ArticleBMC public health2019
Creating a healthy eating and active environment survey (CHEERS) for childcare: an inter-rater, intra-rater reliability and validity study.
Article in BMC public health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- The Impact of COVID-19 on Eating Environments and Activity in Early Childhood Education and Care in Alberta, Canada: A Cross-Sectional Study.Nutrients · 2021Trial
- Enhancing healthy eating and active environments in early learning settings: findings from the eHealth study.Frontiers in nutrition · 2026Article
- "First Bite": An intervention to increase children's vegetable consumption in Early Childhood Education and Care (ECEC) services in areas of high socioeconomic disadvantage - a cluster randomized controlled trial protocol.Nutrition and health · 2025Article
- Creating healthy eating and active environments in early learning settings: protocol of the CHEERS eHealth intervention study.Frontiers in nutrition · 2024Article
- In-Depth Analysis of Diet Diary and Urine pH Measurements Improved Food Diet Reporting in Postmenopausal Women with RUTI.Women's health reports (New Rochelle, N.Y.) · 2024Article
- Is the online 'creating healthy eating and active environments survey' (CHEERS) tool reliable for early childhood educators in Alberta, Canada: a randomized crossover trial.Archives of public health = Archives belges de sante publique · 2023Article
- Update and validation of the Canadian Behavior, Attitude and Nutrition Knowledge Survey (C-BANKS 2.0).Frontiers in public health · 2023Article
- Inter-Rater and Intra-Rater Reliability of the INSPECT (Interactive Nutrition Specific Physical Exam Competency Tool) Measured in Multi-Site Acute Care Settings.Healthcare (Basel, Switzerland) · 2022Article
- Content and Face Validation of a Novel, Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) to Evaluate Registered Dietitians' Competence: A Delphi Consensus from the United States.Healthcare (Basel, Switzerland) · 2021Article
- Scrutinize of healthy school canteen policy in Iran's primary schools: a mixed method study.BMC public health · 2021Article
- Article
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Abstract
backgroundThe CHEERS is a self-administered tool to measure gaps, weaknesses, and strengths of an early childhood education and care (ECEC) centre-based nutrition and physical activity environment. ECEC settings have the potential to profoundly influence early dietary and physical activity behaviours. Content validation of the CHEERS tool has been previously reported. The purpose of this study was to develop reliability and validity evidence for the CHEERS audit tool and the proposed subscales of food served, healthy eating environment, program planning, and physical activity environment in ECEC centre-based programs.
methodsThis cross-sectional study consisted of 2 phases: Phase 1 included inter-, intra-rater and Cronbach's α. A subset of this sample was invited to participate in a second survey (Trial 2) for intra-rater assessment within 3 weeks of completing the first survey (Trial 1). Phase 2 included concurrent validity assessment between a nutrition expert and the ECEC director using within a one-week period.
resultsOne hundred two directors and 85 educators (total of 187) returned the survey. Of these, there were 75 matched pairs for inter-rater reliability analysis providing a CHEERS ICC score of 0.59 and ICC scores ranging from 0.40 to 0.58 for the subscales. The ICC for intra-rater reliability of the CHEERS score was 0.81 for 40 participants completing the survey a second time and a range of 0.72 to 0.79 for the subscales. The CHEERS tool demonstrated very good internal consistency (α = 0.91) and α scores ranging from 0.73 to 0.79 for the subscales. In phase 2, concurrent validation was ICC = 0.65 (n = 30) CHEERS scores with a range of 0.42 to 0.69 for the subscales.
conclusionsThis study provides evidence of inter-, intra-rater reliability, internal consistency, and concurrent validity of an environmental assessment audit tool to assess the nutrition and physical activity environment of ECEC centre-based programs. The results demonstrate that the self-administered CHEERS instrument is stable overtime and between evaluators at the same ECEC centre. The scores obtained with CHEERS self-administered audit tool are reasonably accurate compared to an expert rater (dietitian) assessment. This study adds additional support to establishing the psychometric soundness of the CHEERS tool.
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