Validation of Instruments to Assess Home Food Environment of Pre-Adolescents: A Pilot Study

Abstract

Background: Assessing the home food environment is important for elucidating the underlying causes of childhood obesity; however, few instruments have assessed the visibility of foods in the home along with their availability and accessibility. The purpose of this pilot study was to validate a Home Food Assessment tool (HFA) to evaluate the availability, visibility and accessibility of actual home foods and a 30-day Home Food Environment Survey (HFES) to assess the foods regularly present in the homes of pre-adolescents. Methods: Thirteen pairs of parents and their children aged 9 to 12 years participated in the study in 2014. The HFA was completed by the research staff and parents independently for criterion validity. Kappa statistics was used to compare parent and staff reports. Parents also completed HFES during the home visit and one week after for test-retest reliability which was analyzed using the Intra- Class Correlation Coefficient (ICC). Cronbach’s alpha was used to test the internal consistency of the instruments. Results: Of the 23 healthy and unhealthy items from HFA, moderate to outstanding agreement (0.41–1.00) between research staff and parents was observed on 21, 14, and 18 items for availability, visibility and accessibility, respectively. Two items had low agreement scores for all three categories (availability, accessibility and visibility) and therefore were either modified or removed. Agreement levels for items of fresh fruits and vegetables ranged from moderate to outstanding (0.41-1.00), with the exception of four items. Internal consistency for 12 healthy food, 11 unhealthy food, 18 fresh fruit, and 14 fresh vegetable items were 0.94, 0.91, 0.90, and 0.87, respectively. For HFES, ICCs for test-retest reliabilities were high (0.69-0.96) except for two reduced-fat items. The total scores of the available healthy (r = 0.87, P = 0.0001) or unhealthy items (r = 0.85, P = 0.0005) from the HFA were positively correlated to those from HFES. Conclusion: Our results demonstrated that HFA and HFES are participant-friendly, reliable and valid instruments to assess the home food environment of pre-adolescents. These two instruments complement each other and are useful for future research in exploring the relationship between home food environment and weight status of pre-adolescents.