English terms from Corah's original ISAR () were translated into Spanish by a native English-speaking research team member fluent in Spanish (LWG) and then reviewed with a native Spanish-speaking research team member fluent in English (LJG) to check for accuracy. Once agreement had been reached between the 2 investigators on the Spanish translations, the English and Spanish terms were used in the magnitude estimation and ranking tasks described below.
Anxiety Terms Used in Interval Scale of Anxiety Response (ISAR) Magnitude Estimation Tasks
Magnitude estimation and ranking procedures were explained to participants in English (for native English speakers) or Spanish (for native Spanish speakers). For the magnitude estimation task, participants were told the purpose of the task, namely, to assign a number to each word or phrase to indicate its perceived intensity. To aid participants in this task, one word was consistently presented first as the modulus and given a set value. For Study 1, “Afraid” in English (“Tener Miedo” in Spanish) was used as the modulus and assigned the value 10. All words, English and Spanish, were printed on individual laminated cards and held up while the examiner read each word. (See for English and Spanish words used for each study.)
Once presented with the modulus phrase and its value, participants were asked to assign values to the following phrases in proportion to their relative intensity compared with the modulus. To make this clear, the following instructions were given to the participants:
“I am going to ask you to give numbers to indicate the intensity described by a word or phrase. I want you to assign the number proportionally. So, for example, consider the words ‘Mild,’ ‘Moderate,’ and ‘Strong’ to describe pain. In this case, I want you to start with the word ‘Moderate’ [examiner holds up card reading ‘Moderate’]. The first word I give you will be assigned the value 10. Since ‘Moderate’ is the first word, we'll give it the number 10. If you think that the word ‘Strong’ [holds up card reading ‘Strong’] indicates pain twice as great as ‘Moderate’, you would give a number twice as large as the number for ‘Moderate.’ The number twice the size of 10 is 20, so you would say 20. If ‘Strong’ seems more than twice the intensity, you might want to give it a number like 25 or 30, or even 40 or 50. You can go up as high in numbers as you think is appropriate. Next, I'll give you the word ‘Mild’ to describe pain [holds up card reading ‘Mild’]. If you think that ‘Mild’ pain is half as strong as ‘Moderate’ pain, you would say 5 for ‘Mild.’ However, if they seem more similar, you would give a number closer to 10, such as 8 or 9, or even the same number 10 if you feel that ‘Mild’ and ‘Moderate’ pain are the same thing.”
Participants then completed a practice task, using words to describe height (“Average,” “Tall,” “Short,” “Towering,” “Squat”). Participants' understanding of magnitude estimation was assessed during this task, and further explanations given as needed. Once it was determined that participants understood the task, we proceeded with the magnitude estimation tasks using the words shown in . The modulus was always presented first. The order of the remaining words was determined by a Latin Square design.
The examiner held up laminated cards with each word as the word was read out loud. The participant provided numerical values for each word, which were recorded by the examiner. The magnitude estimation task was repeated twice for each set of words. Once the magnitude estimation task was completed, each participant was handed the entire set of words on laminated cards and asked to place the words in order (from least to most intense) on a table set in front of the participant. The examiner recorded the order provided by the participant. For analyses, numbers recorded by the examiner were entered into an SPSS (version 11) database and checked line by line for accuracy against the paper recording.
Raw magnitude estimates were averaged across the 2 trials. Mean magnitude estimates were then entered into a 2 (language version) by 6 (phrase) repeated measures analysis of variance (ANO-VA) to test for language version differences in magnitude estimates. T-tests were subsequently used to confirm significant differences in magnitude estimates between each English phrase and its Spanish translation. Within each language, sign tests were used to confirm that rankings significantly differed between each of the phrases.
Spanish speakers provided higher magnitude estimates than did English speakers for 4 of 6 terms (). Specifically, independent sample t-tests showed that Spanish speakers were rating the following terms as more intense than their English-speaking counterparts: “Calmado, Relajado” (“Calm, Relaxed”; t = 2.05, P < .05), “Un Poco Nervioso” (“A Little Nervous”; t = 2.34, P < .05), “Tenso, Disgustado” (“Tense, Upset”; t = 2.40, P < .05), and “Aterrorizado” (“Terrified”; t = 2.17, P < .05).
Study 1—Initial Spanish ISAR versus Original English ISAR Magnitude Estimates. The asterisk indicates significance at P < .05. Modulus = 10 (Afraid/Tener Meido). T-bars indicate standard error.
For the ranking task, rankings for all English phrases were significantly different from each other (P < .01). Two Spanish phrases, however, did not significantly differ in ranking from one another. Specifically, rankings for “Tenso, Disgustado” (“Tense, Upset”) were not significantly different from rankings for “Tener Miedo” (“Afraid”; sign test = 1.44, P = 0.15).
Four of 6 terms tested significantly different between Spanish and English, with Spanish speakers giving them higher intensities. Additionally, the 2 other terms tested showed nonsignificant trends to be higher in Spanish than in English. One possible explanation for this is that the phrase selected for the Spanish modulus was not equivalent to the phrase selected as the English modulus. Instead, it is possible that the phrase used as the Spanish modulus has a lower perceived intensity compared with the phrase used as the English modulus. In a situation where the phrase assigned the value 10 in Spanish actually has a lower perceived intensity than the phrase assigned 10 in English, all the phrases tested in Spanish would receive artificially inflated magnitude estimates compared with the English terms. Since all 6 Spanish terms were rated as more intense than the corresponding English terms, 4 significantly so, we felt this was a likely explanation for the large discrepancy in perceived magnitudes observed between language versions. The Spanish translation of the term used for “Afraid” was therefore revisited by the research team.
The word “Afraid” was reviewed by a native Spanish speaker of Mexican descent (LJG) and a native English speaker fluent in Spanish (KAB). The English word was retranslated as “Asustado” in an attempt to develop more comparable scales. For Study 2, “Tener Miedo” (“Afraid”) was replaced with “Asustado,” and “Mucho Miedo” (“Very Afraid”) was replaced with “Muy Asustado.”
A further change resulted from the debriefing of participants in Study 1. Participants indicated that including the word “upset,” in the phrase, “Tense, upset,” made the ranking task difficult and raised the perceived intensity of the entire phrase. After discussion by the research team, the third descriptor, “Tense, upset,” was changed to “Tense,” in order to reduce its perceived intensity. Accordingly, “Tenso, Disgustado,” was changed to “Tenso,” to maintain consistency between the scales. The phrase used as the modulus was also changed to “Very Afraid” (“Muy Asustado”) and set to 12.