Cultural adaptation and validation of the Arabic short version of the Iconographical Falls Efficacy Scale (Icon-FES): Assessing concern about falling among older adults

Background Concern about falling is a significant issue among older adults, affecting their quality of life and functional independence. Culturally adapted and validated assessment tools are essential for accurately evaluating concern about falling. This study aimed to translate, cross-culturally adapt, and validate the Arabic short version of the Iconographical Falls Efficacy Scale (Icon-FES). Methods The translation and cultural adaptation process followed established guidelines. Structural validity was assessed using exploratory factor analysis (EFA). Internal consistency reliability, test-retest reliability, convergent validity, and known-groups validity of the scale were evaluated. Results A total of 123 community-dwelling older adults (mean age 69.54 +/- 3.48 years; 53.7% male) participated. The Arabic short version of Icon-FES demonstrated strong structural validity, with EFA supporting a unidimensional structure accounting for 73.47% of the variance. It exhibited high internal consistency (Cronbach's alpha = 0.95) and excellent test-retest reliability (ICC = 0.97). Convergent validity was confirmed through significant correlations with the Arabic Falls Efficacy Scale-International (FES-I; r(s) = 0.73, p < 0.001), Single Leg Stance (SLS; r(s) = - 0.34, p < 0.001), and Five Times Sit-to-Stand Test (5TSTS; r(s) = 0.44, p < 0.001). Known-groups validity showed higher scores in females, those with lower education, and a history of falls. Conclusions The Arabic short version of Icon-FES is a reliable and valid tool for assessing concern about falling among community-dwelling older adults. It offers an innovative approach through culturally adapted visual elements that could enhance applicability, enabling accurate assessment and supporting targeted interventions among Arabic-speaking older adults.