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J Am Diet Assoc. 2011 Dec;111(12):1852-60. doi: 10.1016/j.jada.2011.09.006.

The Wellness Child Care Assessment Tool: a measure to assess the quality of written nutrition and physical activity policies.

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  • 1Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.



There is a growing interest in studying the influence of child-care center policies on the health of preschool-aged children.


To develop a reliable and valid instrument to quantitatively evaluate the quality of written nutrition and physical activity policies at child-care centers.


Reliability and validation study. A 65-item measure was created to evaluate five areas of child-care center policies: nutrition education, nutrition standards for foods and beverages, promoting healthy eating in the child-care setting, physical activity, and communication and evaluation. The total scale and each subscale were scored on comprehensiveness and strength.


Analyses were conducted on 94 independent policies from Connecticut child-care centers participating in the Child and Adult Care Food Program.


Intraclass correlation coefficient was calculated to measure inter-rater reliability, and Cronbach's α was used to estimate internal consistency. To test construct validity, t tests were used to assess differences in scores between Head Start and non-Head Start centers and between National Association for the Education of Young Children-accredited and nonaccredited centers.


Inter-rater reliability was high for total comprehensiveness and strength scores (intraclass correlation coefficient=0.98 and 0.94, respectively) and subscale scores (intraclass correlation coefficient=0.84 to 0.99). Subscales were adequately internally reliable (Cronbach's α=.53 to .83). Comprehensiveness and strength scores were higher for Head Start centers than non-Head Start centers across most domains and higher for National Association for the Education of Young Children-accredited centers than nonaccredited centers across some but not all domains, providing evidence of construct validity.


This instrument provides a standardized method to analyze and compare the comprehensiveness and strength of written nutrition and physical activity policies in child-care centers.

Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

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