Communicating and Assessing Physical Activity: Outcomes From Cognitive Interviews With Low-Income Adults

Validity and Reliability Assessment of a Food and Physical Activity Questionnaire for Adolescents From Low-Income Communities

OBJECTIVE

Develop and validate an evaluation questionnaire for sixth-12th grade Expanded Food and Nutrition Education Program (EFNEP) participants.

DESIGN

Five-step process: domain concept prioritization, question generation, question pretesting, reliability testing, and criterion validity testing.

SETTING

Community sites in 4 states and New Jersey EFNEP secondary program data.

PARTICIPANTS

Nineteen sixth-12th graders were interviewed; secondary data included 164 ninth-12th graders.

VARIABLES MEASURED

Content, face, and criterion validity; internal reliability.

ANALYSIS

Iterative template analysis to gauge conceptual understanding; exploratory factor analysis with orthogonal Varimax rotation, interitem correlations, and Cronbach α; Spearman correlations and Bland-Altman plots against the Physical Activity Questionnaire for Adolescents and Youth Risk Behavior Survey questions.

RESULTS

Fourteen questions with acceptable face validity were developed. One item (handwashing) had a ceiling effect and was removed. Eleven of the remaining 13 items were loaded onto 4 factors. The remaining 2 items were kept because of conceptual relevance. The questionnaire demonstrated acceptable reliability and validity overall, but subscale Cronbach α values ranged from 0.53-0.75.

CONCLUSIONS AND IMPLICATIONS

This 13-item questionnaire was presented to national EFNEP program leaders and was implemented by EFNEP in October 2023. Further research could establish temporal reliability and gold standard criterion validity estimates with a multistate sample of sixth through 12th graders.

A Proposed Cost-Benefit Analysis of Adult EFNEP Utilizing Biomarkers of Chronic Disease Risk

OBJECTIVE

To assess whether the adult Expanded Food and Nutrition Education Program (EFNEP) is a cost-effective intervention that generates sustained improvement in biomarkers of chronic disease risk.

DESIGN

A longitudinal quasi-experimental design with 2 parallel arms (untreated comparison vs EFNEP) and 4 waves of data collection (pretest, posttest, 6 months, and 12 months after completion).

SETTING

Eligible adult EFNEP community settings in Colorado, Florida, Maryland, and Washington.

PARTICIPANTS

Free-living adults (n = 500) aged 18-50 years, with income ≤ 185% of the Federal Poverty Line.

INTERVENTION(S)

Adult EFNEP delivered using an evidence-based curriculum, Eating Smart • Being Active.

MAIN OUTCOME MEASURE(S)

Chronic disease biomarkers (body mass index, blood pressure, and HbA1c), food and physical activity behaviors, dietary intake, health status, and demographics will be measured using objective biometric indicators, the Adult EFNEP Questionnaire, a 24-hour dietary recall, a health questionnaire, and demographic forms.

ANALYSIS

Linear mixed models will be used to assess whether adult EFNEP has a significant (P < 0.01) impact on 3 chronic disease biomarkers. The program's estimated impact on chronic disease biomarkers will be incorporated into a cost-benefit analysis framework to assess the economic value generated by adult EFNEP through chronic disease risk reduction.

Contextual Factors Influencing the Adoption of Physical Activity Direct Education and Policy, Systems, and Environmental Change Initiatives by Virginia EFNEP and SNAP-Ed Staff

OBJECTIVE

To explore factors influencing the adoption of direct education programs and policy, systems, and environmental (PSE) change initiatives focused on physical activity for Supplemental Nutrition Assistance Program-eligible audiences by Virginia Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education (SNAP-Ed) staff.

METHODS

Online survey with Expanded Food and Nutrition Education Program and SNAP-Ed peer (paraprofessional) educators (n = 28) and SNAP-Ed agents (master of science level) (n = 9) in Virginia. Descriptive statistics were computed for sociodemographic characteristics and responses to questions on the basis of Likert-type scales. Exploratory factor analyses were run to identify the underlying structures of the different variables.

RESULTS

The main factors for peer educators were related to substituting nutrition programs or content for physical activity programs. Other factors included staff qualifications and expectations about leading vs teaching physical activities. For PSEs, the top factors were the capacity to reach many community members, attract new partners and stakeholders, and personal interest in the PSE.

CONCLUSIONS AND IMPLICATIONS

The results provide insight into potential barriers and motivators for adopting physical activity education and PSEs within community-based initiatives and can be used to inform program planning and staff training. Additional research is warranted to examine other factors influencing the adoption and implementation of physical activity programs and PSEs.

A methodological study on the combination of qualitative and quantitative methods in cognitive interviewing for cross-cultural adaptation

Aim

The aim of this study is to explore the use of the Questionnaire Appraisal System with a combination of qualitative and quantitative methods in cognitive interviewing for cross‐cultural adaptation.

Design

This is a descriptive methodological study.

Methods

Using the Mandarin version of the Post‐Stroke Checklist as an example, cognitive interviews were conducted with 27 stroke survivors in Guangzhou between November 2020 and February 2021. The Questionnaire Appraisal System was applied as a codebook in focus group discussions to perform quantitative data collections and quantitative content analysis.

Results

Thirty‐eight problems were proposed in focus group discussions and identified all but four of the 30 questions that emerged in the cognitive interviews. A new item was added to the Questionnaire Appraisal System for better categorization. Four categories and six subcategories of problems in the checklist were revealed.

Community resilience in a rural food system: documenting pathways to nutrition solutions

OBJECTIVE

To describe and determine the barriers and facilitators to food-related health behaviors of residents in a rural Mississippi Delta community.

STUDY DESIGN

Descriptive study of qualitative interviews.

METHODS

A non-random sample of 34 low-income, food-insecure adults residing in a rural Mississippi Delta community were interviewed using fuzzy cognitive mapping, a mixed methods approach.

RESULTS

Participants strongly emphasized the time restraints they faced in both procuring and preparing foods, due to substantial travel time required to procure groceries. Participants also identified key facilitators to healthy eating behaviors, including seasonal produce stands, foraging, fishing, home provisioning, and access to the local food pantry. These barriers and facilitators are highly interconnected with other influential factors including poverty, lack of health care, unemployment, and faith-based support systems.

CONCLUSIONS

While the connection between low food access and poor eating habits is well researched, this novel mixed-method approach details two important elements missing from the literature: (1) other factors often overlooked that mitigate or exacerbate this relationship and (2) the dynamic nature of the relationships between these factors, poor eating habits, and health. Additionally, this research examines these relationships in an underrepresented rural minority population where resources needed to mitigate poor health are often much more limited. Findings from this study are critical to health and food policy in Mississippi and more generally, rural communities.