Developing a binational and bilingual health questionnaire for the US-Mexico border

Background: Little information other than vital statistics is available on health status of the US-Mexico border population. Information is sorely needed for disease prevention and health promotion activities.

Methods: Health professionals from Mexico and the US jointly developed a BRFSS-based questionnaire for both sides of the US-Mexico border. Cognitive testing, pilot interviews and other evaluation techniques were used to ensure comparable.

Results: Collaborators from CDC, the Mexican Secretaría de Salud and border state health departments met in El Paso in 2004 and agreed to develop a cross-border survey based on the BRFSS. The initial English draft included a number of border-specific questions, such as cross-border usual source of health care, recent use of cross-border health care, cross-border source of health insurance, and others. The initial English version was tested in three Texas border counties. Mexican researchers developed a Spanish translation which was evaluated by bilingual researchers from both countries. Following a 2-day workshop on cognitive testing techniques, the Spanish-language version was evaluated using cognitive evaluation methods: 16 trained interviewers interviewed 32 subjects, the average length of time used on each interview was 3 hrs, and 4 interviews were videotaped. Findings: 40% of the questions were identified as having cognitive problems; rewording was suggested for each. Seven questions were reported as extremely hard to understand by 90% of interviewees.

Conclusion: Careful development, translation, and evaluation are required to ensure that binational/bilingual surveys will produce comparable results. Collaborative discussion of the aims of each question and cognitive testing are essential.