Children's cardiovascular health promotion attitude scale: An instrument development
The problem of the study was to develop a valid and reliable instrument to measure school-age children's attitudes toward cardiovascular health promotion. The conceptual framework for the development of the Children's Cardiovascular Health Promotion Attitude Scale evolved through the use of two major theories: Social Learning Theory and Psychometric Theory. In order to examine motivation as a determinent of cardiovascular health promoting lifestyle, the attitudes of the children must be determined. Psychometric theory provides the theory associated with the measurement techniques which guide the development of the instrument and estimation of reliability and validity.
The subjects were 224 school-age children in fourth, fifth, and sixth grade. Both males and females were included in the study. Written parental consent was obtained for all the children prior to participating in the study.
A methodological design was used for this study. The Children's Cardiovascular Health Promotion Attitude Scale (CVHPAS) was a 42 item four-point forced choice Likert scale developed after an extensive literature review and analysis of the concept. The factors identified in the development of the instrument were: nutrition, physical activity, smoking, and stress control. The instrument was revised after statistical analysis yielding a final CVHPAS of a 16 item four-point forced choice Likert scale.
Content validity was evaluated through the utilization of both literature review and the use of six experts in areas of cardiovascular health promotion and children to evaluate the instrument. Reliability estimates were measured using Cronbach's alpha correlation coefficient. Construct validity was estimated by factor analysis to examine the relationships between the items. Four factors were identified from the factor analysis which were consistent with the subgroups identified in the conceptual framework: physical activity, nutrition, smoking, and stress control.
The internal consistency analysis indicated Cronbach's alpha correlation coefficients for the Cardiovascular Health Promotion Instrument subscales of physical activity, nutrition, smoking, and stress control were 0.7621, 0.7035, 0.7409, and 0.6342 respectively. The alpha correlation coefficient for the entire instrument was 0.7993. The results of the statistical analysis for internal consistency and construct validity indicates that the CVHPAS give evidence of being both a reliable and valid instrument, consisting of four distinct subscales: physical activity, nutrition, smoking, and stress control.