Questionnaire regarding childhood obesity

Issue ibe totable of contents of contents receive news and publication updates for journal of obesity, enter your email address in the box mation email ons to this to cite this article. The parent and teacher questionnaires are moderately reliable tools for simultaneously assessing child intakes, environments, attitudes, and knowledge associated with healthy eating and physical activity in the home and school and may be useful for evaluation of similar programs. Introductionoverweight and obesity are a global concern in both developed and developing countries and in school age children, the prevalence continues to remain high. There is a clear need for effective prevention efforts to address the high prevalence of childhood and adult obesity [2] without which obesity will become the primary cause of preventative deaths worldwide [3]. Despite a large body of the literature pertaining to the management of childhood obesity, there are a limited but increasing number of community-wide prevention projects. To effectively target childhood obesity, existing and new programs need to be systematically evaluated to determine the efficacy of the implemented strategies and such evaluations should be of high quality in order to contribute to the evidence for addressing childhood obesity [9]. The eat well be active (ewba) community programs were implemented in south australia from 2005 to 2010, focusing on prevention of obesity through environmental change using a community development approach. To the lack of relevant tools to evaluate the impact of the intervention, a number of program-specific questionnaires were developed to assess behaviours, knowledge, attitudes, and environments relevant to the goals of the program of increasing healthy eating and activity. Aim of this paper is to report the reliability of the parent and teacher questionnaires, tools that assess the diet and physical activity environments of children in the home and school, respectively. These questionnaires can provide relevant insight into the domains which influence nutrition and physical activity behaviours in children, and may be used to evaluate obesity prevention interventions.

Parents who participated in this ewba evaluation follow-up (sept–nov 2009) were invited by letter to complete the questionnaire on a second occasion, and all teachers were asked at a staff meeting to complete the survey a second time. At school 1, the parent questionnaires were sent home by the school to all parents of students in school years five, six, and seven. An introductory letter, an information sheet, and reply-paid envelope to allow return by post accompanied the questionnaire. At school 2, the parent questionnaires were administered as part of the wider ewba evaluation, as reported in [11]. Two weeks later at both schools, teachers completed the questionnaire again at a staff meeting, and parents who completed the first questionnaire were mailed the second questionnaire with a reply-paid envelope. Reminder letters were sent two weeks later by the school to parents who had not returned the second questionnaire. Development of questionnairesthe parent and teacher questionnaires were part of a suite of questionnaires developed for evaluation of the ewba community programs. The questionnaires were developed by the program evaluation committee which included academics with expertise in childhood obesity, nutrition, physical activity, and community development. The items included in the program-specific questionnaires were specifically selected to evaluate each of the program’s relevant objectives. Thus, these questionnaires were likely to be more sensitive to the programs’ goals and objectives than any existing questionnaires which were more general and did not include the breadth of the programs’ parent questionnaire contains 25 questions requiring 67 responses covering the following domains: demographics; obesogenicity of the home environment; parental knowledge and attitudes towards healthy eating and physical activity; child physical activity and healthy eating behaviours.

The teacher questionnaire consists of 15 questions requiring 44 responses covering teaching practices around healthy eating and physical activity inclusion in the school curriculum; training/experience in healthy eating and physical activity; teacher knowledge and attitudes towards healthy eating and physical activity (table 2). Scoring the questionnairesto produce more meaningful and reliable results, some responses are condensed into “scores” by summing items which represent a specific domain. Thus, there are 14 outcomes (seven scores and seven single items) from the parent questionnaire and 12 outcomes (six scores and six single items) from the teacher questionnaire. Internal consistency of the teacher and parent scores (outcomes with multiple items; parent questionnaire seven scores; teacher questionnaire 6 scores) at time 1 was assessed using cronbach’s alpha. Parent questionnaire test-retest reliabilitysixty parents (school 1: 22, school 2: 38) completed the questionnaire on two occasions one to two weeks apart. It is not possible to calculate response rates for parents at both schools as questionnaires were posted to parents by the school and exact numbers posted are unknown. Table 3 shows the outcomes for each questionnaire and the icc (95% confidence interval) for each score. For the scores from the parent questionnaire, with three of seven scores having alpha values greater than 0. Table 4 shows the outcomes for each completion of the questionnaire and the icc (95% confidence interval) for each score. For the scores from the teacher questionnaire, with four of six scores having alpha values greater than 0.

Discussionthe purpose of this study was to determine the reliability of the parent and teacher questionnaires developed to evaluate the ewba community programs, two questionnaires that assess the healthy eating and physical activity environments of children. The parent questionnaire assesses child dietary intakes, parent knowledge of health-related recommendations, and attitudes about healthy behaviours. The teacher questionnaire assesses the degree to which teachers incorporate healthy eating and activity facets in their daily teaching regime and their skills, attitudes, and knowledge around healthy eating and physical activity. These different messages are a potential source of confusion which may mean that respondents are “guessing” the correct option and this in turn would be a source of retest internal consistency of the scores in the parent and teacher questionnaires was poor to moderate. Only one score from the parent questionnaire (non-core food) and three from the teacher questionnaire were in line with this recommendation; however, the value is affected by the number of items in the scale, and it is common to find low cronbach’s alpha values with scales with less than ten items [24]. Four scores from the parent questionnaire had between five and ten items and three scores had less than five items. In the teacher questionnaire, four scores had between five and nine items and two scores had less than five items. This could explain the lower than ideal cronbach’s alpha values for some of the parent questionnaires were identified in the literature that had similar ranges (or slightly better) of internal consistency and test-retest reliability observed in this study. The children’s dietary questionnaire, measuring parent report of child eating patterns, had four subscales with cronbach’s alpha for fruit and vegetable and noncore food subscales ranging from 0. The “meals in our household” questionnaire measured parent report of six domains, including family meal structure and mealtime behaviours.

Similarly, a questionnaire measuring constructs believed to predict fruit and vegetable consumption (in children, completed by parents) had pearson correlation ranging from 0. Strength of this study is the report on two questionnaires with multiple scores/indexes that simultaneously measure diet and physical activity environments of children. Additionally, these tools are unique because they focus on behaviours, environments and attitudes, all of which have been demonstrated as factors contributing to the obesity epidemic [5]. Hence these two tools have the potential to be used in the evaluation of obesity prevention programs and consequently contribute to the evidence about obesity prevention. The low sample size has implications for interpreting the results of the study, in particular those for the teacher questionnaire, because a larger sample size results in a smaller confidence interval which means we can be more certain that the true reliability coefficient is close to that which has been calculated [29]. Despite the recommendation of 100 as the sample size for a test-retest reliability study [29], the sample size for similar studies varies considerably in the literature and the sample size for the parent questionnaire falls within this range. Forty-four parents were used to assess reliability of the “meals in our household” questionnaire [27] and 38 childcare directors completed the “nutrition and physical activity self-assessment for child care” in a test-retest reliability study [30]. A possibility for future research is to test the internal validity of the parent and teacher questionnaires and to retest the reliability of the teacher questionnaire with a larger sample size. Conclusionsthe parent and teacher questionnaires for the ewba community programs are a moderately reliable method for assessing child intakes, environments, attitudes, and knowledge associated with healthy eating and physical activity. These questionnaires assess relevant information and the scores present this information in a meaningful manner, suggesting that they may be useful in similar settings to evaluate similar obesity prevention ct of intereststhe authors declare that they have no conflict of ledgmentsthe eat well be active community programs were funded by the government of south australia, sa health, and implemented by southern primary health, of southern adelaide health service, and murray mallee community health, of country health sa.

Jim dollman, fiona verity, and jeremy moller contributed to the development of the questionnaires, and mel haynes undertook preliminary analysis and wrote a first draft. Magarey contributed to the development of the questionnaires, created the parent and teacher scores, undertook further data analysis, and contributed to the first draft and revisions of the paper. Blanck, “population-level intervention strategies and examples for obesity prevention in children,” annual review nutrition, vol. Raza, “dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity,” preventive medicine, vol. Evidence-based recommendations for the development of obesity prevention programs targeted at preschool children,” obesity reviews, vol. Waters, “obesity prevention programs demand high-quality evaluations,” australian and new zealand journal of public health, vol. Mastersson, “reliability and relative validity of a child nutrition questionnaire to simultaneously assess dietary patterns associated with positive energy balance and food behaviours, attitudes, knowledge and environments associated with healthy eating,” international journal of behavioral nutrition and physical activity, vol. Mastersson, “the challenges of quantitative evaluation of a multi-setting, multi-strategy community-based childhood obesity prevention programme: lessons learnt from the eat well be active community programs in south australia,” public health nutrition, vol. Mastersson, “changes in primary school children's behaviour, knowledge, attitudes, and environments related to nutrition and physical activity,” isrn obesity, vol. Dollman, “improving weight status in childhood: results from the eat well be active community programs,” international journal of public health, 2013.

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