Henderson Kathryn E, Grode Gabrielle M, Middleton Ann E, Kenney Erica L, Falbe Jennifer, Schwartz Marlene B
Rudd Center for Food Policy and Obesity, Yale University, New Haven, CT 06520-8369, USA.
J Am Diet Assoc. 2011 Sep;111(9):1306-13. doi: 10.1016/j.jada.2011.06.011.
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.
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.
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.
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.
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.
持牌儿童保育中心是积极影响儿童健康行为的一个契机。需要有效且易于使用的保育环境评估指标，以评估环境变化对健康的影响。
开发并验证一项用于评估儿童保育中心营养与身体活动环境的自填式调查问卷，并确定可通过自我报告充分评估的领域。
开发了一项调查问卷，以评估与营养和身体活动相关的四个领域：中心政策、与社会环境相关的做法、物理环境和营养质量。开发过程包括查阅文献、现有评估指标以及法规/标准，还与一个工作组进行了合作。该调查问卷进行了预测试，并征求了专家顾问的反馈意见。在全州范围内进行了调查，并与一份菜单评级工具、对中心主任的访谈以及为本研究开发的直接观察工具进行了验证。
参与者/场所：参与调查的场所来自康涅狄格州参与儿童和成人护理食品计划的持牌儿童保育中心，这些中心为13名或更多3至5岁儿童提供服务。纳入了146名中心主任的调查回复、62份中心菜单，以及来自33个场所的主任访谈和观察数据。主要结果/统计分析：通过与其他评估指标中的对应项目的一致率来评估该调查问卷的效标效度。为菜单和调查问卷工具计算了健康食品和不健康食品得分，并计算了皮尔逊相关性。
与效标结果的一致率在39%至97%之间，61%的项目一致率≥80%。营养和政策领域的一致性最高，身体活动和促进健康的障碍领域的一致性最低。不同评估指标的食品得分之间的相关性为中等。
自我报告调查问卷显示出足够的效标效度。我们针对提高一致性较低项目的效度以及对通过自我报告无法充分评估的领域使用劳动强度更大的评估程序提出了建议。
