SPECIAL FEATURE:METHODS Instrument Development of the Confidence in Home Care Services Questionnaire for Use With Elders and Caregivers of Mexican Descent Janice D.Crist, HumbertoVelazquez, Ian Durnan, and Diana Ramirez Figueroa ABSTRACT Mexican American elders use home care services less than non-Hispanic white elders, and a larger study is testing whether lack of confidence in home care services, measured by the Community Service Attitude Inventory, is a factor. In order to further develop the questionnaire for use with Mexican American elders and caregivers, qualitative interviews were conducted with Mexican American elders (n 5 5), Mexican American caregivers (n 5 5), and home care providers (n 5 5). Content analysis of interviews supported 2 dimensions: confidence and fear/worry. The research team developed 29 items from the dimensions. Testing of the items (n 5 15) suggested content validity and two additional items. The revised questionnaire was translated and tested for language equivalence in Spanish and English, assisted by a local community advisory council (n 5 9). Through collaboration, bicultural/bilingual teams and community partners refined 1 instru- ment that can be used to measure one of many barriers to equity in health care services with vulnerable populations. Thematic findings may be incorporated into nurses’ interventions as they offer home care ser- vices to families. Key words: cultural equivalence, health disparities, home care services, instrument development, Mexican American, utilization. Health disparities involving minority groups are a major national priority (National Institute of Nursing Research, 2002). Use of home care services is less fre- quent for Mexican American elders than for non-His- panic white elders, although health disparities, such as impaired functional abilities, are more prevalent in Mexican American elders at earlier ages. There is ev- idence in the literature and recent preliminary studies that Mexican American elders’ lack of confidence in using home care services is a critical factor affecting service use (Crist, 2002; Stommel, Collins, Given, & Given, 1999). The instrument chosen to measure the factor needed to be further developed and translated. In this study, Objective 1 was to establish content validity of new items to be added to the existing Community Service Attitude Inventory (CSAI; Stommel et al., 1999), to form the new Confidence in Home Care Services Questionnaire. The original measure focused on a larger construct, community services, but was inclusive of home care services. Objective 2 was to establish conceptual and language equivalence in Spanish and English for the questionnaire. The adapted instrument would be called the Confidence in Home Care Services Questionnaire. The adaptation process and results are reported in this paper. The term ‘‘Mexican American’’ is used for partic- ipants and researchers living in the United States who self-identify as being of Mexican descent, regardless of whether they are citizens of Mexico or the United Janice D. Crist, R.N., Ph.D, is Assistant Professor, College of Nursing, The University of Arizona, Tucson, Arizona. Humberto Velazquez is Professor, University of Sinaloa, Me¤ xico. Ian Durnan is Student, College of Business, The University of Arizona,Tucson, Arizona. Diana Ramirez Figueroa, B.A., is Student, College of Nursing, The Uni- versity of Arizona,Tucson, Arizona. Correspondence to: Janice D. Crist, College of Nursing, The University of Ar- izona ENCASA Research Project, PO Box 210203, Tuc- son, AZ 85721-0203. E-mail: jcrist@nursing.arizona.edu 284 Public Health Nursing Vol. 23 No. 3, pp. 284–291 0737-1209/r 2006, The Authors Journal Compilation r 2006, Blackwell Publishing, Inc.