Developing a Spanish-language Consumer Report for CAHPS Health Plan Surveys

BACKGROUND: A Spanish-language consumer report on health plan quality was developed for the consumer assessments of Healthcare Providers and Systems (CAHPS) project. METHODS: Multiple translations, a committee review, and a readability assessment were performed to produce a draft Spanish report. The report was revised on the basis of a series of cognitive interviews with 24 Latinos. RESULTS: The median age of participants was 41 years, and the median number of years in the United States was 9; 67% were female, and 63% had less than a high school education. In general, participants understood the report and said they would use it to choose a health plan. Less educated respondents had difficulty understanding the segmented bar graphs that showed the proportion of health plan members' responses. A summary chart comparing all health plans on all dimensions was easier to comprehend when differences were represented by word icons rather than by stars. DISCUSSION: Concepts and terms about health care quality translated well from English to Spanish. Simplifying graphical information involved losing some detail but makes information more usable. Summary charts facilitate comparisons across plans, but differences relative to a mean are difficult for both Spanish- and English-speaking consumers to understand.