Spanish is the official language of over 20 countries/territories, not including the second largest population of Spanish speakers residing in the U.S. Test adaptations for Spanish are typically 1:1 translations of traditional paper-and-pencil tests that prioritize the fidelity of the original measure and have not undergone cross-cultural validation, reliability, or normative studies in accordance with cultural/linguistic test adaptation guidelines. Multicultural Mayo Test Development through Rapid Iteration, Validation, and Expansion (MMTD) is a web-based platform for cultural and linguistic adaptation of self-administered digital novel (=(Stricker Learning Span; SLS) and open access (Symbols Test) cognitive measures. MMTD-Español aims to adapt SLS stimuli and SLS/Symbols instructions for heterogeneous Spanish speaking populations using community centered approaches. The current study examines content validity from virtual focus groups.

First, Spanish SLS stimuli were selected based on high frequency Spanish words (EsPAL), paradigm-relevant word properties, and research team consensus. Instructions were professionally translated. Second, the MMTD-Español registry (REDCap) was developed for ongoing recruitment of Spanish speaking community members, stakeholders (e.g., neuropsychologists, trainees), and patients. Registry participants complete surveys assessing linguistic/cultural background, familiarity with cognitive testing, history of cognitive diagnoses, and use of technology. Over two months, participants meeting inclusion (Spanish speakers, ≥18 years old) and exclusion (diagnosis of dementia or major neurocognitive disorder) criteria were invited to participate in focus groups held via videoconferencing. Focus group participants completed more detailed surveys (language use, acculturation, social determinants of health) and took the English version of Mayo Test Drive to experience the paradigm/platform. Bilingual Spanish/English health professionals (neuropsychologist, psychiatrist) facilitated the focus groups with slides/prompts to elicit feedback on appropriateness of the platform, test paradigm, instructions, and stimuli. Sessions  were professionally transcribed and coded for qualitative themes.

MMTD-Español registry participants (n=82) represented 17 countries of origin (30.5% from Mexico, 22% from the US), Mage=34.86, 70.7% women, 26.8% men, 2.4% nonbinary/gender queer, 75.6% with at least a bachelor's degree; 95.1% Hispanic/Latino, 43.2% native/early English speakers). Participant experience with cognitive testing included minimal-to-none (61.9%) and varied experience with test administration, training, and professional expertise. A subsample enrolled in focus groups (n=38; 1-7 per group for 10 sessions) representing 14 countries of origin with 84% residing in the U.S. Focus group participants did not differ by age, gender, Hispanic/Latino ethnicity, or educational background from non-focus group participants, but had a great proportion of native/early English speakers (55% vs. 32%). Exemplar themes include feedback on Spanish word properties (e.g., lexical, semantic, cultural nuances), and user experience (e.g., performance strategies, item difficulty) that informed iterative revisions and validated the paradigm. Findings contributed to simplified instructions, alternative memory word items, and altered item order (difficulty).

MMTD is an adaptive model for virtually adapting self-administered digital testing for individuals with varied cultural and linguistic backgrounds. Results suggest that engaging with stakeholders and community members from the target population in the early phases of test development may reduce bias. Future work includes piloting of MMTD-Español in more diverse (e.g., upper age range, fewer years of education) samples in-person and virtually.