Abstract:
Objective: Performing high-quality and reliable cognitive testing requires significant resources
and training. As a result, large-scale studies involving cognitive testing are difficult to perform
in low- and middle-income settings, limiting access to critical knowledge to improve academic
achievement and economic production in these populations. The NIH Toolbox® is a collection of
cognitive, motor, sensory, and emotional tests that can be administered and scored using an iPad®
tablet, reducing the need for training and quality monitoring; and thus, it is a potential solution to
this problem.
Method: We describe our process for translation and cultural adaptation of the existing NIH
Toolbox tests of fluid cognition into the Swahili and Dholuo languages for use in children aged
3–14 in western Kenya. Through serial forward and back-translations, cognitive interviews, group
consensus, outside feedback, and support from the NIH Toolbox team, we produced translated
tests that have both face validity and linguistic validation.
Results: During our cognitive interviews, we found that the five chosen tests (one each of
attention, cognitive flexibility, working memory, episodic memory, and processing speed) were
Corresponding Author Megan S. McHenry, MD, MS, FAAP, Assistant Professor of Pediatrics, Division of Pediatric Infectious
Diseases and Global Health, Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5853, Indianapolis, IN 46202,
317.274.4143 tel, 317.948.0860 fax, msuhl@iu.edu.
Declaration of Conflicting Interests
The authors declare that there is no conflict of interest.
HHS Public Access
Author manuscript
J Int Neuropsychol Soc. Author manuscript; available in PMC 2022 April 11.
Published in final edited form as:
J Int Neuropsychol Soc. 2022 April ; 28(4): 414–423. doi:10.1017/S1355617721000497.
Author Manuscript Author Manuscript Author Manuscript Author Manuscriptgenerally well-understood by children aged 7–14 in our chosen populations. The cognitive
interviews informed alterations in translation as well as slight changes in some images to
culturally adapt the tests.
Conclusions: This study describes the process by which we translated five fluid cognition tests
from the NIH Toolbox into the Swahili and Dholuo languages. The finished testing application
will be available for future studies, including a pilot study for assessment of psychometric
properties
