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

In North East Brazil, 1 in 3 children under 5 are affected by overweight or obesity. Family-focused prevention interventions in Brazil are limited by a lack of validated culturally appropriate measurement scales. EPOCH CRE PhD affiliate, Widjane Goncalves, and the Stream 2 team led the cross-cultural adaptation of previously validated movement behaviour measures and parenting practices for economically disadvantaged Brazilian families.

In early childhood, parents play a key role in establishing and supporting healthy movement behaviours. Previous research has shown that active movement in young children is supported by parents’ role modelling, rules and limits around active play and screen time, and provision of opportunities or equipment for active play. Measuring parenting practices that influence movement behaviour in young children needs to be appropriate to the population and their context for it to be accurate and valid. In North-Eastern Brazil, where the childhood overweight and obesity rate is at 34%, such measurement tool is urgently needed to understand how to develop interventions to support Brazilian parents promote healthful movement behaviours in their young children.

The process of culturally adapting measurement scales validated in other population groups involve translating into the language of interest and using an interviewing technique to assess how the target group interpret the statements or questions (cognitive interviewing). 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. Cognitive interviewing was done with 24 parents from urban and rural North-Eastern Brazil addressing the format, content, and clarity of the items. The majority of parents were earning the minimum Brazilian wage, and only 25% had completed elementary school.

During the translation process, 15 discrepancies were identified, mostly due to multiple Portuguese words having the same meaning in English or expressions in English that does not exist in Portuguese such as ‘calm down’ and ‘get tucked in’.  The research team discussed these discrepancies and came to a consensus 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 understanding some terms, for example, ‘sedentary habits’ or ‘unhealthy’. Activities such as ‘ice skating’ are also less relevant and changed to more appropriate examples such as ‘soccer’ or ‘volleyball’. A consistent recall period for all survey items was also suggested, such as ‘a normal day over the last month’. Several formatting changes to improve understanding of items, including putting keywords in italics, underline or in bold type to emphasize importance, and displaying the response choices horizontally across the page rather than vertically was addressed.

‘These findings highlight the importance of undertaking appropriate steps to ensure that measures developed for other cultures are carefully translated and tested for understanding in the target study population’, said Ms Goncalves.

The next step is to use the culturally adapted measurement tool among low-income Brazilian families and assess its validity and reliability. This evidence could then be used to examine the relationships between parenting practices and children’s movement behaviours in low-middle-income countries to inform early childhood obesity prevention interventions.

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