BACKGROUND: Investigators from low-, middle-, and high-income countries representing 6 continents contributed to the development of the Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ). The GAC-PAQ is designed to assess physical activity (PA) across all key domains (i.e., school, chores, work/volunteering, transport, free time, outdoor time). It aimed to address multiple gaps in global PA surveillance (e.g., omission of important PA domains, insufficient cultural adaptation, underrepresentation of rural areas in questionnaire validation studies).The purpose of this study was to assess the content validity of the GAC-PAQ among PA experts, 8- to 17-year-olds, and one of their parents/guardians, and to discuss changes made to the questionnaire based on participants' feedback. METHODS: Sixty-two experts in PA measurement and/or surveillance from 24 countries completed an online survey that included both closed- and open-ended questions about the content validity of the GAC-PAQ. The proportion of experts who agreed or strongly agreed with the items was calculated. Child-parent/guardian dyads from 15 countries (n = 250; 10-40 per country) participated in a structured cognitive interview to assess the clarity of the questions and response options, and they were encouraged to provide suggestions to improve clarity and facilitate completion of the questionnaire. Participating countries are: Aotearoa New Zealand, Brazil, Canada, China, Colombia, Czech Republic, India, Malawi, Mexico, Nepal, Nigeria, Spain, Sweden, Thailand, and the United Arab Emirates. Interviews were conducted in 13 different languages and structured by PA domain. Generic images were included to help participants in answering questions about PA intensity. RESULTS: Expert agreement with the items for each domain exceeded 75%, and their qualitative feedback was used to revise the questionnaire before cognitive interviews. In general, participants found the questionnaire to be comprehensive. Adolescents (12-17 years) found it easier than children (8-11 years) to answer the questions. Several children struggled to answer questions about the duration and intensity of activities and/or concepts related to travel modes, active trips, and organized activities. Many parents/guardians were unsure about the frequency, duration, and intensity of their children's or adolescents' PA at school and/or recommended using more culturally relevant and appropriate images. Some participants misunderstood the concept of activities that "make you stronger" (intended to assess resistance activities) and/or struggled to differentiate between work, volunteering, and chores. CONCLUSION: Participants' feedback was used to develop a revised, simplified, and culturally adapted GAC-PAQ, which will be pilot-tested in all 15 countries in an App that will include country-specific images and narration in local languages. Further research is needed to assess the reliability and validity of the revised GAC-PAQ.

Active Healthy Kids Global Alliance Ottawa ON K1H 8L1 Canada

Active Healthy Kids Global Alliance Ottawa ON K1H 8L1 Canada; Healthy Active Living and Obesity Research Group CHEO Research Institute Ottawa ON K1H 8L1 Canada; Department of Pediatrics Faculty of Medicine University of Ottawa Ottawa Ontario K1H 5B2 Canada

Centre for Social Research University of Malawi Zomba 305200 Malawi

Centre for Social Research University of Malawi Zomba 305200 Malawi; Department of Psychological Sciences and Health University of Strathclyde Glasgow G1 1QE UK

College of Medicine Mohammed Bin Rashid University of Medicine and Health Sciences Dubai PO Box 505055 United Arab Emirates

Department of Medicine Karolinska Institutet NEO Group MLÖ Huddinge 141 83 Sweden

Department of Physical Activity and Healthy Lifestyles National Institute of Public Health Cuernavaca 62100 Mexico

Department of Physical Education Federal University of Santa Catarina Florianópolis 88040 900 Brazil

Department of Physiotherapy Redeemer's University Akoda 232101 Nigeria

Department of Physiotherapy Redeemer's University Akoda 232101 Nigeria; College of Health Solutions Arizona State University Phoenix AZ 85004 USA

Department of Psychological Sciences and Health University of Strathclyde Glasgow G1 1QE UK

Department of Sports and Computer Science Universidad Pablo de Olavide Sevilla 41013 Spain

Division of Medical Sciences University of Northern British Columbia Prince George BC V2N 4Z9 Canada

Faculty of Health Sciences University of Lethbridge Lethbridge AB T1K 3M4 Canada

Faculty of Health Sciences University of Lethbridge Lethbridge AB T1K 3M4 Canada; School of Education Ambrose University Calgary AB T3H 0L5 Canada

Faculty of Kinesiology Sport and Recreation University of Alberta Edmonton AB T6G 2H9 Canada

Faculty of Physical Culture Palacký University Olomouc Olomouc 779 00 Czech Republic

Health Analysis Division Statistics Canada Ottawa ON K1A 0T6 Canada

Healthy Active Living and Obesity Research Group CHEO Research Institute Ottawa ON K1H 8L1 Canada

Healthy Active Living and Obesity Research Group CHEO Research Institute Ottawa ON K1H 8L1 Canada; ParticipACTION Toronto Ontario M5R 1P6 Canada; School of Occupational Therapy University of Western Ontario London Ontario N6A 3K7 Canada

Hirabai Cowasji Jehangir Medical Research Institute Jehangir Hospital Pune 411001 India

Hirabai Cowasji Jehangir Medical Research Institute Jehangir Hospital Pune 411001 India; Interdisciplinary School of Health Sciences Savitribai Phule Pune University Pune 411007 India

Institute for Population and Social Research Mahidol University Nakhon Pathom 73170 Thailand

Nepal Development Society Kathmandu Nepal; Institute for Physical Activity and Nutrition Deakin University Burwood VIC 3125 Australia

School of Medicine Universidad de los Andes Bogotá 111711 Colombia

School of Occupational and Public Health Toronto Metropolitan University Toronto ON M5B 2K3 Canada

School of Physical Education Shanghai University of Sport Shanghai 200438 China

School of Sport Exercise and Health Sciences Loughborough University Loughborough LE11 3TU UK

Te Hau Kori Faculty of Health Victoria University of Wellington Wellington 6140 Aotearoa New Zealand

Waipapa Taumata Rau University of Auckland Auckland 1142 New Zealand

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