Cultural Adaptation for Spain of the Spanish Version of the Short Sensory Profile using Cognitive Interviews

Review Article

Austin J Autism & Relat Disabil. 2015;1(1):1003.

Cultural Adaptation for Spain of the Spanish Version of the Short Sensory Profile using Cognitive Interviews

Beaudry-Bellefeuille I¹* and Lane SJ²

1Private Practice, Virginia Commonwealth University,USA

2Department of Occupational Therapy, Virginia Commonwealth University, USA

*Corresponding author: Beaudry-Bellefeuille I, Beaudry-Bellefeuille Pediatric Occupational Therapy Clinic, C/ Marques de Santa Cruz, 7, 1°E, 33005 Oviedo,Spain,

Received: September 22, 2014; Accepted: March 24,2015; Published: March 26, 2015


Introduction: The published Spanish version of the short sensory profile was designed to be used with Spanish speaking individuals in the United States. Validation for Spain was needed before it could be used clinically and in research studies in this country. The objectives of the study were twofold: 1) examine the validity of the Spanish version of the short sensory profile for Spanish caregivers; 2) insure maximal cultural clarity in item wording to reflect local usage of the Spanish language.

Methods: Cognitive interviews, commonly used to examine comparability of survey questions in different languages, were the basis for evaluating comprehension and relevance of the Spanish version of the short sensory profile with 8 parents living in Spain. Clarification of wording was reviewed by an experienced linguistic consultant.

Results and Discussion: Parents did not experience major difficulties understanding the question content in the current Spanish version and overall found the items pertinent to their culture. However minor adjustments to 25 of the 38 items were made for improved cultural adequacy. Several Spanish regions have another co-official language. Therapists and researchers working in these areas may need to further refine the tool.

Conclusion: The revised version of the SSP-S provides researchers and clinicians working in Spain with a tool adapted to and validated on their population. Collecting norms in Spain would be needed for a thorough adaptation.

Keywords: Sensory function; Culture; Children; Spain


ASI®: Ayres Sensory Integration; SSP: Short Sensory Profile; SSP-S: Spanish Version of the Short Sensory Profile


Correctly identifying and evaluating sensory processing difficulties provides a key contribution to the occupational therapy intervention process in children with suspected sensory issues [1-4]. While the theory and practice of Ayres Sensory Integration (ASI®) was begun in the United States, it has been embraced globally. In recent years the number of occupational therapists using this approach to assessment and intervention has greatly increased in Spain [5]. The Spanish version of short sensory profile [6] is one of the only tools available to analyze sensory processing in the Spanish speaking population [7]. However, it was designed for Spanish speaking individuals in the United States and cultural validity in all Spanish speaking countries was unclear. Establishing culturally valid evaluation tools is a necessary first step in carrying out rigorous clinical practice and research [8-11].

The validity of the original Short Sensory Profile (SSP) is well established. As noted above, the published Spanish version of the SSP (SSP-S) was designed to be used with Spanish speaking individuals who live in the United States. According to Roman- Oyala and Reynolds [7], the SSP was translated into Spanish using a back translation process. Using this process the questionnaire was translated from English to Spanish, and then translated back into English by a translator who had no knowledge of the original version. Finally, the original and back-translated versions were compared to verify for accuracy. This technique is widely accepted and has been used in the translation process of the Sensory Profile [12] into other languages and in the translation process of other English questionnaires into Spanish [13-15]. However, translation alone is insufficient to guarantee the geo-socio-cultural factors which deeply influence the use of a language. The same language is spoken differently in different countries and the use of the language is a reflection of a nation’s culture [16]. Clinically, Spanish caregivers have not reported difficulties understanding the SSP-S, and overall appear to find it pertinent to their culture. However clinicians using the SSP-S are aware that some of the items include terms and expressions that are not typically used in Spain, and that some items could be improved from a cultural point of view. To address these issues this study sought to answer the following question: Do Spanish speaking parents living in Spain have any difficulties understanding the current Spanish version of the SSP and do they find the items pertinent to their culture?

Materials and Methods

This study took place in Oviedo, Spain. While Spanish caregivers had not expressed significant difficulties understanding the current Spanish version, and items overall appeared to be culturally relevant, clinicians and researchers were in need of verification. Cognitive interviews and linguistic review were conducted to confirm these impressions.

Study design

Cognitive interviewing is a common method for evaluating the comparability of survey questions in different languages [17]. This technique allows researchers to examine the manner in which targeted audiences understand, mentally process, and respond to questions presented to them [18]. The insight gained through this process guides the researcher in the modification of the questions to enhance comprehension and clarity [18]. Sample sizes used in cognitive interviewing are small, generally between 5 and 15 [7,15,18]. Subject recruitment usually depends on quota sampling in an effort to obtain subject variation across a range of characteristics [18]. Interviews are conducted individually and it is recommended that audio or video recording be used to attend to subtle issues that may be missed during the live interview [18].

In the current study cognitive interviews were conducted with eight caregivers of children aged 3 to 5 years, using the methodology described by Roman-Oyala and Reynolds [7]. Other authors describe similar approaches in the study of surveys and questionnaires [19- 21]. As an extension of the cognitive interviews, wording of all items was carefully examined by a linguistic consultant to insure contextual meaning.

Caregivers were asked to complete the SSP-S for their own child, and were asked a series of open ended questions concerning each item of the SSP-S. The questions were posed to the caregiver following completion of each section of the SSP-S. During the interview, participants were asked to communicate questions or doubts concerning the SSP-S. They were also encouraged to share suggestions on how to make the SSP-S more understandable. Interviews were conducted individually and audio-recorded.

After completing each one of the SSP-S sections, parents were asked the following probe questions:

1) How do you interpret what the item is asking?

2) What are some examples of your child’s behavior that made you choose that answer?

3) What changes, if any, would you make to the item to improve its understanding? [7].

Other spontaneous questions and comments made by the respondents were taken into account. Questions that were unclear to two or more of the interviewed parents were revised for clarity. Questions that were substantially revised were posed to four parents for affirmation; two who had initially identified the questions as unclear and two additional parents. The same probe questions were used to verify the revised questions. All items, both the revised and unchanged items, were reviewed by an experienced linguistic consultant to ensure grammatical and cultural (Spain) accuracy.


Participants in cognitive interviews were recruited from among the families who attend the private OT clinic of the first author using a quota sampling method. A sample of eight caregivers was recruited based on a heterogeneous representation of the following characteristics: private vs public school, parent education, and family income. To avoid asking directly for family income, a cultural taboo in Spain, income level was determined based on eligibility of the family to receive governmental scholarships for school supplies and lunch at school. At the time the study took place, families were eligible for scholarships when the total annual income of the family was less than €5000 per member. Participant demographics are presented in Table 1.