Cross-Cultural Adaptation of the Community Healthy Activities Model Program for Seniors (CHAMPS) Physical Activity Questionnaire Among Hausa Older Adults

Cross-Cultural Adaptation of the Community Healthy Activities Model Program for Seniors (CHAMPS) Physical Activity Questionnaire Among Hausa Older Adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cross-Cultural Adaptation of the Community Healthy Activities Model Program for Seniors (CHAMPS) Physical Activity Questionnaire Among Hausa Older Adults Fatima Grema Mustapha, Abiola Abdulkareem Olaoluwa, Mamman Ali Masta, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8564131/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The Community Healthy Activities Model Program for Seniors (CHAMPS) Questionnaire is a widely used and validated tool for assessing physical activity in older adults. However, this instrument was developed and validated in Western contexts, limiting its cultural relevance and applicability to diverse populations. Therefore, this study aims to translate and culturally adapt the CHAMPS questionnaire in Hausa-speaking older adults in Nigeria and evaluate its content validity. We followed Beaton’s adaptation process and COSMIN protocols which include forward translation, synthesis of forward translation, back translation, expert review, and prefinal testing. A total of 20 older adults participated in the prefinal phase by completing the CHAMPS-Hausa version to explore their comprehensibility and clarity of the CHAMPS-Hausa version. In addition, content validity was assessed through cognitive debriefing with 10 of the participants. This involves the use of semi-structured interviews to probe their interpretation of the items, response choices, and recall period. We summarized the all-related activity, moderate-vigorous intensity physical activity and walking. Through this process, 18 items were replaced with culturally acceptable and relevant activities. While we also considered if the MET values of the replaced items were equivalent to the new items according to the Compendium of Physical Activities. A structured and iterative process produced a culturally relevant CHAMPS questionnaire with acceptable content validity among older adults who speak-Hausa. Further psychometric analysis of the CHAMPS-Hausa is needed such as reliability, construct and criterion validity. CHAMPS Physical activity Questionnaires Cultural adaptation Hausa Language Figures Figure 1 INTRODUCTION Sufficient physical activity can improve cardiovascular health, reduce the risk of chronic diseases, certain cancers, and enhance mental well-being( 1 ). In older adults, moderate-to-vigorous intensity physical activity (MVPA) is associated with maintaining functional independence, improving bone density, reducing mortality, lowering blood pressure, preventing stroke, and decreasing the risk of developing type 2 diabetes( 2 , 3 ). As people get older, their physical activity levels tend to decline, which can lead to various health issues such as chronic diseases, loss of muscle mass, and decreased mobility( 4 ). The World Health Organization (WHO) recommends that older adults participate in at least 150 minutes of MVPA per week including additional muscle-strengthening activities or balance exercises on at least two days per week and limiting the time spent being sedentary ( 5 ). However, various studies have indicated that a significant portion of older adults do not meet the recommended physical activity guidelines( 6 – 10 ). A systematic review found that globally, only 25% of older adults aged 65 and above met the recommended levels of physical activity( 11 ). Few studies have explored the prevalence and pattern of physical activity among older adults in Nigeria( 12 , 13 ). A study by Oyeyemi et al (2013) found that participants reported an average of 427.5 min/week of MVPA and 138.8 min/week of walking( 14 ). It is surprising that such large volume of physical activity was accumulated in this population. It is important to note that this study used a self-reported measure- the international Physical Activity Questionnaire (IPAQ) short form to assess the physical activity level that was not initially designed to measure physical activity among older adult( 15 ). Several self-reported measures have been developed to assess and monitor physical activity levels in older adults, which include the Community Healthy Activities Model Program for Seniors questionnaire (CHAMPS)( 16 ), the Yale Physical Activity Survey (YPAS)( 17 ), and the Physical Activity Scale for the Elderly (PASE)( 18 ). Of these three commonly utilized questionnaires, the CHAMPS has proven to be a promising tool for monitoring physical activity( 19 , 20 ). CHAMPS is particularly suitable for older adults as it captures a broad range of activities including light and moderate-intensity tasks across various domains such as leisure, household, and occupational activities( 16 ). This approach allows a more comprehensive assessment of physical activity levels. Also, it demonstrated stronger psychometric properties, including better test-retest reliability and construct validity, compared to YPAS and PASE ( 16 , 21 ). In addition, CHAMPS has been culturally adapted to other languages including French( 22 ), Polish ( 23 ), and Chinese( 24 , 25 ). Whilst the CHAMPS has been successfully adapted for various cultures and languages globally, to date, there appear to be no documented studies involving its adaptation in Africa or Nigeria. Even though, other physical activity measures have been adapted in the Nigerian context ( 26 – 28 ). For example, Oyeyemi et al (2011) and Awotidebe et al (2021) translated and adapted the short version of IPAQ into Hausa and Yoruba Language respectively( 26 , 27 ). On the other hand, Onwuakagba et al (2024) conducted a cross-cultural adaptation of Global Physical Activity Questionnaire (GPAQ) among Igbo native speakers. Neither the IPAQ nor the GPAQ were originally designed to assess physical activity that is specifically relevant to the older adult population. Using a measure like CHAMPS designed for older adults to capture relevant physical activity is important in epidemiological survey and for evaluating physical activity intervention in the Nigerian context. Furthermore, adapting the CHAMPS questionnaire into Hausa, a widely spoken languages in Nigeria ( 29 ), is essential to ensure that the instrument is acceptable, comprehensible, and culturally relevant for the Hausa-speaking population. This study aims to translate and culturally adapt CHAMPS questionnaire into Hausa language and to examine the content validity of the adapted Hausa version of the CHAMPS questionnaire. METHOD Design We followed Beaton’s cross cultural adaptation process which include forward translation, synthesis of forward translation, back translation, expert review, and prefinal testing ( 30 ). Overall, this study was divided into two phases: Phase 1 involved forward and back translation of the CHAMPS questionnaire. Phase 2 involved examining the content validity of the CHAMPS Hausa version. This study was reported following the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) ( 31 ) study checklist (see appendix 1). Consent was obtained from the participants before enrolling into the study. Ethics was obtained from research/ethics committee of the University of XXX (ethic no: Ref: XXX). Study Site and Participant This study was conducted in Maiduguri, Borno State, Nigeria. The Hausa language is one of the most widely spoken language in the Northern part of Nigeria ( 32 , 33 ). Linguistically, while Kanuri is the indigenous language of the Borno region, Hausa has become the lingua franca throughout northern Nigeria, including Maiduguri ( 34 ). Participants were included in this study if: 1) aged 65 years or older 2) able to read and/or speak Hausa language fluently 3) capable of performing activities of daily living [ADLs], 4) able to ambulate and walk independently in the community. Participants were excluded if they had cognitive impairments and disabilities, younger than 65 years of age, or were not fluent in or did not speak Hausa. Recruitment strategy and sample size estimation Participants were recruited using a multi-stage sampling method. Neighbourhoods were divided into high- and low-income neighbourhoods. Subsequently, one neighbourhood was randomly chosen from each category. This is to ensure that we captured physical activity that are relevant to both neighbourhoods. For content analysis, we recruited 20 participants for the pre-testing and, 10 older adults were selected for cognitive debriefing, following the recommendations of Beaton et al ( 30 ) Translation procedure The process involves five stages to ensure the translated version maintains equivalence with the original source version in terms of semantics, idioms, experiences, and concepts ( 17 ). Figure 1 shows each stage of cross-cultural adaptation process. Phase I Stage I: Initial Translation This stage involved the forward translation of the CHAMPS questionnaire from English language to Hausa Language. Two translators were involved in this stage. Translator 1 had the knowledge of the concepts being measured to aim for equivalency from a clinical or epidemiological perspective. Translator 2 was naive to the concepts being measured and was able to detect subtle differences in meaning, although the translator had no medical/clinical background. Both translators were native speakers of Hausa, this was to ensure accurate interpretation and translation of the questionnaire. The translators independently translated the CHAMPS questionnaire from English to Hausa language. These translations, referred to as C1 and C2, formed the foundation of the adaptation process. Each translator produced a written report documenting their translation process and rationale. Stage II: Synthesis of Translations The next stage was synthesizing the two translated versions (C1 and C2) of CHAMPS questionnaire into one common translation (C-12). The team of researchers met with the translators and discussed the two forward translations and resolved items with inconsistent translations. This was achieved through two virtual meetings, which lasted 100 minutes and 160 minutes respectively. This stage involved collaborative discussions to reconcile differences and ensure linguistic accuracy. Stage III: Back Translation This stage involved backward translation of the synthesized version (C-12). The translations were done by two translators who are experts in linguistic. They independently translated the Hausa version back to English Language and both were blinded to the original version. The translators were individuals who did not have knowledge on the measurement of physical activity and had not previously used the CHAMPS questionnaire. The two backward translated versions (B1 and B2) were compared for similarities and differences in terms of semantics, expression and concept. Stage IV: Expert Committee A multi-disciplinary expert committee was formed, including CHAMPS experts, health professionals, methodologists, and all translators involved. The committee met at three different time to discuss the adaptation process. The committee reviewed and consolidated all versions (original English, Hausa translations, synthesized Hausa version, and back-translations). The review process involved three comprehensive meetings, lasting 107 minutes, 120 minutes, and 64 minutes, respectively. The committee adapted items that were not culturally relevant and ensure that it is equivalence to the original items with respect to metabolic equivalence. The essence of this meeting is to develop a pre-final version of the CHAMPS Hausa version. We resolved any discrepancies, and developed a pre-final version, ensuring semantic, idiomatic, experiential, and conceptual equivalence between original English version and Hausa versions of CHAMPS. All decisions were documented with rationale. Phase II Stage V: Test of the Pre-Final Version (content validity) Content validity was assessed in two stages- first, we invited 20 older adults who spoke Hausa fluently to complete the pre-final version. This was to assess the comprehensibility, clarity, and cultural appropriateness of the questionnaire. Secondly, through cognitive debriefing, we invited 10 (eight males and two females) out of the 20 older adults for additional semi-structured interviews to probe their interpretations and cultural relevant of the items. Items that participants found challenging to address during the initial invitation were subsequently examined more thoroughly through cognitive debriefing (see appendix 2 for the semi-structured interview questionnaire). Results Synthesizing forward Translation Following the forward translation, we synthesized the two Hausa translations. Fifteen items were culturally adapted with items of similar metabolic equivalent while ensuring cultural relevance and conceptual equivalent among Hausa-speaking communities. The item 4 “Attend church or take part in church activities”, was adapted to “Halarci gurin ibada ko gabatar da wani aiki a gurin” “(Attend a worship place or take part in worship activities)” to reflect the diverse religious practices in Hausa-speaking regions. We discuss about replacing it with “mosque activities”, however, it was argued that not all Hausa-speaking individuals attend mosque and instead uses a more inclusive term to capture participation in various forms of worship. The original item 6, “Use a computer”, was adapted to " Amfani da Wayar salula" “(Use a cellular (handset)” to reflect the more accessible technology among older adults living in Hausa community. This change recognizes that cell phones are more widely available and used in Hausa-speaking communities than computers. Item 7: “Dance (do not count aerobic dance here)” the phrase “such as square, folk, line, ballroom” was adapted to “(such as traditional dances)” to reflect culturally significant forms of dance more familiar to the target community. This ensures alignment with the cultural practices of the respondents. The items 9 and 10 “Play golf, carrying or pulling your equipment (count walking time only)” and “Play golf, riding a cart (count walking time only)”, were adapted to "zuwa kasuwa kuma ka dau dakon kayanka da kanka (ka lissafa lokutan tattakin motsa jiki kawai) " “Go to market, carrying your load (count walking time only)” and "zuwa kasuwa da daukan kaya mara nauyi/ ko bada dakon kayanka (ka lissafa lokutan tattakin motsa jiki kawai)", “[Go to market, carrying your light load or given it to porter (count walking time only)]”, respectively. These changes reflect culturally relevant activities that reflect similar metabolic equivalence (MET) value. Item 12 “Play cards, bingo, or board games with other people” was replaced with “card, dara game, or Ludo”, as these games are widely recognized and commonly played in the local context. Item 13 “Shoot pool or billiards” this was adapted to “Play snooker” a game more commonly known and practiced within the cultural setting, ensuring participants can relate to and accurately respond to the item. See table 1 for details of each item translation and adaptation. Back translation and Expert committee report The synthesized C12 Hausa version was back translated into English. Following this, an expert committee was assembled to critically evaluate and refine the translation process. We identified inconsistency in translation of five items from Hausa to English Language. These items were reviewed, and consensus were reached to ensure semantic and experiential equivalence in Hausa context. Item 16 “Skate (ice, roller, in-line)”, adapted to “Jumping (for exercise)” but differences in metabolic equivalent value exist. Item 21 “Do heavy gardening (such as making ridges, raking)”, the activity “making ridges” was culturally relevant and retained, with “cutting grass” added to enhance experiential applicability. Finally, the pre-final version was developed (see table 2 for details). Pretesting and Cognitive Debriefing Table 3 shows the sociodemographic of the participants (N = 20) included in the pre-testing, with the mean age of 69.8±2.4 years. Among 20 participants, 70% were men and half were retired. One-third of the participants identified as Hausa with no formal education. The mean of the moderate-to-vigorous intensity and walking were 7.4 (8.2) hours/week and 3.5 (3.5) hours/week respectively. Out of the 20 participants, 10 were involved in cognitive debriefing. We asked the participants about what they feel while answering some items in the questionnaire. Specific items were selected based on feedback from the expert committee meeting and pre-testing. Participants were asked if there were any items that they found difficult to recall or answer. They highlighted difficulty in answering some of the items or challenges its cultural relevance. For instance, item 7 “Dance (such as traditional dances) (Do not count fitness dance)?” Many participants mentioned that they don't dance, but a few enjoyed dancing in weddings or other events. Below are some of the responses from the participants. What do you think about answering item 13? “it’s shameful for old man like me to do such” (participant 4, Male, 71years) What do you think about answering item 31? “don’t have time to find a swimming pool nearby” (participants 6, Female, 65years) What do you think about answering item 32? “Where will I find a swimming pool?” (Participant 7, Male, 67years) What do you think about answering item 33? “Swimming pools are hard to find” (participant 9, Male, 71years) Do you know any activity or suggestion of any relevant activity? “Going to the Farm” and “Rearing animals” (participants 2,10, both Male, 70years) Final version After conducting cognitive debriefing, the committee convened to deliberate on participant responses, Items 31, 32, and 33 which pertained to water activities were identified as not culturally relevant and subsequently were replaced with farming-related activities that maintain equivalent metabolic values (see table 4). These items were deemed unsuitable for the significant portion of older adults living in urban areas, although they held some relevance for those in rural areas. Item 7 and item 13 were retained as they were culturally relevant. Refer to Appendix 3 and 4 for the final adapted versions in English and Hausa. Discussion We culturally adapt the CHAMPS questionnaire into the Hausa language for use among Hausa-speaking older adults in Nigeria. Rigorous methodological steps were followed as outlined by Beaton et al (2000) and COSMIN protocol ( 30 , 31 ). Due to cultural differences, a total of 18 items were modified or culturally adapted to suit the local context at different stage of the process. These modifications were necessary to ensure that the questionnaire is culturally relevant, acceptable, and comprehensible to the target population. Activities such as computer use, tennis, and swimming were replaced with alternatives like mobile use, fetching water, and farming to ensure better resonance with the target population. Item 6 which involve the use of computer was replaced with cell phone use. Given the limited access to computers amongst older adults in Hausa-speaking communities, cell phones were a more practical and familiar alternative, this adaptation is like modifications made in the Chinese version ( 25 ). Similarly, item 13, “Shoot pool or billiards,” was replaced with the locally popular game of “sunuka”. While both activities involve similar movements and energy expenditure, snooker is far more familiar to older adults in Hausa-speaking communities, especially among men who sometimes play in local clubs or social centres. A similar approach was reported in the Chinese adaptation of CHAMPS ( 25 ), where activities uncommon in their setting were replaced with more familiar ones. For item 7, there were mixed reaction, however, we decided to keep the item after making a small cultural adjustment–from “ Dance (such as square, folk, line, ballroom) ” to “Dance (such as traditional dances)” based on feedback we received during cognitive debriefing. Some participants reported that they rarely danced and considered it inappropriate for older men. While others mentioned that they dance occasionally during social events like weddings. Dancing, in this context, may not be a regular form of exercise but still represents an important part of cultural and social life. Keeping this item, therefore, allows the questionnaire to capture those culturally significant movements that contribute to physical activity, even if they are done occasionally. Games and sport related activities that are not commonly engaged in Hausa culture were adapted. For example, golf-related items (items 9 and 10) were replaced with culturally relevant activities such as going to the market while carrying loads. Golf is not a common activity among older adults in Nigeria, particularly in the Hausa-speaking regions. In fact, golf is often associated with affluent communities and is not a culturally relevant activity in many parts of Nigeria. This modification is consistent with other cultural adaptations of the CHAMPS questionnaires in non-Western settings ( 24 , 25 ), where golf is often replaced with more culturally appropriate leisure activities or deleted from the adapted questionnaire. Swimming items 31–33 were replaced with farming-related activities in this adaptation. Limited access to swimming facilities, combined with prevailing cultural attitudes, has made swimming unsuitable activity for most Hausa-speaking older adults. However, farming, with its physical demands and cultural significance, provided a feasible alternative. This type of adaptation is not unique to our study, other studies have also reported similar adaptations, such as the replacement of swimming with standing/childcare in Chinese populations ( 24 ). Also, tennis related items (items14 and 15) were adapted to fetching water from a well/tap, to reflect culturally relevant activities in Hausa-speaking communities. Conclusion, Limitations, and Recommendations This is the first study to culturally adapt the CHAMPS questionnaire into Hausa language, providing a valuable tool for assessing physical activity levels among Hausa-speaking older adults. Following rigorous protocols, including forward and backward translation, expert review, and cognitive debriefing, the study identified areas requiring cultural adjustments such as items related to games, sport, and water activities, which were irrelevant to most participants, were replaced with culturally relevant activities while maintaining equivalent metabolic values. Items reflecting traditional practices and values, such as dance and self-identity expressions, were retained for their cultural resonance. However, there are some limitations to this study. Foremost, the sample size was relatively small, and the geographic scoping was limited to specific Hausa-speaking communities, which may not represent all regional variations within the Hausa-speaking population and might limit the generalizability of our findings. Also, there was exclusive focus on translation, adaptation and evaluation of content validity without extending to a comprehensive evaluation of other psychometric properties. Consequently, reliability and additional validity evidence could not be established within this study. It is recommended that future research investigates the reliability and conducts further validity tests such as construct and criterion validity of the CHAMPS-Hausa questionnaire. The adapted instrument should also be used in subsequent studies to evaluate physical activity levels among older adults in Hausa-speaking communities. Declarations Author Contribution Authors’ Contributions:O.A conceptualized and supervised the research. F.G.M led in data collection and writing the manuscript. O.A, M.A.M and F.G.M involved in refining the research questions. M.A.M co-supervised, all authors were involved in the translation process and reviewed the manuscript.Funding:This study did not receive any specific funding from public, commercial, or not-for-profit funding agencies. Data Availability The data used for analysis in this study is not publicly available but can be provide on request from the corresponding author. References Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: The evidence. CMAJ [Internet]. 2006 Mar 14 [cited 2025 Jul 27];174(6):801–9. 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COSMIN reporting guideline for studies on measurement properties of patient-reported outcome measures. Quality of Life Research [Internet]. 2021 Aug 1 [cited 2025 Sep 8];30(8):2197–218. Available from: https://pubmed.ncbi.nlm.nih.gov/33818733/ Hausa Language | Research Starters | EBSCO Research [Internet]. [cited 2025 Sep 8]. Available from: https://www.ebsco.com/research-starters/language-and-linguistics/hausa-language Hausa. 2017 Jul 5 [cited 2025 Sep 8];637–48. Available from: https://www.taylorfrancis.com/chapters/edit/10.4324/9781315084862-59/hausa FMACCE | Indigenous Language [Internet]. [cited 2025 Oct 8]. Available from: https://www.fmacce.gov.ng/indigenous-language Tables Tables are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Appendix1COSMIN.docx Appendix2openendedquestions.docx FinalEnglishappendix3.docx FinalHausaappendix4.docx Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8564131","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":574205882,"identity":"8416f373-3a6d-4599-b63f-1e026554c955","order_by":0,"name":"Fatima Grema Mustapha","email":"data:image/png;base64,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","orcid":"","institution":"University of Maiduguri","correspondingAuthor":true,"prefix":"","firstName":"Fatima","middleName":"Grema","lastName":"Mustapha","suffix":""},{"id":574205883,"identity":"ca031ba6-5f3f-44d7-83ce-161ecda169bc","order_by":1,"name":"Abiola Abdulkareem Olaoluwa","email":"","orcid":"","institution":"University of Maiduguri","correspondingAuthor":false,"prefix":"","firstName":"Abiola","middleName":"Abdulkareem","lastName":"Olaoluwa","suffix":""},{"id":574205886,"identity":"d714dc53-7d11-4333-b86d-f10c0296b6f9","order_by":2,"name":"Mamman Ali Masta","email":"","orcid":"","institution":"University of Maiduguri","correspondingAuthor":false,"prefix":"","firstName":"Mamman","middleName":"Ali","lastName":"Masta","suffix":""},{"id":574205887,"identity":"46d03aa9-aed6-418f-8a8c-1ebf2c292645","order_by":3,"name":"Henrietta O. Fawole","email":"","orcid":"","institution":"Coventry University","correspondingAuthor":false,"prefix":"","firstName":"Henrietta","middleName":"O.","lastName":"Fawole","suffix":""},{"id":574205889,"identity":"ce08d7ac-422d-4af9-be27-6de6b4fd209e","order_by":4,"name":"Maina Tar Alhaji Bulama","email":"","orcid":"","institution":"University of Maiduguri","correspondingAuthor":false,"prefix":"","firstName":"Maina","middleName":"Tar Alhaji","lastName":"Bulama","suffix":""},{"id":574205891,"identity":"502955bb-943d-4829-8ca3-0535645ea531","order_by":5,"name":"Olayinka Akinrolie","email":"","orcid":"","institution":"University of Calgary","correspondingAuthor":false,"prefix":"","firstName":"Olayinka","middleName":"","lastName":"Akinrolie","suffix":""}],"badges":[],"createdAt":"2026-01-09 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14:19:43","extension":"xml","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":95343,"visible":true,"origin":"","legend":"","description":"","filename":"694b6293bc764e2998c554724d47eeca1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8564131/v1/f19d8c2ea43da0c2ffa5b60e.xml"},{"id":100426786,"identity":"e4f43d07-6e74-45a5-9566-53229aee59f5","added_by":"auto","created_at":"2026-01-16 14:19:54","extension":"html","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":108194,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8564131/v1/a5bd76e6c65fb8dce7b4f0ff.html"},{"id":100426701,"identity":"7841f09c-5f5f-4e6a-ab32-09a8eb26e40b","added_by":"auto","created_at":"2026-01-16 14:19:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":457301,"visible":true,"origin":"","legend":"\u003cp\u003eA diagrammatic representation of the step-by-step process of cross-cultural adaptation of the CHAMPS questionnaire into Hausa Language\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8564131/v1/70fa32bbc03d62f4bc0a613c.png"},{"id":103504553,"identity":"9cbfc64f-b733-4195-9c9e-304576bcd7b5","added_by":"auto","created_at":"2026-02-26 13:20:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":905361,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8564131/v1/1d6cd0b0-7c91-444a-92e5-b8ecf3f0e7de.pdf"},{"id":100426613,"identity":"45f4c539-166d-47ad-b1a7-645b0b70d930","added_by":"auto","created_at":"2026-01-16 14:19:44","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23011,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1COSMIN.docx","url":"https://assets-eu.researchsquare.com/files/rs-8564131/v1/47ed15c5ecf5af7ec80fad14.docx"},{"id":100426653,"identity":"fb4b922b-e03b-4c5c-a19d-dc75d1e957cb","added_by":"auto","created_at":"2026-01-16 14:19:47","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":17450,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix2openendedquestions.docx","url":"https://assets-eu.researchsquare.com/files/rs-8564131/v1/cfd3c977c74049674d0685fe.docx"},{"id":100426615,"identity":"94145d11-27fa-444e-9e52-1122a600ce91","added_by":"auto","created_at":"2026-01-16 14:19:44","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":46761,"visible":true,"origin":"","legend":"","description":"","filename":"FinalEnglishappendix3.docx","url":"https://assets-eu.researchsquare.com/files/rs-8564131/v1/2a8e1133b90f185461dd8b39.docx"},{"id":100426703,"identity":"f324f9db-8587-4bf4-b53e-86ac0968cc80","added_by":"auto","created_at":"2026-01-16 14:19:50","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":51305,"visible":true,"origin":"","legend":"","description":"","filename":"FinalHausaappendix4.docx","url":"https://assets-eu.researchsquare.com/files/rs-8564131/v1/d2843e78ce2db24d0d4758a7.docx"},{"id":100426712,"identity":"2340970d-98bd-49ef-b1a3-8c53339f1dd5","added_by":"auto","created_at":"2026-01-16 14:19:51","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":22835,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8564131/v1/1a634e736068536f4a68891b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eCross-Cultural Adaptation of the Community Healthy Activities Model Program for Seniors (CHAMPS) Physical Activity Questionnaire Among Hausa Older Adults\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eSufficient physical activity can improve cardiovascular health, reduce the risk of chronic diseases, certain cancers, and enhance mental well-being(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In older adults, moderate-to-vigorous intensity physical activity (MVPA) is associated with maintaining functional independence, improving bone density, reducing mortality, lowering blood pressure, preventing stroke, and decreasing the risk of developing type 2 diabetes(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). As people get older, their physical activity levels tend to decline, which can lead to various health issues such as chronic diseases, loss of muscle mass, and decreased mobility(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe World Health Organization (WHO) recommends that older adults participate in at least 150 minutes of MVPA per week including additional muscle-strengthening activities or balance exercises on at least two days per week and limiting the time spent being sedentary (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, various studies have indicated that a significant portion of older adults do not meet the recommended physical activity guidelines(\u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). A systematic review found that globally, only 25% of older adults aged 65 and above met the recommended levels of physical activity(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Few studies have explored the prevalence and pattern of physical activity among older adults in Nigeria(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A study by Oyeyemi et al (2013) found that participants reported an average of 427.5 min/week of MVPA and 138.8 min/week of walking(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). It is surprising that such large volume of physical activity was accumulated in this population. It is important to note that this study used a self-reported measure- the international Physical Activity Questionnaire (IPAQ) short form to assess the physical activity level that was not initially designed to measure physical activity among older adult(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral self-reported measures have been developed to assess and monitor physical activity levels in older adults, which include the Community Healthy Activities Model Program for Seniors questionnaire (CHAMPS)(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), the Yale Physical Activity Survey (YPAS)(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and the Physical Activity Scale for the Elderly (PASE)(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Of these three commonly utilized questionnaires, the CHAMPS has proven to be a promising tool for monitoring physical activity(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). CHAMPS is particularly suitable for older adults as it captures a broad range of activities including light and moderate-intensity tasks across various domains such as leisure, household, and occupational activities(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This approach allows a more comprehensive assessment of physical activity levels. Also, it demonstrated stronger psychometric properties, including better test-retest reliability and construct validity, compared to YPAS and PASE (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In addition, CHAMPS has been culturally adapted to other languages including French(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), Polish (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), and Chinese(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhilst the CHAMPS has been successfully adapted for various cultures and languages globally, to date, there appear to be no documented studies involving its adaptation in Africa or Nigeria. Even though, other physical activity measures have been adapted in the Nigerian context (\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). For example, Oyeyemi et al (2011) and Awotidebe et al (2021) translated and adapted the short version of IPAQ into Hausa and Yoruba Language respectively(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). On the other hand, Onwuakagba et al (2024) conducted a cross-cultural adaptation of Global Physical Activity Questionnaire (GPAQ) among Igbo native speakers. Neither the IPAQ nor the GPAQ were originally designed to assess physical activity that is specifically relevant to the older adult population. Using a measure like CHAMPS designed for older adults to capture relevant physical activity is important in epidemiological survey and for evaluating physical activity intervention in the Nigerian context. Furthermore, adapting the CHAMPS questionnaire into Hausa, a widely spoken languages in Nigeria (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), is essential to ensure that the instrument is acceptable, comprehensible, and culturally relevant for the Hausa-speaking population. This study aims to translate and culturally adapt CHAMPS questionnaire into Hausa language and to examine the content validity of the adapted Hausa version of the CHAMPS questionnaire.\u003c/p\u003e"},{"header":"METHOD","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eWe followed Beaton\u0026rsquo;s cross cultural adaptation process which include forward translation, synthesis of forward translation, back translation, expert review, and prefinal testing (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Overall, this study was divided into two phases: Phase 1 involved forward and back translation of the CHAMPS questionnaire. Phase 2 involved examining the content validity of the CHAMPS Hausa version. This study was reported following the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) study checklist (see appendix 1). Consent was obtained from the participants before enrolling into the study. Ethics was obtained from research/ethics committee of the University of XXX (ethic no: Ref: XXX).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Site and Participant\u003c/h3\u003e\n\u003cp\u003eThis study was conducted in Maiduguri, Borno State, Nigeria. The Hausa language is one of the most widely spoken language in the Northern part of Nigeria (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Linguistically, while Kanuri is the indigenous language of the Borno region, Hausa has become the lingua franca throughout northern Nigeria, including Maiduguri (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Participants were included in this study if: 1) aged 65 years or older 2) able to read and/or speak Hausa language fluently 3) capable of performing activities of daily living [ADLs], 4) able to ambulate and walk independently in the community. Participants were excluded if they had cognitive impairments and disabilities, younger than 65 years of age, or were not fluent in or did not speak Hausa.\u003c/p\u003e\n\u003ch3\u003eRecruitment strategy and sample size estimation\u003c/h3\u003e\n\u003cp\u003eParticipants were recruited using a multi-stage sampling method. Neighbourhoods were divided into high- and low-income neighbourhoods. Subsequently, one neighbourhood was randomly chosen from each category. This is to ensure that we captured physical activity that are relevant to both neighbourhoods. For content analysis, we recruited 20 participants for the pre-testing and, 10 older adults were selected for cognitive debriefing, following the recommendations of Beaton et al (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\n\u003ch3\u003eTranslation procedure\u003c/h3\u003e\n\u003cp\u003eThe process involves five stages to ensure the translated version maintains equivalence with the original source version in terms of semantics, idioms, experiences, and concepts (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows each stage of cross-cultural adaptation process.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003ePhase I\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStage I: Initial Translation\u003c/h2\u003e \u003cp\u003eThis stage involved the forward translation of the CHAMPS questionnaire from English language to Hausa Language. Two translators were involved in this stage. Translator 1 had the knowledge of the concepts being measured to aim for equivalency from a clinical or epidemiological perspective. Translator 2 was naive to the concepts being measured and was able to detect subtle differences in meaning, although the translator had no medical/clinical background. Both translators were native speakers of Hausa, this was to ensure accurate interpretation and translation of the questionnaire. The translators independently translated the CHAMPS questionnaire from English to Hausa language. These translations, referred to as C1 and C2, formed the foundation of the adaptation process. Each translator produced a written report documenting their translation process and rationale.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStage II: Synthesis of Translations\u003c/h3\u003e\n\u003cp\u003eThe next stage was synthesizing the two translated versions (C1 and C2) of CHAMPS questionnaire into one common translation (C-12). The team of researchers met with the translators and discussed the two forward translations and resolved items with inconsistent translations. This was achieved through two virtual meetings, which lasted 100 minutes and 160 minutes respectively. This stage involved collaborative discussions to reconcile differences and ensure linguistic accuracy.\u003c/p\u003e\n\u003ch3\u003eStage III: Back Translation\u003c/h3\u003e\n\u003cp\u003eThis stage involved backward translation of the synthesized version (C-12). The translations were done by two translators who are experts in linguistic. They independently translated the Hausa version back to English Language and both were blinded to the original version. The translators were individuals who did not have knowledge on the measurement of physical activity and had not previously used the CHAMPS questionnaire. The two backward translated versions (B1 and B2) were compared for similarities and differences in terms of semantics, expression and concept.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStage IV: Expert Committee\u003c/h2\u003e \u003cp\u003eA multi-disciplinary expert committee was formed, including CHAMPS experts, health professionals, methodologists, and all translators involved. The committee met at three different time to discuss the adaptation process. The committee reviewed and consolidated all versions (original English, Hausa translations, synthesized Hausa version, and back-translations). The review process involved three comprehensive meetings, lasting 107 minutes, 120 minutes, and 64 minutes, respectively. The committee adapted items that were not culturally relevant and ensure that it is equivalence to the original items with respect to metabolic equivalence. The essence of this meeting is to develop a pre-final version of the CHAMPS Hausa version. We resolved any discrepancies, and developed a pre-final version, ensuring semantic, idiomatic, experiential, and conceptual equivalence between original English version and Hausa versions of CHAMPS. All decisions were documented with rationale.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePhase II\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eStage V: Test of the Pre-Final Version (content validity)\u003c/h2\u003e \u003cp\u003eContent validity was assessed in two stages- first, we invited 20 older adults who spoke Hausa fluently to complete the pre-final version. This was to assess the comprehensibility, clarity, and cultural appropriateness of the questionnaire. Secondly, through cognitive debriefing, we invited 10 (eight males and two females) out of the 20 older adults for additional semi-structured interviews to probe their interpretations and cultural relevant of the items. Items that participants found challenging to address during the initial invitation were subsequently examined more thoroughly through cognitive debriefing (see appendix 2 for the semi-structured interview questionnaire).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eSynthesizing forward Translation\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the forward translation, we synthesized the two Hausa translations. Fifteen items were culturally adapted with items of similar metabolic equivalent while ensuring cultural relevance and conceptual equivalent among Hausa-speaking communities. The item 4 \u0026ldquo;Attend church or take part in church activities\u0026rdquo;, was adapted to \u003cem\u003e\u0026ldquo;Halarci gurin ibada ko gabatar da wani aiki a gurin\u0026rdquo;\u003c/em\u003e \u0026ldquo;(Attend a worship place or take part in worship activities)\u0026rdquo; to reflect the diverse religious practices in Hausa-speaking regions. We discuss about replacing it with \u0026ldquo;mosque activities\u0026rdquo;, however, it was argued that not all Hausa-speaking individuals attend mosque and instead uses a more inclusive term to capture participation in various forms of worship. The original item 6, \u0026ldquo;Use a computer\u0026rdquo;, was adapted to \u0026quot;\u003cem\u003eAmfani da Wayar salula\u0026quot;\u003c/em\u003e \u0026ldquo;(Use a cellular (handset)\u0026rdquo; to reflect the more accessible technology among older adults living in Hausa community. This change recognizes that cell phones are more widely available and used in Hausa-speaking communities than computers. Item 7: \u0026ldquo;Dance (do not count aerobic dance here)\u0026rdquo; the phrase \u0026ldquo;such as square, folk, line, ballroom\u0026rdquo; was adapted to \u0026ldquo;(such as traditional dances)\u0026rdquo; to reflect culturally significant forms of dance more familiar to the target community. This ensures alignment with the cultural practices of the respondents. The items 9 and 10 \u0026ldquo;Play golf, carrying or pulling your equipment (count walking time only)\u0026rdquo; and \u0026ldquo;Play golf, riding a cart (count walking time only)\u0026rdquo;, were adapted to \u003cem\u003e\u0026quot;zuwa kasuwa kuma ka dau dakon kayanka da kanka (ka lissafa lokutan tattakin motsa jiki kawai)\u003c/em\u003e\u0026quot; \u0026ldquo;Go to market, carrying your load (count walking time only)\u0026rdquo; and \u003cem\u003e\u0026quot;zuwa kasuwa da daukan kaya mara nauyi/ ko bada dakon kayanka (ka lissafa lokutan tattakin motsa jiki kawai)\u0026quot;,\u003c/em\u003e \u0026ldquo;[Go to market, carrying your light load or given it to porter (count walking time only)]\u0026rdquo;, respectively. These changes reflect culturally relevant activities that reflect similar metabolic equivalence (MET) value. Item 12 \u0026ldquo;Play cards, bingo, or board games with other people\u0026rdquo; was replaced with \u0026ldquo;card, dara game, or Ludo\u0026rdquo;, as these games are widely recognized and commonly played in the local context. Item 13 \u0026ldquo;Shoot pool or billiards\u0026rdquo; this was adapted to \u0026ldquo;Play snooker\u0026rdquo; a game more commonly known and practiced within the cultural setting, ensuring participants can relate to and accurately respond to the item. See table 1 for details of each item translation and adaptation.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBack translation and Expert committee report\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe synthesized C12 Hausa version was back translated into English. Following this, an expert committee was assembled to critically evaluate and refine the translation process. We identified inconsistency in translation of five items from Hausa to English Language. These items were reviewed, and consensus were reached to ensure semantic and experiential equivalence in Hausa context. Item 16 \u0026ldquo;Skate (ice, roller, in-line)\u0026rdquo;, adapted to \u0026ldquo;Jumping (for exercise)\u0026rdquo; but differences in metabolic equivalent value exist. Item 21 \u0026ldquo;Do heavy gardening (such as making ridges, raking)\u0026rdquo;, the activity \u0026ldquo;making ridges\u0026rdquo; was culturally relevant and retained, with \u0026ldquo;cutting grass\u0026rdquo; added to enhance experiential applicability. Finally, the pre-final version was developed (see table 2 for details).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePretesting and Cognitive Debriefing\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 shows the sociodemographic of the participants (N = 20) included in the pre-testing, with the mean age of 69.8\u0026plusmn;2.4 years. Among 20 participants, 70% were men and half were retired. One-third of the participants identified as Hausa with no formal education. The mean of the moderate-to-vigorous intensity and walking were 7.4 (8.2) hours/week and 3.5 (3.5) hours/week respectively. Out of the 20 participants, 10 were involved in cognitive debriefing. We asked the participants about what they feel while answering some items in the questionnaire. Specific items were selected based on feedback from the expert committee meeting and pre-testing. Participants were asked if there were any items that they found difficult to recall or answer. They highlighted difficulty in answering some of the items or challenges its cultural relevance. For instance, item 7 \u0026ldquo;Dance (such as traditional dances) (Do not count fitness dance)?\u0026rdquo; Many participants mentioned that they don\u0026apos;t dance, but a few enjoyed dancing in weddings or other events. Below are some of the responses from the participants.\u003c/p\u003e\n\u003cp\u003eWhat do you think about answering item 13?\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;it\u0026rsquo;s shameful for old man like me to do such\u0026rdquo; (participant 4, Male, 71years)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eWhat do you think about answering item 31?\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;don\u0026rsquo;t have time to find a swimming pool nearby\u0026rdquo; (participants 6, Female, 65years)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eWhat do you think about answering item 32?\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Where will I find a swimming pool?\u0026rdquo; (Participant 7, Male, 67years)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eWhat do you think about answering item 33?\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Swimming pools are hard to find\u0026rdquo; (participant 9, Male, 71years)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eDo you know any activity or suggestion of any relevant activity?\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Going to the Farm\u0026rdquo; and \u0026ldquo;Rearing animals\u0026rdquo; (participants 2,10, both Male, 70years)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinal version\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter conducting cognitive debriefing, the committee convened to deliberate on participant responses, Items 31, 32, and 33 which pertained to water activities were identified as not culturally relevant and subsequently were replaced with farming-related activities that maintain equivalent metabolic values (see table 4). These items were deemed unsuitable for the significant portion of older adults living in urban areas, although they held some relevance for those in rural areas. Item 7 and item 13 were retained as they were culturally relevant. Refer to Appendix 3 and 4 for the final adapted versions in English and Hausa.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe culturally adapt the CHAMPS questionnaire into the Hausa language for use among Hausa-speaking older adults in Nigeria. Rigorous methodological steps were followed as outlined by Beaton et al (2000) and COSMIN protocol (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Due to cultural differences, a total of 18 items were modified or culturally adapted to suit the local context at different stage of the process. These modifications were necessary to ensure that the questionnaire is culturally relevant, acceptable, and comprehensible to the target population. Activities such as computer use, tennis, and swimming were replaced with alternatives like mobile use, fetching water, and farming to ensure better resonance with the target population. Item 6 which involve the use of computer was replaced with cell phone use. Given the limited access to computers amongst older adults in Hausa-speaking communities, cell phones were a more practical and familiar alternative, this adaptation is like modifications made in the Chinese version (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilarly, item 13, “Shoot pool or billiards,” was replaced with the locally popular game of “sunuka”. While both activities involve similar movements and energy expenditure, \u003cem\u003esnooker\u003c/em\u003e is far more familiar to older adults in Hausa-speaking communities, especially among men who sometimes play in local clubs or social centres. A similar approach was reported in the Chinese adaptation of CHAMPS (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), where activities uncommon in their setting were replaced with more familiar ones. For item 7, there were mixed reaction, however, we decided to keep the item after making a small cultural adjustment–from “\u003cem\u003eDance (such as square, folk, line, ballroom)\u003c/em\u003e” to \u003cem\u003e“Dance (such as traditional dances)”\u003c/em\u003e based on feedback we received during cognitive debriefing. Some participants reported that they rarely danced and considered it inappropriate for older men. While others mentioned that they dance occasionally during social events like weddings. Dancing, in this context, may not be a regular form of exercise but still represents an important part of cultural and social life. Keeping this item, therefore, allows the questionnaire to capture those culturally significant movements that contribute to physical activity, even if they are done occasionally.\u003c/p\u003e \u003cp\u003eGames and sport related activities that are not commonly engaged in Hausa culture were adapted. For example, golf-related items (items 9 and 10) were replaced with culturally relevant activities such as going to the market while carrying loads. Golf is not a common activity among older adults in Nigeria, particularly in the Hausa-speaking regions. In fact, golf is often associated with affluent communities and is not a culturally relevant activity in many parts of Nigeria. This modification is consistent with other cultural adaptations of the CHAMPS questionnaires in non-Western settings (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), where golf is often replaced with more culturally appropriate leisure activities or deleted from the adapted questionnaire.\u003c/p\u003e \u003cp\u003eSwimming items 31–33 were replaced with farming-related activities in this adaptation. Limited access to swimming facilities, combined with prevailing cultural attitudes, has made swimming unsuitable activity for most Hausa-speaking older adults. However, farming, with its physical demands and cultural significance, provided a feasible alternative. This type of adaptation is not unique to our study, other studies have also reported similar adaptations, such as the replacement of swimming with standing/childcare in Chinese populations (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Also, tennis related items (items14 and 15) were adapted to fetching water from a well/tap, to reflect culturally relevant activities in Hausa-speaking communities.\u003c/p\u003e "},{"header":"Conclusion, Limitations, and Recommendations","content":"\u003cp\u003eThis is the first study to culturally adapt the CHAMPS questionnaire into Hausa language, providing a valuable tool for assessing physical activity levels among Hausa-speaking older adults. Following rigorous protocols, including forward and backward translation, expert review, and cognitive debriefing, the study identified areas requiring cultural adjustments such as items related to games, sport, and water activities, which were irrelevant to most participants, were replaced with culturally relevant activities while maintaining equivalent metabolic values. Items reflecting traditional practices and values, such as dance and self-identity expressions, were retained for their cultural resonance.\u003c/p\u003e\u003cp\u003eHowever, there are some limitations to this study. Foremost, the sample size was relatively small, and the geographic scoping was limited to specific Hausa-speaking communities, which may not represent all regional variations within the Hausa-speaking population and might limit the generalizability of our findings. Also, there was exclusive focus on translation, adaptation and evaluation of content validity without extending to a comprehensive evaluation of other psychometric properties. Consequently, reliability and additional validity evidence could not be established within this study. It is recommended that future research investigates the reliability and conducts further validity tests such as construct and criterion validity of the CHAMPS-Hausa questionnaire. The adapted instrument should also be used in subsequent studies to evaluate physical activity levels among older adults in Hausa-speaking communities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthors\u0026rsquo; Contributions:O.A conceptualized and supervised the research. F.G.M led in data collection and writing the manuscript. O.A, M.A.M and F.G.M involved in refining the research questions. M.A.M co-supervised, all authors were involved in the translation process and reviewed the manuscript.Funding:This study did not receive any specific funding from public, commercial, or not-for-profit funding agencies.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data used for analysis in this study is not publicly available but can be provide on request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWarburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: The evidence. CMAJ [Internet]. 2006 Mar 14 [cited 2025 Jul 27];174(6):801\u0026ndash;9. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/31032354/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/31032354/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao Y, Wang Q, Chung PK, Cai K. Cross-cultural modifications and measurement properties of the CHAMPS questionnaire among Chinese older adults. J Exerc Sci Fit [Internet]. 2021 Jan 1 [cited 2025 Jul 27];19(1):13\u0026ndash;8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/32904054/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/32904054/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShi X, Wang Y, Huang X, Gao S, Wan Q, Shang S. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.fmacce.gov.ng/indigenous-language\u003c/span\u003e\u003cspan address=\"https://www.fmacce.gov.ng/indigenous-language\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"CHAMPS, Physical activity, Questionnaires, Cultural adaptation, Hausa Language","lastPublishedDoi":"10.21203/rs.3.rs-8564131/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8564131/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe Community Healthy Activities Model Program for Seniors (CHAMPS) Questionnaire is a widely used and validated tool for assessing physical activity in older adults. However, this instrument was developed and validated in Western contexts, limiting its cultural relevance and applicability to diverse populations. Therefore, this study aims to translate and culturally adapt the CHAMPS questionnaire in Hausa-speaking older adults in Nigeria and evaluate its content validity. We followed Beaton\u0026rsquo;s adaptation process and COSMIN protocols which include forward translation, synthesis of forward translation, back translation, expert review, and prefinal testing. A total of 20 older adults participated in the prefinal phase by completing the CHAMPS-Hausa version to explore their comprehensibility and clarity of the CHAMPS-Hausa version. In addition, content validity was assessed through cognitive debriefing with 10 of the participants. This involves the use of semi-structured interviews to probe their interpretation of the items, response choices, and recall period. We summarized the all-related activity, moderate-vigorous intensity physical activity and walking. Through this process, 18 items were replaced with culturally acceptable and relevant activities. While we also considered if the MET values of the replaced items were equivalent to the new items according to the Compendium of Physical Activities. A structured and iterative process produced a culturally relevant CHAMPS questionnaire with acceptable content validity among older adults who speak-Hausa. Further psychometric analysis of the CHAMPS-Hausa is needed such as reliability, construct and criterion validity.\u003c/p\u003e","manuscriptTitle":"Cross-Cultural Adaptation of the Community Healthy Activities Model Program for Seniors (CHAMPS) Physical Activity Questionnaire Among Hausa Older Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 14:13:51","doi":"10.21203/rs.3.rs-8564131/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c37fbd69-b1fd-401a-a581-7c0b299da886","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-20T14:26:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 14:13:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8564131","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8564131","identity":"rs-8564131","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}