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PLoS One. 2016 Dec 21;11(12):e0168538. doi: 10.1371/journal.pone.0168538. eCollection 2016.

Developing and Pilot Testing a Spanish Translation of CollaboRATE for Use in the United States.

Author information

The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, United States of America.
Harvard Medical School, Boston, MA, United States of America.
Massachusetts General Hospital Chelsea HealthCare Center, Chelsea, MA, United States of America.
Primary Care Research Unit, The Alamedilla Health Center. Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain.
Centro Universitario San Rafael-Nebrija, Madrid, Spain.



Given the need for access to patient-facing materials in multiple languages, this study aimed to develop and pilot test an accurate and understandable translation of CollaboRATE, a three-item patient-reported measure of shared decision-making, for Spanish-speaking patients in the United States (US).


We followed the Translate, Review, Adjudicate, Pre-test, Document (TRAPD) survey translation protocol. Cognitive interviews were conducted with Spanish-speaking adults within an urban Massachusetts internal medicine clinic. For the pilot test, all patients with weekday appointments between May 1 and May 29, 2015 were invited to complete CollaboRATE in either English or Spanish upon exit. We calculated the proportion of respondents giving the best score possible on CollaboRATE and compared scores across key patient subgroups.


Four rounds of cognitive interviews with 26 people were completed between January and April 2015. Extensive, iterative refinements to survey items between interview rounds led to final items that were generally understood by participants with diverse educational backgrounds. Pilot data collection achieved an overall response rate of 73 percent, with 606 (49%) patients completing Spanish CollaboRATE questionnaires and 624 (51%) patients completing English CollaboRATE questionnaires. The proportion of respondents giving the best score possible on CollaboRATE was the same (86%) for both the English and Spanish versions of the instrument.


Our translation method, guided by emerging best practices in survey and health measurement translation, encompassed multiple levels of review. By conducting four rounds of cognitive interviews with iterative item refinement between each round, we arrived at a Spanish language version of CollaboRATE that was understandable to a majority of cognitive interview participants and was completed by more than 600 pilot questionnaire respondents.

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

GE reports personal fees from EMMI Solutions LLC, National Quality Forum, Washington State Health Department, and Radcliffe Press outside the submitted work. GE has initiated and led the Option Grid TM patient decisions aids collaborative, which produces and publishes patient knowledge tools, and has been a member of teams that have developed measures of shared decision--making and care integration which are published and available for use. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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