Abstract

Citation

Benjamin SE, Neelon B, Ball SC, Bangdiwala SI, Ammerman AS, Ward DS. Reliability and validity of a nutrition and physical activity environmental self-assessment for child care. Int J Behav Nutr Phys Act 2007 Jul 5;4:29.

Abstract

BACKGROUND: Few assessment instruments have examined the nutrition and physical activity environments in child care, and none are self-administered. Given the emerging focus on child care settings as a target for intervention, a valid and reliable measure of the nutrition and physical activity environment is needed. METHODS: To measure inter-rater reliability, 59 child care center directors and 109 staff completed the self-assessment concurrently, but independently. Three weeks later, a repeat self-assessment was completed by a sub-sample of 38 directors to assess test-retest reliability. To assess criterion validity, a researcher-administered environmental assessment was conducted at 69 centers and was compared to a self-assessment completed by the director. A weighted kappa test statistic and percent agreement were calculated to assess agreement for each question on the self-assessment. RESULTS: For inter-rater reliability, kappa statistics ranged from 0.20 to 1.00 across all questions. Test-retest reliability of the self-assessment yielded kappa statistics that ranged from 0.07 to 1.00. The inter-quartile kappa statistic ranges for inter-rater and test-retest reliability were 0.45 to 0.63 and 0.27 to 0.45, respectively. When percent agreement was calculated, questions ranged from 52.6% to 100% for inter-rater reliability and 34.3% to 100% for test-retest reliability. Kappa statistics for validity ranged from -0.01 to 0.79, with an inter-quartile range of 0.08 to 0.34. Percent agreement for validity ranged from 12.9% to 93.7%. CONCLUSION: This study provides estimates of criterion validity, inter-rater reliability and test-retest reliability for an environmental nutrition and physical activity self-assessment instrument for child care. Results indicate that the self-assessment is a stable and reasonably accurate instrument for use with child care interventions. We therefore recommend the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) instrument to researchers and practitioners interested in conducting healthy weight intervention in child care. However, a more robust, less subjective measure would be more appropriate for researchers seeking an outcome measure to assess intervention impact.

Full Text

The full text is available at https://dx.doi.org/10.1186/1479-5868-4-29

At A Glance

Food Environment Variables

# Type of Environment/Institution
69Total Environments/Locations
69Child Care (Daycare, Pre-school)
Measure objective perceived
Availability/Access
Food Quality
Policy/Practice
Provision of nutrition education; Supportive healthy eating practices
Food Group/Type of Food
Fruits and vegetables
Low-fat dairy
Whole grains
Foods of minimal nutritional value
Sweetened beverages
Fried foods and high-fat meats

Physical Activity Environment Variables

# Type of Environment/Location
69Total Environments/Locations
69Child Care
# Scale
-Building
Measure objective perceived
Policy
Crime/Safety
Facility Adequacy/Appeal or Quality
Aesthetics/Beautification

Domain(s)

Food Environment

Physical Activity Environment

Measure Type

Questionnaire

Measure Availability

Measure included in article

Download measure from riskfactor.cancer.gov

Number of Items

56 Reported

Study location

NC, USA

Child care centers across North Carolina

Languages

Not applicable

Information about Development of Measure

Nothing to add

Study Design

Study Participants

Age

2 - 5 Years

Sex

Not reported

Race/Ethnicity

Hispanic

White

Black/African American

Asian

American Indian/Alaska Native

Predominantly Low-income/Low-SES

Not reported

Sample Size

69

Study Design

Design Type

Validation/Reliability

Health Outcomes Assessed

None

Obesity Measures

Not applicable

BMI Measured or Self-reported

Not applicable

Covariates

Not reported

Data Reported on Race/Ethnicity

Quantitative data for community or area

Data Reported on SES

Not applicable

SES-related Variables

Not applicable

How To Use

Administration

Who Administered

Self-administered

How Administered

Email/postal mail

Time Required

Not reported

Training Required

Not reported

Instructions on Use

Not reported

Data Analysis

Data Collection/Analysis Costs

Not available

Data Collection/Protocol

Not available

Instructions on Data Analysis

Not reported

Validity (7)

Type of validity Construct/subscale assessed Criterion measure used Test/statistic used Result
Face See paper Face validity established
Content See paper Content validity established
Construct NAP SACC National expert review Found to be accurate and comprehensive
Criterion Nutrition construct (30 of 38 questions) Environmental and Policy Assessment and Observation (EPAO) system Percent Agreement 12.9 to 93.7
Criterion Physical Activity construct (14 of 18 questions) Environmental and Policy Assessment and Observation (EPAO) system Percent Agreement 0.0 to 90.6
Criterion Nutrition construct (30 of 38 questions) Environmental and Policy Assessment and Observation (EPAO) system Kappa statistic -0.01 to 0.78
Criterion Physical Activity construct (14 of 18 questions) Environmental and Policy Assessment and Observation (EPAO) system Kappa statistic 0.00 to 0.77

Reliability (8)

Type of reliability Construct/subscale assessed Test/statistic used Result
Inter-rater Physical Activity construct Kappa statistic 0.44 to 0.85
Inter-rater Nutrition construct Kappa statistic 0.20 to 1.0
Inter-rater Nutrition construct Percent agreement 52.6 to 100.0
Inter-rater Physical Activity construct Percent agreement 52.6 to 92.1
Test-retest Physical Activity construct Percent agreement 37.1 to 87.4
Test-retest Nutrition construct Kappa statistic 0.07 to 1.00
Test-retest Physical Activity construct Kappa statistic 0.17 to 0.70
Test-retest Nutrition construct Percent agreement 34.3 to 100.0