168338 20260204153543.0 doi 10.1186/s12889-025-25925-w sideral 147853 ART-2025-147853 eng Antón-Solanas, Isabel Universidad de Zaragoza (orcid)0000-0002-8206-4803 Development and content validation of a questionnaire of activities in health promotion for primary and secondary education: PromoACTIVA-CE 2025 Background This study aimed to develop, refine, and assess content validity of the PromoACTIVA-CE questionnaire, designed to assess health promotion activities in primary and secondary education. The tool addresses the need for a culturally and contextually relevant instrument to systematically evaluate and support health promotion initiatives in schools. Methods Questionnaire development followed a five-phase process that included the following phases: (1) conceptualization; (2) item generation, structure and format; (3) content validation; (4) comprehensibility and semantic fit testing; and (5) pilot testing Results The PromoACTIVA-CE questionnaire was successfully developed and validated, resulting in a reliable tool with 37 items classified into eight health promotion action areas. Minor floor effects were observed, but no ceiling effects were detected. Conclusions The PromoACTIVA-CE questionnaire is a valid and reliable tool for assessing health promotion activities in primary and secondary schools. Its development leveraged existing evidence-based practices while ensuring cultural and contextual relevance. The tool facilitates systematic assessment and operationalization of health promotion activities, contributing to the sustainability and effectiveness of health promotion initiatives in educational settings. Future research should explore the questionnaire’s sensitivity to changes over time and its applicability in diverse school contexts. Access copy available to the general public Unrestricted info:eu-repo/grantAgreement/ES/ISCIII/PI21-01449 info:eu-repo/semantics/openAccess by-nc-nd https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Callén-Galindo, Marta Urcola-Pardo, Fernando Universidad de Zaragoza (orcid)0000-0001-7049-8295 López-Dicastillo, Olga Mujika, Agurtzane Hernantes, Naia Benito-Ruiz, Eva Universidad de Zaragoza (orcid)0000-0001-6170-072X Zabaleta-del-Olmo, Edurne Juvinyá-Canal, Dolors Pumar-Méndez, María Jesús 1006 255 Universidad de Zaragoza Dpto. Fisiatría y Enfermería Área Enfermería 26, 324 (2025), 19 BMC Public Health BMC PUBLIC HEALTH 1471-2458 2045477 http://zaguan.unizar.es/record/168338/files/texto_completo.pdf Versión publicada 1852363 http://zaguan.unizar.es/record/168338/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:168338 articulos driver 2026-02-04-13:14:04 ARTICLE