The approach to the adaptation of the OPDG was tailored to meet the needs of those participating in and using the information for the study. The study design incorporated the socio-cultural context of the OPDG users into the process of adaptation and usability testing,an important feature in cross-cultural questionnaires [51].An additional strength of this study included maintaining the principles underlying the OPDG and therefore the fidelity of the culturally adapted tool [23]. Finally, the second reviewer and members of the advisory group are familiar with the women of Minwaashin Lodge, and were able to verify the study process and findings as relevant to women of Minwaashin Lodge.