title: Development and validation of a questionnaire to evaluate lifestyle-related behaviors in elementary school children.
abstract: BACKGROUND
  The SI! Program promotes cardiovascular health through a multilevel school-based intervention on four lifestyle-related components: diet, physical activity, understanding the body and heart, and management of emotions. We report here the development and validation of the KAH (knowledge, attitudes and habits)-questionnaire adapted for elementary school children (6-7 years old) as a tool for the forthcoming evaluation of the SI! Program, where the KAH scoring will be the primary outcome. The efficacy of such an intervention will be based on the improvements in children's KAH towards a healthy lifestyle.
  
  
  METHODS
  The questionnaire validation process started with a pool of items proposed by the pedagogical team who developed the SI! Program for elementary school. The questionnaire was finalized by decreasing the number of items from 155 to 48 using expert panels and statistical tests on the responses from 384 children (ages 6-7). A team of specialized psychologists administered the questionnaire at schools providing standard directions for the final administration. The internal consistency was assessed using Cronbach's α coefficients. Reliability was measured through the split-half method, and problematic items were detected applying the item response theory. Analysis of variance and Tukey's test of additivity were used for multiple comparisons.
  
  
  RESULTS
  The final KAH-questionnaire for elementary school children should be administered to children individually by trained staff. The 48 items-questionnaire is divided evenly between the 4 components of the intervention, with an overall Cronbach's α = 0.791 (α = 0.526 for diet, α = 0.537 for physical activity, α = 0.523 for human body and heart, and α = 0.537 for management of emotions).
  
  
  CONCLUSIONS
  The KAH-questionnaire is a reliable instrument to assess the efficacy of the SI! Program on instilling healthy lifestyle-related behaviors in elementary school children.
authors.affiliation: Foundation for Science Health and Education, Avda. Diagonal 442, 3°, 1ª, 08037, Barcelona, Spain. gsantos@fundacionshe.org.
authors.forename: G
authors.initials: G
authors.lastname: Santos-Beneit
authors.affiliation: Foundation for Science Health and Education, Avda. Diagonal 442, 3°, 1ª, 08037, Barcelona, Spain. merchesotosprieto@gmail.com.|Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. merchesotosprieto@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Sotos-Prieto
authors.affiliation: Foundation for Science Health and Education, Avda. Diagonal 442, 3°, 1ª, 08037, Barcelona, Spain. pbodega@fundacionshe.org.
authors.forename: P
authors.initials: P
authors.lastname: Bodega
authors.affiliation: Foundation for Science Health and Education, Avda. Diagonal 442, 3°, 1ª, 08037, Barcelona, Spain. crodriguez@fundacionshe.org.
authors.forename: C
authors.initials: C
authors.lastname: Rodríguez
authors.affiliation: Foundation for Science Health and Education, Avda. Diagonal 442, 3°, 1ª, 08037, Barcelona, Spain. xorrit@fundacionshe.org.
authors.forename: X
authors.initials: X
authors.lastname: Orrit
authors.affiliation: GROP (Grup de Recerca en Orientació Psicopedagògica), Departament MIDE (Mètodes d'Investigació i Diagnòstic en Educació), Universitat de Barcelona, Barcelona, Spain. nperezescoda@ub.edu.
authors.forename: N
authors.initials: N
authors.lastname: Pérez-Escoda
authors.affiliation: GROP (Grup de Recerca en Orientació Psicopedagògica), Departament MIDE (Mètodes d'Investigació i Diagnòstic en Educació), Universitat de Barcelona, Barcelona, Spain. rbisquerra@ub.edu.
authors.forename: R
authors.initials: R
authors.lastname: Bisquerra
authors.affiliation: Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. valentin.fuster@mssm.edu.|Icahn School of Medicine at Mount Sinai, New York, NY, USA. valentin.fuster@mssm.edu.
authors.forename: V
authors.initials: V
authors.lastname: Fuster
authors.affiliation: Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. jpenalvo@cnic.es.|Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, USA. jpenalvo@cnic.es.
authors.forename: J L
authors.initials: JL
authors.lastname: Peñalvo
mesh_terms: D002648:Child; D004032:Diet; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires