Measurement tools for sedentary behavior in the Arabic-speaking countries in MENA region: a systematic review of validated instruments from the BRIDGE project

Abstract

Background: Sedentary behavior is an independent risk factor for adverse health outcomes. Screen time represents a specific domain of sedentary behavior and is often used as a proxy. Accurate measurement of these behaviors is essential for surveillance, research, and intervention. However, the availability, characteristics, and psychometric quality of validated instruments used to assess these behaviors in Arabic-speaking countries in the Middle East and North Africa (MENA) region have not been well documented. This systematic review aimed to identify, describe, and critically appraise the instruments used to assess sedentary behavior and/or screen time in this region. Methods: This systematic review was conducted according to the PRISMA guidelines. Major electronic databases were searched to identify studies that reported the development, cross-cultural adaptation, or validation of instruments measuring sedentary behavior or screen time in Arabic-speaking MENA countries. Studies assessing at least one measurement property were eligible. Data on study characteristics, instruments, and psychometric properties were extracted. The methodological quality and measurement properties were evaluated using the COSMIN framework. Results: Ten studies conducted in five MENA countries (Jordan, United Arab Emirates, Saudi Arabia, Morocco, and Syria) were included. Most studies relied on self-reported questionnaires originally designed to assess physical activity, with sedentary behavior measured as a secondary dimension. The most frequently evaluated instruments were the International Physical Activity Questionnaire (IPAQ), Global Physical Activity Questionnaire (GPAQ), and Global School-based Student Health Survey (GSHS). Only one instrument, the Sedentary Behavior Questionnaire (SBQ), was specifically designed to measure sedentary behavior and was validated in two countries among adults and university students. Overall, the psychometric properties were often insufficient or inconsistent, particularly for criterion validity. Evidence among children and adolescents is limited and mainly focuses on screen time, showing weak agreement with objective measures. Conclusion: The measurement of sedentary behavior in Arabic-speaking MENA countries relies largely on non-specific instruments with limited psychometric evidence. There is a clear need for the development and rigorous validation of culturally adapted, sedentary behavior-specific tools across age groups to support research, surveillance, and public health policies in the region. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261283730, Identifier: CRD420261283730.