Abstract
BackgroundThe contribution of the environment to the obesity epidemic is well recognized. Parents have control over their home environment and can, therefore, support healthy dietary and activity habits in their children by manipulating factors such as access to energy-dense foods, availability of physical activity equipment, and restricting screen time. This paper describes the development of the Healthy Home Survey and its reliability and validity. The Healthy Home Survey was designed to assess characteristics of the home environment that are hypothesized to influence healthy weight behaviors in children including diet and physical activity.MethodsWe recruited 85 families with at least one child between 3–8 years. The Healthy Home Survey was administered to parents via telephone and repeated in a random sample of 45 families after 7 days. In-home observations were performed within 14 days of the first Healthy Home Survey interview. Percent agreement, Kappa statistics, Intra-class correlation coefficients and sensitivity analyses were used to evaluate reliability and validity evidence.ResultsReliability and validity estimates for the Healthy Home Survey were varied, but generally high (0.22–1.00 and 0.07–0.96 respectively), with lower scores noted for perishable foods and policy items. Lower scores were likely related to actual change in the perishable foods present and the subjective nature or clarity of policy questions and response categories.ConclusionInitial testing demonstrated that the Healthy Home Survey is a feasible, reliable, and valid assessment of the home environment; however, it has also highlighted areas that need improvement. The Healthy Home Survey will be useful in future research exploring the relationship between the home environment and child weight.
Highlights
The contribution of the environment to the obesity epidemic is well recognized
The purpose of this paper is to describe the development of the Healthy Home Survey (HHS), as well as the reliability and validity testing of this instrument
Survey development Development of the Healthy Home Survey began with a review of the literature for confirmed or hypothesized associations between physical and social characteristics of the home environment and healthy weight in children
Summary
The contribution of the environment to the obesity epidemic is well recognized. Parents have control over their home environment and can, support healthy dietary and activity habits in their children by manipulating factors such as access to energy-dense foods, availability of physical activity equipment, and restricting screen time. In the US, the most recent data suggest that 34% of children are overweight (>85th percentile) and 17% are obese (>95th percentile)[2] Given these alarming trends, increased attention has been focused on understanding the etiology of obesity and possible management strategies, the contribution of the environment [1,3,4,5]. The current environment has been described as "toxic" or "obesogenic'" due to the presence of an almost unlimited, convenient supply of highly palatable, energy dense foods, coupled with conditions that encourage sedentary behaviors and discourage physical activity [1,4,6]. Most environmental research to date has focused on the impact of macro-level environments such as neighborhoods and communities on healthy weight behaviors. Such research has launched a wave of 'active living' initiatives that promote building, neighborhood and road network designs that encourage communities to become more active [7,8,9]
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