Cross-Cultural Adaptation of Instruments Measuring Children’s Movement Behaviors and Parenting Practices in Brazilian Families

Abstract

Childhood obesity is a global problem, disproportionately affecting children in low-to-middle income countries (LMIC). Despite this evidence, no previous study has adapted instruments measuring children’s movement behaviors and associated parenting practices for use in LMIC families. This study reports the results of a cross-cultural adaptation of previously validated measures of children’s movement behaviors and parenting practices in economically disadvantaged Brazilian families. Study 1 involved translation of the instruments from English to Portuguese. A team of translators (fluent in both English and Portuguese) and researchers followed established procedures for translating measurement scales, identifying problematic items, and reaching consensus on discrepancies. Study 2 involved cognitive interviews with 24 parents from urban and rural North-eastern Brazil addressing the format, content, and clarity of the items. Half the parents provided feedback on the first 33 items of the questionnaire, with the remaining parents providing feedback on the final 29 items. Notes were recorded during the interview and parents’ feedback summarized in a report. In the translation and back-translation, 15 discrepancies were identified. These were mostly due to multiple Portuguese words having the same meaning in English. The research team discussed these discrepancies and consensus was reached to ensure that the concepts depicted in the Portuguese version were consistent with the English version. In the cognitive interviews, parents identified minor problems with item comprehension resulting in minor adaptations to response options, recall period, and format of the questionnaire. The process of translation and cognitive interviews conducted in Brazilian families resulted in an appropriate cultural adaptation of scales measuring children’s movement behaviors and parenting practices. Future studies should evaluate the validity and reliability of the measures in LMIC families.

A systematic review of proxy-report questionnaires assessing physical activity, sedentary behavior and/or sleep in young children (aged 0–5 years)

“…Additionally: Digital media environment at home, parent digital media habits, perception, concern, awareness and practice of guidelines, demographic information Toddlers and preschoolers (2–6 years old) Parent Typical weekday and weekend day Digital media use: F,D; Non-digital behavior: D, Sleep: D, I PA/SB/S: 4 items ScT: 4 items Total questionnaire: 25 items across 3 subscales: Digital media use (9 items), Non-digital behavior (3 items), Child and Parent information (13 items) Continuous: duration (h/min), and percentage of time spent Ordinal: 6 point-scale ranging from never to 9 or more times a week Family Health Survey (consists a.o. of Outdoor Playtime Recall, InFANT, POI.nz) [ 66 ] PA, SB, ScT, S Outdoor play, duration watching TV/DVD, using computer, using smartphone/tablet, playing videogame, sleep duration Additionally: Child parent interactions in relation to physical activity, screen time, and sleep Preschoolers (3–6 years old) Parent Typical weekday and weekend day D PA: 1 item ScT: 4 items S: 2 items Total questionnaire: number of items differs depending on answers (max. 55 questions) Continuous: time, duration (h/min) Healthy Active Preschool Years (HAPPY) parent proxy report survey [ 67 ] PA, SB, ScT, S Participation in active transport, non-organized activities, participation in organized activities, attendance at playgroup, usual participation in screen behaviors, quiet play & imaginary games, time spent playing outdoors, night & day sleep time Additionally: Demographic and family profile; child personality, preferences and constraints; parental influence; rules and boundaries, social interaction and support; modeling of physical activity; home physical environment; neighborhood physical environment Preschoolers (3–5 years old) Parent Typical week, typical weekday and weekend day F, D PA/SB/ScT: 28 items S: 2 items Total questionnaire: 230 items Continuous: duration (h) and frequency (times per week) Ordinal: never-daily Nominal: yes/no Abbreviations: BISQ Brief Infant Sleep Questionnaire, D duration, F frequency, h hour, I intensity, nn no name, nr not reported, M/E morningness/eveningness, MVPA moderate-to-vigorous activity, PA physical activity, PREPS Parents’ Role in Establishing healthy Physical activity and Sedentary behaviour habits, S sleep, SB sedentary behavior, ScT screen time, ST sedentary time, TV television a Questionnaire included from previous review b Behaviors: physical activity (PA), sedentary behavior (SB), screen time (ScT) and/or sleep (S) c Infants: 0 – 1 year old, Toddlers: 1 – ...…”

“…(+) ?Low Family Health Survey (consists a.o. of Outdoor Playtime Recall, InFANT, POI.nz) [ 66 ] n = 24 parents of children in ECE (from urban and rural North-eastern Brazil) Doubtful na na In the cognitive interviews, parents understood most items, but requested modifications to the formatting of the questionnaire, recall period, and the wording of a small number of items. The process of translation and cognitive interviews conducted in Brazilian families resulted in an appropriate cultural adaptation of scales measuring children’s movement behaviors and parenting practices.…”

Psychometric properties of instruments to measure parenting practices and children’s movement behaviors in low-income families from Brazil

“…This study had several strengths. To our knowledge, this is the first study to evaluate the concurrent validity, internal consistency reliability, and test-retest reliability of measurement tools to assess parenting practices and children’s movement behaviors in a LMIC country, using measurement tools that have gone through a rigorous process of translation and cognitive testing prior to validation [ 24 ]. Second, this study recruited a diverse sample from urban and rural disadvantaged Brazilian families with low literacy levels.…”

“…Parents completed a survey measuring parenting practices and children’s movement behaviors translated into Portuguese and adapted for use in Brazilian families [ 24 ]. The Portuguese and English versions of the survey are included as Supplementary material .…”

“…Parenting practices related to physical activity and screen time were measured using translated and culturally adapted versions of the measurement scales developed by Vaughn [ 24 , 25 ]. These scales measure parenting practices used to control or support children’s physical activity and screen time.…”