Cross-cultural adaptation and preliminary validation of the adolescent obesity environmental questionnaire (AOEQ) in LMICs: family, school, and peer contexts

Objectives Although adolescent obesity is a growing concern in low- and middle-income countries (LMICs), culturally adapted tools to assess environmental risk factors are limited. This study developed and conducted a preliminary validation of the Adolescent Obesity Environmental Questionnaire (AOEQ), with a design intended to be relevant for LMIC contexts. Methods Items were generated via literature review, adaptation of existing tools, and focus group discussions. Forward-backward translation and expert panel review ensured content validity. Five experts rated items using Content Validity Index (CVI), and face validity was evaluated with adolescents (FVI). Results The preliminary AOEQ included 40 items across three domains: family (27), school (6), and peer (7). Expert review showed high content validity (S-CVI/Ave=0.90; I-CVI 0.83–1.00). Face validity confirmed clarity and cultural appropriateness (S-FVI/Ave=0.94). Internal consistency was high (Cronbach’s α=0.813–0.948). Conclusions The AOEQ is a reliable, culturally valid tool for assessing obesogenic environments among Indonesian adolescents, with potential applicability to other adolescents in LMIC settings.