Cultural adaptation

General concepts

The development of IPAQ placed great emphasis on developing and creating measures that have high levels of cultural equivalence so measures and results can be compared between countries. Several things to consider when adapting IPAQ to new countries/languages are:

Conceptual equivalence
Do people attach the same meanings to terms and concepts? This is critical, because the concepts of activity types and intensity of activities must be understood in similar ways. In each country the terms must be defined and explained to get across the same, or very similar, meanings.

Metric equivalence
Do the numbers mean the same thing? This is not a major consideration for most items that ask about frequency in times/week or duration in hours or minutes per session. However, the intensity levels must be consistent for activities given as examples, with moderate intensity being activities of 3-6 METs and vigorous intensity being activities of > 6 METs.

Linguistic equivalence
Do the words and grammar have similar meanings across different cultures and languages? It is much more important to translate the meaning of the survey, rather than the words. Translation procedures must establish that the original and new surveys mean the same things to different people.

Here are some suggestions to follow if you wish to adapt the IPAQ to a new country or language:

Cultural Adaptation

The IPAQ survey instruments should not be focused on a single culture or language. Instead the material should be translated and culturally adapted so there will be a smooth, natural sounding version in each language. IPAQ must have the same interpretation in all languages.

There are a wide variety of physical activities undertaken by people throughout the world. In developing countries, occupational activities and transportation may involve more activity than in more developed countries. In specific countries or regions, discretionary or leisure time physical activities may be more prevalent than occupational or transportation activities. We recommend that you identify culturally relevant activities in the introductory comments that are read to the participants about the questions (example, see 1, 3, 5, and 7). However, please retain the intent of the items in terms of choosing physical activities that represent the appropriate intensity (light, moderate, and vigorous).

Translate and back-translate

a. Make all translations from the original English version. This is when you may need to make changes in the words to get across the same meanings. Some words may need to be changed to match words with a similar concept in your country (e.g., “vigorous” may not be familiar in your country, but the term, “very hard” may be understood). For all items, make sure the underlying concept is retained in translations. When examples of physical activities are given, you may want to substitute activities that are more culturally appropriate for your country or region. In this case, make sure you check the MET intensities from the 2011 Compendium of Physical Activities (  to make sure that vigorous intensity activities are ≥ 6 METs and moderate intensity activities are 3-5.9 METs.

b. Have the instrument translated into the second language by at least two independent translators. Ask them to make the concepts understandable by people in the second culture. In countries where there are multiple dialects of the same language, it may be necessary to have translators who speak the different dialects translate the survey and agree on the best translation for use in the study.

c. Have these translations reviewed by a group of bilingual people that are similar to the intended users. Ask the group to ensure that the translation will be acceptable to monolingual people.

d. Have two different translators translate the new version back into English (back translation).

e. A group of bilingual people meets again to review the back-translation and decide on the final version. It is most important that the meanings of the two versions are comparable; the back-translation does not need to produce the exact original wording.

Pilot test

Pilot test the translated instrument with a few people from a broad range of backgrounds who may speak different dialects of the same language including low and middle education levels or social class. Interview them as they complete each item. Ask questions such as these:

a. Did you understand all the words?
b. How clear was the intent of the question? (Do you know what is being asked?)
c. Do you have any questions about it?
d. How could the wording be clearer?

At the end of the survey, ask more general questions such as these:
a. Did any of the questions make you feel uncomfortable?
b. Were there activities that we missed?

Based on pilot testing, consider if other changes to the instrument are necessary. Make only changes that do not change the meaning of the instrument.

Make note of frequently asked questions

Develop standard answers to common questions from respondents. Put your standard answers in a manual and train interviewers in how to deal with these questions. 


Geisinger KF. Cross-cultural normative assessment: Translation and adaptation issues influencing the normative interpretation of assessment instruments. Psychological Assessment 1994, 6, 304-312.

Sperber AD, Devellis RF, Boehlecke B. Cross-cultural translation: Methodology and validation. Journal of Cross-Cultural Psychology 1994, 25, 501-524.
Subpages (1): Questionnaires