Table 2 Spanish A-HRSI modified terms and reasons for modifications

Response Category

Very much- 4

Mucho- 4

Muchísimo- 4

Participants had difficulty discriminating between “bastante” (3) and “mucho” (4); these were overlapping and/or interchangeable terms (R1)

Not at all- 0

Para Nada- 0

Nada- 0

Para nada seen as an “unusual” expression or difficult to distinguish from “Not applicable” (R2)

Physical Symptoms

I have pain during bowel movements

Tengo dolor durante la defecación

Tengo dolor cuando entro al baño a defecar

Participants had difficulty understanding the noun “defecación” (defecate/ defecating) (R1)

I have urgency for bowel movements

Siento urgencia de defecar

Siento urgencia de entrar al baño a defecar

Physical Impacts

I have problems taking care of myself (e.g., bathing, dressing, shaving)

Tengo problemas con mis deberes personales diarios (por ej., bañándome, vistiéndome, afeitándome)

Problemas con mi arreglo personal

“Problemas personales” (“problems with everyday duties”) was unclear to participants—they did not interpret this to mean daily care activities such as bathing, brushing teeth, etc. (R1)

I have problems with my physical ability to move around

Tengo problemas con mi capacidad física para movilizarme

Tengo problemas con mi capacidad física para moverme

 “Movilizarse” is not specific enough to the act of physical movement (e.g. walking). Some participants interpreted this to mean “problems mobilizing myself”, or motivation (R2)

I have problems completing daily household chores (e.g., cleaning, cooking, laundry, house maintenance)

Tengo problemas terminando las tareas de la casa (por ej., limpiar, cocinar, hacer la colada, administrar la casa)

Tengo problemas manteniendo la casa (por ej., limpiar, cocinar, preparar el café, administrar la casa)

“Tareas” was initially confusing to participants; “hacer la colada” was seen as unfamiliar or “too regional”; “preparar el café” is a more widely understood example (R2)

I have problems participating in leisure activities (e.g., watching television, relaxing)

Tengo problemas participando en actividades de ocio (por ej., mirar televisión, relajarme)

Tengo problemas participando en actividades de relajo (por ej., mirar televisión, relajarme)

“Ocio” viewed as an “archaic” phrase for “leisure”, difficult to understand (R2)

Psychological Symptoms

I have a decreased enjoyment of anal sexual activity

Me ha disminuido el placer de la actividad sexual anal

Me ha disminuido el disfrute de la actividad sexual anal

Participants often interpreted these items in terms of desire, rather than physical pleasure. Changed to “placer” to “disfrute” to specify physical enjoyment (R2)

I have a deceased enjoyment for any form of sexual activity other than anal sexual activity

Me ha disminuido el placer de cualquier forma de actividad sexual diferente a la actividad sexual anal

Me ha disminuido el disfrute de cualquier forma de actividad sexual diferente a la actividad sexual anal