Do we have to reduce the recall period? Validity of a daily physical activity questionnaire (PAQ24) in young active adults

Measuring Active Transportation on National Health Surveys in Canada From 1994 to 2020

BACKGROUND

Active transportation (AT), described as self-powered modes of travel (eg, walking and cycling), is an important source of health-promoting physical activity. While AT behaviors have been measured on national health surveys in Canada for over 2 decades, historic prevalence has not been previously reported. We aimed to document the measures of AT on Canada's various national health surveys, examine AT over time, and interpret them within the context of evolving methods of assessment.

METHODS

We compiled and summarized the questions used to measure AT among Canadians on 4 national health surveys: National Population Health Survey (1994-1998), Canadian Community Health Survey (2000-2020), Canadian Health Measures Survey (2007-2019), and the Health Behaviour in School-aged Children Study (2010-2018). Among youth and adults (12+ y), we summarized over time: (1) the prevalence of AT participation and (2) time spent in AT (in hours per week) among those who report any AT participation. Where possible, we reported separate estimates of walking and cycling and produced an aggregate estimate of total AT. We stratified results by age group and sex.

RESULTS

Changes in AT survey questions over time and between surveys limit the interpretation and comparability of temporal trends. Nevertheless, a consistently higher proportion of females report walking, while a higher proportion of males report cycling. Irrespective of mode, males report spending more total time in AT. Participation in AT tends to decrease with age, with youth reporting the highest rates of AT and young adults often spending the most time in AT.

CONCLUSIONS

Monitoring trends in AT can help assess patterns of behavior and identify whether promotion strategies are needed or whether population interventions are effective. Our evaluation of AT over time is limited by questions surveyed; however, consistent differences in AT by age and sex are evident over time. Moving forward, ensuring consistency of AT measurement over time is essential to monitoring this important behavior.

Sub-categories of moral distress among nurses: A descriptive longitudinal study

BACKGROUND

There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard "narrow" definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown.

RESEARCH AIMS

To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument.

RESEARCH DESIGN

A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data.

PARTICIPANTS

Registered nurses from four hospitals within one large healthcare system in Midwest United States.

ETHICAL CONSIDERATIONS

IRB approval was obtained.

RESULTS

246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by "other" distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation.

CONCLUSIONS

Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed.

Differences in physical activity behaviors between university women from metropolitan, micropolitan, and rural areas

Objective: Rural and emerging adult women report low physical activity (PA) levels. This study identified differences in current self-reported PA levels and perceived resources among US university women from metropolitan, micropolitan, and rural areas. Participants: Women were ages 18-24 y, full-time students who attended in-person university classes before COVID-19. Methods: They completed an online cross-sectional survey between July-September 2020 collecting demographic, university PA (via IPAQ), and perceived PA resource data. Results: Most participants reported metropolitan area high school (70.4%) and university (92.3%) attendance. Metropolitan participants did less job-related moderate PA during university (0.0 (0.0-360.0) MET-min) than rural (160.0 (0.0-1320.0) MET-min) participants. Metropolitan and micropolitan participants identified more high school community and natural resources than rural participants. Rural participants identified more university campus and community resources than metropolitan participants. Conclusions: University women reported similar levels of PA regardless of the rurality of their high school community.

Reliability and Validity of Slovenian Versions of IPAQ-SF, GPAQ, and EHIS-PAQ for Assessing Physical Activity and Sedentarism of Adults

Health policies rely on physical activity (PA) and sedentary behavior data collected through PA questionnaires (PAQs). Validity of international PAQs varies among countries. Therefore, it is important to know the validity of the national versions of the PAQs to properly evaluate the results. We conducted a validation study of the Slovenian versions of the International PAQ Short Form (IPAQ-SF), the Global PAQ (GPAQ), and the PAQ used in the European Health Interview Survey (EHIS-PAQ) on 306 healthy adults. The most valid and reliable constructs in all tested were sedentary behavior and vigorous PA (VPA), however the criterion validity of these constructs was low (Spearman's ρ 0.38-0.45 for sedentary behavior and 0.34-0.42 for VPA). Moderate to vigorous PA (MVPA) had low validity (0.26-0.29) despite being used as a standard measure of PA behavior. Participants over-reported MVPA for 17 to 156 min and underreported the sedentary behavior for more than two hours. The test-retest study found high reliability for sedentary behavior (0.69-0.81) and low to moderate reliability for PA behavior (0.42-0.76). The Slovenian versions of the observed PAQs are a useful tool for national PA surveillance, but for qualitative assessment of individual health-related PA behavior they should be combined with accelerometer-based devices.

Validity and Reliability of IPAQ-SF and GPAQ for Assessing Sedentary Behaviour in Adults in the European Union: A Systematic Review and Meta-Analysis

Current lifestyles are marked by sedentary behaviour; thus, it is of great importance for policymaking to have valid and reliable tools to measure sedentary behaviour in order to combat it. Therefore, the aim of this review and meta-analysis is to critically review, assess, and compile the reliability, criterion validity, and construct validity of the single-item sedentary behaviour questions within national language versions of most commonly used international physical activity questionnaires for adults in the European Union: The International Physical Activity Questionnaire-Short Form and the Global Physical Activity Questionnaire. A total of 1749 records were screened, 287 full-text papers were read, and 14 studies were included in the meta-analysis. The results and quality of studies were evaluated by the Quality Assessment of Physical Activity Questionnaires checklist. Meta-analysis indicated moderate to high reliability (rw = 0.59) and concurrent validity (rw = 0.55) of national language versions of single-item sedentary behaviour questions. Criterion validity was rather low (rw = 0.23) but in concordance with previous studies. The risk of bias analysis highlighted the poor reporting of methods and results, with a total bias score of 0.42. Thus, we recommend using multi-item SB questionnaires and smart trackers for providing information on SB rather than single-item sedentary behaviour questions in physical activity questionnaires.

Development of the Digital Assessment of Precise Physical Activity (DAPPA) Tool for Older Adults

Physical activity (PA) is central to maintaining health and wellbeing as we age. Valid, reliable measurement tools are vital for understanding, and evaluating PA. There are limited options for comprehensively, accurately and affordably measuring older adults’ PA at scale at present. We aimed to develop a digital PA measurement tool specifically for adults aged 65+ using a person-based approach. We collated evidence from target users, field experts and the relevant literature to learn how older adults comprehend PA and would accept a digital tool. Findings suggest that older adults’ PA is often integrated into their daily life activities and that commonly applied terminology (e.g., moderate and vigorous) can be difficult to interpret. We also found that there is increasing familiarity with digital platforms amongst older adults, and that technological simplicity is valued. These findings informed the development of a digital tool that asks users to report their activities across key PA domains and dimensions from the previous 7-days. Users found the tool easy to navigate and comprehensive in terms of activity reporting. However, real-world usability testing revealed that users struggled with seven-day recall. Further work will address the identified issues, including creating a single-day reporting option, before commencing work to validate this new tool.

Validity and Reliability of International Physical Activity Questionnaires for Adults across EU Countries: Systematic Review and Meta Analysis

This review and meta-analysis (PROSPERO registration number: CRD42020138845) critically evaluates test-retest reliability, concurrent validity and criterion validity of different physical activity (PA) levels of three most commonly used international PA questionnaires (PAQs) in official language versions of European Union (EU): International Physical Activity Questionnaire (IPAQ-SF), Global Physical Activity Questionnaire (GPAQ), and European Health Interview Survey-Physical Activity Questionnaire (EHIS-PAQ). In total, 1749 abstracts were screened, 287 full-text articles were identified as relevant to the study objectives, and 20 studies were included. The studies' results and quality were evaluated using the Quality Assessment of Physical Activity Questionnaires checklist. Results indicate that only ten EU countries validated official language versions of selected PAQs. A meta-analysis revealed that assessment of moderate-to-vigorous PA (MVPA) is the most relevant PA level outcome, since no publication bias in any of measurement properties was detected while test-retest reliability was moderately high (r_w = 0.74), moderate for the criterion (r_w = 0.41) and moderately-high for concurrent validity (r_w = 0.72). Reporting of methods and results of the studies was poor, with an overall moderate risk of bias with a total score of 0.43. In conclusion, where only self-reporting of PA is feasible, assessment of MVPA with selected PAQs in EU adult populations is recommended.