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Content Validity for a Child Care Self-assessment Tool: Creating Healthy Eating Environments Scale (CHEERS)

Publication: Canadian Journal of Dietetic Practice and Research
15 January 2016


The purpose of this project was to develop and content validate both a formative and summative self-assessment scale designed to measure the nutrition and physical activity environment in community-based child care programs. The study followed a mixed-method modified Ebel procedure. An expert group with qualifications in nutrition, physical activity, and child care were recruited for content validation. The survey was subjected to expert review through digital communication followed by a face-to-face validation meeting. To establish consensus for content validity beyond the standard error of proportion (P < 0.05) the content validity index (CVI) required was ≥0.78. Of the initial 64 items, 44 scored an acceptable CVI for inclusion. The remaining items were discussed, missing concepts identified, and a final CVI employed to determine inclusion. The final tool included 62 items with 5 subscales: food served, healthy eating program planning, healthy eating environment, physical activity environment, and healthy body image environment. Content validation is an integral step in scale development that is often overlooked or poorly carried out. Initial content validity of this scale has been established and will be of value to researchers and practitioners interested in conducting healthy eating interventions in child care.


Le présent projet avait pour objectif de mettre au point une échelle d’auto-évaluation à la fois formative et sommative et d’en valider le contenu. L’échelle était conçue pour mesurer l’environnement propre à la nutrition et à l’activité physique de programmes communautaires de services de garde. L’étude a été menée selon une procédure Ebel modifiée à méthode mixte. On a fait appel à un groupe d’experts possédant des qualifications en nutrition, en activité physique et en services de garde pour procéder à la validation du contenu. L’étude a été soumise à des experts par communication numérique aux fins d’examen, puis une rencontre en personne a eu lieu pour la validation. Pour parvenir à un consensus quant à la validité du contenu au-delà de l’erreur-type de proportion (P < 0,05), l’indice de validité de contenu (IVC) devait être égal ou supérieur à 0,78. Parmi les 64 articles initiaux, 44 ont obtenu un IVC acceptable aux fins d’inclusion. On a discuté des autres articles, cerné les concepts manquants et appliqué un IVC final pour déterminer si l’article pouvait être inclus. L’outil final comprenait 62 articles et 5 sous-échelles : aliments servis, planification des programmes de saine alimentation, environnement sain pour la prise des repas, environnement pour l’activité physique et environnement favorisant une saine image corporelle. La validation du contenu est une étape faisant partie intégrante du développement d’échelles et qui est souvent négligée ou réalisée incorrectement. La validité de contenu initiale de cette échelle a été établie et sera utile pour les chercheurs et cliniciens qui souhaitent prendre des mesures pour encourager une saine alimentation dans les services de garde.

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Nicklaus S, Boggio V, Chabanet C, and Issanchou S A prospective study of food variety seeking in childhood, adolescence and early adult life Appetite 2005 44 3 289 -297
Vanderloo LM, Tucker P, Johnson AM, van Zandvoort MM, Burke SM, and Irwin JD The influence of centre-based childcare on preschoolers’ physical activity levels: a cross-sectional study Int J Environ Res Public Health 2014 11 2 1794 -1802
Sinha M. Child care in Canada. Ottawa: Statistics Canada; 2014. Report No.: Catalogue no. 89-652-X — No. 005.
Ammerman AS, Ward DS, Benjamin SE, Ball SC, Sommers JK, Molloy M, et al. An intervention to promote healthy weight: Nutrition and Physical Activity Self-assessment for Child Care (NAP SACC) theory and design Prev Chronic Dis 2007 4 3 A67
Benjamin SE, Ammerman A, Sommers J, Dodds J, Neelon B, and Ward DS Nutrition and Physical Activity Self-assessment for Child Care (NAP SACC): results from a pilot intervention J Nutr Educ 2007 39 3 142 -149
Henderson KE, Grode GM, Middleton AE, Kenney EL, Falbe J, and Schwartz MB Validity of a measure to assess the child-care nutrition and physical activity environment J Am Diet Assoc 2011 111 9 1306 -1313
Ward DS, Benjamin SE, Ammerman AS, Ball SC, Neelon BH, and Bangdiwala SI Nutrition and physical activity in child care: results from an environmental intervention Am J Prev Med 2008 35 4 352 -356
Whitaker RC, Gooze RA, Hughes CC, and Finkelstein DM A national survey of obesity prevention practices in head start Arch Pediatr Adolesc Med 2009 163 12 1144 -1150
Dodds P, Wyse R, Jones J, Wolfenden L, Lecathelinais C, Williams A, et al. Validity of a measure to assess healthy eating and physical activity policies and practices in Australian childcare services BMC Public Health 2014 14 1 572
Ajja R, Beets MW, Chandler J, Kaczynski AT, and Ward DS Physical activity and healthy eating environmental audit tools in youth care settings: a systematic review Prev Med 2015 77 80 -98
Lynn MR Determination and quantification of content validity Nurs Res 1986 35 6 382 -386
Streiner DL and Kottner J Recommendations for reporting the results of studies of instrument and scale development and testing J Adv Nurs 2014 70 9 1970 -1979
Burton LJ and Mazerolle SM Survey instrument validity part I: principles of survey instrument development and validation in athletic training education research Athl Train Educ J 2011 6 1 27
Tremblay MS, Leblanc AG, Carson V, Choquette L, Connor Gorber S, Dillman C, et al. Canadian sedentary behaviour guidelines for the early years (aged 0–4 years) Appl Physiol Nutr Metab 2012 37 2 370 -391
Bandura A Health promotion by social cognitive means Health Educ Behav 2004 31 2 143 -164
DeVellis RF. Scale development: theory and applications (Vol. 26). 3rd ed. Sage Publications; 2012.
Weng L Impact of the number of response categories and anchor labels on coefficient alpha and test-retest reliability Educ Psychol Meas 2004 64 6 956 -972
Preston CC and Colman AM Optimal number of response categories in rating scales: reliability, validity, discriminating power, and respondent preferences Acta Psychol 2000 104 1 1 -15
Grant JS and Davis LL Selection and use of content experts for instrument development Res Nurs Health 1997 20 3 269 -274
Butterwick DJ, Paskevich DM, Lagumen NG, Vallevand ALC, and Lafave MR Development of content-valid technical skill assessment instruments for athletic taping skills J Allied Health 2006 35 3 147 -155
Polit DF, Beck CT, and Owen SV Is the CVI an acceptable indicator of content validity? Appraisal and recommendations Res Nurs Health 2007 30 4 459 -467
Polit DF and Beck CT The content validity index: are you sure you know what’s being reported? Critique and recommendations Res Nurs Health 2006 29 5 489 -497
Ley P and Florio T The use of readability formulas in health care Psychol Health Med 1996 1 1 7 -28
Delgado-Rico E, Carretero-Dios H, and Ruch W Content validity evidences in test development: an applied perspective Int J Clin Health Psychol 2012 12 3 449 -460
Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires J Clin Epidemiol 2007 60 1 34 -42
Haynes SN, Richard DCS, and Kubany ES Content validity in psychological assessment: a functional approach to concepts and methods Psychol Assess 1995 7 3 238 -247
Calderon JL, Morales LS, Liu H, and Hays RD Variation in the readability of items within surveys Am J Med Qual 2006 21 1 49 -56
Streiner D, Norman G. Health measurement scales: a practical guide to their development and use. New York: Oxford University Press; 2008.
Krosnick JA and Berent MK Comparisons of party identification and policy preferences: the impact of survey question format Am J Polit Sci 1993 941 -964
White LA Ideas and the welfare state explaining child care policy development in Canada and the United States Comp Polit Stud 2002 35 6 713 -743
Rubio DM, Berg-Weger M, Tebb SS, Lee ES, and Rauch S Objectifying content validity: conducting a content validity study in social work research Soc Work Res 2003 27 2 94 -104

Information & Authors


Published In

cover image Canadian Journal of Dietetic Practice and Research
Canadian Journal of Dietetic Practice and Research
Volume 77Number 2June 2016
Pages: 89 - 92


Version of record online: 15 January 2016



Lynne Lafave PhD
Health and Physical Education, Mount Royal University, Calgary, AB
Sheila Tyminski MEd, RD
Nutrition Services, Alberta Health Services, Calgary, AB
Theresa Riege B.H.Ecol., RD
Nutrition Services, Alberta Health Services, Calgary, AB
Diane Hoy BSc, RD
Nutrition Services, Alberta Health Services, Calgary, AB
Bria Dexter MPH, RD
Nutrition Services, Alberta Health Services, Calgary, AB

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