Cross-cultural adaptation of the Athlete Diet Index, a web-based dietary assessment tool for athletes

Background The literature suggests that many athletes fail to meet health and sport-specific dietary recommendations which may negatively impact their overall health and performance. Moreover, completing a proper assessment of an athlete's diet is complex; the quality and validity of assessment tools are lacking in this population and resources to conduct these evaluations are limited. The Athlete Diet Index (ADI) is a validated dietary assessment tool that evaluates dietary intake and patterns of Australian athletes. However, the ADI does not consider Canadian nutrition recommendations or country-specific dietary patterns in language relevant to the population.Methods The cross-cultural adaptation initially began with a revision of the ADI by three experienced sport dietitians. This Canadian version was then reviewed using a modified Delphi process involving a panel of eight experienced Canadian sport dietitians. Next, the forward-backward translation method was applied to obtain the French language version. Lastly, as recommended in the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology, a pilot study with a convenience sample of Canadian athletes (n = 49) was conducted.Results The initial revision stage led to the adaptation of 67 of the 112 questions and text elements (i.e. 97 questions and 15 instructional statements) for reasons such as language (65), Canadian dietary context (35), and relevance to Canadian athletes (4). After two rounds of Delphi interspersed with a roundtable meeting, the panelists agreed to modify 56, add five, and delete four questions. The forward-backward translation process resulted in a total of 48 changes to improve terminology (32), syntax errors (9), and align with decisions of the modified Delphi panel (7). The pilot study indicated the tool was relevant/very relevant (n = 44) and easy/very easy to understand (n = 39). English and French versions were judged equivalent by a majority (80%) of the bilingual athlete participants (n = 11).Conclusion The cross-cultural adaptation of the ADI resulted in a 98-question Canadian version of the dietary assessment tool supported by evidence of face and content validity and available in the language of their choice.