Development and usability testing of a Spanish version of a mobile app–based adaptive coping skills intervention for critical illness survivors: Blueprint en español

Abstract Rationale The exclusion of Spanish-speaking participants in psychobehavioral trials among critical illness survivors limits the generalizability of evidence-based interventions. However, adapting interventions for inclusivity is challenging, and few examples exist in the field for replication. Objectives To describe the cultural and linguistic adaptation of the Blueprint mobile app–based adaptive coping skills intervention to Spanish for inclusion in a multicenter trial, its usability testing, and lessons learned from the process. Methods A multidisciplinary team of native English and Spanish speakers conducted an iterative 3-step adaptation. Step 1 involved an initial cultural and linguistic adaptation of key scripted content of an existing psychobehavioral intervention for critical illness survivors (“Blueprint”) to Spanish by a group that included community members, members of a Latino-serving health advocacy group, and clinicians. In Step 2, bilingual trial network members created final versions of all text and images, which were then professionally produced for an equivalent Spanish language version of the Blueprint mobile application. Step 3 involved a formal usability test of the final Spanish version among bilingual participants (n = 10) by comparing observed to target values of the Systems Usability Scale (SUS). Results The team successfully developed adaptations of 35 elements of audio, video, and text content. The mean SUS score of 83.1 (10.7 SD) exceeded our a priori usability target of 80. Key lessons learned included that translation software is inadequate to comprehensively incorporate cultural norms, diverse dialect representation is essential, extensive time and expense is required, and consensus must be balanced against cost and time constraints. Conclusions We conducted a successful cultural and linguistic adaptation of an English language psychobehavioral intervention to a highly usable Latin American Spanish version using a methodologically rigorous process. Lessons learned from this project can assist researchers seeking to increase the number of Spanish language psychobehavioral interventions and the generalizability of future trials. Clinical trial registration The parent trial is registered on ClinicalTrials.gov as NCT06538246 (https://clinicaltrials.gov/study/NCT06538246).