title: Use of the Environment and Policy Evaluation and Observation as a Self-Report Instrument (EPAO-SR) to measure nutrition and physical activity environments in child care settings: validity and reliability evidence.
abstract: BACKGROUND
  Early care and education (ECE) centers are important settings influencing young children's diet and physical activity (PA) behaviors. To better understand their impact on diet and PA behaviors as well as to evaluate public health programs aimed at ECE settings, we developed and tested the Environment and Policy Assessment and Observation - Self-Report (EPAO-SR), a self-administered version of the previously validated, researcher-administered EPAO.
  
  
  METHODS
  Development of the EPAO-SR instrument included modification of items from the EPAO, community advisory group and expert review, and cognitive interviews with center directors and classroom teachers. Reliability and validity data were collected across 4 days in 3-5 year old classrooms in 50 ECE centers in North Carolina. Center teachers and directors completed relevant portions of the EPAO-SR on multiple days according to a standardized protocol, and trained data collectors completed the EPAO for 4 days in the centers. Reliability and validity statistics calculated included percent agreement, kappa, correlation coefficients, coefficients of variation, deviations, mean differences, and intraclass correlation coefficients (ICC), depending on the response option of the item.
  
  
  RESULTS
  Data demonstrated a range of reliability and validity evidence for the EPAO-SR instrument. Reporting from directors and classroom teachers was consistent and similar to the observational data. Items that produced strongest reliability and validity estimates included beverages served, outside time, and physical activity equipment, while items such as whole grains served and amount of teacher-led PA had lower reliability (observation and self-report) and validity estimates. To overcome lower reliability and validity estimates, some items need administration on multiple days.
  
  
  CONCLUSIONS
  This study demonstrated appropriate reliability and validity evidence for use of the EPAO-SR in the field. The self-administered EPAO-SR is an advancement of the measurement of ECE settings and can be used by researchers and practitioners to assess the nutrition and physical activity environments of ECE settings.
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2207 McGavran-Greenberg Hall, CB 7461, Chapel Hill, NC, 27599-7461, USA. dsward@email.unc.edu.
authors.forename: Dianne S
authors.initials: DS
authors.lastname: Ward
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, and Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC, 27599-7426, USA. mazzucca@email.unc.edu.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Mazzucca
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC, 27599-7426, USA. cjmcwill@email.unc.edu.
authors.forename: Christina
authors.initials: C
authors.lastname: McWilliams
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, and Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC, 27599-7426, USA. derekh@email.unc.edu.
authors.forename: Derek
authors.initials: D
authors.lastname: Hales
mesh_terms: D000328:Adult; D026683:Advisory Committees; D002654:Child Care / Q000706:statistics & numerical data*; D002664:Child Nutritional Physiological Phenomena / Q000502:physiology*; D002675:Child, Preschool; D004032:Diet; D004777:Environment; D015444:Exercise; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D009657:North Carolina; D009752:Nutritional Status / Q000502:physiology*; D015203:Reproducibility of Results; D057566:Self Report; D011795:Surveys and Questionnaires