Validation of the SQUASH Physical Activity Questionnaire in a Multi-Ethnic Population: The HELIUS Study

Abstract

PurposeTo investigate the reliability and validity of the SQUASH physical activity (PA) questionnaire in a multi-ethnic population living in the Netherlands.MethodsWe included participants from the HELIUS study, a population-based cohort study. In this study we included Dutch (n = 114), Turkish (n = 88), Moroccan (n = 74), South-Asian Surinamese (n = 98) and African Surinamese (n = 91) adults, aged 18–70 years. The SQUASH was self-administered twice to assess test-re-test reliability (mean interval 6–7 weeks) and participants wore an accelerometer and heart rate monitor (Actiheart) to enable assessment of construct validity.ResultsWe observed low test-re-test reliability; Intra class correlation coefficients ranged from low (0.05 for moderate/high intensity PA in African Surinamese women) to acceptable (0.78 for light intensity PA in Moroccan women). The discrepancy between self-reported and measured PA differed on the basis of the intensity of activity: self-reported light intensity PA was lower than measured but self-reported moderate/high intensity PA was higher than measured, with wide limits of agreement. The discrepancy between questionnaire and Actiheart measures of moderate intensity PA did not differ between ethnic minority and Dutch participants with correction for relevant confounders. Additionally, the SQUASH overestimated the number of participants meeting the Dutch PA norm; Cohen’s kappas for the agreement were poor, the highest being 0.30 in Dutch women.ConclusionWe found considerable variation in the test-re-test reliability and validity of self-reported PA with no consistency based on ethnic origin. Our findings imply that the SQUASH does not provide a valid basis for comparison of PA between ethnic groups.

Objectively measured sedentary time among five ethnic groups in Amsterdam: The HELIUS study

“…One possible limitation of this study might be the presence of selection bias, as only a selection of the HELIUS participants might have been willing to participate in this particular sub-study. Non-responder analyses indeed showed differences in BMI, gender, and migration generation between responders and non-responders in the sub-study [ 10 ]. More specifically, it is possible that more active and less sedentary participants were willing to participate in this sub-study and wear the Actiheart monitor, causing the ethnic groups in the study to be more homogenous than in real life, possibly concealing existing differences in the prevalence of sedentary time between the ethnic groups.…”

“…It is likely that this resulted in more valid and better comparable levels of sedentary time than self-report measures, as self-report measures suffer from recall and social desirability bias and possible linguistic and cultural differences in the interpretation of the questions. The latter might be an especially important consideration in research focussed on differences between cultures or ethnicities, even though Nicolaou and colleagues did not find ethnic differences in the reliability and validity of the SQUASH questionnaire when compared to the Actiheart monitor [ 10 ]. Nevertheless, objective measures such as the Actiheart lack contextual and domain specific information, which might have concealed ethnic differences in sedentary time domains.…”

“…Those individuals that gave permission were invited to participate in the current sub-study, in which detailed information about physical activity and sedentary time was collected, aiming to validate the SQUASH physical activity questionnaire. More information about this sub-study can be found elsewhere [ 10 ]. In summary, this study aimed to include 500 participants, with equal distributions between ethnicity and gender.…”

Cohort profile: the Healthy Life in an Urban Setting (HELIUS) study in Amsterdam, The Netherlands

“…In addition, low test–retest reliability was found for the SQUASH in all groups, implying no valid basis for the comparison of physical activity between the different ethnic groups. 21 …”

Understanding vocational students' motivation for dietary and physical activity behaviours

“…In this study, recall bias could thus have led to an overestimation of the diet and physical activity behaviour of the study population. Additionally, the SQUASH questionnaire is known to overestimate the physical activity that participants conduct, which could have caused an overestimation of the physical activity of vocational students (54). The exact effect that these possible overestimations might have had on the found associations cannot be inferred.…”