, studies on CAM use in the island are non-existent. This methodology paper presents findings from the cultural adaptation of a CAM survey instrument designed to examine CAM use patterns in Puerto Rico using the U.S. National Health Interview Survey. Focus groups and expert panel meetings were utilized to adapt the instrument to Puerto Rican culture. Results emphasize the importance of semantic, concept and normative equivalencies in developing an instrument sensitive to the cultural context where it will be administered. This is the first study of its kind in Puerto Rico and is funded by the Agency for Healthcare Research and Quality (AHRQ).