Introduction
As the Chinese-American population rapidly grows in the United States, the need for culturally and linguistically accessible healthcare services becomes increasingly urgent. Between 2010 and 2020, the Chinese-American population rose by 53%, from 4.0 to 6.1 million. By 2022, 14.3% of this population was aged 65 or older, placing them at an increased risk for age-related cognitive decline and dementia. Over 82.6% of these older adults are first-generation immigrants, the majority of whom lack sufficient English proficiency to complete standard cognitive assessments.
While some cognitive screening tools, such as the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), have been translated or adapted into Chinese, their use is constrained. These tools often require bilingual providers for administration and scoring, lack reimbursement pathways, and are supported by limited normative data. These barriers contribute to delayed or missed diagnoses and underscore the urgent need for digital cognitive assessments that are both linguistically appropriate and culturally relevant.
Study Objective
This pilot study aimed to assess the feasibility and usability of a Simplified Chinese version of BrainCheck Assess (C-BC-Assess), a digital cognitive assessment battery, for use with older Chinese-American adults.
Methods
Translation Process
BrainCheck Assess (BC-Assess) is a suite of computerized neuropsychological tests designed to evaluate key cognitive domains, including memory, attention, executive function, mental flexibility, and processing speed. To adapt the battery for Chinese-speaking populations, two independent bilingual translators fluent in both English and Chinese translated all test content and instructions into Simplified Chinese.
Cognitive Interview Study
A cognitive interview study was conducted with five healthy older Chinese-American adults. Each participant completed the translated assessment on an iPad in a supervised in-person setting. During the test, the “think-aloud” method was employed to prompt participants to verbalize their thoughts, questions, and difficulties in real time. Participants were reminded that the study was not measuring their cognitive performance, but rather evaluating the usability of the tool.
Following the assessment, participants took part in a debrief interview to provide qualitative feedback on their experience.
Results
Participant Demographics
- Total participants: 5 (3 female, 2 male)
- Age range: 60–73 years
- Education: 3 had college degrees; 2 held graduate degrees
- Language: All participants spoke Mandarin; 3 were more familiar with Traditional Chinese
- English proficiency: Self-reported as 1 basic, 2 intermediate, and 2 proficient
Usability Outcomes
- All participants rated the usability of the C-BC-Assess highly, with an average score of 1.6 out of 5 (where 1 = very easy).
- Participants more familiar with Traditional Chinese reported no difficulties completing the test in Simplified Chinese.
- Overall, participants described the tests as intuitive and enjoyable once instructions were understood.
Identified Challenges
While feedback was overwhelmingly positive, several areas for improvement were identified:
- Instruction Clarity: Some assessments, notably Digital Symbol and Trail Making, lacked clear instructions. Participants suggested adding more culturally familiar examples and enhancing explanation steps.
- Assessment Difficulty: Trail Making B was perceived as particularly challenging for participants with limited English proficiency.
- Interaction Design: Participants noted confusion when no feedback was provided after button presses, and some experienced challenges due to overly literal translations.
Conclusions
This pilot cognitive interview study confirmed the feasibility of adapting BrainCheck Assess into Simplified Chinese and demonstrated its high usability among older Chinese-American adults. Importantly, the study also highlighted that successful adaptation requires more than direct translation; cultural nuances and user experience design must be considered to ensure accessibility and effectiveness.
BrainCheck is committed to expanding equitable access to cognitive health tools and invites collaboration on future research and development efforts.
Interested in piloting BrainCheck in your community?
Visit https://braincheck.com/pilot-grant
