Development of a questionnaire to assess knowledge, attitudes, and behaviors in American Indian children.

One aim of the Pathways study is to improve the knowledge, attitudes, and behaviors of American Indian children in grades 3-5 regarding physical activity and diet in. This article describes the development of a culturally sensitive, age-appropriate questionnaire to assess these variables. The questionnaire was designed to be administered in the classroom in two 30-min sessions. Questions were developed to assess 4 key areas: physical activity, diet, weight-related attitudes, and cultural identity. Potential questions were written after review of relevant literature and existing questionnaires. Numerous and extensive revisions were made in response to input from structured, semistructured, and informal data collection. Questions were pretested in 32 children in grades 3-5 by using semistructured interviews. Test-retest reliability and the internal consistency of scales were examined in 371 fourth-grade children and subsequently in 145 fourth-grade children. Questions were reviewed by American Indians from the communities involved in the Pathways study several times during the developmental process. The process described here serves as one model for the development of a culturally appropriate tool to assess knowledge, attitudes, and behaviors in American Indian children.

Patterns of physical activity among American Indian children: an assessment of barriers and support.

Estimates indicate that 10% to 50% of American Indian and non-Indian children in the U.S. are obese, defined as a body mass index > or = 95th percentile of the NHANES II reference data. Pathways is a two-phase, multi-site study to develop and test a school-based obesity prevention program in American Indian schoolchildren in grades three through five. During Phase I feasibility prior to initiation of the Pathways trial, data were collected related to physical activity patterns, and the supports of, and barriers to, physical activity. Nine schools from communities representing six different tribal groups participated in this study. Multiple measures were used for data collection including direct observation, paired child interviews, and in-depth interviews and focus groups with adults. Students completed the self-administered Knowledge, Attitudes, and Behaviors (KAB) survey, and a Physical Activity Questionnaire (PAQ). Barriers to physical activity at schools included a lack of facilities, equipment, and trained staff persons for PE. Adults were not consistently active with their children, but they were highly supportive of their children's activity level. Children reported a strong enjoyment of physical activity and strong peer support to be physically active. Weather conditions, safety concerns, and homework/chores were common barriers to physical activity reported by children and adult caregivers. The information was used to design culturally and age-appropriate, practical interventions including the five physical activity programs for schoolchildren in the Pathways study.

Weight-related attitudes and behaviors in fourth grade American Indian children.

OBJECTIVE: American Indian children have a high prevalence of obesity, yet little is known about weight-related attitudes and the prevalence of dieting in this population. This study assessed weight concerns, body size perceptions, weight reduction attempts, and weight loss methods in fourth grade American Indian children. RESEARCH METHODS AND PROCEDURES: Participants (n = 304) attended one of eight schools in the Pathways Feasibility Study. Question and answer choices were read to children by trained staff, and children marked their own answers. RESULTS: Thirty-eight percent of the children reported that they had tried to lose weight. The most common strategy for weight reduction was exercising more. Girls were more likely than boys to be dissatisfied with their body size (48% of girls vs. 34% of boys desired a slimmer body size; 22% of girls vs. 15% of boys desired a larger body size; p<0.001). Children who had tried to lose weight were more likely to indicate that the size they most desired and the most healthy size were smaller than their perceived size (p<0.001). Children who reported trying to lose weight were also more likely to want to be skinnier and to be unhappy about their weight than were children who did not report trying to lose weight (p<0.001 for both). DISCUSSION: We conclude that weight loss attempts and weight-related concerns are prevalent in American Indian children at a young age.