The validation and cross-cultural adaptation of the Arabic version of the pregnancy physical activity questionnaire

Afnan S. Younis; Nada A. Alyousefi; Dina M. Al-Habib; Amal T. Al-Omran

doi:10.15537/smj.2021.42.5.20200826

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Table 1

- Demographic characteristics of participants (N=118).

Variables	Total (%)
Age (years) Mean ± SD	30.15 ± 5.59
Pregestational body mass index
Underweight	2 (2.2)
Normal weight	45 (38.2)
Overweight	28 (30.1)
Obese	18(19.4)
Trimester
First	6 (5.1)
Second	64 (54.2)
Third	47 (39.8)
Previous abortion
No	74 (62.7)
Yes	44 (37.3)
Gravity
Primigravida	33 (28.0)
Multigravida	85 (72.0)
Children
0 children	24 (20.9)
1-2 children	60 (52.2)
3-4 children	23 (20.0)
>5 children	8 (7.0)
Level of education
Any school education	22 (20.6)
Bachelor	77 (72.3)
Higher education	8 (7.5)
Occupation
Housewife	69 (58.5)
Employed	38 (32.1)
Student	2 (1.7)
Others	9 (7.6)
Family income (SAR)
<5000	26 (33.9)
5000 to <10000	40 (11)
10000 to <15000	13 (7.6)
>15000	9 (25.4)
Don’t know/don’t want to answer	30 (25.4)
Accommodation
Apartment	81 (75.7)
Villa	26 (24.3)
Home ownership
Rented	55 (52.4)
Owned	30 (28.6)
Work housing	1 (1.0)
Living with husband’sfamily	19 (18.1)

SAR: Saudi Riyals

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Table 2

- Energy expenditure in METs.hours/week classified by intensity and type of activities.

Activities	25^thquartile	Median	75^thquartile
Total activity	162.3	356.1	648.3
By intensity
Total (light and greater than	58.1	163.8	344.5
light)	36.5	135.4	355.1
Sedentary activity	47.9	125.5	264.9
Light intensity	3.5	18.7	83.1
Moderate intensity	0.0	0.0	0.4
Vigorous intensity
By type
Household/caregiving	46.7	123.5	227.8
Occupational	0.0	0.0	101
Sports	0.2	0.49	1.8
Transportation	2.2	7.3	22.4

METs.hours/week, metabolic equivalent hours per week

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Table 3
- Internal consistency of PPAQ-A using Cronbach’s alpha (N=118).
Activity type Cronbach’s alpha
Household activity 0.68
Transportation 0.56
Leisure/sports Activity 0.83
Occupational Activity 0.83
PPAQ-A: pregnancy physical activity questionnaire-Arabic version

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Table 3

- Content validity, relevance rating from ten experts.

Item no.	E1	E2	E3	E4	E5	E6	E7	E8	E9	E10	I-CVI	UA
1	1	1	1	1	1	1	1	1	1	1	1	1
2	1	1	1	1	1	1	1	1	1	1	1	1
3	1	1	1	1	1	1	1	1	1	1	1	1
4	1	1	1	1	1	1	1	1	1	1	1	1
5	1	1	1	1	1	1	1	1	1	1	1	1
6	1	1	1	1	1	1	1	1	1	1	1	1
7	1	1	1	1	1	1	1	1	1	1	1	1
8	1	1	1	1	1	1	1	1	1	1	1	1
9	1	1	1	1	1	1	1	1	1	1	1	1
10	1	1	1	1	1	1	1	1	1	1	1	1
11	1	1	1	1	1	1	1	1	1	1	1	1
12	1	1	1	1	1	1	1	1	1	1	1	1
13	1	1	1	1		1	1	1	1	1	0.9	0
14	1	1	1	1	1	1	1			1	0.8	0
15	1	1	1	1	1	1	1	1	1	1	1	1
16	1	1	1	1	1	1	1	1		1	0.9	0
17	1	1	1	1	1	1	1	1	1	1	1	1
18	1	1	1	1	1	1	1	1	1	1	1	1
19	1	1	1	1	1	1	1	1		1	0.9	0
20	1	1	1	1	1	1	1	1	1	1	1	1
21	1	1	1	1		1	1	1	1	1	0.9	0
22	1	1	1	1	1	1	1	1		1	0.9	0
23	1	1	1	1		1	1	1	1	1	0.9	0
24	1	1	1	1	1	1	1	1	1	1	1	1
25	1	1	1	1	1	1	1	1	1	1	1	1
26	1	1	1	1	1	1	1	1	1	1	1	1
27	1	1	1	1	1	1	1	1	1	1	1	1
28	1	1	1	1	1	1	1	1	1	1	1	1
29	1	1	1	1	1	1	1	1	1	1	1	1
30	1	1	1	0	1	1	1	1	1	1	0.9	0
31	1	1	1	0	1	1	1	1	1	1	0.9	0
32	1	1	1	1	1	1	1	1	1	1	1	1
33	1	1	1	1	1	1	1	1	1	1	1	1
34	1	1	1	1	1	1	1	1	1	1	1	1
35	1	0	1	1	1	1	1	1	1	1	0.9	0
36	1	1	1	1	1	1	1	1	1	1	1	1
Proportion relevance	1	0.97	1	0.94	0.92	1	1	0.97	0.89	1
S-CVI\ave											0.94
S-CVI\UA												0.72
Average proportion of items judged as relevant across the ten experts												0.97

E: expert, I-CVI: item content validity index, UA: universal agreement, S-CVI: scale content validity index, S-CVI\ave: scale content validity index based on average, S-CVI\UA: scale content validity index based on universal agreement

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Table 4

- Rasch analysis, item difficulty and fit statistics.

Domain/item number*		Activity MET value	Difficulty (SE)	Infit mean square (SE)	Outfit mean square (SE)
Household activity
12	Watching TV	1.0	-0.56 (0.08)	1.30 (2.43)	1.31 (2.46)
13	Sitting and reading or talking on the phone	1.1	-0.88 (0.08)	1.07 (0.62)	1.22 (1.58)
11	Sitting and writing or using computer	1.8	-0.62 (0.06)	1.46 (3.74)	1.77 (5.01)
5	Childcare while sitting	2.0	-0.41 (0.06)	0.76 (-2.35)	0.75 (-1.95)
15	Light cleaning	2.3	-0.48 (0.08)	0.89 (-0.85)	0.84 (-1.19)
16	Shopping	2.3	-0.14 (0.08)	1.14 (1.05)	1.12 (0.85)
4	Preparing meals	2.5	-0.77 (0.08)	0.91 (-0.75)	0.91 (-0.69)
7	Playing with children while sitting or standing	2.7	-0.06 (0.08)	0.80 (-1.55)	0.74 (-1.95)
17	Heavier cleaning in the house	2.8	-0.29 (0.07)	1.04 (0.34)	1.07 (0.51)
18	Mowing lawn on riding mower or cleaning the front or backyards	2.8	0.63 (0.12)	1.00 (0.06)	0.80 (-0.65)
6	Childcare while standing	3.0	-0.21 (0.07)	0.71 (-2.58)	0.66 (-2.71)
9	Carrying children	3.0	0.23 (0.09)	0.91 (-0.36)	0.74 (-1.09)
14	Playing with pets	3.2	1.04 (0.21)	1.06 (0.29)	1.44 (0.99)
8	Playing with children while walking or running	4.0	0.33 (0.10)	0.98 (-0.08)	0.87 (-0.64)
10	Taking care of an older adult	4.0	0.81 (0.18)	1.05 (0.27)	1.07 (0.34)
19	Mowing lawn or gardening	4.4	1.38 (0.24)	1.01 (0.13)	0.99 (0.06)
Transportation
22	Driving or riding a car or a bus	1.5	-0.55 (0.13)	1.07 (0.49)	0.94 (-0.37)
20	Walking slowly to go places	2.5	0.05 (0.14)	0.86 (-0.81)	0.87 (-0.82)
21	Walking quickly to go places	4.0	0.50 (0.15)	1.04 (0.31)	1.00 (0.05)
Leisure/sports activity
23	Walking slowly	3.2	-1.03 (0.16)	0.88 (-0.80)	0.88 (-0.82)
27	Prenatal exercise classes	3.5	0.43 (0.32)	0.88 (-0.21)	2.09 (1.22)
29	Dancing	4.5	0.64 (0.27)	1.65 (1.58)	1.37 (0.76)
24	Walking quickly	4.6	-0.57 (0.18)	0.82 (-1.22)	0.75 (-1.63)
28	Swimming	6.0	0.90 (0.36)	0.75 (-0.30)	4.09 (1.76)
25	Walking quickly up hills	6.5	-1.03 (0.20)	1.09 (0.70)	1.08 (0.55)
26	Jogging	7.0	0.66 (0.28)	0.80 (-0.53)	1.57 (0.97)
Occupational activity
32	Sitting	1.6	-1.71 (0.16)	1.15 (0.76)	1.01 (0.11)
34	Standing or walking slowly not carrying things	2.2	-0.51 (0.16)	0.90 (-0.42)	0.89 (-0.43)
33	Standing or walking slowly while carrying things	3.0	0.32 (0.18)	1.01 (0.13)	0.91 (-0.21)
36	Walking quickly not carrying things	3.3	0.58 (0.18)	0.87 (-0.44)	0.95 (-0.07)
35	Walking quickly while carrying things	4.0	1.32 (0.25)	1.24 (0.92)	0.99 (-0.17)

SE: standard error; *Items listed ascendingly according to the MET value for its activity

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Table 5
- Item separation, item reliability and ratio of first-to-second eigen values for residuals from Rasch analysis.
Domain Item separation Item reliability Ratio of first-to-second eigenvalues
Household activity 5.45 0.97 1.23
Transportation 2.83 0.89 1.48
Leisure/sports activity 2.81 0.89 1.30
Occupational activity 5.40 0.97 1.37

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Table 6

- Test-retest reliability of PPAQ-A using intraclass correlation coefficients (ICC) with 95% confidence intervals (CI).

Variable	ICC (N=59)	95% CI for ICC
By type of activity
Household activity	0.85	0.74-0.91
Transportation	0.59	0.30-0.76
Leisure/sports activity	0.70	0.45-0.84
Occupational activity (n=27)	0.15	-0.78-0.60
By intensity
Vigorous intensity activity	0.61	-0.21-0.87
Moderate intensity activity	0.80	0.61-0.89
Light intensity activity	0.78	0.62-0.87
Sedentary activity	0.65	0.40-0.79
Total activity	0.78	0.55-0.88