Researchers in Cuba developed and validated the CELF-Q, a new questionnaire measuring how lifestyle and environmental factors affect COVID-19 outcomes, achieving nearly perfect reliability with a test-retest kappa coefficient of 0.89 among 309 COVID-positive participants. According to Gram Research analysis, this validated tool enables healthcare providers to systematically assess diet, self-care, socioeconomic conditions, and living environments to better understand individual COVID-19 severity and guide personalized health interventions.
Researchers in Cuba created a new questionnaire to help doctors understand how lifestyle and environment affect COVID-19 outcomes. The tool, called CELF-Q, asks people about their habits, living conditions, diet, and self-care practices. Scientists tested it with over 300 people who had COVID-19 and found it works reliably. According to Gram Research analysis, this questionnaire could help public health officials better predict who might get sicker from COVID and design better prevention strategies for different communities.
Key Statistics
A 2026 validation study of the CELF-Q questionnaire in 309 Cuban COVID-19 patients found test-retest reliability of 0.89 (nearly perfect agreement), with Cronbach’s alpha values between 0.7-0.8 for self-care, diet, and socioeconomic dimensions.
Expert panel review of the CELF-Q by 15 specialists rated content validity as acceptable across all dimensions, with only minor revisions needed, indicating the questionnaire effectively measures lifestyle and environmental factors influencing COVID-19 outcomes.
The CELF-Q demonstrated exceptional test-retest correlation of 0.99, showing that participants gave nearly identical responses when completing the questionnaire twice, confirming high reliability for measuring lifestyle factors in Cuban populations.
The Quick Take
- What they studied: Can a new questionnaire accurately measure how lifestyle and environmental factors (like diet, exercise, living conditions, and self-care) affect COVID-19 severity in Cuban populations?
- Who participated: 309 people in Cuba who had tested positive for COVID-19, plus 60 additional participants for reliability testing, and 15 expert reviewers who evaluated the questionnaire’s quality.
- Key finding: The CELF-Q questionnaire proved highly reliable, with test-retest agreement scores of 0.89 out of 1.0 (nearly perfect consistency) and strong internal consistency across most dimensions, particularly for diet, self-care, and socioeconomic factors.
- What it means for you: This tool could help doctors and public health workers better understand which lifestyle factors matter most for COVID outcomes, potentially leading to more personalized health advice. However, it’s designed specifically for Cuban populations and may need adjustment for other communities.
The Research Details
Researchers started with an existing lifestyle questionnaire designed for Latin American populations and carefully adapted it for Cuban culture and context. They created the CELF-Q by modifying questions, having experts review them, and testing the tool with real people who had COVID-19.
The validation process happened in stages. First, 15 expert reviewers evaluated whether the questions actually measured what they were supposed to measure. Then, 60 people took the questionnaire twice to see if they gave similar answers both times (test-retest reliability). Finally, 309 COVID-positive individuals completed the full questionnaire so researchers could check if all the questions worked together consistently.
Researchers used statistical tests to confirm the questionnaire’s structure made sense and that different sections (like diet questions, self-care questions, and socioeconomic questions) hung together logically.
Creating a reliable measurement tool is foundational for public health research. Without a validated questionnaire, researchers can’t accurately collect information about lifestyle factors that influence disease. This tool specifically addresses the gap in understanding how environmental and behavioral factors shaped COVID-19 outcomes in Cuba, which has unique healthcare and social conditions.
The study demonstrates strong methodological rigor through multiple validation approaches. The high test-retest reliability (0.89 kappa coefficient) indicates people answered consistently. Cronbach’s alpha values between 0.7-0.8 for major dimensions show good internal consistency. Expert panel review (15 reviewers) and confirmatory factor analysis provide additional confidence. The main limitation is that this tool was specifically designed and validated for Cuban populations, so results may not directly apply elsewhere without further testing.
What the Results Show
The CELF-Q questionnaire successfully measured environmental and lifestyle factors affecting COVID-19 in Cuban populations. Content validity was rated as acceptable across all dimensions, meaning the questions actually measured what researchers intended. The test-retest reliability showed nearly perfect agreement (mean kappa of 0.89), indicating that when people answered the same questions again, they gave very similar responses.
Internal consistency analysis revealed that most dimensions of the questionnaire worked well together. Three dimensions performed particularly well: self-care behavior, socioeconomic restrictions, and diet and nutritional habits all achieved Cronbach’s alpha values between 0.7 and 0.8, which is considered respectable in research standards. This means questions within these sections were measuring related concepts consistently.
The confirmatory factor analysis validated the overall structure of the questionnaire, confirming that the way researchers organized the questions into different categories made statistical sense. The tool successfully captured information about how people’s daily habits, living situations, and health practices related to their COVID-19 experiences.
Expert reviewers provided qualitative feedback suggesting only minor revisions to specific questions, indicating the questionnaire was well-designed from the start. The high correlation coefficient (0.99) between test-retest measurements showed exceptional stability in responses. The questionnaire’s comprehensive nature means it captures multiple lifestyle dimensions simultaneously—diet, exercise, self-care, socioeconomic factors, and environmental conditions—rather than focusing on just one aspect.
This research builds on existing lifestyle questionnaires developed for Latin American populations but represents the first validated tool specifically adapted for Cuban contexts. Previous COVID-19 research identified lifestyle and environmental factors as important, but lacked a standardized, validated measurement tool for this specific population. The CELF-Q fills that gap by providing a culturally appropriate, scientifically validated instrument.
The questionnaire was developed and validated only in Cuban populations, so it may not work as well in other countries without additional testing and adaptation. The study focused on people who already had COVID-19, so it measures factors after infection occurred rather than predicting who will get infected. The research doesn’t prove that these lifestyle factors cause different COVID outcomes—it only measures their association. Additionally, the study doesn’t compare the CELF-Q’s predictive power against other measurement tools.
The Bottom Line
Healthcare providers and public health officials in Cuba can use the CELF-Q to systematically assess lifestyle and environmental factors in COVID-19 patients. This information could guide personalized health recommendations and identify communities needing additional support. For other countries, this questionnaire serves as a model for developing culturally adapted tools, though direct use requires validation in those populations. Confidence level: High for Cuban populations; Moderate for adaptation to other regions.
Public health officials, epidemiologists, and healthcare providers in Cuba should find this tool immediately useful. Researchers studying COVID-19 or other infectious diseases in Latin America may adapt it for their work. International health organizations developing culturally sensitive assessment tools can use this as a template. People with COVID-19 in Cuba may benefit from more personalized care based on this assessment. This tool is less relevant for individuals in countries with very different healthcare systems or cultural contexts.
The questionnaire can be administered immediately to assess current or recent COVID-19 cases. Results from using this tool should inform health recommendations within days. Long-term benefits depend on how public health systems implement findings—changes to health guidance or targeted interventions could take weeks to months to show population-level effects.
Frequently Asked Questions
What is the CELF-Q questionnaire and how does it help with COVID-19?
The CELF-Q is a validated tool that measures lifestyle and environmental factors (diet, self-care, living conditions, socioeconomic status) affecting COVID-19 outcomes. Developed for Cuban populations, it helps doctors understand which factors influence disease severity and enables personalized health recommendations based on individual circumstances.
How reliable is this new COVID-19 questionnaire?
The CELF-Q showed excellent reliability with a test-retest kappa coefficient of 0.89 (nearly perfect) and correlation of 0.99, meaning people gave nearly identical answers when completing it twice. Cronbach’s alpha values of 0.7-0.8 for major dimensions indicate strong internal consistency.
Can I use this questionnaire if I don’t live in Cuba?
The CELF-Q was specifically validated for Cuban populations and may not work as well elsewhere without adaptation and testing. Other countries would need to modify questions for their cultural context and validate the tool with their own populations before using it clinically.
What lifestyle factors does the CELF-Q measure?
The questionnaire assesses diet and nutritional habits, self-care behaviors (sleep, exercise, hygiene), socioeconomic restrictions (access to food and healthcare), and environmental conditions. These dimensions were chosen because research shows they influence COVID-19 severity and outcomes.
Does this questionnaire predict who will get severe COVID-19?
The CELF-Q measures lifestyle factors in people who already have COVID-19 but doesn’t predict future infection or severity. It helps understand which factors are associated with outcomes after infection occurs, potentially informing better care strategies.
Want to Apply This Research?
- Users could log weekly responses to key CELF-Q dimensions: daily self-care activities (hours of sleep, exercise minutes), dietary choices (servings of fruits/vegetables, water intake), and socioeconomic barriers encountered (access to healthy food, healthcare appointments missed). Track these metrics alongside COVID-19 symptom severity if applicable.
- Based on CELF-Q results, users could set specific goals: improve sleep consistency, add one additional vegetable serving daily, establish a 15-minute daily self-care routine, or identify and address one socioeconomic barrier to health. The app could provide reminders and track progress toward these personalized lifestyle improvements.
- Implement monthly CELF-Q reassessments to track how lifestyle changes correlate with health outcomes. Create a dashboard showing trends across diet, self-care, and socioeconomic dimensions. Compare personal baseline scores to population averages (for Cuban users) to identify priority improvement areas. Use historical data to predict which lifestyle factors most strongly influence individual health outcomes.
This questionnaire was developed and validated specifically for Cuban populations and may not be appropriate for use in other countries without further adaptation and validation. The CELF-Q measures associations between lifestyle factors and COVID-19 outcomes but does not establish causation. Results should be interpreted by qualified healthcare professionals in clinical contexts. This tool is designed for research and clinical assessment purposes and should not replace professional medical diagnosis or treatment. Individuals with COVID-19 should consult their healthcare provider for personalized medical advice.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.