Table 1.

Original Survey Adaptation to Develop BAST, Translation of BAST to BAST-ESP, Modifications, and Final Validation of BAST and BAST-ESP

Original Items from Various Surveys Literacy Level: 12th Grade	Phase 1		Phase 2		Rationale for Modification
	BAST Literacy Level: 9th Grade	BAST-ESP Translation Literacy Level: 7th Grade	BAST-Validated Literacy Level: 8.8th Grade	BAST-ESP-Validated Literacy Level: 6.9th Grade
Sometimes I fly off the handle for no good reason	I got mad easily	Me enojaba fácilmente	No change	No change	Eliminated idiomatic expressed and simplified syntax
When I encounter a difficult, stressful, or upsetting situation, I “freeze” and do not know what to do	Do you feel stressed? [branching logic] When stressed, I was unable to make decisions	¿Se siente estresado? Cuando estaba estresado, no podía hacer decisiones	No change	¿Se siente estresado? Cuando estaba estresado, no podía tomar decisiones.	Simplified syntax and only asked when individuals endorsed stress, per focus group results “Tomar” is the best word for making decisions
Please check the response that corresponds to your answer	Then, circle the response that corresponds to your answer	Luego, circula la respuesta que corresponda a la pregunta	Then, choose your answer	Luego, escoja su respuesta	“Check” was odd without a checkbox “Circle” is appropriate for a paper survey, but “choose” is better for a mobile health app
Never Rarely Sometimes Frequently Always	Never Rarely Sometimes Frequently Always	Nunca Raro A veces Frecuentemente Siempre	Never Rarely Sometimes Often Very often	Nunca Rara vez A veces Seguido Muy seguido	The modified scales were previously validated and used as best practice for frequency Likert scales
Derived from multiple itemsa	When something upset me, I had a hard time letting it go	Cuando algo me molestaba, era difícil olvidarme de ello	When something upset me, I kept thinking about it	Cuando algo me molestaba, seguía pensando en eso	Translation of “letting it go” as “olvidarme” (forget) was deemed conceptually nonequivalent. “Kept thinking about it” translates equally and preserves the original survey items' intention
Derived from multiple itemsa	I used strategies in my day to day life	Usaba estrategias en mi días cotidianos	I used coping strategies in my day-to-day life	Usaba estrategias para superar mi vida día a día	Adding “coping” to “strategies” increases clarity
Apologize for misbehavior (for example, apologize for swearing)	I apologized when I did something wrong	Pedía perdón cuando hacía algo malo	No change	Me disculpaba cuando hacía algo malo	“Me disculpaba” (apologized) is a closer translation than “pedía perdón” (asked for forgiveness)
If somebody hits me, I hit back	I was able to walk away from a fight	Podía alejarme de una pelea	I could walk away from a fight	Podía salirme de una pelea	English: “could” is simpler than “able to.” Spanish: “salirme” (remove myself) is closer to “walk away from” than “alejarme” (distance myself)
Investigator created itema	I used drugs for non-medical reasons	Usaba drogas sin razón médica	Two items: I used recreational drugs. I used medications not according to prescription	Two ítems: Usaba drogas. Usaba medicamentos solamente por gusto o para razones no médicas	Split to 2 sentences given conceptual differences. “Drogas” connotes only illicit drugs in Spanish (e.g., cocaine), whereas “drugs” can sometimes mean prescription medicines in English so we added “recreational” in English. Language for prescription medication abuse suggested by cognitive interview participants in English and Spanish
Laugh or cry easily	I was quick to laugh or cry	Lloraba o reía muy rápido	I laughed or cried easily	Me reía o lloraba fácilmente	“Easily” and “fácilmente” are closer to the intended English colloquialism “quick to”
Recommended by consumer focus groupa	Thoughts got stuck in my head, and I could not stop thinking about them	Pensamientos se quedaban en mi cabeza y no podía parar de pensar en ellos	No change	Los pensamientos se me quedaban en mi mente y no podía dejar de pensar en ellos	“Got stuck” didn't translate well; “se me quedaba” (stayed in) translated well. “Mi mente” (my mind) was preferable to “my head” for Spanish participants, and “dejar” (also ‘stop’) was preferable in cognitive interviews
Example: “The following are ways people react to various difficult, stressful, or upsetting situations”	Instructions: Please answer the following questions to give us a better understanding of the current stresses or problems you have experienced	Instrucciones: Por favor contesta la siguiente encuesta para darnos un mejor entendimiento de su situación de estrés o problemas que haiga experimentado	Instructions: Please answer the following questions so we can better understand your recent experiences	Instrucciones: Por favor conteste las siguientes preguntas para que podamos entender mejor sus experiencias recientes	The revision reduces the wordiness and thus the literacy level of the original
Investigator created itema	Marriage or marital reconciliation	Casamiento, o reconciliación conyugal	Marriage or getting back together	Casamiento, o juntarse otra vez	English: “Getting back together is simpler than “marital reconciliation.” Spanish: “en el matrimonio” is simpler than “conyugal.” For “getting back together”, “juntarse otra vez” is better than “reconciliación,” which is too formal and high lit
Investigator created itema	Are you being treated by a doctor, counselor, rehabilitation therapist, or other professional or do you feel you need additional support?	¿Estas siendo tratado por un doctor, consejero, terapeuta de rehabilitación, o algún otro profesional o sientes que necesitas apoyo adicional?	Are you being treated by a doctor, counselor, rehabilitation therapist, or other professional? Do you feel you need additional support?	¿Está recibiendo tratamiento por un doctor, consejero, terapeuta de rehabilitación, u otro profesional? ¿Usted siente que necesita apoyo adicional?	Splitting the long sentence into two shorter sentences reduced the literacy level. Spanish cognitive interviews confirmed that the two shorter sentences were understandable
Modified and added items related to sources of stress	Loss of employment Promotion in employment Increase in financial stress Major personal injury/illness	-	Not enough work Too much work Financial stress Personal injury/illness	No suficiente trabajo Demasiado trabajo Estrés económico Lesión o enfermedad personal Added: Racismo u otras formas de discriminación social Preocupación o temor relacionado al estado migratorio/ciudadanía Separación familiar	Participants in cognitive interviews felt that promotion in employment was not stressful; rather, long work hours or not having enough work (and therefore enough money) was stressful. Thus proposed change from “loss/promotion” to “too little/too much work.” Changed “increase in” in financial stress to just “financial stress” because the stress was reportedly chronic. Similarly, the personal injury/illness need not be “major”; participants reported stress from chronic health problems. Lastly, participants in Spanish cognitive interviews reported sources of stress they felt were uniquely applicable to Spanish-speaking populations; these were added to BAST-ESP

Note. Items in italics represent changes across phases. BAST = Behavioral Assessment Screening Tool; ESP = Spanish.

^aThis is a comment/note added by the authors. It is not an original item from another survey.