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The development and validation of a new survey tool: the first step to profiling New Zealanders' eating styles and moving patterns

The development and validation of a new survey tool: the first step to profiling New Zealanders'... Letters doi: 10.1111/1753-6405.12544 moving at a population level will enable a vigorous-intensity, moderate-intensity, sport- more comprehensive understanding of the related, strength and resistance training, and The development and relationship between these behaviours and flexibility); as well as the social context of validation of a new survey health. these exercise activities. tool: the first step to profiling Survey development Psychometrics New Zealanders’ eating styles Content validity was a crucial part of the This involved content validity assessment and moving patterns survey development process. The questions (as outlined above) and a pilot study to 1 2 Olivia Maclaren, Lisa Mackay, underwent two reviews and modifications examine test–retest reliability. Participants 2 2 Grant Schofield, Caryn Zinn by an expert panel that included a registered were recruited from a NZ academic institution 1. School of Nursing, Eastern Institute of Technology, dietitian, a public health academic, an exercise and associated contacts for the pilot. A New Zealand physiologist and two epidemiologists; repeated measures online approach (9 2. School of Sport and Recreation, Auckland University of Technology, New Zealand all employed in academic institutions. days, SD ± 4 days between surveys) was Furthermore, to improve the content used. Percentage agreement and Cohen’s Nutrition and physical activity behaviours 17 17,18 validity, verbal feedback was obtained from linear and quadratic weighted kappas 1-7 are well-known determinants of health. participants involved in the test–retest were calculated. Strength of agreement Current New Zealand (NZ) surveys monitoring reliability assessment (described below). thresholds were assigned to the quadratic these important behaviours are designed weighted kappa values. During initial development, the primary around understanding whether or not best 8 9-13 inclusion criteria for each question was the practice guidelines have been met. Results ability to differentiate a range of eating and These behaviours have been predominantly Content validity appeared to be robust from physical activity approaches. Additional quantified by a 24-hr diet recall, combined analysis of participant and expert panel criteria were the ease of interpretation, with a food frequency questionnaire looking feedback. Twenty-two participants (17 10,11 suitability for online use, conciseness and at specific food consumption, and females) completed the test–retest reliability reliability. The final survey was structured into questionnaires that examine the intensity and pilot study (mean age 51 SD ± 11 years). 10-12 two parts: basic demographic questions; and time spent in physical activity. Participants were primarily European (90%) nutrition and physical activity questions. Current population-wide surveys in NZ that and in full- or part-time employment (59%). The nutrition questions examined the examine nutrition and physical activity fail It is acknowledged that this is a not a fully approximate weekly consumption (over the to adequately examine the pattern and representative sample of the NZ population previous four weeks) of major food groups context to these behaviours. In everyday and is therefore considered a pilot study. (grains, dairy, eggs, fats, red meat, white meat, life, it is unlikely that many people weigh For the test–retest reliability (42 questions fish, fruit, vegetables and nuts) and processed and measure their food on a regular basis, or across nutrition and physical activity), five foods (processed meats, snack foods, consider the frequency of their consumption questions (11.9%) showed perfect agreement, confectionery, sugary drinks, takeaways of individual foods. Similarly, it is unlikely 19 (45.2%) showed excellent strength of and protein powder). Dairy was further that they would consider their physical agreement, 16 (38.1%) showed fair-to-good distinguished as low-fat or full-fat, separate activity (athletes may be the exception) strength of agreement, and two (4.8%) options were included for starchy vegetables with such precision as daily duration and showed poor strength of agreement. The two and non-starchy vegetables, and fat sources intensity. Nutrition and physical activity questions that showed poor agreement were were itemised as butter, margarine, processed behaviours are complex and are influenced on frequency of soft drink consumption and or non-processed oils. In addition, a set of by the physiology, ecological and social evening household activities. Further review 14,15 questions investigated the participants’ environments of the individual. Different and amendments are required with these beliefs in their food choices and were philosophies around nutrition and physical questions. designed to distinguish whether participants activity behaviours are not fully understood prioritised eating low-fat options; high-fat Overall, the majority (40) of the survey items and have not been well examined in options; or processed, convenient foods. A showed fair-to-excellent test–retest reliability population-wide studies. set of questions also examined participants’ within the pilot study sample. Additionally, This work aimed to develop a new and attitudes to weight loss and weight gain to the content was considered to be valid for the straightforward tool to move beyond the provide some idea of the motivation for their survey aims. All indirect nutrition and physical simple quantification of food consumption dietary behaviours. activity assessments have methodological and physical activity by investigating the limitations, and web-based administration The physical activity questions included broader context to eating and moving. is likely to share similar issues to traditional exercise (planned, structured and repetitive Developing a new tool is the first step paper-based counterparts. physical activity ) and non-exercise physical to enable the examination of whether activity (unstructured activity). The first set A four-week recall period was stipulated someone follows a specific eating philosophy of questions examined non-exercise activity to provide a reasonably stable period for (e.g. plant-based, Mediterranean, low- (work-related activity demands, transport analysis. The time period between surveys carbohydrate or low-fat approach), and modes, evening activity and sitting time). was designed to limit participants’ recall of how, where, and with whom they are The second set of questions examined responses; but at the same time it maintained physically active. A broader understanding approximate weekly engagement in different the stability of their responses. Five questions of the common approaches to eating and types of exercise (short or long duration were answered identically between rounds, 396 Australian and New Zealand Journal of Public Health 2016 vol . 40 no . 4 © 2016 Public Health Association of Australia Letters 11. Research and Evaluation Unit Health Promotion which suggests that these patterns were Agency. 2012 Health and Lifestyles Survey [Internet]. either very reliable or potentially some recall Wellington (NZ): Health Promotion Agency; 2012 [cited between surveys was occurring. A slightly 2015 Sep 10]. Available from: www.hpa.org.nz 12. Bascand G. Time Use Survey: 2009/10: Key Facts [Internet]. longer period between surveys may have Wellington (NZ): Statistics New Zealand; June 2011 minimised any recall; however, a longer [cited 2016 Jan 25]. Available from: http://www.stats. govt.nz/browse_for_stats/people_and_communities/ period would have changed the recall time_use/TimeUseSurvey_HOTP2009-10.aspx window and potentially the participants’ 13. Sport New Zealand. Sport and Active Recreation in the Lives of New Zealand Adults. 2013/14 Active New Zealand eating patterns. Survey Results [Internet]. Wellington (NZ): Government of New Zealand; 2015 [cited 2016 Feb 2]. Available Implications from: http://www.sportnz.org.nz/managing-sport/ research/201314-active-nz-survey-2 The next step in the survey development 14. Galef BG Jr. Food selection: Problems in understanding process is to implement the survey within how we choose foods to eat. Neurosci Biobehav Rev. 1996;20(1):67-73. a large population sample and explore 15. Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJF, Martin patterns to the data. This will hopefully BW. Physical Activity 2: Correlates of physical activity: Why are some people physically active and others not? identify common patterns in New Zealanders’ Lancet. 2012;380(9838):258-71. approach to eating and moving. If distinct 16. Caspersen CJ, Powell KE, Christenson GM. Physical patterns become evident, associations with activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health health and wellbeing may be elucidated. In Rep. 1985;100(2):126-31. addition, these patterns may enable more 17. Sim J, Wright CC. The kappa statistic in reliability studies: Use, interpretation, and sample size requirements. Phys targeted research and interventions focusing Ther. 2005;85(3):257-68. on the philosophies governing food choice 18. Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures and activity patterns. of reliability. Educ Psychol Meas. 1973;33(3):613-9. For additional details or copies of the final 19. Salerno DF, Franzblau A, Armstrong TJ, Werner RA, Becker MP . Test-retest reliability of the Upper Extremity survey and SPSS syntax for Cohen’s weighted Questionnaire among keyboard operators. Educ Psychol kappa, contact the corresponding author. Meas. 2001;40(6):655-66. 20. Illner AK, Freisling H, Boeing H, Huybrechts I, Crispim SP, Slimani N. Review and evaluation of innovative References technologies for measuring diet in nutritional epidemiology. Int J Epidemiol. 2012;41(4):1187-203. 1. World Health Organization. Obesity: Prevention and Managing the Global Epidemic: Report of a WHO Correspondence to: Ms Olivia Maclaren, Consultation. WHO Technical Report Series No. 894. Geneva (CHE): WHO; 2000. School of Nursing, Eastern Institute of Technology, 2. World Health Organization. Global Recommendations Private Bag 1201, Hawkes Bay Mail Centre, on Physical Activity for Health [Internet]. Geneva (CHE): Napier 4142, Hawkes Bay, New Zealand; WHO; 2010 [cited 2016 Jan 10]. Available from: http:// e-mail: omaclaren@eit.ac.nz www.who.int/dietphysicalactivity/publications/ recommendations5_17years/en/ 3. Steyn NP, Mann J, Bennett PH, Temple N, Zimmet P, Tuomilehto J, et al. Diet, nutrition and the prevention of type 2 diabetes. Public Health Nutr. 2004;7(1a):147-65. 4. Reddy KS, Katan MB. Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Public Health Nutr. 2004;7(1a):167-86. 5. Key TJ, Schatzkin A, Willett WC, Allen NE, Spencer EA, Travis RC. Diet, nutrition and the prevention of cancer. Public Health Nutr. 2004;7(1a):187-200. 6. Owen N, Healy GN, Matthews CE, Dunstan DW. Too much sitting: The population health science of sedentary behavior. Exerc Sport Sci Rev. 2010;38(3): 105-13. 7. Penedo FJ, Dahn JR. Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry. 2005;18(2): 189-93. 8. Ministry of Health. Eating and Activity Guidelines for New Zealand Adults [Internet]. Wellington (NZ): Government of New Zealand; 2015 [cited 2015 Nov 23]. Available from: http://www.health.govt.nz/publication/eating- and-activity-guidelines-new-zealand-adults 9. University of Otago and Ministry of Health. A Focus on Nutrition: Key Findings of the 2008/09 New Zealand Adult Nutrition Survey [Internet]. Wellington (NZ): Government of New Zealand; 2011 [cited 2014 Jan 5]. Available from: http://www.health.govt.nz/ 10. Ministry of Health. A Potrait of Health. Key Results of the 2006/07 New Zealand Health Survey [Internet]. Wellington (NZ): Government of New Zealand; 2008 [cited 2014 Jan 5]. Available from: http://www.health. govt.nz/publication/portrait-health-key-results-2006- 07-new-zealand-health-survey 2016 vol . 40 no . 4 Australian and New Zealand Journal of Public Health 397 © 2016 Public Health Association of Australia http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

The development and validation of a new survey tool: the first step to profiling New Zealanders' eating styles and moving patterns

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References (29)

Publisher
Wiley
Copyright
© 2016 Public Health Association of Australia
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/1753-6405.12544
pmid
27372305
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Abstract

Letters doi: 10.1111/1753-6405.12544 moving at a population level will enable a vigorous-intensity, moderate-intensity, sport- more comprehensive understanding of the related, strength and resistance training, and The development and relationship between these behaviours and flexibility); as well as the social context of validation of a new survey health. these exercise activities. tool: the first step to profiling Survey development Psychometrics New Zealanders’ eating styles Content validity was a crucial part of the This involved content validity assessment and moving patterns survey development process. The questions (as outlined above) and a pilot study to 1 2 Olivia Maclaren, Lisa Mackay, underwent two reviews and modifications examine test–retest reliability. Participants 2 2 Grant Schofield, Caryn Zinn by an expert panel that included a registered were recruited from a NZ academic institution 1. School of Nursing, Eastern Institute of Technology, dietitian, a public health academic, an exercise and associated contacts for the pilot. A New Zealand physiologist and two epidemiologists; repeated measures online approach (9 2. School of Sport and Recreation, Auckland University of Technology, New Zealand all employed in academic institutions. days, SD ± 4 days between surveys) was Furthermore, to improve the content used. Percentage agreement and Cohen’s Nutrition and physical activity behaviours 17 17,18 validity, verbal feedback was obtained from linear and quadratic weighted kappas 1-7 are well-known determinants of health. participants involved in the test–retest were calculated. Strength of agreement Current New Zealand (NZ) surveys monitoring reliability assessment (described below). thresholds were assigned to the quadratic these important behaviours are designed weighted kappa values. During initial development, the primary around understanding whether or not best 8 9-13 inclusion criteria for each question was the practice guidelines have been met. Results ability to differentiate a range of eating and These behaviours have been predominantly Content validity appeared to be robust from physical activity approaches. Additional quantified by a 24-hr diet recall, combined analysis of participant and expert panel criteria were the ease of interpretation, with a food frequency questionnaire looking feedback. Twenty-two participants (17 10,11 suitability for online use, conciseness and at specific food consumption, and females) completed the test–retest reliability reliability. The final survey was structured into questionnaires that examine the intensity and pilot study (mean age 51 SD ± 11 years). 10-12 two parts: basic demographic questions; and time spent in physical activity. Participants were primarily European (90%) nutrition and physical activity questions. Current population-wide surveys in NZ that and in full- or part-time employment (59%). The nutrition questions examined the examine nutrition and physical activity fail It is acknowledged that this is a not a fully approximate weekly consumption (over the to adequately examine the pattern and representative sample of the NZ population previous four weeks) of major food groups context to these behaviours. In everyday and is therefore considered a pilot study. (grains, dairy, eggs, fats, red meat, white meat, life, it is unlikely that many people weigh For the test–retest reliability (42 questions fish, fruit, vegetables and nuts) and processed and measure their food on a regular basis, or across nutrition and physical activity), five foods (processed meats, snack foods, consider the frequency of their consumption questions (11.9%) showed perfect agreement, confectionery, sugary drinks, takeaways of individual foods. Similarly, it is unlikely 19 (45.2%) showed excellent strength of and protein powder). Dairy was further that they would consider their physical agreement, 16 (38.1%) showed fair-to-good distinguished as low-fat or full-fat, separate activity (athletes may be the exception) strength of agreement, and two (4.8%) options were included for starchy vegetables with such precision as daily duration and showed poor strength of agreement. The two and non-starchy vegetables, and fat sources intensity. Nutrition and physical activity questions that showed poor agreement were were itemised as butter, margarine, processed behaviours are complex and are influenced on frequency of soft drink consumption and or non-processed oils. In addition, a set of by the physiology, ecological and social evening household activities. Further review 14,15 questions investigated the participants’ environments of the individual. Different and amendments are required with these beliefs in their food choices and were philosophies around nutrition and physical questions. designed to distinguish whether participants activity behaviours are not fully understood prioritised eating low-fat options; high-fat Overall, the majority (40) of the survey items and have not been well examined in options; or processed, convenient foods. A showed fair-to-excellent test–retest reliability population-wide studies. set of questions also examined participants’ within the pilot study sample. Additionally, This work aimed to develop a new and attitudes to weight loss and weight gain to the content was considered to be valid for the straightforward tool to move beyond the provide some idea of the motivation for their survey aims. All indirect nutrition and physical simple quantification of food consumption dietary behaviours. activity assessments have methodological and physical activity by investigating the limitations, and web-based administration The physical activity questions included broader context to eating and moving. is likely to share similar issues to traditional exercise (planned, structured and repetitive Developing a new tool is the first step paper-based counterparts. physical activity ) and non-exercise physical to enable the examination of whether activity (unstructured activity). The first set A four-week recall period was stipulated someone follows a specific eating philosophy of questions examined non-exercise activity to provide a reasonably stable period for (e.g. plant-based, Mediterranean, low- (work-related activity demands, transport analysis. The time period between surveys carbohydrate or low-fat approach), and modes, evening activity and sitting time). was designed to limit participants’ recall of how, where, and with whom they are The second set of questions examined responses; but at the same time it maintained physically active. A broader understanding approximate weekly engagement in different the stability of their responses. Five questions of the common approaches to eating and types of exercise (short or long duration were answered identically between rounds, 396 Australian and New Zealand Journal of Public Health 2016 vol . 40 no . 4 © 2016 Public Health Association of Australia Letters 11. Research and Evaluation Unit Health Promotion which suggests that these patterns were Agency. 2012 Health and Lifestyles Survey [Internet]. either very reliable or potentially some recall Wellington (NZ): Health Promotion Agency; 2012 [cited between surveys was occurring. A slightly 2015 Sep 10]. Available from: www.hpa.org.nz 12. Bascand G. Time Use Survey: 2009/10: Key Facts [Internet]. longer period between surveys may have Wellington (NZ): Statistics New Zealand; June 2011 minimised any recall; however, a longer [cited 2016 Jan 25]. Available from: http://www.stats. govt.nz/browse_for_stats/people_and_communities/ period would have changed the recall time_use/TimeUseSurvey_HOTP2009-10.aspx window and potentially the participants’ 13. Sport New Zealand. Sport and Active Recreation in the Lives of New Zealand Adults. 2013/14 Active New Zealand eating patterns. Survey Results [Internet]. Wellington (NZ): Government of New Zealand; 2015 [cited 2016 Feb 2]. Available Implications from: http://www.sportnz.org.nz/managing-sport/ research/201314-active-nz-survey-2 The next step in the survey development 14. Galef BG Jr. Food selection: Problems in understanding process is to implement the survey within how we choose foods to eat. Neurosci Biobehav Rev. 1996;20(1):67-73. a large population sample and explore 15. Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJF, Martin patterns to the data. This will hopefully BW. Physical Activity 2: Correlates of physical activity: Why are some people physically active and others not? identify common patterns in New Zealanders’ Lancet. 2012;380(9838):258-71. approach to eating and moving. If distinct 16. Caspersen CJ, Powell KE, Christenson GM. Physical patterns become evident, associations with activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health health and wellbeing may be elucidated. In Rep. 1985;100(2):126-31. addition, these patterns may enable more 17. Sim J, Wright CC. The kappa statistic in reliability studies: Use, interpretation, and sample size requirements. Phys targeted research and interventions focusing Ther. 2005;85(3):257-68. on the philosophies governing food choice 18. Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures and activity patterns. of reliability. Educ Psychol Meas. 1973;33(3):613-9. For additional details or copies of the final 19. Salerno DF, Franzblau A, Armstrong TJ, Werner RA, Becker MP . Test-retest reliability of the Upper Extremity survey and SPSS syntax for Cohen’s weighted Questionnaire among keyboard operators. Educ Psychol kappa, contact the corresponding author. Meas. 2001;40(6):655-66. 20. Illner AK, Freisling H, Boeing H, Huybrechts I, Crispim SP, Slimani N. Review and evaluation of innovative References technologies for measuring diet in nutritional epidemiology. Int J Epidemiol. 2012;41(4):1187-203. 1. World Health Organization. Obesity: Prevention and Managing the Global Epidemic: Report of a WHO Correspondence to: Ms Olivia Maclaren, Consultation. WHO Technical Report Series No. 894. Geneva (CHE): WHO; 2000. School of Nursing, Eastern Institute of Technology, 2. World Health Organization. Global Recommendations Private Bag 1201, Hawkes Bay Mail Centre, on Physical Activity for Health [Internet]. Geneva (CHE): Napier 4142, Hawkes Bay, New Zealand; WHO; 2010 [cited 2016 Jan 10]. Available from: http:// e-mail: omaclaren@eit.ac.nz www.who.int/dietphysicalactivity/publications/ recommendations5_17years/en/ 3. Steyn NP, Mann J, Bennett PH, Temple N, Zimmet P, Tuomilehto J, et al. Diet, nutrition and the prevention of type 2 diabetes. Public Health Nutr. 2004;7(1a):147-65. 4. Reddy KS, Katan MB. Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Public Health Nutr. 2004;7(1a):167-86. 5. Key TJ, Schatzkin A, Willett WC, Allen NE, Spencer EA, Travis RC. Diet, nutrition and the prevention of cancer. Public Health Nutr. 2004;7(1a):187-200. 6. Owen N, Healy GN, Matthews CE, Dunstan DW. Too much sitting: The population health science of sedentary behavior. Exerc Sport Sci Rev. 2010;38(3): 105-13. 7. Penedo FJ, Dahn JR. Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry. 2005;18(2): 189-93. 8. Ministry of Health. Eating and Activity Guidelines for New Zealand Adults [Internet]. Wellington (NZ): Government of New Zealand; 2015 [cited 2015 Nov 23]. Available from: http://www.health.govt.nz/publication/eating- and-activity-guidelines-new-zealand-adults 9. University of Otago and Ministry of Health. A Focus on Nutrition: Key Findings of the 2008/09 New Zealand Adult Nutrition Survey [Internet]. Wellington (NZ): Government of New Zealand; 2011 [cited 2014 Jan 5]. Available from: http://www.health.govt.nz/ 10. Ministry of Health. A Potrait of Health. Key Results of the 2006/07 New Zealand Health Survey [Internet]. Wellington (NZ): Government of New Zealand; 2008 [cited 2014 Jan 5]. Available from: http://www.health. govt.nz/publication/portrait-health-key-results-2006- 07-new-zealand-health-survey 2016 vol . 40 no . 4 Australian and New Zealand Journal of Public Health 397 © 2016 Public Health Association of Australia

Journal

Australian and New Zealand Journal of Public HealthWiley

Published: Aug 1, 2016

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