Measures for Children at High Risk for Obesity

Case Study 5

How to develop a new measure for your research/evaluation project? The Preschooler Physical Activity Parenting Practice (PPAPP) scale for Latino parents

Background

Latino children experience health disparities in obesity. This may be due to health disparities in physical activity, cultural beliefs about physical activity among young children, and/or unique challenges in accessing physical activity venues in their communities, to name a few. This case study describes the development of a new measure to assess the combined effects of environmental and psychosocial determinants of physical activity among Latino preschool-aged children The intent of the study is to assess physical activity parenting practices in addition to other social and environmental variables that could affect young children’s physical activity levels.

 

Considerations and challenges

Who is the target population for the measure?

The study uses a cross-sectional observational design to measure children’s physical activity and locations objectively, along with parental report of perceptions of their environment, cultural variables, and their own physical activity parenting practices. Children are too young to report on their parent’s behaviors. Therefore, the team needs to identify a self-report instrument for Latino parents of 3–5 year old children.

Do any measures on physical activity parenting practices for Latinos exist?

The study team searches for available physical activity parenting practice scales and finds that most published physical activity parenting practice scales were developed for older children and/or for children of other ethnicities. Very few physical activity parenting practice instruments are available for parents of preschool-aged children and none specifically for Latino parents. The existing instruments that were intended for parents of 3–5 year old children are not comprehensive, since parents likely interact differently with 3–5 year old children than with elementary school aged children or adolescents. For example, younger children may engage in different physical activities during play and may require more supervision and more hands-on sport skill development than older children. Therefore, adapting the comprehensive parenting practices scales for older children would be insufficient. Additionally, the Latino culture may have other important influences on how parents interact with their young children that should be captured. Lastly, no current instrument is available in English and Spanish, which was an important consideration since many Latino parents in the study region spoke Spanish as their primary language. Based on these considerations, the study team seeks to develop a new Preschooler Physical Activity Parenting Practice (PPAPP) instrument for Latino parents of preschool-aged children.

Measure Development

Stakeholder input is critical when developing new instruments to ensure the appropriate behaviors or attitudes are included to correctly measure a construct of interest. It was therefore deemed essential to obtain input from Latino parents of 3–5 year old children when developing the PPAPP instrument. Ten focus groups were conducted to identify what Latino parents do to either encourage or discourage physical activity among their preschool-aged children. Nominal group technique was selected as an efficient, yet comprehensive approach to use in this important initial step. This semi-qualitative, multi-step method allowed participants to brainstorm and nominate ideas that the group could then prioritize as more or less important. The ideas generated from this stakeholder input were then used to develop 38 parenting practices items, which were characterized as encouraging or discouraging based on the parents’ input and prior published parenting instruments. The psychometrics of the resulting scales were then assessed on data obtained from 240 Latino parents of preschoolers of the planned study. This included assessing the factor structure, test-retest reliability, and internal reliabilities of the resulting 31-item instrument, as well as the associations to objectively assess physical activity among a sub-sample of the parents’ children.

The team used the resulting instrument in the planned cross-sectional observation study to assess the combined effects of environmental and psychosocial determinants of physical activity among Latino preschool-aged children. Since then, the instrument has been used in other studies of Latino parents and their preschool-aged children and adapted for other populations. 

Lessons Learned

  • Obtaining input from the target population when developing the measure was critical. Their input generated some items that were not included in previous measures. It is unlikely those items would have been included if the measure was developed by the research team alone.
  • Mothers were the primary participants in both the formative qualitative work to inform the development of PPAPP and the planned cross-sectional observational study. In retrospect, additional efforts should have been made to include fathers as well, since they also have an important influence on young children’s physical activity.
  • The use of nominal group technique provided an efficient method for generating lists of things mothers do to encourage or discourage physical activity among their children. However, it did not allow a way to explore why parents do these things. More in-depth focus group discussions or interviews would have provided greater understanding of mother’s attitudes and motivations that could inform the development of other measures or interventions.

Related Resources

  • O’Connor TM, Cerin E, Hughes SO, Robles J, Thompson D, Baranowski T, et al. What Hispanic parents do to encourage and discourage 3-5 year old children to be active: A qualitative study using nominal group technique. Int J Behav Nutr Phys Act. 2013;10:93.doi: 10.1186/1479-5868-10-93
  • O’Connor TM, Cerin E, Hughes SO, Robles J, Thompson DI, Mendoza JA, et al. Psychometrics of the preschooler physical activity parenting practices instrument among a Latino sample. Int J Behav Nutr Phys Act. 2014;11:3.doi:10.1186/1479-5868-11-3
  • Cerin E, Baranowski T, Barnett A, Butte N, Hughes S, Lee RE, et al. Places where preschoolers are (in)active: An observational study on Latino preschoolers and their parents using objective measures. Int J Behav Nutr Phys Act. 2016;13:29.doi: 10.1186/s12966-016-0355-0
  • O’Connor TM, Cerin E, Lee RE, Parker N, Chen TA, Hughes SO, et al. Environmental and cultural correlates of physical activity parenting practices among Latino parents with preschool-aged children: Ninos Activos. BMC Public Health. 2014;14:707.doi: 10.1186/1471-2458-14-707
  • Ambler C, Eliakim A, Brasel JA, Lee WN, Burke G, Cooper DM. Fitness and the effect of exercise training on the dietary intake of healthy adolescents. Int J Obes Relat Metab Disord. 1998;22(4):354-62.doi: 10.1038/sj.ijo.0800595
  • Heerman WJ, Teeters L, Sommer EC, Burgess LE, Escarfuller J, Van Wyk C, et al. Competency-Based Approaches to Community Health: A Randomized Controlled Trial to Reduce Childhood Obesity among Latino Preschool-Aged Children. Child Obes. 2019;15(8):519-31.doi: 10.1089/chi.2019.0064
  • Gubbels JS, Sleddens EF, Raaijmakers L, Gies JM, Kremers SP. The Child-care Food and Activity Practices Questionnaire (CFAPQ): development and first validation steps. Public Health Nutr. 2016;19(11):1964-75.doi: 10.1017/S1368980015003444

 Previous