The Wellness Child Care Assessment Tool: a measure to assess the quality of written nutrition and physical activity policies

BackgroundThere is a growing interest in studying the influence of child-care center policies on the health of preschool-aged children.ObjectiveTo develop a reliable and valid instrument to quantitatively evaluate the quality of written nutrition and physical activity policies at child-care centers.DesignReliability and validation study. A 65-item measure was created to evaluate five areas of child-care center policies: nutrition education, nutrition standards for foods and beverages, promoting healthy eating in the child-care setting, physical activity, and communication and evaluation. The total scale and each subscale were scored on comprehensiveness and strength.SettingAnalyses were conducted on 94 independent policies from Connecticut child-care centers participating in the Child and Adult Care Food Program.Statistical analyses performedIntraclass correlation coefficient was calculated to measure inter-rater reliability, and Cronbach's α was used to estimate internal consistency. To test construct validity, t tests were used to assess differences in scores between Head Start and non–Head Start centers and between National Association for the Education of Young Children–accredited and nonaccredited centers.ResultsInter-rater reliability was high for total comprehensiveness and strength scores (intraclass correlation coefficient=0.98 and 0.94, respectively) and subscale scores (intraclass correlation coefficient=0.84 to 0.99). Subscales were adequately internally reliable (Cronbach's α=.53 to .83). Comprehensiveness and strength scores were higher for Head Start centers than non–Head Start centers across most domains and higher for National Association for the Education of Young Children–accredited centers than nonaccredited centers across some but not all domains, providing evidence of construct validity.ConclusionsThis instrument provides a standardized method to analyze and compare the comprehensiveness and strength of written nutrition and physical activity policies in child-care centers.