Assessment of Barriers to Physical Activity Practice: Spanish Cross-Cultural Adaptation,Reliability and Validity of the Barriers to Being Active Quiz

Abstract

The general population struggles to meet physical activity recommendations, risking mental and physical health. Validated, culturally adapted tools are essential for identifying barriers and implementing effective, context-specific strategies to promote exercise participation. Despite its wide use, the cross-cultural equivalence, and psychometric properties of the Barriers to Being Active Quiz (BBAQ) have not been confirmed. The purpose of this study was to validate the BBAQ cross-culturally into European Spanish (BBAQ-ES). Following international guidelines, the BBAQ underwent a systematic four-step process involving a multidisciplinary translation, synthesis, reconciliation, review, and a population-based comprehensibility test. Measurement properties—including structural and construct validity, and internal consistency, measurement error and test-retest reliability—were assessed following COSMIN guidelines on a sample of 589 Spanish University students. The IPAQ-SF was used as comparator instrument during hypothesis testing for construct validity (i.e. convergent, and discriminative validity). The BBAQ-ES demonstrates strong cross-cultural equivalence and good measurement properties (RMSEA = 0.0485, CFI = 0.946; Cronbach’s alpha = 0.875; ICC = 0.724 –0.878; confirmed hypotheses testing >75%). The BBAQ-ES is a cross-culturally adapted, reliable and valid measure to assess multidimensional obstacles to physical activity. This study provides valuable new insights for international research and clinical practice.

Keywords

physical inactivity cross-cultural adaptation barriers to being active psychometric properties

Introduction

Physical activity—defined as any skeletal muscle movement that raises energy expenditure (Thivel et al., 2018) —provides significant physical, mental, and social health benefits. It helps prevent cardiovascular, metabolic, and cancerous diseases while reducing depression and anxiety (World Health Organization, 2024). Despite these lifelong benefits (Kokkinos, 2012), about one-third of the global population remains insufficiently active (Denche-Zamorano et al., 2022). Due to the health risks this poses by increasing the risk of morbidity and mortality (World Health Organization, 2024), it is essential for the scientific community to explore the reasons and challenges that limit people’s ability to engage in physical activity.

In Spain, most people fail to meet physical activity recommendations, with women particularly affected (Denche-Zamorano et al., 2022; Marín-Jiménez et al., 2020). Rising sedentarism, especially among women, worsens this trend (Montero-Torreiro et al., 2024). Common barriers to exercise include lack of time, fatigue, low motivation, financial and health issues, and limited facilities (Delahanty et al., 2019; Farah et al., 2021; Pedersen et al., 2021; Rech et al., 2018). These factors vary by sex, ethnicity, socioeconomic status, and disability (Moreno-Llamas et al., 2023; Pedersen et al., 2021; Reyes-Molina et al., 2023; Zapata-López & Betancourt-Peña, 2024). Broadly, such barriers reflect individuals’ perceptions of what limits their participation in physical activity (Rech et al., 2018).

Identifying barriers to exercise is crucial, as it helps prevent physical inactivity (Dias et al., 2015) or the abandonment of sports practice (López-Castedo et al., 2020). In this way, it becomes possible to develop person-centered enhancement strategies, as well as foster motivation toward physical activity (Delahanty et al., 2019; Rech et al., 2018; Reyes-Molina et al., 2023).

In general, barriers to exercise are usually identified through questionnaires. Various tools exist to explore these obstacles, such as the Determinants of Physical Activity Questionnaire (Taylor et al., 2013), the Perceived Barriers Questionnaire (PBQ) (O'Neill & Reid, 1991), the Kinesiophobia Causes Scale (KCS) (Knapik et al., 2011), the Exercise Benefits/Barriers Scale (EBBS) (Sechrist et al., 1987), the Barriers to Being Active Quiz (BBAQ) (U.S. Department of Health and Human Services, 1999), or the Self-Report of Barriers to Physical Exercise (ABPEF) (Niñerola et al., 2006).

However, only the ABPEF has been adapted and validated for the Spanish population (Domínguez-Alonso et al., 2018), focusing mainly on motivational factors rather than the physical and social barriers to physical activity. In contrast, the BBAQ offers a simpler research tool with strong potential to enhance understanding of factors underlying inactivity. It also enables the examination of psychological, social, and contextual variables linked to physical inactivity, providing valuable insights for professionals and researchers across disciplines.

Most existing exercise barrier questionnaires have notable limitations: they are often lengthy (Sechrist et al., 1987), mix barriers with benefits or motivational factors (Niñerola et al., 2006; Sechrist et al., 1987; Taylor et al., 2013), focus on specific age groups (Niñerola et al., 2006), or were not designed specifically to assess barriers (Knapik et al., 2011). In contrast, the BBAQ is a concise, multidimensional tool focused solely on barriers (U.S. Department of Health and Human Services, 1999). Its 21 items across seven domains minimize participant burden while effectively capturing physical, psychological, and social obstacles. Demonstrating strong results among adolescents (Sampaio et al., 2024) and young adults (Rubio-Henao et al., 2015), the BBAQ shows versatility and broad applicability. These features make the BBAQ a particularly relevant instrument to validate in Spanish, as it addresses current limitations by offering a concise, specific, and adaptable tool for the assessment of barriers to physical activity.

However, despite its wide use across different health conditions—including arthritis (Hutton et al., 2010), elderly populations (Sawchuk et al., 2011), older adults undergoing rehabilitation (Zalewski et al., 2014), patients with type 2 diabetes (Alghafri et al., 2017; Call et al., 2020; Chang et al., 2018; Martin et al., 2019; Taylor et al., 2023), individuals recovering from hip fracture (Rasmussen et al., 2018), and women with depressive symptoms (Figueroa et al., 2024)—and cultural contexts (Alghafri et al., 2017; Alrimali, 2023; Bhatnagar et al., 2021; Chang et al., 2018; Martin et al., 2019; Rasmussen et al., 2018; Richards & Woodcox, 2021; Sawchuk et al., 2011; Taylor et al., 2023), the psychometric properties of the BBAQ have only been partially confirmed in the Colombian (Rubio-Henao et al., 2015) and Brazilian (Sampaio et al., 2024) population. This can pose a significant bias in the application and clinical translation of research.

Ensuring cross-cultural equivalence and psychometric validity is essential for questionnaires assessing constructs shaped by sociocultural factors. Simple translation often overlooks cultural nuances vital for accurate evaluation (Beaton et al., 2000). Moreover, no expert panel has yet verified the tool’s internal validity, and its convergent validity remains untested. Existing psychometric evidence—limited to Colombian university students (Rubio-Henao et al., 2015) and Brazilian adolescents (Sampaio et al., 2024) —is inconsistent. Notably, the seven-factor structure proposed by the U.S. Department of Health and Human Services (1999) was either unsupported (Sampaio et al., 2024) or not examined (Sampaio et al., 2024). Assessing psychometric properties like convergent validity is particularly challenging without a gold-standard measure, often requiring a proxy approach (Kolbaşı et al., 2024).

Given the widespread use of the BBAQ, a thorough evaluation of its cross-cultural equivalence and psychometric properties in Spanish-speaking populations is urgently needed. The aim of this study was to cross-culturally adapt the BBAQ into the European Spanish context and to assess its reliability and validity in the Spanish population.

Material and Methods

Measures

Barriers to Being Active Quiz Questionnaire (BBAQ)

The BBAQ is a brief questionnaire that assesses the perceived barriers preventing individuals from being more active. It contains 21 questions that explore seven potential barriers: lack of time, social influences, lack of energy, lack of willpower, fear of injury, lack of skill, and lack of resources (Ramírez-Vélez et al., 2015; Rosselli et al., 2020; Rubio-Henao et al., 2015; Sampaio et al., 2024; U.S. Department of Health and Human Services, 1999).

The items are rated on a scale from 0 to 3 points (0 = very unlikely, 1 = somewhat unlikely, 2 = somewhat likely, 3 = very likely). Thus, scores for each of the seven barriers range from 0 to 9 points, with a score of ≥5 considered a significant barrier (Rosselli et al., 2020).

The BBAQ has shown preliminary good internal consistency, with Cronbach’s alpha values of 0.83 in the Colombian validation (Rubio-Henao et al., 2015) and 0.86 in the Brazilian Portuguese adaptation for adolescents (Sampaio et al., 2024), as well as moderate-to-large test-retest reliability (intraclass correlation coefficients [ICC] = 0.46–0.87) (Ramírez-Vélez et al., 2015; Rubio-Henao et al., 2015).

International Physical Activity Questionnaire-Short Form

The Spanish version of the International Physical Activity Questionnaire-Short Form (IPAQ-SF) was used to examine the convergent and discriminative validity of the BBAQ in Spanish population (Grupo CTS 545, Universidad de Granada, Junta de Andalucía, 2005). The IPAQ-SF is a self-administered measure that assesses physical activity during the last week. This measure yields three outcomes of physical activity calculated based on the metabolic equivalents (MET-min) (i.e., low physical activity [≤600 MET], moderate physical activity [3000 – 600 MET], and high physical activity [≥3000 MET]). The IPAQ-SF shows good reliability and validity in Spanish population (Mantilla-Toloza & Gómez-Conesa, 2007).

Ethical Considerations

This study was approved by the Research Ethics Committee of the Faculty of Education and Sport Sciences at the University of Vigo.

Cross-Cultural Adaptation

The process of cross-cultural adaptation and validation of the BBAQ to European Spanish followed international guidelines (Figure A1, Supplemental Online Material) (Beaton et al., 2000; Epstein et al., 2015; Koller et al., 2012).

Step1: Two Independent Translations into European Spanish

In order to linguistically and culturally adapt the BBAQ (U.S. Department of Health and Human Services, 1999) while maintaining the original meaning of the scale, two independent translations into European Spanish were carried out. One was done by a professional translator unfamiliar with the scale (translator 1 = T1), and the other one proposed by a health practitioner and researcher with a C1 level in English who was familiar with the scale (translator 2 = T2). The translators were asked to rate the difficulty of translating each questionnaire item on a scale from 0 to 10 (low difficulty, 0–3; moderate difficulty, 4–6; high difficulty, 7–10).

Step 2: Reconciliation of the Direct Translations

To ensure better adaptation, a consensus synthesis was made between the translators and the author of the study (expert 1 = E1), where each of the translations was independently compared and discussed to produce a single translation that better captured the grammatical, conceptual and experiential nuances of the original source. This reconciliation followed the recommendations of the Translation and Cultural Adaptation Special Interest Group of the International Society for Quality of Life Research (IOQOL), using systematized processes in which each item was decided based on conceptually, experientially, and linguistic equivalent aspects (Koller et al., 2012).

Step 3: Review and Harmonization by the Expert Committee

Following international guidelines (Beaton et al., 2000; Epstein et al., 2015; Koller et al., 2012), the expert panel included the two initial translators, the principal researcher, an occupational therapist with experience in cross-cultural adaptation (E2), and a physical education specialist in physical activity, disability, and health (E3). The committee reviewed the translation for quality and clarity and classified each item’s equivalence as A (conceptually, experientially, and linguistically equivalent), B (conceptually and experientially equivalent with grammatical changes), or C (not equivalent). Items rated as C by any member were subsequently reviewed by the principal researcher and both translators.

Step 4: Piloting – Cognitive Evaluation Interviews

The revised questionnaire was tested on three convenience samples of 5 people each (N = 15), with a similar gender distribution, ages ranging from 23 to 82 years, from northern and central regions of the peninsula, and with different backgrounds in physical activity practice. Participants were recruited using a convenient sampling at University of Vigo. Cognitive interviews were conducted using techniques such as read-aloud, paraphrasing, exemplification, and practical case questioning. After this phase, the Spanish version of the BBAQ (BBAQ-ES) was obtained (Table A1).

Measurement Properties Validation

The final phase involved assessing the measurement properties of the BBAQ-ES among Spanish university students. This included analyses of internal consistency, test–retest reliability, measurement error, and construct validity (i.e., structural, convergent, and discriminative/known-groups validity). To ensure a systematic and replicable evaluation, the study followed COSMIN guidelines for taxonomy and definitions of measurement properties (Mokkink et al., 2024).

Students from undergraduate, master’s, and doctoral programs at public universities in the Galician University System completed an online survey containing the information sheet, informed consent, a sociodemographic questionnaire, and the BBAQ-ES. Two weeks later, the questionnaire was re-administered to University of Vigo students to assess test–retest reliability and measurement error. Of 104 students who completed the retest, 77 were included in the analyses—those who answered consistently to the control question, “Would you like to be more physically active?” across both assessments. This ensured a stable subgroup, as COSMIN recommends calculating intra-class correlation coefficient (ICC), standard error measurement (SEM), and smallest detectable change (SDC) in participants whose construct remains stable over time. Participants who changed their responses between the two assessments were excluded from these analyses, as their variability might reflect real change rather than measurement error. Data collection took place between January and March 2023.

Sample Size Calculation

Sample size requirements were calculated on the basis of confirmatory factor analyses (CFA) indicators (i.e., factor loadings and variability in the number of indicators and factors) (Wolf et al., 2013). Therefore, for the psychometric examination of the BBAQ in the most conservative scenario (factor loadings of 0.50), a minimum sample size of n ≥ 420 was required to perform a CFA achieving minimum bias (α ≤ 0.05) and a statistical power of β ≥ 0.8. In addition, for the purposes of test-retest reliability, a minimum sample of 45 students was needed to assess an expected ICC ≥0.468–0.876 (Rubio-Henao et al., 2015), achieving minimum bias (α ≤ 0.01) and great statistical power (β ≥ 0.9). Both sample sizes comply with the COSMIN risk of bias recommendations (Mokkink et al., 2024).

Statistical Analysis

The original BBAQ structure was examined using a CFA following a maximum likelihood estimation. The following indices and criteria were used to determine an adequate fit: a X²/degrees of freedom ratio values ≤5, which is used instead of X² p-value because of its sensitivity to sample size; a Root Mean Square Error of Approximation (RMSEA) values ≤0.06; a Comparative Fit Index (CFI) values ≥0.95; and a Tucker-Lewis Index (TLI) values ≥0.95 (Mokkink et al., 2024). Internal consistency of the BBAQ-ES was evaluated using Cronbach’s alpha, with a value greater than 0.70 being considered an indicator of good internal consistency (Mokkink et al., 2024). Several ICC were calculated to examine total and each subscale test-retest reliability, with values above 0.7 being considered indicators of sufficient reliability (Mokkink et al., 2024). Similarly, SEM and SDC were calculated for the total and each BBAQ-ES subscale scores to test measurement error. Both test-retest reliability and measurement error were examined in those participants who reported a consistent desire to be more physically active at both measurements (see above).

As recommended by COSMIN guidelines (Mokkink et al., 2024), several strategies were performed to further assess construct validity via hypotheses testing. The relationship between total MET-min according to the IPAQ-SF and the BBAQ-ES total score was examined using Pearson correlation coefficients to assess convergent validity, hypothesizing a significant and moderate correlation between these two moderately related constructs (r ≥ 0.300).

In addition, discriminative or known-groups validity was evaluated by comparing the BBAQ-ES total score between (1) those students categorized as being low, moderate, and high physically active according to the IPAQ-SF, and (2) those students who expressed a desire to increase their PA levels and those who did not, based on their responses to the control question (i.e., ‘Would you like to be more physically active than you are now?’ [Yes/No]. The predefined hypotheses were that the low physically active group and those students who desired to be more physically active, would score significantly higher on BBAQ-ES than those who were highly physically active and those who did not desire to be more physically active, showing medium to large effect sizes (Cohen’s d ≥ 0.5).

Results

Cross-Cultural Adaptation

The translators found that the items in the BBAQ questionnaire had a low to moderate translation difficulty (T1 = 1.667, SD = 1.853; T2 = 1.762, SD = 0.889). Only one translator encountered high difficulty in translating item 18. However, high to moderate difficulty was found in translating the instructions (initial and final), the question label, and the response options (Table 1).

Table 1

Subjective Translation Difficulty, Equivalences and Internal Consistency of BBAQ-ES

	Subjective difficulty of translation	Equivalence	Cronbach´s alpha if item is deleted
	T1	T2	T1	T2	E1	E2	E3	N = 589
Title and subtitle	1	3	A	A	A	A	A	-
Initial instructions	7	7	A	A	A	A	A	-
Question label	6	7	B	B	B	B	B	-
Response options	0	6	A	A	A	A	A	-
Item 1	2	1	B	B	B	B	A	0.870
Item 2	4	2	B	A	B	A	B	0.870
Item 3	0	2	B	B	B	B	B	0.865
Item 4	3	1	A	A	A	A	A	0.866
Item 5	0	1	A	A	A	A	B	0.876
Item 6	1	2	A	A	A	A	A	0.868
Item 7	1	3	B	B	B	B	A	0.873
Item 8	1	2	B	B	B	B	A	0.869
Item 9	4	2	B	A	B	B	A	0.868
Item 10	4	1	A	A	B	A	B	0.868
Item 11	0	1	A	A	A	A	B	0.866
Item 12	1	1	A	A	A	A	B	0.878
Item 13	2	1	A	A	A	A	A	0.873
Item 14	0	1	B	B	B	B	B	0.868
Item 15	2	4	B	B	A	A	A	0.867
Item 16	0	1	A	A	A	A	A	0.870
Item 17	2	1	B	B	B	B	B	0.864
Item 18	7	3	B	B	B	B	A	0.865
Item 19	0	2	A	A	A	A	B	0.873
Item 20	1	2	A	A	A	A	A	0.867
Item 21	0	3	B	B	B	B	B	0.877
Final instructions	4	3	B	B	B	B	B	-

Note. A = conceptually, experientially, and semantically equivalent (including the replacement of colloquialisms with culturally appropriate expressions in the target language); B = conceptually and experientially equivalent, although semantic modifications were introduced (e.g., adding examples, modifying examples, changing sentence wording, etc.); C = cannot be deemed equivalent.

As shown in Table A2 (Supplemental Online Material) provides examples that illustrate the reconciliation and harmonization process of the scale, using the approach proposed by the ISOQOL Translation and Cultural Adaptation Special Interest Group (Koller et al., 2012). Conceptual and experiential equivalence was maintained for all items, and none were classified as C (not considered equivalent). After the pilot test, conducted with 15 adults aged between 23 and 82, modifications were made to both the items and instructions to ensure greater clarity and comprehension.

The synthesis of the items underwent changes to make the reading sound more natural in Spanish (for example: item 15 “I have little free time each day to exercise” instead of “the moments I have free”/“my free times”), to add complementary elements (for example: item 19 “I am afraid of getting injured or that it could affect my health (dizziness, hypoglycaemia, heart attack, etc.)” instead of “I am afraid of getting injured or having a heart attack”), or to adapt them to the Spanish context (for example: item 7 “designated areas for running” instead of “running trails”) (Table 2).

Table 2

Factor Loadings of the BBAQ-ES (n = 589)

	Indicator	Standard Estimate	SE	Z	p
Lack of time	Item 1	0.767	0.0350	20.70	<0.001
	Item 8	0.620	0.0390	15.52	<0.001
	Item 15	0.883	0.0351	24.77	<0.001
Influence from others	Item 2	0.486	0.0383	10.77	<0.001
	Item 9	0.647	0.0486	15.28	<0.001
	Item 16	0.533	0.0431	12.36	<0.001
Lack of energy	Item 3	0.801	0.0352	21.81	<0.001
	Item 10	0.640	0.0410	16.22	<0.001
	Item 17	0.801	0.0372	21.80	<0.001
Lack of willpower	Item 4	0.774	0.0397	20.91	<0.001
	Item 11	0.749	0.0375	19.85	<0.001
	Item 18	0.844	0.0385	23.47	<0.001
Fear of injury	Item 5	0.434	0.0198	8.79	<0.001
	Item 12	0.499	0.0395	10.36	<0.001
	Item 19	0.772	0.0415	14.33	<0.001
Lack of skill	Item 6	0.847	0.0331	23.44	<0.001
	Item 13	0.453	0.0307	10.87	<0.001
	Item 20	0.889	0.0320	24.90	<0.001
Lack of resources	Item 7	0.501	0.0376	10.59	<0.001
	Item 14	0.723	0.0485	14.83	<0.001
	Item 21	0.425	0.0517	8.98	<0.001

Notes. SE = standard error.

Psychometric Properties

A total sample of 589 University students was included in the psychometric validation (M_age = 22.4, SD = 5.6; women = 62.8%). Socio-demographic and academic-related data of the sample are depicted in Table A3 (Supplemental Online Material). The original proposed 7-factor model revealed a good fit (X²/df = 2.387; RMSEA = 0.0485 [CI 90% 0.424-0.0547], CFI = 0.95; TLI = 0.93). The factor loadings and covariances are shown in Tables 2 and 3. All indicators significantly loaded to each factor, and all factor-factor correlations were significant.

Table 3

Factor Covariances of the BBAQ-ES (n = 589)

		Standard Estimate	SE	Z	p
Lack of time	Influence from others	0.465	0.0522	8.92	<0.001
	Lack of energy	0.779	0.0270	28.86	<0.001
	Lack of willpower	0.444	0.0413	10.74	<0.001
	Fear of injury	0.168	0.0538	3.12	0.002
	Fear of skill	0.240	0.0458	5.25	<0.001
	Lack of resourcees	0.406	0.0518	7.83	<0.001
Influence from others	Lack of energy	0.655	0.0456	14.36	<0.001
	Lack of willpower	0.784	0.0391	20.04	<0.001
	Fear of injury	0.314	0.0625	5.02	<0.001
	Fear of skill	0.719	0.0409	17.58	<0.001
	Lack of resourcees	0.715	0.0544	13.13	<0.001
Lack of energy	Lack of willpower	0.612	0.0357	17.15	<0.001
	Fear of injury	0.325	0.0523	6.21	<0.001
	Fear of skill	0.380	0.0434	8.75	<0.001
	Lack of resourcees	0.474	0.0505	9.38	<0.001
Lack of willpower	Fear of injury	0.218	0.0534	4.08	<0.001
	Fear of skill	0.547	0.0368	14.88	<0.001
	Lack of resourcees	0.459	0.0495	9.27	<0.001
Fear of injury	Fear of skill	0.449	0.0472	9.52	<0.001
Fear of injury	Lack of resourcees	0.500	0.0591	8.46	<0.001
Lack of skill	Lack of resourcees	0.474	0.0492	9.64	<0.001

Note. SE = standard error.

Overall, the internal consistency of the BBAQ-ES was excellent (Cronbach’s alpha = 0.875). The overall internal consistency would only increase marginally if items 12 and 21 were removed (Table 1), so it was decided to retain them. The test-retest reliability examination yielded good values for all seven subscales (ICC = 0.724 – 0.878) and overall BBAQ-ES (ICC = 0.865). Reliability and measurement error indices (i.e., SEM and SDC) are displayed in Table A4 (Supplemental Online Material).

Low physical activity students as classified by IPAQ-SF and those who expressed a desire to be more physically active scored significantly higher in BBAQ-ES total score than physically active students and those who did not pursue to be more physically active, respectively, confirming the discriminative validity of the BBAQ-ES (low physical activity [n = 55]: M_BBAQ-ES = 29.9 [SD = 8.9], moderate physical activity [n = 254]: M_BBAQ-ES = 24.5 [SD = 9.8], heavy physical activity [239]: M_BBAQ-ES = 17.9 [SD = 9.5], p < 0.001, f = 1.324; would like to be more physically active [482]: M_BBAQ-ES = 25.0 [SD = 9.6], would not like to be more physically active [108]: M_BBAQ-ES = 12.8 [SD = 8.8], p < 0.001, d = 1.325).

A moderate-to-large and significant correlation between total MET-min assessed by IPAQ-SF and the BBAQ-ES total score was found (r = 0.472, p < 0.001), confirming the predefined hypothesis for convergent validity. More information regarding the influence of age and sex on these hypotheses is provided in Table A5 (Supplemental Online Material).

Discussion

Physical inactivity is a major public health issue (World Health Organization, 2024), making it crucial to identify barriers to physical activity. The lack of validated tools for the Spanish population has limited this assessment. Consequently, this study aimed to cross-culturally adapt and validate the BBAQ for Spain. Results show that the European Spanish version (BBAQ-ES) is clear, conceptually equivalent to the original, and demonstrates strong psychometric properties, including internal consistency, test–retest reliability, convergent validity, and a confirmed seven-factor structure. These findings support the BBAQ-ES as a reliable and valid tool for assessing barriers to physical activity in young Spanish adults.

Cross-Cultural Adaptation

The cross-cultural adaptation involved several semantic and conceptual changes, primarily during translation and reconciliation. While overall translation difficulty was low to moderate, the non-professional translator experienced more challenges than the professional, a common finding when familiar translators strive to preserve the original meaning (Delgado-Lobete et al., 2020, 2021). This highlights the importance of using at least two independent translators with different profiles, followed by a synthesis process, to ensure both conceptual and experiential equivalence (Epstein et al., 2015; Koller et al., 2012).

The three experts agreed that the preliminary version expressed the original meaning of the items more naturally in Spanish and better reflected sociocultural influences. This finding underscores the importance of reconciliation and synthesis in the cross-cultural adaptation process (Beaton et al., 2000; Epstein et al., 2015; Sousa & Rojjanasrirat, 2011). Additionally, all items were considered at least experientially and conceptually equivalent by the expert committee, consistent with the findings of the Brazilian Portuguese adaptation, in which no item was classified as non-equivalent (Sampaio et al., 2024).

The cross-cultural equivalence of the BBAQ to Spanish was finally tested on a sample of university students, which only led to minor changes in Spanish (for example: item 15 “I have little free time each day to exercise” instead of “the moments I have free”/”my free times”) and the inclusion of complementary elements (for example: item 19 “I am afraid of getting injured or that it could affect my health [dizziness, hypoglycemia, heart attack, etc.]” instead of “I am afraid of getting injured or having a heart attack”) for a better adaptation. Overall, the BBAQ-ES was determined to be easy to understand, retains good cross-cultural equivalence with the original version, and its examples are culturally significant to the daily experience of the Spanish population. Notably, while the Brazilian Portuguese version also examined this process through a systematic cross-cultural adaptation (Sampaio et al., 2024), the Colombian version was based on a simple non-systematized translation (Rubio-Henao et al., 2015).

International guidelines recommend cross-cultural adaptation before using a tool in a population with a different language or culture than the original (Beaton et al., 2000; Epstein et al., 2015). This ensures semantic accuracy and proper interpretation, while incorporating culturally relevant activities and examples (Delgado-Lobete et al., 2021). For the BBAQ-ES, terms like “designated areas for running, swimming pools, bike lanes” replaced “running trails, swimming pools, bike paths,” and “I’m getting older” replaced “I’m becoming older” for semantic precision. The absence of significant discrepancies or interpretation difficulties among the participants of the piloting step, regardless of their location (i.e., northern or central Spain), further supports the cultural representation and comprehensibility of the BBAQ-ES among Spanish regions.

Reliability

The Cronbach’s alpha and ICC values in the Spanish population were similar to those reported by Rubio-Henao et al. (2015) in the validation study for Latin Spanish population (Cronbach´s alpha = 0.812 – 0.844; ICC = 0.46 – 0.87) and by Sampaio et al. (2024) in the Brazilian Portuguese adaptation (Cronbach´s alpha = 0.86), further supporting the cross-cultural reliability of the BBAQ across different cultural contexts. Compared to other questionnaires assessing barriers in adult populations, the Cronbach’s alpha and ICC values are similar or slightly higher than those previously reported, such as in the Perceived Benefits and Barriers Scale for Strenuous Physical Activity (Cronbach’s alpha = 0.59–0.88; ICC = −0.01–0.89) (Brown et al., 2006), the ABPEF (Cronbach’s alpha = 0.85; ICC = 0.51) (Niñerola et al., 2006), and the barriers subscale of the EBBS (Cronbach’s alpha = 0.886; ICC = 0.772) (Sechrist et al., 1987).

This study is also the first to report the BBAQ’s measurement error. Although the minimal important change was not established, SEM and SDC values were provided, offering practical insights. Clinically, only changes exceeding an individual’s SDC can be interpreted as real shifts in perceived barriers rather than random measurement error. Additionally, by providing the group SDC, researchers can also apply these values to examine changes in group assessments over time.

Validity

A key contribution of this study is the comprehensive examination of the construct validity of the BBAQ, which had not been previously established. However, criterion validity could not be evaluated, as no cross-culturally validated gold-standard instruments exist to measure barriers to physical activity in the Spanish population.

The only instrument adapted for young Spanish adults—the ABPEF (Niñerola et al., 2006)—focuses primarily on motivational and psychological aspects, with a narrower scope that does not specifically address physical, social, or contextual factors. Consequently, convergent and known-groups (discriminative) validity were tested using the IPAQ-SF as a comparator instrument. Although the IPAQ-SF does not assess the same construct as the BBAQ-ES, the two are conceptually related. Specifically, higher perceived barriers to physical activity would be expected to correspond with lower levels of reported physical activity. Indeed, total MET-min and the BBAQ-ES total score demonstrated significant but moderate-to-strong correlations, supporting convergent validity. Moreover, the BBAQ-ES total score demonstrated excellent capacity to discriminate between physically and inactive young adults, providing enough evidence for good discriminative validity.

This approach has also been applied in previous validation studies of exercise barrier questionnaires, in which physical activity measures were considered moderately related constructs (Connolly et al., 2023; Dai et al., 2024; Demirdel et al., 2018; Schembre et al., 2015). In contrast, the use of other constructs, such as the Short Form-12 Health Survey, has shown lower correlations in the Turkish validation of the Self-Perceived Barriers for Physical Activity Questionnaire (Kolbaşı et al., 2024).

It is important to note that perfect correlations or agreements between different assessment tools are rare, even when these instruments aim to measure similar constructs, due to variations in focus, item formulation, and response scales (Montes-Montes et al., 2020). Thus, these findings make a significant contribution to international research and the clinical application of the BBAQ as a reliable instrument for investigating psychosocial and environmental barriers to physical activity engagement and enhancement.

Regarding the structural validity, the original proposed 7-factor structure confirmed in this study showed superior fit indices when directly compared with the 4-factor structure proposed for Colombian adults (Rubio-Henao et al., 2015). Further studies are required to examine whether variations in age, cultural elements, or other factors account for the differing results regarding the factor structure of the BBAQ across diverse populations. For instance, performing factor analyses of the BBAQ-ES structure among young adults from different national regions (e.g., southern Spain) would further inform the structure stability of this instrument among Spanish population.

To our knowledge, this is the first study assessing the cross-cultural equivalence of the BBAQ in a new population. Replication in other populations is needed to confirm whether its strong psychometric properties hold across cultures. The findings support using the BBAQ in young Spanish adults to identify barriers to physical activity and to explore links between inactivity and limiting factors.

Limitations, Strengths, and Future Lines of Research

This study has several limitations. First, as previously argued, the absence of a gold-standard instrument prevented us from examining criterion validity. Second, Spain’s diverse dialects and regional experiences mean that, although the adaptation was conducted in standard Spanish (Castilian), both the expert panel and pilot participants were only from northern and central regions, and all reliability and validity participants were university students from a specific area. Third, the use of self-administered online questionnaires, common in cross-cultural validations (Delgado-Lobete et al., 2021; Kirby et al., 2010; Meachon et al., 2022), may introduce selection and recall bias. Finally, responsiveness was not assessed, as no questionnaire was administered to evaluate the presence or absence of changes in participants’ general condition over time; therefore, we could not estimate the minimal important change and the ability of the BBAQ-ES to detect change remains to be established. Future studies may be of interest to evaluate the capacity of this instrument in populations from all regions of Spain, which should include an explicit anchor of perceived change in barriers to physical activity to enable a more comprehensive evaluation of responsiveness and interpretability.

Nevertheless, this study also has several strengths. First, the reliability and validity assessments were on a relatively large sample. Second, as previously mentioned, both the translators and the expert committee members were professionals from different disciplines, with experience in adaptation processes and coming from various regions. Additionally, the systematic process undertaken to ensure cross-cultural adaptation facilitates the replication and discussion of the study, which usually remains uncovered in this type of research, especially regarding the reconciliation step. Finally, this study provides Spanish researchers, policy makers and health practitioners with a reliable, valid and freely available tool that can be used to inform universal and selective, local-tailored interventions aimed at promoting physical activity engagement and enhancement.

Overall, the results of this study indicate that the BBAQ-ES is an equivalent instrument across various sociocultural contexts and presents good psychometric values in the Spanish population. These findings support the use of the BBAQ-ES to promote research on the barriers to physical activity practice and develop strategies aimed at reducing inactivity.

Conclusions

The European Spanish version of the BBAQ has proven to be transculturally equivalent to the original tool. Additionally, it has been shown to be a valid and reliable measure of barriers to physical activity among Spanish young adults, that can be used to better understand the difficulties faced by this population impacting their physical health.

The findings of this study underscore the importance of following a systematic process when adapting and validating an assessment measure to new social and cultural contexts.

Supplemental Material

Supplemental Material - Assessment of Barriers to Physical Activity Practice: Spanish Cross-Cultural Adaptation, Reliability and Validity of the Barriers to Being Active Quiz

Supplemental Material for Assessment of Barriers to Physical Activity Practice: Spanish Cross-Cultural Adaptation, Reliability and Validity of the Barriers to Being Active Quiz by Nerea Blanco-Martínez, Rebeca Montes-Montes, Carlos Ayán-Pérez, Alicia Beatriz Berlier-Cea and Laura Delgado-Lobete in Evaluation & the Health Professions

Footnotes

ORCID iD

Nerea Blanco-Martínez

Consent to Participate

Informed consent was obtained from all subjects involved in the study.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a predoctoral fellowship (FPU) from the Spanish Ministry of Science, Innovation and Universities (Grant number: FPU23/00151).

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author, Nerea Blanco-Martínez (n.blanco@uvigo.gal). The data are not publicly available as they contain information that could compromise the privacy of the research participants.

Supplemental Material

Supplemental material for this article is available online.

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