Preschools' friendliness toward physical activity: item battery and two scores developed by mixed methods

Background: Previous work suggests that many context-level characteristics of preschools are associated with increased physical activity (PA) in children.

Purpose: To facilitate assessment of preschools' friendliness toward PA, an item battery as well as comprehensive and short rating scores were developed based on mixed methods with validity and reliability tested.

Methods: Organizational and contextual characteristics of 24 German preschools were assessed by direct observation and semi-structured interviews (September 2008 to April 2009; analyzed in 2012). Twenty-seven items across seven domains of friendliness toward PA were rated independently by two researchers as being limited (0); adequate (1); or extraordinarily (2) friendly toward PA. Values were summed to a comprehensive rating score value (RS-c). To increase feasibility, a short score (RS-s) was developed using an item subset identified by both item-item correlations and positive association with moderate to vigorous PA. Validity of items and scores was tested by their association with preschoolers' accelerometer-measured PA (n=405) in covariate-adjusted multilevel models. Reliability was tested by inter-rater reliability coefficients.

Results: Nine of 27 items were included in the RS-s. In the multilevel model, four single items and both the RS-c and RS-s were positively associated with children's moderate to vigorous PA (RS-c: β=0.5 minutes, p=0.003, explained variance=9%; RS-s: β=1.3 minutes, p<0.001, variance=23%), but not with light activity or sedentary behavior. Inter-rater reliability was 0.80 (RS-c) and 0.88 (RS-s).

Conclusions: There is potential value for mixed methods in assessing preschools' friendliness toward PA.