Development of measures for the study of environmental neighborhood and family determinants of physical activity in Hong Kong preschoolers

Abstract

Motivations: The prevalence of childhood obesity in Hong Kong has been increasing in the last couple of decades. Childhood obesity may lead to adverse health outcomes in adolescence and adulthood. Regular engagement in physical activity (PA) can reduce the risk of childhood obesity. The establishment of an active lifestyle needs to start in early childhood as PA behavior in the preschool age tracks to childhood and adulthood. To achieve this goal, modifiable determinants of Hong Kong preschoolers’ PA and sedentary behaviors need to be identified. However, measures of such determinants appropriate for Hong Kong preschoolers and their primary caregivers were lacking. Thus, this PhD project focused on the development and validation of culturally- and linguistically-appropriate measures of neighborhood environmental and family factors that may contribute to an active lifestyle in Hong Kong preschoolers.

Methods: This project was based on a socio-ecological model of Hong Kong preschoolers’ PA and sedentary behaviors. It included qualitative and quantitative studies. Fifty-six primary caregivers (mainly parents) of Hong Kong Chinese preschoolers participated in the qualitative stage, including an unstructured focus group, individual interviews, cognitive interviews and nominal group technique sessions for the purpose of the development of new scales assessing PA-related parental practices and informal social control, and the adaptation and translation (into Chinese) of seven extant questionnaires of relevant neighborhood variables. The quantitative stage of the project involved the assessment of test-retest reliability and internal consistency of all instruments (n=61); an evaluation of the factorial validity of two newly-developed scales via confirmatory factor analysis (n=394); and, the assessment of the construct validity of the instruments and proposed model of PA. The latter component of the project entailed an analysis of correlates of PA-related parental practices (n=411) and those of preschoolers’ PA and sedentary behaviors (n=164).

Results: Two preliminary instruments were developed in the qualitative stage: (1) Physical Activity Parental Practices for Preschoolers – Hong Kong (PAPPP-HK) and (2) PA-related Informal Social Control. Seven extant neighborhood-related questionnaires and two newly-developed scales were tested by cognitive interviews and minor changes were made. All nine instruments showed acceptable to excellent levels of test-retest reliability and internal consistency. The final measurement models for PAPPP-Encouragement consisted of two subscales and that for PAPPP-Discouragement had four subscales. All measurement models showed moderate to good fit to the data. The final measurement model for PA-related Informal Social Control showed acceptable fit and had three subscales.

Neighborhood environmental factors were found to be associated with parental practices discouraging PA only, while socio-demographic and family characteristics were significantly correlated with parental practices encouraging and discouraging PA. This study also found that neighborhood, parental and family characteristics contributed to the explanation of preschoolers’ PA and sedentary behaviors.

Significance: This study developed culturally- and linguistically-appropriate, reliable and valid measures of family and neighborhood determinants of Hong Kong preschoolers’ PA that can be used in future larger studies. The findings from this study suggest that preschoolers’ PA and sedentary behaviors may be changed by modifying the neighborhood environment and some of PA-related parental practices.