Metric properties of the "prescribe healthy life" screening questionnaire to detect healthy behaviors: a cross-sectional pilot study

Paola Bully, Alvaro Sanchez, Gonzalo Grandes, Haizea Pombo, Ma Soledad Arietalenizbeaskoa, Veronica Arce, Catalina Martinez, PVS Group, Paola Bully, Alvaro Sanchez, Gonzalo Grandes, Haizea Pombo, Ma Soledad Arietalenizbeaskoa, Veronica Arce, Catalina Martinez, PVS Group

Abstract

Background: Feasible and valid assessment of healthy behaviors is the first step for integrating health promotion in routine primary care. Therefore, the aim of this study was to develop and evaluate the validity and reliability of the "prescribe healthy life" screening questionnaire, a brief tool for detecting physical activity levels, consumption of fruit and vegetables, tobacco use and patients' compliance with minimal recommendations.

Methods: An observational cross-sectional study to determine the reliability and validity of this questionnaire by means of mixed (qualitative and quantitative) methods. Thirteen healthcare professionals designed the questionnaire. One hundred and twenty-six patients from three primary care health centers within Osakidetza (Basque Health Service, Spain) filled in the "Prescribe Healthy Life" Screening Questionnaire and completed an accelerometry record, the PREDIMED Food Frequency Questionnaire and a co-oximetry as gold standards for physical activity, dietary intake and tobacco use, respectively. Correlations, sensitivities, specificities, likelihood ratios and test-retest reliability were calculated. Additionally, the feasibility and utility of the questionnaire were evaluated.

Results: Both reliability and concurrent validity for the consumption of fruit and vegetables (rspearman = 0.59, rspearman = 0.50) and tobacco use (rspearman = 0.76, r = 0.69) as their overall performance in the detection of unhealthy diet (accuracy = 76.8%, LR + = 3.1 and LR- = 0.31) and smokers (accuracy = 86.8%, LR + = 6.1 and LR- = 0.05) were good. Meanwhile, the reproducibility (0.38), the correlation between the minutes of physical activity (0.34) and LR+ (1.00) for detection of physical activity were low. On average the questionnaire was considered by patients easy to understand, easy to fill in, short (5-6 min) and useful.

Conclusion: The "Prescribe Healthy Life" Screening Questionnaire, PVS-SQ, has proved to be a simple and practical tool for use in the actual context of primary care, with guarantees of validity and reliability for the diet and tobacco scales. However, the physical activity scale show unsatisfactory results, and alternative questions ought to be tested.

Keywords: Lifestyle; Mass screening; Primary health care; Risk reduction behavior; Sensitivity and specificity; Validation studies.

Figures

Fig. 1
Fig. 1
Timeline of measurement and data collection
Fig. 2
Fig. 2
PVS-SQ ROC curves
Fig. 3
Fig. 3
Feasibility and utility scores distribution

References

    1. IHME Institute for Health Metrics and Evaluation. 2013. . Accessed 15 May 2015.
    1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–2260. doi: 10.1016/S0140-6736(12)61766-8.
    1. Grandes G, Sánchez A, Cortada JM, Balague L, Calderon C, Arrazola A, Vergara I, Millan E, Prescribe Vida Saludable group Is integration of healthy lifestyle promotion into primary care feasible? Discussion and consensus sessions between clinicians and researchers. BMC Health Serv Res. 2008;8:213–225. doi: 10.1186/1472-6963-8-213.
    1. Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, et al. A framework for development and evaluation of complex interventions to improve health. BMJ. 2000;7262:694–696. doi: 10.1136/bmj.321.7262.694.
    1. Moore Graham F, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350:h1258. doi: 10.1136/bmj.h1258.
    1. Sanchez A, Grandes G, Cortada JM, Pombo H, Balague L, Calderon C. Modelling innovative interventions for optimising healthy lifestyle promotion in primary health care: 'Prescribe Vida Saludable' phase I research protocol. BMC Health Serv Res. 2009;9:103–113. doi: 10.1186/1472-6963-9-103.
    1. Withlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med. 2002;22:267–284. doi: 10.1016/S0749-3797(02)00415-4.
    1. IHME Institute for Health Metrics and Evaluation. 2016. . Accessed 20 May 2016.
    1. Brühmann BA, Schmidt ME, Steindorf K. Assessment of physical activity in epidemiological studies: Are questionnaires obsolete in the era of accelerometry? GMS Med Inform Biom Epidemiol. 2014
    1. Riebl SK, Paone AC, Hedrick VE, Zoellner JM, Estabrooks PA, Davy BM. The comparative validity of interactive multimedia questionnaires to paper-administered questionnaires for beverage intake and physical activity: pilot study. JMIR Res Protoc. 2013
    1. Illner AK, Nöthlings U, Wagner K, Ward H, Boeing H. The assessment of individual usual food intake in large-scale prospective studies. Ann Nutr Metab. 2010;56:99–105. doi: 10.1159/000277667.
    1. NIH National Institutes of Health, National Cancer Institute. . Accessed 20 Jul 2015
    1. Campbell DR, Gross MD, Martini MC, Grandits GA, Slavin JL, Potter JD. Plasma carotenoids as biomarkers of vegetable and fruit intake. Cancer Epidemiol Biomarkers Prev. 1994;3:493–500.
    1. Long JD, Littlefield LA, Estep G, Martin H, Rogers TJ, Boswell C, Shriver BJ, Roman-Shriver CR. Evidence review of technology and dietary assessment. Worldviews Evid Based Nurs. 2010;7:191–204. doi: 10.1111/j.1741-6787.2009.00173.x.
    1. Barrueco M, Jiménez Ruiz C, Palomo L, Torrecilla M, Romero P, Riesco JA. Veracity of smokers' reports of abstinence at smoking cessation clinics. Arch Bronconeumol. 2005;41:135–40. doi: 10.1157/13071584.
    1. Babor TF, Sciamanna CN, Pronk NP. Assessing multiple risk behaviors in primary care. Screening issues and related concepts. Am J Prev Med. 2004;27(Suppl 2):42–53. doi: 10.1016/j.amepre.2004.04.018.
    1. Goodyear-Smith F, Coupe N, Arroll B, Elley C, Sullivan S, McGill A. Case-finding of lifestyle and mental health problems in primary care: validation of the ‘CHAT’. Br J Gen Pract. 2008;58:26–31. doi: 10.3399/bjgp08X263785.
    1. Krist AH, Glenn BA, Glasgow RE, Balasubramanian B, Chambers DA, Fernandez M, Heurtin-Roberts S, Kessler R, Ory MG, Phillips SM, Ritzwoller DP, Roby DH, Rodriguez H, Sheinfeld-Gorin SN, Stange KC. Designing a valid randomized pragmatic primary care implementation trial: the my own health report (MOHR) project. Implement Sci. 2013;25:73. doi: 10.1186/1748-5908-8-73.
    1. Bossuyt PM, Reitsma JB, Bruns DE, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Fam Pract. 2004;21:4–10. doi: 10.1093/fampra/cmh103.
    1. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39:1423–34. doi: 10.1249/mss.0b013e3180616b27.
    1. Engineering/Marketing A . ActiLife users manual. Pensacola: ActiGraph; 2009.
    1. John D, Freedson P. ActiGraph and Actical physical activity monitors: a peek under the hood. Med Sci Sports Exerc. 2012;44:86–89. doi: 10.1249/MSS.0b013e3182399f5e.
    1. Heil DP, Brage S, Rothney MP. Modeling physical activity outcomes from wearable monitors. Med Sci Sports Exerc. 2012;44:50–60. doi: 10.1249/MSS.0b013e3182399dcc.
    1. Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc. 1998;30:777–781. doi: 10.1097/00005768-199805000-00021.
    1. Matthews CE, Ainsworth BE, Thompson RW, Bassett DR., Jr Sources of variance in daily physical activity levels as measured by an accelerometer. Med Sci Sports Exerc. 2002;34:1376–1381. doi: 10.1097/00005768-200208000-00021.
    1. Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40:181–188. doi: 10.1249/mss.0b013e31815a51b3.
    1. Martin-Moreno JM, Boyle P, Gorgojo L, et al. Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol. 1993;22:512–519. doi: 10.1093/ije/22.3.512.
    1. Fernandez-Ballart JD, Piñol JL, Zazpe I, et al. Relative validity of a semi quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain. Br J Nutr. 2010;103:1808–1816. doi: 10.1017/S0007114509993837.
    1. de la Fuente-Arrillaga C, Vázquez-Ruiz Z, Bes-Rastrollo M, et al. Reproducibility of a food frequency questionnaire (FFQ) validated in Spain. Public Health Nutr. 2010;13:1364–1372. doi: 10.1017/S1368980009993065.
    1. Glasgow RE, Ory MG, Klesges LM, Cifuentes M, Fernald DH, Green LA. Practical and relevant self-report measures of patient health behaviors for primary care research. Ann Fam Med. 2005;3:73–81. doi: 10.1370/afm.261.
    1. Grandes G, Sánchez A, Torcal J, Ortega R, Lizarraga K, Serra J, on behalf of the PEPAF Group Targeting physical activity promotion in general practice: characteristics of inactive patients and willingness to change. BMC Public Health. 2008;8:172. doi: 10.1186/1471-2458-8-172.
    1. Guenther PM, Reedy J, Krebs-Smith SM, Reeve BB, Basiotis PP. Development and Evaluation of the Healthy Eating Index-2005. United States Department of Agriculture. . Accessed 19 Jul 2015.
    1. van Poppel MN, Chinapaw MJ, Mokkink LB, van Mechelen W, Terwee CB. Physical activity questionnaires for adults: a systematic review of measurement properties. Sports Med. 2010;40:565–600. doi: 10.2165/11531930-000000000-00000.
    1. Helmerhorst H, Brage S, Warren J, Besson H, Ekelund U. A systematic review of reliability and objective criterion-related validity of physical activity questionnaires. Int J Behav Nutr Phys Act. 2012;9:103. doi: 10.1186/1479-5868-9-103.
    1. Vega-Lopez S, Chavez A, Farr KJ, Ainsworth BE. Validity and reliability of two brief physical activity questionnaires among Spanish-speaking individuals of Mexican descent. BMC Res Notes. 2014
    1. Puig-Ribera A, Martín-Cantera C, Puigdomenech E, et al. Screening Physical Activity in Family Practice: Validity of the Spanish Version of a Brief Physical Activity Questionnaire. PLoS One. 2015
    1. Yaroch AL, Tooze J, Thompson FE, Blanck HM, Thompson OM, Colón-Ramos U, Shaikh AR, McNutt S, Nebeling LC. Evaluation of three short dietary instruments to assess fruit and vegetable intake: the National Cancer Institute's food attitudes and behaviors survey. J Acad Nutr Diet. 2012
    1. England CY, Andrews RC, Jago R, Thompson JL. A systematic review of brief dietary questionnaires suitable for clinical use in the prevention and management of obesity, cardiovascular disease and type 2 diabetes. Eur J Clin Nutr. 2015;69:977–1003. doi: 10.1038/ejcn.2015.6.
    1. Arganini C, Saba A, Comitato R, Virgili F, Turrini A. Gender Differences in Food Choice and Dietary Intake in Modern Western Societies. In: Maddock J, editor. Public Health - Social and Behavioral Health. London: Intech; 2012.
    1. Baker AH, Wardle J. Sex differences in fruit and vegetable intake in older adults. Appetite. 2013;40:269–275. doi: 10.1016/S0195-6663(03)00014-X.
    1. Greene GW, Resnicow K, Thompson FE, et al. Correspondence of the NCI Fruit and Vegetable Screener to repeat 24-H recalls and serum carotenoids in behavioral intervention trials. J Nutr. 2008;138:200–204.
    1. Serdula M, Coates R, Byers T, et al. Evaluation of a brief telephone questionnaire to estimate fruit and vegetable consumption in diverse study populations. Epidemiology. 1993;4:455–463. doi: 10.1097/00001648-199309000-00012.
    1. IOM Institute of Medicine . Capturing social and behavioral domains and measures in electronic health records: Phase 2. Washington: The National Academies Press; 2014.
    1. WHO World Health Organization. 2014. . Accessed 15 Jun 2015.
    1. Bensley L, Van Eenwyk J, Bruemmer BA. Measuring fruit and vegetable consumption: providing serving size information doubles estimated percent eating five per day. J Am Diet Assoc. 2003;103:1530–2. doi: 10.1016/j.jada.2003.08.021.
    1. Bully P, Sanchez A, Zabaleta E, Pombo H, Grandes G. Evidence from interventions based on theoretical models for lifestyle modification (physical activity, diet, alcohol and tobacco use) in primary care settings: A systematic review. Prev Med. 2015;76(Suppl Jul):76–93. doi: 10.1016/j.ypmed.2014.12.020.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe