|Year : 2020 | Volume
| Issue : 2 | Page : 64-69
Cross-cultural adaptation, translation, and psychometric properties of Gujarati version of physical activity questionnaire for older children
Salvi S Shah1, Shraddha J Diwan2
1 Ph.D. Scholar (Gujarat University, Ahmedabad) & Assistant Professor, Department of Physiotherapy, SPB Physiotherapy College, Surat, Gujarat, India
2 Ph. D. Guide (Gujarat University, Ahmedabad) & Lecturer, Adult and Pediatric Neurorehabilitation Department, SBB Physiotherapy College, V.S. Hospital, Ahmedabad, Gujarat, India
|Date of Submission||29-Nov-2019|
|Date of Decision||17-Mar-2020|
|Date of Acceptance||04-Oct-2020|
|Date of Web Publication||31-Dec-2020|
Dr. Salvi S Shah
SPB Physiotherapy College, Ugat-Bhesan Road, Surat - 395 005, Gujarat
Source of Support: None, Conflict of Interest: None
BACKGROUND: The Physical Activity Questionnaire for Older Children (PAQ-C) is a self-administered questionnaire to assess physical activity (PA) among older children, and it is available in English, Dutch, Malay, Spanish, Turkish, and Gujarati languages. Cross-cultural adaptation and robust research on psychometric properties arise the need for current research on the PAQ-C in Gujarati language (PAQ-C [G]).
METHODS: The study was carried out in three phases: cultural adaptation and translation into the Gujarati language from English using the forward-backward-forward method, pilot study on 10 children to assess the comprehensibility of the prefinal version, and psychometric properties of the final version of the questionnaire. To ensure the face and content validity of the PAQ-C (G) group, a consensus method was used. Each item was examined by a group of experts having a mean experience of 22.11 years in different fields. Each item was analyzed for content, meaning, wording, format, ease of administration, and scoring. Each item was scored by an expert group as either rejected, accepted, or accepted with modification. The procedure was continued until 80% of consensus for all items. Finally, 20 children were asked to complete the PAQ-C (G) on two occasions 1 week apart to examine its test–retest reliability.
RESULTS: The reliability coefficient using the average-measure intraclass correlation coefficient (ICC) total score of PAQ-C (G) was 0.82 which is a strong positive correlation. The test–retest between individual items shows that PAQ-C (G) had a moderate-to-strong correlation with ICC value between 0.78 and 0.91. The internal consistency reliability of PAQ-C (G) was α = 0.94 and α = 0.92 for assessments 1 and 2, respectively.
CONCLUSION: PAQ-C (G) has a good face–content validity and test–retest reliability which can be used to measure PA among Gujarati speaking older schoolchildren.
Keywords: Physical activity, Physical Activity Questionnaire for Older Children Gujarati language, questionnaire for physical activity, schoolchildren
|How to cite this article:|
Shah SS, Diwan SJ. Cross-cultural adaptation, translation, and psychometric properties of Gujarati version of physical activity questionnaire for older children. Physiother - J Indian Assoc Physiother 2020;14:64-9
|How to cite this URL:|
Shah SS, Diwan SJ. Cross-cultural adaptation, translation, and psychometric properties of Gujarati version of physical activity questionnaire for older children. Physiother - J Indian Assoc Physiother [serial online] 2020 [cited 2021 Jan 19];14:64-9. Available from: https://www.pjiap.org/text.asp?2020/14/2/64/305840
| Introduction|| |
Physical inactivity in children and adolescents has become a major issue in public health. Physical activity (PA) is the most variable component of energy expenditure, providing a major outlet for daily caloric usage. PA is a powerful predictor of cardiovascular, skeletal, and mental health in children and adolescents, yet contemporary youth, and especially girls, are often insufficiently active.,
The American Heart Association recommends that children and adolescents participate in at least 60 min of moderate-to-vigorous PA every day. Another guideline from Canada suggests that a minimal target of 60 min/day may be appropriate. Recommended PA for children (National guidelines in the year 2010) stated that children should participate in 60 min or more of daily PA, most of which should be moderate to vigorous in intensity. Children of all ages require vigorous PA at least 3 times a week for 60 minutes as per WHO guidelines.
Various objective and subjective methods have already been suggested to evaluate the level of PA in children and adolescents. Unfortunately, some objective measurements such as heart rate monitoring and accelerometry require special equipment and are more difficult to perform in children, especially on a large scale, compared to subjective measurements. Subjective methods to estimate PA, including questionnaires, interviews, and diaries, are preferred in large epidemiological studies. Accelerometry is the tool of choice to objectively measure PA in youth but may not be feasible and affordable in all studies, especially field or school-based assessments of larger samples. Self-reported PA offers a frequently used alternative despite the well-acknowledged potential limitations of subjectivity and questionable recall ability, particularly in younger people., One valuable questionnaire for the use in children and adolescents was the PA Questionnaire for Older Children (PAQ-C).
The PAQ-C was developed by Kowalski and colleagues which initially used in the Saskatchewan Pediatric Bone Mineral Accrual Study. The PAQ-C was designed for large-sample studies and can be completed in a classroom setting. It takes approximately 10–15 min for a student to complete the PAQ-C. Each item was scored using a five-point scale, with higher scores indicating higher levels of activity. A mean score of 1 indicates low PA and a mean score of 5 indicates high PA. PAQ-C was designed to be used during the school year, rather than summer vacation or school holiday periods., Questionnaire items (PAQ-C) include weekly participation in different types of activities and sports (activity checklist), effort during physical education, and activity during lunch, after school, evening, and at the weekend. The PAQ has acceptable reliability and convergent validity, as well as construct validity.
PAQ-C is available in English, Dutch, Malay, Spanish, Turkish, and Gujarati languages. Cross-cultural adaptation and robust research on psychometric properties arise the need for current research on the PAQ-C in Gujarati language (PAQ-C [G]). The current project is taken as a part of a larger study to be done on school-going children of Surat city to assess physical fitness, PA, and academic achievement.
| Materials and Methods|| |
Before the commencement of the study, ethical approval was obtained from the Institutional Ethical Committee of SPB Physiotherapy College, Surat, with Reg. no. EC/SPB/011. The study is also registered in the Clinical Trials Registry of India with Reg. no. CTRI/2018/12/016800. The present study is a cross-sectional observational (methodological) study conducted at SPB Physiotherapy College, Surat. The study was conducted in three phases: the first was cultural adaptation and translation into the Gujarati language from English using a forward-backward-forward method. The second was a pilot study on 10 children to assess the comprehensibility of the prefinal version; the third was to find the psychometric properties of the final version of the questionnaire. Each phase was carefully conducted to eliminate bias and to produce reliable results. Before starting the translation work of PAQ-C, approval from the original author Kent C. Kowalski, Ph. D. (College of Kinesiology, University of Saskatchewan) was obtained. The study was conducted from January 2019 to June 2019.
Considering common sports activities and sociocultural adaptations, few sports activities from the original PAQs were substituted by sports activities being practiced in Gujarat [Table 1]. Gujarati translation was done independently by two Gujarati native speakers: one familiar with health care and its terminology and the other not familiar with health care and its terminology (T1 and T2, respectively). Subsequently, a version combining both initial translations (T1/T2) was written, based on the consensus of the two initial translators. This synthesized version was then back-translated into English by two independent professional translators (BT1 and BT2) to allow the verification of consistencies with the original English version.
Pilot study and modification of the prefinal version
A convenient sample of n = 10 aged between 8 and 14 years with the ability to read and understand Gujarati language were included sfor the study after obtaining the written consent of the parents/guardians and assent of children. The participants were asked to fill the questionnaire and also asked to give feedback and comments regarding the questions and identify words or sentences that were difficult to understand at the end of filling of the questionnaire. The findings were discussed among the translators, resulting in only minor changes to the prefinal PAQ-C (G), as mentioned in [Table 2].
|Table 2: Minor changes in prefinal Physical Activity Questionnaires for older Children in Gujarati language|
Click here to view
Face and content validity
For the face and content validity of the Gujarati translated version of the PAQ-C group, a consensus method was used. Participants for face and content validity were (n = 8) experts having mean experience of 22.11 years in the field of orthopedics, sports, cardiovascular physiotherapy, and coaching in different sports (Appendix 1). The purpose and nature of the study were explained to all professionals, and informed written consent along with self-filled personal and professional information was obtained from all professionals. Each item (total of 10) was examined by a group of experts (n = 8). The consensus is defined as an agreement with a question by at least 80% of participants. Characteristics of group consensus method are the selection of expert participants. Each professional was contacted by the primary author separately for their expert opinion in the first step of validation. Each item was analyzed by professionals for content, meaning, wording, format, ease of administration, and scoring. Each item was scored as either rejected, accepted with modification, or accepted. Coded responses were then given to the second author for analysis. The procedure was continued until 80% of consensus for all items. Their reviews and feedbacks were considered. Modifications were done in item 2, item 4, and item 5 as suggested by expert committee members, as mentioned in [Table 3].
After obtaining the written consent of the parents/guardians and assent from the children, 20 children with the ability to read and understand Gujarati language were asked to complete the PAQ-C (G) on two occasions 1 week apart to examine its test–retest reliability.
Physical Activity Questionnaire scoring
Scoring of PAQs was performed as described by Kowalski et al. PAQ-C has been originally designed for children aged 8–14 and consists of nine questions structured to discern low (score 1) to high (score 5) PA during the last 7 days and the tenth question to identify children who had unusual activity during the previous week. However, the last question was not used as a part of the summary activity score.
All the data were entered into an excel sheet. Descriptive statistics, test–retest reliability, and internal consistency (intraclass correlation coefficient [ICC]) and Cronbach's alpha (α) were assessed using SPSS version 20 (IBM SPSS 20 (trial version)). The level of the significance was kept at P < 0.05.
| Results|| |
The mean age of children was 10.25 ± 1.15 years including 11 girls and 9 boys.
Face and content validity
The team of the experts (n = 8) accepted all the 10 items with only minor modifications in item no. 2, item no. 4, and item no. 5 of PAQ-C (G), as mentioned in [Table 3], and no change was suggested in a sequence of item presentation.
Internal consistency and test–retest reliability
The internal consistency of the PAQ-C (G) was examined by Cronbach's alpha (α), and to measure test–retest reliability, the ICC was calculated and the scale was considered stable with an ICC of >0.70. Readings were documented on the first occasion and 7 days later.
The result of the internal consistency of PAQ-C (G) assessment calculated from a sample of 20 children in the study was α = 0.94 and α = 0.92 for assessments 1 and 2, respectively.
The assessment of test–retest reliability for PAQ-C (G) between the first and second administrations is shown in [Table 1]. The reliability coefficient using average-measure ICC total score of PAQ-C (G) was 0.82 which is considered as a good correlation. The test–retest reliability between individual items shows that PAQ-C (G) had a moderate-to-good correlation with ICC value between 0.78 and 0.91 [Table 4].
|Table 4: Reliability of Physical Activity Questionnaires for older Children in Gujarati language|
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| Discussion|| |
Being a self-reported questionnaire, PAQ-C provides important applicability among the schoolchildren. Therefore, it is important to employ a validated questionnaire to measure the PA.
In this study, PAQ-C was translated into the Gujarati language, and its validity and test–retest reliability were assessed among Gujarati medium students aged between 8 and 14 years. The results of the study suggest good psychometric properties of PAQ-C (G), which makes it a valid and reliable tool for research and practice (Appendix 2).
In the present study, few games (11 games) were substituted from the original English version (Appendix 2) by the games which were mostly played in Gujarat. A study done by Belim et al. among Gujarati children,in PAQ-C(G)only three games (seven stones, ice-water, kabbadi in place of ice skating, cross-country skiing, ice hockey)were changed according to the playing conditions and games which are played more frequently in India which differ from the Western country.
A study done by Wang et al. among Chinese children had also changed the games name according to their playing conditions “ice skating” changed to “inline skating” and “football” to “soccer,” and uncommon activities were removed such as “street hockey” and “ice hockey.” Overall, the PAQ-C was found to have acceptable measurement properties.
In this study, the authors found that the PAQ-C (G) provided reliable estimates of PA among older children. The findings of Cronbach's alpha (α = 0.94 and α = 0.92 for assessments 1 and 2, respectively) suggested that PAQ-C (G) had a good internal consistency, and the result was consistent with other studies. Crocker et al. reported that the internal consistency of the PAQ-C scores using coefficient alpha was α = 0.79 and α = 0.89 for first and second assessments, 1 week apart, respectively. Janz et al. conducted a study in 210 children at the age of 11 years who also found a good internal consistency (α = 0.72) of PAQ-C and suggested that it can be used during the school year and the summer vacation. Another study also presented a high internal consistency of PAQ-C from a sample of 36 students aged 13 years. Moore et al. who assessed the questionnaire through different races examined the psychometric properties of PAQ-C and suggested that the internal consistency of the questionnaire could be improved and the factor model could be constructed with the removal of the PAQ-C addressing PA during lunch (α = 0.74 and 0.64, respectively). Bervoets et al. conducted a study on 192 children in Belgium and found a good internal consistency of the Dutch version of PAQ-C (Cronbach's α = 0.777 [95% confidence interval: 0.726–0.821]). A study conducted by Zaki et al. on 73 students in Malaysia aged between 10 and 17 years found a good internal consistency (Cronbach's α = 0.75 and α = 0.77 for assessments 1 and 2, respectively) of PAQ-C in the Malay language. Martínez et al. who conducted a study on 82 adolescents aged between 10 and 17 years also showed a good internal consistency for PAQ-C (Cronbach's α = 0.65 and α = 0.67 for assessments 1 and 2, respectively). A study was done by Belim et al. who conducted a study on 20 children and found a good internal consistency. Of PAQ-C (G) (Cronbach's α = 0.716), a probable reason for the high value of Cronbach's α for the assessments 1 and 2 in the present study was a very small sample size.
The test–retest reliability correlation coefficients (ICC = 0.82) in the present study showed a higher value with the original PAQ-C studies that have found test–retest correlations ranging from 0.75 to 0.82 among 83 students aged 9–14 years. Martinez et al. (ICC = 0.71) and Manchola-Gonzalez et al. (ICC = 0.721) found test–retest reliability values lower than those from the present study. A study done by Zaki et al. found a similar result for the test–retest reliability of PAQ-C as shown in the present study (ICC = 0.82). A study was done by Belim et al. on 20 Gujarati children and found that a test–retest reliability correlation coefficient for PAQ-C (G) was 0.934. The probable reason for the very high value (0.934) of the test–retest reliability result of the study done by Zishan Khan et al. was that an interval of only 1 day was kept between the administrations of questionnaires in their study. A reliability study should have an adequate time interval between the two administrations, or otherwise, lower ICCs result may be observed due to actual differences in the activity pattern between the recalled days. Based on the present study reliability result, the 7-day interval time between first and second administered recalls of the respondents' PA was considered relatively stable. It is possible that the activities reported changed during the 1-week test–retest period resulting in higher reliability.
Future studies should include a large sample size of children. Future research work can also investigate the association of PAQ-C (G) with other PA measures.
| Conclusion|| |
PAQ-C (G) provides valid as well as reliable estimates of PA among 8–14-year-old children. PAQ-C can be considered as very useful in clinical practice to assess the overall level of PA in children. Finally, assessment of PA both at an individual and at a population level could lead to the improvement of personalized interventions and also new school policies to prevent as well as to fight against weight gain and associated health complications.
The authors are greatly thankful to Kent C. Kowalski, Ph.D. (College of Kinesiology, University of Saskatchewan) for his kind approval for the translation of PAQ-C into Gujarati language. The authors are greatly thankful to people who are involved in the translation process of PAQ-C in Gujarati. The authors are greatly thankful to participants of group consensus method for sharing their experience and knowledge in validation of the Gujarati translated version of PAQ-C as well as all the children to participate in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Participants of the expert committee:
Participants for the expert committee were 6 physiotherapists (including Master of Physiotherapy in orthopedics, cardiovascular physiotherapy and sports) and 2 coaches for the children (karate and taekwondo).
- Dr. Anjali Bhise (PT)
- Dr. Yagna Shukla (PT)
- Dr. Nehal Shah (PT)
- Dr. Priyanshu Rathod (PT)
- Dr. Mehul Jadav (PT)
- Dr. Sarfraznawaz F. Shah (PT)
- Mr. Paresh Bhatt (Karate coach)
- Mr. Pameer Shah (Taekwondo coach)
- The original English version of PAQ-C
- Gujarati version of PAQ-C
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[Table 1], [Table 2], [Table 3], [Table 4]