Establishing the Reliability and Validity of HeartSmartKids Cardiovascular Risk Assessment for Children 2-18 Years

Gance-Cleveland, Bonnie

Purpose: To describe the development of a computerized decision support technology to prevent pediatric obesity and report on reliability and validity of screening questions used in the screening tool.

Background: Experts have developed guidelines for childhood obesity. Clinicians report difficulty incorporating the screening and counseling components into routine care. HeartSmartKids^TM (HSK) is a decision support tool for implementation of the obesity guidelines. HSK assesses family health behaviors and provides tailored guidance. Patients complete a bilingual screening interview on health behaviors using a touchscreen computer. Clinic staff add the clinical measurements and print the tailored guidance for families. The purpose of this study was to document the reliability and validity of the screening questions included in this technology for assessing eating, activity, and inactivity.

Methods: This study was part of a larger intervention study. Children aged 11-14 years old were enrolled in a community-based healthy eating and activity after school program. Children in the control group (n=35) completed the HSK at two time points 8 weeks apart to establish test-retest reliability. Baseline reponses from children in the intervention and control groups (n=103) on the HSK and HABITS, a 19-item questionnaire with subscales for diet, activity, and sedentary behaviors, were used to establish concurrent validity.

Statistical Analysis: A multitrait/multimethod correlation matrix (MTMM) was used to examine the reliability and validity of HSK relative to HABITS.

Results: Reliability of HSK using the main diagonal elements in the monomethod blocks established that reliability coefficients were equal to or higher for HSK than for HABITS. Convergent validity using the main diagonal of the monotrait/heteromethod block was established. Convergent validity was good for all items (r values ranged from .33 to .62, all p’s <0.05) with the exception of milk consumption (r = .28, p < 0.05) and eats at restaurants (r = 0.16, n.s.) where questions differed considerably on the questionnaires.

Conclusion: The questions used in the HSK are equivalent or superior to the HABITS questionnaire and are integrated into technology that is user friendly and generates a tailored patient education handout.