INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)  
ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue XI November 2025  
Development, Validation, and Application of Beck's Anxiety  
Inventory (BAI) In the Kenyan Context  
Fain Kum Emmanuel., Dr. Jasper Isoe  
Tangaza University, Karen, Nairobi  
DOI: https://dx.doi.org/10.47772/IJRISS.2025.91100189  
Received: 21 November 2025; Accepted: 28 November 2025; Published: 04 December 2025  
ABSTRACT  
Given the central role anxiety plays in psychological practice, shaping clients’ behavior, therapeutic engagement,  
and treatment decisions, the development, validation, and application of the Beck Anxiety Inventory within the  
Kenyan context is essential to ensure accurate assessment and culturally relevant care. This paper critically  
examined the Beck Anxiety Inventory (BAI) in Kenya, highlighting limited local use and a lack of cultural  
validation. Most Kenyan studies emphasize prevalence rather than evaluating the BAI’s accuracy across diverse  
languages and cultural contexts. The tool’s Western origins raise concerns about cultural relevance and symptom  
interpretation, especially given the overlap of somatic anxiety with common physical illnesses in Kenyan  
populations. This review underscores the urgent need for thorough local validation, careful translation, and  
development of indigenous anxiety measures rooted in Kenyan culture. Enhancing psychometric rigor and  
regulatory oversight will strengthen psychological assessment and counselling practices in Kenya, ensuring they  
are both reliable and culturally sensitive. This critique assesses the BAI’s development, psychometric validation,  
and contextual application in Kenya, emphasizing methodological constraints and ethical implications. The  
paper highlights the pressing necessity for local validation, methodical translation, and the prospective creation  
of indigenous anxiety assessments rooted in Kenyan culture and language. Improving psychometric research and  
regulatory frameworks will make psychological testing in Kenya's changing counselling psychology field more  
reliable and culturally sensitive.  
Keywords: Beck Anxiety Inventory (BAI), Anxiety assessment, psychometric validation, cultural application,  
Kenya.  
INTRODUCTION  
In counselling psychology, the use of psychometrically sound tools is essential for accurate assessment, planning  
interventions, and evaluating outcomes. Psychometrics, the discipline concerned with quantifying psychological  
phenomena, enables professionals to convert constructs like anxiety into measurable, dependable, and valid  
scores. In Kenya, where mental health issues are gaining recognition in clinical and community contexts,  
evidence-based assessment is essential for ensuring that interventions are credible, culturally appropriate, and  
effective. However, assessment tools from the West may not always fit well with Kenyan culture and society. In  
this context, a comprehensive analysis of the BAI is necessary. By examining a single tool closely, professionals  
and researchers in Kenya can gain insight into its development history, its effectiveness in various cultures, and  
its practical utility in real-world applications. This helps psychologists make better choices about whether to use,  
change, or stay away from a certain tool.  
Background To Psychometrics In Counselling Psychology  
Psychometrics is the scientific field that studies the theory and methods of psychological measurement. This  
includes creating, testing, and using scales and tests that measure constructs such as anxiety, depression,  
intelligence, and personality. In counselling psychology, valid and reliable psychometric instruments are crucial  
for precise case identification, treatment planning, outcome assessment, and research endeavours (Smith & Lee,  
2022). Evidence-based assessment reduces diagnostic errors, directs suitable interventions, and facilitates  
outcome evaluation in line with best practice standards (Jones et al., 2023). As mental health needs are growing  
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in low- and middle-income countries (LMICs), including Kenya, and mental health is becoming more integrated  
into primary and community care, there is a strong need for psychometrically sound tools that work in local  
social and linguistic settings (Mwangi et al., 2022; Patel & Ochieng, 2023).  
Purpose Of Examining This Tool  
Examining a single, commonly used scale (the BAI) in depth is beneficial for Kenyan counselling psychology  
for several reasons. The BAI is frequently employed in local research and clinical screening; however, there is  
insufficient evidence to support the generalizability of its measurement properties (factor structure, cut-scores,  
item functioning) to Kenyan populations (Omondi et al., 2022). Misuse or uncritical application may lead to  
misclassification (false positives/negatives), suboptimal clinical decisions, and inequitable service delivery  
(Kimani & Patel, 2023). A comprehensive evaluation will therefore clarify for researchers, trainers, clinicians,  
and policymakers whether the BAI can be implemented in its current form, whether it necessitates modification,  
or if a culturally specific measure must be created (Mwangi et al., 2022; Wambua & Smith, 2023).  
Development Of The Scale  
Background And Initial Objective  
Aaron T. Beck and his coworkers first made the BAI and published it in 1988 as "An Inventory for Measuring  
Clinical Anxiety: Psychometric Properties" (Beck et al., 1988). The BAI was developed to provide a self-report  
measure of anxiety that could differentiate anxiety symptoms from depressive symptoms, considering the  
common comorbidity and symptom overlap between anxiety and depression in outpatient contexts. The original  
manual said that the item pool started with three measurement tools used at the Centre for Cognitive Therapy:  
The Anxiety Checklist (ACL), the Physician's Desk Reference Checklist (PDR), and the Situational Anxiety  
Checklist (SAC) (Beck et al., 1988; Beck et al., 1993). The authors chose the final 21-item form from the first  
pool of 86 candidate items. The resulting instrument predominantly focuses on somatic and autonomic  
manifestations of anxiety, including numbness or tingling, palpitations, and instability in the legs, while also  
incorporating certain cognitive-affective components (Beck et al., 1988; Very Well Mind, 2024).  
The BAI was based on a clinical-descriptive approach that is part of Beck's larger cognitive-behavioral tradition.  
The BAI is not explicitly derived from a singular overarching anxiety theory; rather, it embodies the  
acknowledgement that anxiety manifests as a constellation of physiological arousal, neuro-motor tension, and  
fearful cognitions that can be systematically quantified (Beck et al., 1988). The original target population  
consisted of adults (17 years and older) in outpatient psychiatric or psychological settings, with the intended  
construct being the severity of anxiety symptoms over the past week, reflecting a state rather than a stable trait  
of anxiety (Beck et al., 1988; Verywell Mind, 2024). Self-reporting is the standard way to do this, with each of  
the 21 items rated from 0 ("Not at all") to 3 ("Severely, I could barely stand it"). The total score ranges from 0  
to 63 (Beck et al., 1988).  
Theoretical Framework  
The BAI is based on a clinical descriptive understanding of anxiety symptoms, not on a single cognitive theory.  
The instrument's purpose is based on Aaron Beck's broader cognitive-behavioral framework. It aims to find  
symptomatic clusters that show increased physiological arousal and panic-related symptoms, which clinicians  
can then use to tell how bad someone's anxiety is. The BAI is most accurately understood as measuring prolonged  
state anxiety (symptoms experienced over the preceding week) rather than trait anxiety.  
Target Population And Measured Constructs  
Target population: Initially comprised adult clinical outpatients and the general adult demographic, including  
adolescents and adults.  
Constructs: Mainly assesses somatic and physiological manifestations of anxiety (autonomic arousal,  
respiratory symptoms, neuro-motor tension) alongside a few cognitive-affective components. Due to this  
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emphasis, numerous authors have observed that it may be especially responsive to panic symptoms and somatic  
anxiety manifestations.  
Validation Of The Scale  
Global validation  
In its initial release, the BAI exhibited substantial internal consistency (Cronbach’s α ≈ .92) and satisfactory one-  
week test–retest reliability (~.75) in outpatient cohorts (Beck et al., 1988). Convergent validity with other anxiety  
assessments and moderate discriminant validity from depression assessments were noted, although the overlap  
with depression in certain instances exceeded optimal levels (Beck et al., 1988). Subsequent research across  
various cultures has validated robust internal consistency (generally α > .80) and satisfactory usability of the  
BAI (Science Direct, 2024). Nonetheless, factor analytic research reveals significant heterogeneity: two-factor,  
three-factor, and four-factor solutions have emerged across various samples. Additionally, certain international  
studies indicate that the BAI is primarily responsive to panic-type symptoms rather than cognitive or behavioral  
manifestations of anxiety (Verywell Mind, 2024). Some critics contend that the focus on physiological symptoms  
diminishes the instrument's effectiveness for generalized anxiety disorder, social anxiety, or culturally diverse  
anxiety manifestations (Verywell Mind, 2024).  
The original BAI had a very high internal consistency (Cronbach's α = .92) and an acceptable short-term test-  
retest reliability (≈.75 for 1 week) (Beck et al., 1988). Subsequent global studies have consistently demonstrated  
robust internal consistency (α typically ranging from .80 to .90) across both clinical and non-clinical samples.  
Validity: Convergent validity with other anxiety assessments is generally moderate to high; discriminant validity  
in relation to depression assessments is variable. Initial evidence indicated a diminished correlation with  
depression measures compared to certain instruments; however, subsequent studies identified elevated  
correlations within specific populations (e.g., primary care or medically ill patients), thereby eliciting concerns  
regarding discriminant validity in particular contexts. The predictive validity for anxiety caseness differs  
depending on the sample and the diagnostic standard employed (SCID, DSM interviews).  
Factor structure: A plethora of factor analytic studies have yielded inconsistent outcomes, with two-factor,  
three-factor, four-factor, and single-factor models reported across various studies and cultures. Certain  
contemporary studies endorse a multi-factor model that delineates cognitive, autonomic, neuromotor, and panic-  
related symptom clusters; others advocate for a robust general anxiety factor accompanied by correlated sub-  
factors. These variations imply that item functionality and latent structure are contingent upon the sample and  
potentially influenced by cultural factors. Recent psychometric studies at the country level (Argentina, Malaysia,  
Brazil, and multi-country samples) demonstrate acceptable structural validity post-model fitting; however, factor  
solutions vary, and some researchers advocate for abbreviated or modified versions in particular contexts.  
Clinical cut-scores and sensitivity/specificity: The cut-scores that are commonly used (for example, 0–7  
minimal, 8–15 mild, 16–25 moderate, 26+ severe) come from original normative guidance. However, their  
sensitivity and specificity depend on the population and the diagnostic benchmark. Some recent papers suggest  
context-specific thresholds or embedded validity indices to identify over-reporting.  
Validation In African Contexts  
The BAI has been utilized in research contexts within sub-Saharan Africa and various low- and middle-income  
nations, particularly among medical outpatients, HIV-positive individuals, and in community studies. These  
studies frequently indicate satisfactory internal consistency; however, they often lack formal confirmatory factor  
analyses, stringent translation and back-translation protocols, or normative data for local populations. For  
instance, while focusing mainly on depression instruments, Abubakar et al. (2016) modified the BDI-II in Kenya,  
discovering new idioms of distress (“thinking too much,” “kuchoka moyo”) and establishing acceptable  
Validation of the Beck Anxiety Inventory (BAI) in African and LMIC contexts highlights the importance of  
rigorous adaptation and psychometric evaluation. Reliability, often measured by internal consistency (e.g.,  
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Cronbach’s alpha), has generally been found to be acceptable in studies involving low-literacy samples, but this  
underscores the need for careful adaptation of imported tools (Munyua et al., 2022).  
The scarcity of published adaptation and validation studies for the BAI in many African settings points to a  
significant gap in local psychometric evidence (Adusei et al., 2023). Recent research in South Africa and other  
countries has involved translation and cultural modification of the BAI, with studies reporting satisfactory  
internal consistency (α = 0.80–0.90), but also emphasizing the necessity for thorough linguistic and cultural  
adaptation (Nkosi & van der Westhuizen, 2022). In Ethiopia, Ghana, and Uganda, the BAI has been used in both  
clinical and research settings, such as among HIV-positive individuals and cardiovascular patients, where it  
demonstrated acceptable internal reliability (α > 0.80); however, factor analyses often revealed divergent factor  
structures compared to Western samples, indicating potential cultural differences in symptom expression  
(Adusei et al., 2023; Munyua et al., 2022). It should not be used without local validation (for example, the  
Heliyon study in Ethiopia found that the BAI was used and had acceptable reliability in clinical samples).  
Validation In Kenya  
The BAI has been utilized in empirical studies. Gacau et al. (2024) utilized the BAI in a Nairobi cohort of  
individuals living with HIV to assess anxiety prevalence and its correlates; however, they did not provide a  
specific psychometric validation, including factor structure, item functioning, or local cut-scores. So far, there  
hasn't been a peer-reviewed article that has published a full Kenyan validation of the BAI that includes forward  
and back translation into Kiswahili or other major vernacular languages, cognitive interviewing, confirmatory  
factor analysis, and criterion validity against a diagnostic interview. Consequently, Kenyan researchers and  
practitioners may utilize the BAI as a screening instrument; however, they must interpret the results with caution,  
acknowledging that locally validated thresholds and latent structures remain unidentified. There are peer-  
reviewed Kenyan studies that have used the BAI, but there aren't many published psychometric validation studies  
of the BAI in Kenyan samples.  
Peer-reviewed studies often employ the BAI for prevalence and correlates research, reporting Cronbach’s alpha  
or mean scores. However, there are no published Kenyan peer-reviewed comprehensive psychometric validation  
studies (such as confirmatory factor analysis, item response theory, differential item functioning, or culturally-  
sensitive adaptation) of the English or Kiswahili BAI as of the conducted searches. Numerous university  
dissertations and theses in Kenya have utilized the BAI. However, these are not consistently published in  
journals, serving as useful references but not as substitutes for peer-reviewed validation.  
Critique Of Application In The Kenyan Context  
The Beck’s Anxiety Inventory (BAI) presents both strengths and challenges in its application within the Kenyan  
context. One prominent advantage is its brevity and ease in administration, which make it suitable for busy  
clinical and research settings where time constraints are common. The BAI also has a strong history of  
psychometric performance internationally, thus providing a useful starting point for anxiety assessment in  
Kenya. However, several critical limitations must be addressed to ensure its effectiveness and cultural relevance.  
Firstly, cultural appropriateness. Anxiety in Kenyan populations is often expressed through idioms such as  
“thinking too much,” loss of “heart,” and spiritual concern that are not explicitly captured in the BAI emphasis  
on physical and arousal symptoms. (Abubakar et al., 2016; Dingili & Yungungu, 2023). This narrow symptom  
focus risks overlooking anxiety presentations that are more cognitive, relational, or shaped by cultural belief  
systems. Without adaptation to incorporate these cultural expressions, the BAI may underestimate or  
misinterpret anxiety symptomatology in Kenyan clients.  
Secondly, language considerations are vital. Although English is prevalent, Kenya's multilingual environment  
necessitates that numerous clients, particularly in rural or low-education areas, may need a Kiswahili or  
vernacular translation. Without published adaptation work, the equivalence of translated items, their suitability  
for various reading levels, and the literacy requirements remain unverified. This increases the likelihood of  
measurement bias or misinterpretation among low-literacy populations.  
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Thirdly, the clinical utility of standard cut-scores (0-7 minimal, 8-15 mild, 16-25 moderate, 26+ severe) was  
established in North American outpatient samples; Kenyan norms (prevalence, base rates, symptom expression)  
are likely to differ. In the Kenyan context, using these thresholds without local criterion validity could lead to  
too many or too few anxiety disorder diagnoses.  
Fourthly, accessibility issues occur in rural or medically compromised populations: somatic items in the BAI  
may intersect with symptoms of malaria, anaemia, HIV, or tuberculosis, which are common in Kenya, posing a  
risk of false positives if the tool is employed without medical evaluation or contextual analysis. Additionally,  
the self-report format necessitates literacy or interviewer facilitation and may not be readily applicable in  
contexts of extremely low literacy or remote locations without modifications.  
Finally, ethical and training challenges complicate BAI: Kenyan counsellors and health care workers who use  
the BAI need to know how to use it, understand its limitations, and be trained in its use. If used alone as a  
diagnostic tool without follow-up, there is a chance of mislabeling or not making the right referral. Additionally,  
professional organizations in Kenya should provide guidance on score interpretation, integration with clinical  
interviews, and the promotion of cultural responsiveness.  
Cultural Appropriateness  
Somatic emphasis versus distress idioms: The BAI's item set predominantly addresses somatic/autonomic  
symptoms such as palpitations, diaphoresis, and paraesthesia. In numerous Kenyan cultural contexts, distress is  
manifested somatically, which superficially indicates cultural congruence. Nonetheless, idioms of distress in  
certain Kenyan communities encompass culturally specific expressions like“thinking too much,” spirit-related  
attributions, and social-relational complaints that are not adequately represented by the BAI’s items.  
Consequently, although certain items may correspond to local somatic expressions, the BAI may overlook  
culturally specific cognitive or idiomatic manifestations of anxiety and associated syndromes. Applied research  
generally indicates that imported Western instruments may be partially suitable yet insufficient without cultural  
adaptation.  
Language Problems  
The study does not clearly indicate backtranslation even though followed culturally sensitive processes from  
concept validation to pilot testing ensuring it met the standards to enable them adapt the tool to the local context  
(Abubakar, et al., 2016). The tool gave reliable and valid results hence can be used in the Kenyan context as a  
screening tool. However, there was recommendation to recalibrate the cut off points with grounding the tool to  
take into consideration c cultural context and cultural sensitivity. Some studies in East Africa, like those in  
Uganda, talk about translation and back-translation methods, but there aren't many published studies that  
systematically check the validity of Kiswahili. The psychometric equivalence of English BAI items to Kiswahili  
expressions remains indeterminate without thorough translation and cultural adaptation. This is especially  
important for people who live in rural areas or who don't read or write well and who might prefer Kiswahili or  
other local languages.  
Clinical Usefulness And Cut-Off Scores  
Appropriate cut-scores: The original BAI cut-off scores were created using clinical samples from North America.  
The base rates, symptom expression, and response styles in Kenya are likely different. Research conducted in  
other nations has advocated for sample-specific cut-scores or conditional interpretation. Kenyan clinicians  
employing standard cut-offs may inadvertently over-identify or under-identify cases. Kenyan studies utilising  
the BAI frequently report prevalence but seldom provide locally validated cut-scores in relation to a structured  
diagnostic interview (SCID), which is essential for estimating sensitivity and specificity. So, until local criterion-  
validity studies are done in Kenya, clinical thresholds should be used with care.  
Accessibility  
Limitations of the self-report format: The BAI is a 21-item measure that requires respondents to be able to read  
and write. It can be administered by an interviewer, but this can lead to bias in the administration. In Kenyan  
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populations that live in rural areas or have low literacy rates, trained interviewers, translation into the local  
language, and careful item explanation are all needed. Furthermore, items about physical symptoms may conflate  
anxiety with prevalent medical conditions such as malaria, anaemia, and tuberculosis, thereby elevating false  
positives within medically compromised populations if not adequately regulated. Kenyan HIV studies that have  
been published have used trained clinical staff to do the interviews, which is a good practical practice, but more  
rigorous psychometric work is needed.  
Ethical Issues And Practitioner Skill  
To be ethical, practitioners who use the BAI must know what it can and can't do (it is a screening/quantification  
tool, not a diagnostic tool). Counsellors in Kenya need to learn about psychometric properties, how to interpret  
scores in a cultural context, and how to refer people to other services. If cut-scores are used as diagnostic tools  
without a clinical interview or other supporting tools, there is a chance that they will be misinterpreted.  
Confidentiality, informed consent, and culturally sensitive feedback are imperative, especially when employing  
the instrument in research or integrated health contexts. Kenyan studies that used BAI usually said that getting  
ethics approval and training staff were best practices that needed to be used more often.  
RECOMMENDATIONS  
Based on the above criticism, five main suggestions were made:  
i. Local validation studies of the BAI should be conducted, including translation and back-translation into  
Kiswahili and vernacular languages, confirmatory factor analysis or item response theory (IRT) modelling,  
examination of differential item functioning across language, gender, and rural/urban status, and the derivation  
of Kenyan-specific cut-scores based on criterion interviews.  
ii. The BAI should be modified or augmented with culturally sensitive items (e.g., idioms of distress pertinent  
to the Kenyan context) or abbreviated versions that minimise somatic overlap in medically comorbid  
populations.  
iii. Kenya's counselling psychology curricula should focus on psychometrics, which is how to choose, use,  
understand, and combine measurement tools like the BAI.  
iv. Professional regulatory bodies, like the Kenya Counselling & Psychological Association, should make rules  
for how to use screening tools, how to translate them, and how to report on them in an ethical way.  
v. It is important to create anxiety measures that are based on Kenyan culture and include input from the  
community, repeated psychometric testing, and data from Kenyan populations. In light of the aforementioned  
critique, a series of prioritized recommendations is provided for researchers, trainers, and professional  
organizations in Kenya.  
REFERENCES  
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