Available online 2 February 2023, 101447

Author links open overlay panel, , , AbstractBackground

Practitioners and researchers often adapt tools, practices, and programs to meet the needs of culturally diverse population groups, but do not consider populations with disability. While there is some research on guidelines for adapting evidence-based programs, there is no systematic process for adapting survey instruments. Rather than creating separate instruments for people with physical disabilities (PWD), it is critical that instruments are designed to capture data on people with and without disabilities for comparison purposes. Given the disproportionately high rates of physical inactivity and obesity in PWD, we developed a methodology to adapt an evidence-based physical activity instrument.

Objective

To create a methodology to adapt surveys to be inclusive of PWD and use the methodology to adapt an evidence-based physical activity survey.

Methods

A framework was developed to adapt a physical activity survey instrument (International Physical Activity Questionnaire, IPAQ) to be inclusive of PWD. The framework, referred to as SAVe-IT, includes five steps: Step 1) Select survey instrument to adapt; Step 2) Adapt the survey instrument; Step 3) Verify adaptations with experts; Step 4) Implement Pilot Test; Step 5) Test the tool to confirm reliability.

Results

The adapted IPAQ passed review by the expert panels and the pilot test (n=20). Assessment of test-retest reliability (n=30) yielded strong intraclass correlation coefficients of 0.950 for the total score for the whole sample, 0.950 for PWD (n=15) and 0.952 for people without disability (n=15).

Conclusions

The SAVe-IT framework resulted in the successful adaptation of the IPAQ and can be used in populations with and without physical disabilities.

Section snippetsBackground

The epidemic of physical inactivity and obesity is one of the most significant public health problems in the United States (1, 2, 3). Physical inactivity and obesity are linked to a number of medical complications including higher rates of type 2 diabetes, cardiovascular disease, osteoarthritis, gall bladder and liver disease, certain forms of cancer, depression and other mental health disorders (4).

People with physical disabilities (PWD) are at a disproportionate risk for physical inactivity

Methods

The adaptation process used in this study was derived from the work of Rimmer et. al who developed a set of evidence-informed guidelines for adapting obesity prevention programs for people with disabilities (20). The Guidelines, Recommendations and Adaptations for Including Disability (referred to as GRAIDs) was modified to adapt survey instruments. The GRAIDs components consisted of a) identifying relevant content experts including people with disabilities to serve as reviewers of the adapted

Results

The results of the SAVe-IT methodology are described under each step.

Discussion

To our knowledge, this is the first study that developed and tested a methodology to adapt a popular physical activity survey instrument to be inclusive of PWD. The SAVe-IT framework provides a systematic process to accomplish this goal and contributes to the field of inclusion science (20, 35, 36) by promoting use of an existing physical survey instrument for PWD. Additionally, the SAVe-IT framework adds to the existing literature by providing a method for including PWD to the processes used

Conclusion

The lack of a systematic process for modifying existing survey instruments to be used with PWD has reduced our understanding of obesity and physical inactivity disparities between people with and without disabilities. PWD have disproportionately higher rates of obesity (5, 6, 7) and obesity-related comorbidities (7, 39, 40) and are therefore in need of obesity and weight management interventions relevant to their disability. The SAVe-IT framework provides a methodological process that can be

Funding:

This work was supported by NCHPAD funded by the Centers for Disease Control and Prevention (CDC), Division of Birth Defects and Developmental Disabilities (NCBDDD), Grant #NU27DD000022. Funding supporting the postdoctoral training for Cassandra Herman provided by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) under grant 90ARCP0004

Author contributions

JGC conceptualized the methodology and was the primary contributor to this manuscript. CH and CCF contributed to the development of the framework and provided critical revisions to the manuscript. JHR was a key contributed to the content and editing of the manuscript. All authors read and approved the final manuscript.

Ethics approval and consent to participate:

Approval for the pilot test and test-retest reliability was provided by the University of Alabama at Birmingham Institutional Review Board (#300009073) and (#300009389) respectively.

Conflicts of Interest:

The authors report no conflicts of interest.

Acknowledgements:

The authors acknowledge those who participated in the adaptation panels as well as those who participated in the pilot test and evaluation of test-retest reliability for their time and efforts on this project.

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