EPD205 - A Cultural and Linguistic Translation of the Transportation Security Index to Measure Barriers to Colorectal Cancer Screening among Spanish-Speaking Patients

Monday, May 11, 2026

8:32 AM - 8:37 AM ET

ePoster of Distinction Presenter(s)

AL

Alejandro A. Lopez, BS

Medical Student
The Ohio State University College of Medicine
Columbus, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

AR

Aidan A. Rodwell, n/a

Assistant Clinical Research Coordinator
Stanford School of Medicine
Palo Alto, California, United States

Disclosure information not submitted.
AP

Alexa Pohl, MD, PhD

Resident
Stanford University
Palo Alto, California, United States

Disclosure information not submitted.
Aaron J. Dawes, MD, PhD (he/him/his)

Assistant Professor
Stanford University School of Medicine
Stanford University School of Medicine
Stanford, California, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
AA

Aderinsola Aderonmu, MD, MS

Resident
Stanford University
Palo Alto, California, United States

Disclosure information not submitted.
Cindy Kin, MD, MS, FACS, FASCRS (she/her/hers)

Associate Professor
Stanford University
Stanford University
Stanford, CA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
MM

Miquell O. Miller, MD, MSc

Assistant Professor of Surgery
UC Davis Health
Sacramento, California, United States

Disclosure information not submitted.

Senior Author(s)

Arden Morris, MD, MS

Professor
Stanford Hospital
Stanford University School of Medicine
Palo Alto, California, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Alejandro A. Lopez, BS: This individual has no financial relationships with ineligible companies.

Aaron J. Dawes, MD, PhD: This individual has no relevant relationships with ineligible companies.

Cindy Kin, MD, MS, FACS, FASCRS: This individual has no financial relationships with ineligible companies.

Purpose/Background: The incidence of colorectal cancer (CRC) has risen sharply among Latinx Americans, who account for >20% of the US population. Colonoscopy remains the gold standard for CRC screening since it facilitates both early diagnosis and cancer prevention through polyp removal. However, lack of reliable transportation is a frequent, preventable cause of missed colonoscopy appointments. Few studies have explored transportation barriers among Spanish-speaking patients and the only validated instrument, the Transportation Security Index (TSI-16), is available only in English. We aimed to develop a culturally and linguistically valid Spanish-language translation of the TSI-16 for use across clinical contexts, with an additional item specific to CRC screening.

Methods/Interventions: We performed 2 independent forward-translations of the TSI-16 which were reconciled through discussion, back-translation, review, and harmonization. Two native Spanish-speaking team members conducted cognitive interviews with Spanish-speaking community members to assess appropriateness across dialects. Interview participants completed demographics, health literacy, and the “TSI-16-Spanish” questionnaires with $20 cash compensation. Interviewers recorded behavioral observations and confirmed logistic and cultural appropriateness, reporting concerns and suggestions to the study team for iterative refinement until there were no further new concerns (saturation). An external expert panel of native Spanish-speaking clinicians and community advocates then was convened for item-by-item review and refinement of the final TSI-16-Spanish for large scale deployment and psychometric testing.

Results/Outcomes: 46 individuals (22 women, 24 men) participated in cognitive interviews. Participants’ mean age was 37.1 years (range 21-66) and countries of origin were predominantly Mexico (n=26), but also Colombia, El Salvador, Guatemala, Honduras, and Puerto Rico in the US. Cognitive interviews identified several opportunities for improvement: we revised 2 items with major wording issues, shortened redundant phrases, simplified language to be functionally understood by all levels of education, and clarified the meaning of items. Critical changes based on expert panel review included more wording changes aimed at making items more understandable to Spanish-speakers of diverse backgrounds, changes to the formatting, and adaptation for better gender-inclusivity.

Conclusion/Discussion: We developed and iteratively refined a Spanish-language translation of the TSI-16 that focused on sense-for-sense rather than word-for-word translation, based on modern survey translation principles. Future work will include psychometric validation among a large cohort of Spanish-speaking patients. Ultimately, this tool will be used to improve our understanding of transportation barriers to colonoscopy among Spanish-speaking individuals and to inform targeted and culturally-appropriate interventions to increase screening adherence.