Validation of a water consumption questionnaire for a study of the adverse health outcomes associated with disinfection by-products

The aim of this study was to assess the validity and reliability of a questionnaire to estimate water exposure through drinking, showering, bathing or swimming. Forty-seven pregnant women were recruited from antenatal or exercise classes and were randomly allocated into three groups. The first group completed the water exposure questionnaire one-week apart. The second group completed a three-day diary and then the questionnaire. The third group completed the questionnaire first followed by the diary. Agreement was assessed by the Intraclass correlation coefficient (ICC) and the Kappa statistic. The questionnaire demonstrated good reliability (ICC 0.93 for water consumption and 0.91 for time spent showering). With regard to validity, average daily water consumption was estimated to be 8.1 glasses/day (2 litres) from the diary compared with 12.2 (3 litres) from the questionnaire. The ICCs comparing the diary and questionnaire responses were 0.31 for water consumption and 0.72 for showering. The water exposure questionnaire overestimated levels of exposure when compared with diary-reporting of consumption. While a water exposure questionnaire may be a less intrusive research instrument than a diary, further development is required to improve the validity of this instrument.