Mani SS, Riang’a RM, Nagarajan N, Ngugi AK, Mwangi EM, Gichu M, Mwangala PN, Miguel E, Walker M, Langa KM, Ehrlich JR, Gross AL. Validation of cognitive and psychosocial tools in Kenya: findings from the LOSHAK feasibility pilot. BMC Public Health. 2025 Nov 17;25(1):4008. doi: 10.1186/s12889-025-24918-z. PMID: 41249975; PMCID: PMC12625501.

Background and objectives: Adapting cognitive tests to culturally diverse and low-resource settings is essential
for expanding knowledge of cognitive health in older adults beyond high-income countries. However, contextual
differences in novel settings can affect reliability and validity. There is limited evidence on the feasibility of
implementing culturally adapted cognitive assessments in Sub-Saharan Africa, a region projected to have over
158 million adults aged 60 and older by 2050. The Longitudinal Study of Health and Ageing in Kenya (LOSHAK) is
designed to address this measurement gap by evaluating cognitive tests in this context.

Research design and methods: We analyzed data from 205 adults aged 45 years and older from the Kaloleni/
Rabai Health and Demographic Surveillance System in Coastal Kenya. Using McDonald’s omega and confirmatory
factor analysis, we evaluated the internal consistency reliability and the factor structure of four cognitive domains
(orientation, memory, executive functioning, language/fluency) and four psychosocial constructs (depressive
symptoms, loneliness, subjective well-being, and life satisfaction).

Results: McDonald’s omegas ranged from ω=0.78 to 0.95 for cognitive domains and were above 0.83 for each
psychosocial domain, suggesting high reliability. Factor analyses revealed adequate to perfect fit for most domains,
and patterns of factor loadings were mostly acceptable.

Conclusion: The successful adaptation of these assessment tools in Kenya demonstrates the feasibility of
implementing rigorous cognitive and psychosocial measurements in low-resource settings. These findings provide a
methodological framework for future aging studies in similar contexts across Sub-Saharan Africa.

Keywords: Cognition, Dementia, Successful aging, Sub-Saharan Africa, Validation