Content validation of the Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) in low-, middle-, and high-income countries across 6 continents

Abstract

Background: Investigators from low-, middle-, and high-income countries representing 6 continents contributed to the development of the Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ). The GAC-PAQ is designed to assess physical activity (PA) across all key domains (i.e., school, chores, work/volunteering, transport, free time, outdoor time). It aimed to address multiple gaps in global PA surveillance (e.g., omission of important PA domains, insufficient cultural adaptation, underrepresentation of rural areas in questionnaire validation studies).The purpose of this study was to assess the content validity of the GAC-PAQ among PA experts, 8- to 17-year-olds, and one of their parents/guardians, and to discuss changes made to the questionnaire based on participants’ feedback. Methods: Sixty-two experts in PA measurement and/or surveillance from 24 countries completed an online survey that included both closed- and open-ended questions about the content validity of the GAC-PAQ. The proportion of experts who agreed or strongly agreed with the items was calculated. Child–parent/guardian dyads from 15 countries (n = 250; 10–40 per country) participated in a structured cognitive interview to assess the clarity of the questions and response options, and they were encouraged to provide suggestions to improve clarity and facilitate completion of the questionnaire. Participating countries are: Aotearoa New Zealand, Brazil, Canada, China, Colombia, Czech Republic, India, Malawi, Mexico, Nepal, Nigeria, Spain, Sweden, Thailand, and the United Arab Emirates. Interviews were conducted in 13 different languages and structured by PA domain. Generic images were included to help participants in answering questions about PA intensity. Results: Expert agreement with the items for each domain exceeded 75%, and their qualitative feedback was used to revise the questionnaire before cognitive interviews. In general, participants found the questionnaire to be comprehensive. Adolescents (12–17 years) found it easier than children (8–11 years) to answer the questions. Several children struggled to answer questions about the duration and intensity of activities and/or concepts related to travel modes, active trips, and organized activities. Many parents/guardians were unsure about the frequency, duration, and intensity of their children's or adolescents’ PA at school and/or recommended using more culturally relevant and appropriate images. Some participants misunderstood the concept of activities that “make you stronger” (intended to assess resistance activities) and/or struggled to differentiate between work, volunteering, and chores. Conclusion: Participants’ feedback was used to develop a revised, simplified, and culturally adapted GAC-PAQ, which will be pilot-tested in all 15 countries in an App that will include country-specific images and narration in local languages. Further research is needed to assess the reliability and validity of the revised GAC-PAQ.