Reliability and Validity of a Tool to Measure School Nurse Perceptions and Practices Associated With Childhood Obesity Prevention.

Background and Purpose: Childhood obesity prevention (COP) should include increasing school nurse involvement. Measurements of school nurse perceptions influencing COP practices are limited. The purpose of this study is to evaluate the reliability and validity of 5 measures of school nurse COP practices and perceptions. Methods: A 70-item anonymous survey was completed by 171 Florida registered nurse (RN) school nurses and tested for reliability and validity. Results: Internal reliability was acceptable with Cronbach's alphas ranging from .81 to .94. Uncertain to adequate test-retest reliability was determined by correlation coefficients (r = .55-.78). Significant correlations (p Keywords: school nurse; childhood obesity; prevention; perceptionsApproximately one-third of children in the United States are overweight or obese (Ogden, Carroll, Kit, & Flegal, 2012) and have increased risks for multiple health problems (S. R. Daniels, 2009) such as cardiovascular disease (Freedman, Mei, Srinivasan, Berenson, & Dietz, 2007; Raghuveer, 2010) and Type 2 diabetes (Aschemeier, Kordonouri, Danne, & Lange, 2008; Lipton et al., 2011). A consensus report issued by the Institute of Medicine (2012) recommends that schools and health care providers be a focus for obesity prevention efforts. School nurses are uniquely positioned health care providers to address the childhood obesity epidemic. It is the position of the National Association of School Nurses (NASN, 2013) that school nurses have the expertise and knowledge to engage in practices to prevent childhood obesity. This position supports the finding that an increase in school nurse activities was associated with a reduction in the percentage of students classified as obese (O'Brien, 2012).Childhood obesity is also associated with poor academic performance (D. Y. Daniels, 2008; Datar & Sturm, 2006; Taras & Potts-Datema, 2005), linking this health problem specifically to the school nurses' role to enhance academic success by promoting children's health (NASN, 2010). Unfortunately, school nurse participation in childhood obesity prevention (COP) practices is inconsistent, and this variation is poorly understood. Reliable and valid instruments are needed to measure school nurse COP perceptions and practices to enable analyses of associations between them. Identifying the perceptions that most affect school nurse practices may guide the development and implementation of targeted interventions and support policy changes to increase school nurse engagement in COP.The purpose of this study is to refine and evaluate measures of school nurse COP practices and related key perceptions of self-efficacy, benefits, and barriers. Two existing instruments with scales that measured school nurse COP practices or perceptions (Hendershot, Telljohann, Price, Dake, & Mosca, 2008; Kubik, Story, & Davey, 2007) with limited psychometric testing were identified to modify and evaluate for this study. New items derived from previous findings were added to the perception scales. Response options, wording of items, and instructions were altered through the following four-step process: Step 1, initial scale modification; Step 2, content validity; Step 3, pretesting; Step 4, pilot study.BACKGROUND AND CONCEPTUAL FRAMEWORKBandura's (2004) model of health promotion by social cognitive theory (SCT) guided the adapted conceptual framework (Figure 1) used in measurement development and validity testing in this preliminary study. According to SCT, self-efficacy directly affects perceived benefits, perceived barriers, goals, and behaviors. Self-efficacy is the belief in one's ability to perform specific behaviors under certain conditions to achieve desired outcomes and is a key determinant of intentional behavior (Bandura, 1977, 1986, 1997, 2004). …