Health Risks of Latino Children

To the Editor: Dr Flores and colleagues¹ cited an article² about the translation of the Spanish version of the Consumer Assessment of Health Plans Study (CAHPS) 1.0 survey and summarized it by saying that "initial Spanish translations were too awkward, culturally inappropriate, insufficiently idiomatic, frequently lacking in conceptual equivalence, and at an inappropriately high reading level." We wish to clarify that the focus of that article was not only to outline some of the issues and problems with the Spanish version of CAHPS 1.0 but also to explain some of the measures that were taken to address these issues, including conducting cognitive interviews and a small field test. The instrument was revised (CAHPS 2.0)³ according to this information by using alternative Spanish wording that was more colloquial, which improved the conceptual equivalence between the Spanish and English versions of this instrument.