Validation of the healthy habits questionnaire

Background: Over the past four decades, global obesity rates, especially among children, have increased significantly. Modifiable factors like diet, physical activity, family dynamics, screen time, and sleep play crucial roles in the genesis of obesity in children, and are oftentimes the targets for weight management and prevention interventions. Yet, the availability of psychometrically robust, cohort-specific, multidimensional tools for screening and monitoring these factors is limited. This research programme was designed to address the critical need for a review of available assessment instruments in this field and the development and validation of a brief, multi-domain, assessment tool which could be used to identify and monitor familial, lifestyle and behavioural factors contributing to childhood overweight and obesity. Method: Study 1 - a systematic review was conducted following PRISMA guidelines to identify self- or informant-rated multidimensional lifestyle assessment tools validated for children (aged 2-12 years) living with overweight and obesity. Four databases were searched. Screening of 7844 studies and full text review of 141 were conducted in duplicate. Data were extracted on scale psychometric properties. A narrative synthesis of extracted data was produced. Study 2 involved a psychometric validation evaluation study of the Healthy Habits Questionnaire, a 48-item tool developed to monitor outcomes in the Parent Plus Healthy Families programme and as a standalone measure for use in clinical settings. The HHQ, along with other scales, was administered to an online community sample of 480 parents/caregivers of children aged 2-12 years old, and also to 91 parents/ caregivers of children aged between 2- 12 years old who participated in an RCT evaluating the PP-HF intervention. This evaluation study determined the HHQ's factor structure, internal consistency, test-retest reliability, responsiveness to change, correlations with other measures, and percentile norms. Results: Results from study 1: Thirteen papers describing studies of the eight instruments were selected for review. The reviewed scales assessed a range of factors including diet, mealtime routines, eating habits, physical activity, sedentary behaviour (including screen-time), and sleep; parental behaviour and beliefs; and home and family environment. Aside from a small number of commonalities, the reviewed measures were largely heterogenous. No single measure spanned the entire 2-12 years age range. The quality of the reviewed studies varied significantly, especially regarding the range of psychometric scale properties examined. Results from study 2: Exploratory and confirmatory factor analysis showed that a 23-item, 4-factor version of the HHQ (i.e., the HHQ-23) best fit the data. The scale and factor subscales had good internal consistency and test-retest reliability. They also had good concurrent and construct validity shown by significant correlations with another scale that assessed lifestyle issues, and scales that assessed parenting satisfaction, family functioning, and children’s strengths and difficulties. The HHQ-23 was sensitive to change following parents completing the PP-HF programme. Conclusions: Findings from this research programme indicate that there is a dearth of validated, cohort- specific, psychometrically robust, multidimensional scales for children aged between 2 – 12 years living with overweight or obesity, or at risk of developing obesity. One measure, the HHQ-23 which was validated as part of this research programme, addressed this gap in knowledge. It shows potential for monitoring positive lifestyle changes arising from interventions for childhood overweight and obesity. Likewise the HHQ-23 also shows promising potential as a standalone screening measure or as part of a larger battery of screening assessments in paediatric weight-management services.