Content and statistical validation of the FNPA survey in Modern Standard Arabic (MSA) for use with Palestinian populations in the West Bank

Childhood overweight and obesity (OW/OB) are rising globally, with disproportionate impacts in lower-middle-income countries, including Palestinian populations. The Family Nutrition and Physical Activity (FNPA) survey is a validated tool for assessing family-level behaviors associated with pediatric OW/OB risk. However, no Arabic version has been statistically validated for use in Arabic-speaking populations. This study aimed to translate and validate the FNPA survey in Modern Standard Arabic (MSA) for use among Palestinian families. A sequential, multi-phase validation study was conducted from September 2024 to February 2025 across two pediatric clinics in the West Bank. The process included translation, cognitive validation (content and face validity), and statistical validation (construct validity). Content validity was assessed by eight experts using the Content Validity Index (CVI). Face validity was evaluated through cognitive interviews with 40 parents. Statistical validation involved exploratory and confirmatory factor analyses (EFA and CFA) using data from 470 parent respondents. Internal consistency was assessed using Cronbach’s alpha and item-total correlations. Content and face validity analyses supported the cultural and linguistic appropriateness of the MSA FNPA. The overall scale CVI/Average was 0.99, indicating excellent content validity. Cronbach’s alpha for the 20-item scale was 0.729, suggesting acceptable internal consistency. EFA revealed a six-factor structure, while CFA supported a five-factor model that retained all original items and demonstrated good model fit (CFI = 0.93, RMSEA = 0.034). The five latent factors included: physical activity encouragement, screen and food environment, sleep routines, parental monitoring, and family mealtime practices. The MSA FNPA survey is a valid and reliable tool for assessing family behaviors linked to pediatric OW/OB in Palestinian populations. Its use can support culturally tailored interventions, inform public health strategies, and enhance pediatric obesity prevention efforts across Arabic-speaking regions. Future research should explore its applicability in other Arabic-speaking contexts and its integration into clinical and community-based health initiatives.