Autor de correspondencia. Correo electrónico: josema_delaroca@yahoo.com.mx
To validate the questionnaire “Stage of Change in Behavior of Scholars in Eating Habits and Physical Activity" (CEHAF). It is based on the Transtheoretical Model, and it intends to be a useful tool for developing strategies against childhood obesity. It measures knowledge, attitudes, and habits towards nutrition and physical activity. Observational, cross-sectional, randomized, and multi-center study in a sample of 1671 Mexican school-age children, from 8 to 12 years old, both genders. The CEHAF questionnaire is self-administered and consists of 35 questions, including 18 multiple choices, on habits and attitudes towards alimentation and physical activity. Reliability analysis through Cronbach’s alpha resulted in an alpha coefficient of 0.845. The exploratory factor analysis revealed three theoretically-congruent factors. The final version of the CEHAF questionnaire was conformed of 14 items. The psychometric characteristics of the CEHAF questionnaire indicate that it is a valid and reliable tool for assessing the stage of change in school-age population.
Validar el cuestionario “Etapa de cambio del comportamiento de escolares en hábitos alimentarios y actividad física” (CEHAF), el cual está basado en el modelo transteórico, y pretende ser una herramienta útil para desarrollar estrategias para combatir la obesidad infantil. Dicha herramienta mide conocimientos, actitudes y hábitos sobre nutrición y actividad física. Estudio observacional, transversal y aleatorizado en una muestra de 1671 estudiantes mexicanos, de 8 a 12 años de edad, ambos sexos. El cuestionario CEHAF es auto-administrado y se conforma por 35 preguntas, incluyendo 18 de opción multiple, sobre hábitos de alimentación y actividad física. Resultados: El análisis de confiabilidad mediante alfa de Cronbach resultó en un coeficiente alfa de 0.845. El análisis factorial exploratorio reveló tres factores teóricamente congruentes. La versión final del cuestionario CEHAF estuvo compuesta de 14 items. Las características psicométricas del cuestionario CEHAF lo vuelven una herramienta válida y confiable para evaluar la etapa de cambio en estudiantes de escuela primaria.
Obesity is a chronic disease characterized by an abnormal and excessive accumulation of body fat (
About 70-80% of children and adolescents diagnosed with obesity will become obese adults (
Nowadays, children have become more sedentary by spending more hours watching television, playing video games, or surfing on the internet, and less hours participating in physical activities such as walking or sports (
Schools are the key places for receiving education about healthy lifestyles, this due the presence of qualified personnel and because of the long time that children spend at school (
This could be translated as a poor adherence to nutrition and PA recommendations, which implies changing cognitive, emotional, and behavioral habits (
It is necessary to develop comprehensive strategies with measurable impact that address knowledge, attitudes, and habits towards nutrition and PA (Escalante-Guerrero et al., 2012). For these purposes, the trans-theoretical model of health behavior change (TTM) can result helpful, since it evaluates the readiness to change a behavior (Greene et al., 1999). The TTM involves a progression process through a series of five temporal stages that compose the behavior change (
Questionnaires and scales about the stage of change of an individual can be useful to assess the attitudinal factors and the willingness to change the lifestyle (
Therefore, the aim of this study was to validate a TTM-based, culturally-relevant (
The study was approved by the University of Guanajuato Psychology Department ethics committee.
The “Stage of Change in Behavior of
Scholars in Eating habits and Physical Activity” (CEHAF) is a self-administered
questionnaire. It consists of 35 questions, including 18 multiple choices, on
habits and attitudes towards alimentation and PA. For the purposes of this
project, breakfast contents and food eaten as snacks were considered the main
habits to change, since breakfast is the meal skipped more often (
This was an observational, cross sectional
study. The participants were 1671 school-age children from several primary
schools across Mexico (49.2% male, 50.8% female). They were studying from 4th
through 6th grade. The ages of the participants were between 8 and 12 years
old, since evidence shows that children at these ages have acquired greater
autonomy to internalize knowledge and change attitudes towards food and PA
(
For the scale validation, the Reyes Lagunes
and García y Barragán methodological and statistical proposal (
For the items associated with eating
habits, a frequency analysis was implemented with the purpose of verifying the
correct data collection and also to corroborate that all response options
resulted appealing for the participants. A new variable was created with the
sums of the scores of every item, and the values for percentiles 25 and 75 were
obtained. With these values, a new dichotomous variable was created and
utilized as grouping variable for executing t-tests for independent samples in
order to verify that the items discriminated between high and low scores. An
internal consistency analysis using Cronbach’s alpha was implemented to
determine the scale’s reliability. Three items were deleted for showing low
item-total correlations. This changed the alpha coefficient from 0.671 to
0.845, with 15 items remaining (
CTIC = Corrected
Total-Item Correlation. SMC = Squared multiple correlation. CAID = Cronbach’s Alpha if Item Deleted.
Following this, an exploratory factor
analysis with oblique rotation was executed to test construct validity. Three
factors were obtained, which together explained 52.498% of the variance. Since
items 9 and 10 had very low factor loadings, these were omitted from the final
structure (
F = Factor.
Extraction Method: Principal Component Analysis. Rotation Method: Oblimin with Kaiser Normalization. The rotation converged
in 6 iterations.
A
bivariate Pearson’s correlation analysis was implemented between the three
factors. A moderate association was found, highlighting, with a correlation
value of 0.549, the relation between the factors 1 and 3 (
Pearson’s
correlation analysis. Correlation is significant at a significance level of 0.01.
SD = Standard
Deviation. a = Cronbach’s Alpha.
In the present study, the psychometric properties of questionnaire “Stage of Change in Behavior of Scholars in Eating Habits and Physical Activity” were investigated and validated. An alpha coefficient of 0.845 was obtained for the whole scale, which indicates a high internal consistency. Concerning the analysis of the resulting factor structure, theoretical congruence was found between the factors and the items that conformed them. The first factor relates to the attempts at eliminating or reducing fat and sugars in the daily diet. The second factor consisted of three items associated to physical activity, opposed to the sedentary lifestyle caused by spending time in front of electronic media. Finally, the third factor gathers items which relate to healthy habits (both physical activation and alimentation).
Since the mean scores of factors 1 and 2 were below the theoretical mean, this could indicate that there is only an intention to improve on these health habits, but no actual actions to change them yet. Factor 3 had a mean higher than the theoretical, which could mean that the participants have less than six months performing these behaviors associated with healthy habits. The alpha coefficient of factor two points out that it does not have a sufficient reliability to use it as an individual scale, however, it can still be used as part of the whole scale.
In conclusion, the psychometric properties of the CEHAF questionnaire indicate that it is a valid and reliable instrument for assessing the stage of change in school-age children. It can be utilized in school interventions to dissuade sedentary lifestyle and inadequate nutrition habits, or maintaining the current conditions if these are found appropriate. This instrument proved to comprehensively cover the fundamental aspects that involve the issue of childhood obesity: Diet, PA, and habits regarding the willingness to change (
The authors would like to thank the study participants, their parents who gave their informed consent, as well as the Secretaries of Health who provide facilities for the development of the research.
Research article.