Validity of a Measure to Assess the Child-Care Nutrition and Physical Activity Environment

Abstract

Background Licensed child-care centers represent an opportunity to positively influence children's health behaviors. Valid and easy-to-use measures of the child-care environment are needed to assess the influence of environmental change on health. Objective To develop and validate a self-administered survey to assess the nutrition and physical activity environment of child-care centers, and to identify domains that may be evaluated adequately through self-report. Design A survey was developed to assess four areas related to nutrition and physical activity: center policies, practices related to the social environment, physical environment, and nutrition quality. Development involved review of the literature, existing measures, and regulations/standards as well as collaboration with a working group. The survey was pilot tested and feedback was sought from expert consultants. It was administered statewide and validated against a menu rating tool, interviews with a center director, and a direct observation tool that was developed for this study. Participants/setting Participating sites were drawn from Child and Adult Care Food Program-participating licensed Connecticut child-care centers serving 13 or more children aged 3 to 5 years. Survey responses from 146 center directors were included, as were 62 center menus, and director interviews and observational data from 33 sites. Primary outcomes/statistical analyses Criterion validity of the survey was assessed through percent agreement with mirroring items in the additional measures. Healthy and unhealthy food scores were calculated for menu and survey tools, and Pearson correlations were computed. Results Percent agreement with criterion outcomes ranged from 39% to 97%, with 61% of items achieving agreement ≥80%. Agreement was highest for nutrition and policy domains, and lowest for physical activity and barriers to promoting health. Correlations between food scores across measures were moderate. Conclusions The self-report survey demonstrated adequate criterion validity. We make recommendations for improving validity of low-agreement items and for the use of more labor-intensive evaluation procedures for domains not adequately assessed through self-report.