Supplementary information files for "Content validation of the global adolescent and child physical activity questionnaire (GAC-PAQ) in low-, middle-, and high-income countries across 6 continents"

Supplementary files for article "Content validation of the global adolescent and child physical activity questionnaire (GAC-PAQ) in low-, middle-, and high-income countries across 6 continents"<br><br><b>Background</b>: 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.<b>Methods</b>: 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.<b>Results</b>: 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.<b>Conclusion</b>: 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.

《全球青少年儿童体力活动问卷（Global Adolescent and Child Physical Activity Questionnaire，GAC-PAQ）在六大洲低收入、中等收入与高收入国家中的内容效度验证》论文补充材料

背景：来自六大洲低收入、中等收入及高收入国家的研究人员共同参与了全球青少年儿童体力活动问卷（GAC-PAQ）的开发工作。该问卷旨在评估覆盖所有核心领域的体力活动（physical activity，PA），即校园活动、家务劳动、工作/志愿活动、交通出行、闲暇时间活动与户外时段活动。其研发初衷为填补全球体力活动监测领域的多项空白，例如遗漏关键体力活动领域、文化适配不足、问卷效度验证研究中农村地区代表性不足等问题。本研究旨在针对体力活动领域专家、8至17岁青少年及其一名家长/监护人评估GAC-PAQ的内容效度，并基于参与者反馈讨论问卷的修订方案。

方法：来自24个国家的62名体力活动测量与/或监测领域专家参与了线上问卷调研，调研包含针对GAC-PAQ内容效度的封闭式与开放式问题。研究计算了对各条目表示同意或完全同意的专家占比。来自15个国家的250对儿童-家长/监护人组合（每个国家10至40对）参与了结构化认知访谈，以评估问题与应答选项的清晰度，并鼓励参与者提出优化清晰度、提升问卷填写便利性的改进建议。参与调研的国家包括：新西兰（Aotearoa New Zealand）、巴西、加拿大、中国、哥伦比亚、捷克共和国、印度、马拉维、墨西哥、尼泊尔、尼日利亚、西班牙、瑞典、泰国以及阿拉伯联合酋长国。访谈采用13种不同语言开展，并按体力活动领域进行结构化设计。研究使用通用图片辅助参与者理解与体力活动强度相关的问题。

结果：各领域条目的专家同意率均超过75%，研究人员在认知访谈前基于专家的质性反馈对问卷进行了修订。总体而言，参与者认为该问卷覆盖全面。12至17岁的青少年相较于8至11岁的儿童，作答问卷更为轻松。部分儿童难以回答关于活动时长与强度的问题，以及与出行方式、主动出行和团体活动相关的概念类问题。许多家长/监护人无法准确回忆子女在校园内的体力活动的频率、时长与强度，部分参与者建议使用更贴合文化背景且适配性更强的图片。部分参与者误解了“使你感到强健”的活动概念（该条目旨在评估抗阻活动），且难以区分工作、志愿活动与家务劳动的边界。

结论：基于参与者反馈，研究团队开发了修订版、简化版且完成文化适配的GAC-PAQ。该修订版问卷将通过一款集成各国家定制化图片与本土语言旁白的应用程序（App），在全部15个国家开展预试验。未来仍需开展进一步研究以评估修订版GAC-PAQ的信度与效度。