Original ArticlesHeart Attacks, Bloody Noses, and Other “Emotional Problems” Cultural and Conceptual Issues With the Spanish Translation of Self-Report Emotional Health ItemsFlynn, Michael A. MA; Eggerth, Donald E. PhD; Jacobson, C. Jeffery Jr PhD; Lyon, Sarah M. PhDAuthor Information Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio (Mr Flynn and Dr Eggerth); Consortium for Multicultural Psychology Research, Michigan State University, East Lansing (Mr Flynn and Dr Eggerth); Departments of Anthropology (Dr Jacobson) and Family and Community Medicine (Dr Jacobson), University of Cincinnati, Cincinnati, Ohio; and Department of Anthropology, University of Kentucky, Lexington (Dr Lyon). Correspondence: Michael A. Flynn, MA, Division of Science Integration, National Institute for Occupational Safety and Health, 1090 Tusculum Ave, Cincinnati, OH 45226 ([email protected]). Funding for phase 1 of the study was provided by the UC College of Medicine's “Deans Discovery Fund.” Phase 2 was a National Institute for Occupational Safety and Health (NIOSH)–led project, and no external financial resources were sought to support the research. Existing internal funds were used to support a purchase order (214-2016-M-90262) for data collection in phase 2. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the NIOSH. The authors declare they have no real or potential conflict(s) of interest that may inappropriately impact or influence the research and interpretation of findings. Family & Community Health: January/March 2021 - Volume 44 - Issue 1 - p 1-9 doi: 10.1097/FCH.0000000000000279 Buy Metrics Abstract This article examines how respondents understood items in the Spanish versions of the Short-Form 36 (SF-36v2). Cognitive interviews of the SF-36 were conducted in 2 phases with 46 Spanish speakers living in the United States. Roughly one-third (17/46) of respondents had difficulty understanding the Role Emotional items upon their initial reading, and almost half (21/46) provided examples that were inconsistent with the intended meaning of the items. The findings of this study underscore the importance of conducting cognitive testing to ensure conceptual equivalence of any instrument regardless of how well validated it appears to be. © 2020 Wolters Kluwer Health, Inc. All rights reserved.