Family health climate scale (FHC-scale): development and validation

BACKGROUND: The family environment is important for explaining individual health behaviour. While previous research mostly focused on influences among family members and dyadic interactions (parent-child), the purpose of this study was to develop a new measure, the Family Health Climate Scale (FHC-Scale), using a family-based approach. The FHC is an attribute of the whole family and describes an aspect of the family environment that is related to health and health behaviour. Specifically, a questionnaire measuring the FHC (a) for nutrition (FHC-NU) and (b) for activity behaviour (FHC-PA) was developed and validated. METHODS: In Study 1 (N=787) the FHC scales were refined and validated. The sample was randomly divided into two subsamples. With random sample I exploratory factor analyses were conducted and items were selected according to their psychometric quality. In a second step, confirmatory factor analyses were conducted using the random sample II. In Study 2 (N=210 parental couples) the construct validity was tested by correlating the FHC to self-determined motivation of healthy eating and physical activity as well as the families' food environment and joint physical activities. RESULTS: Exploratory factor analyses with random sample I (Study 1) revealed a four (FHC-NU) and a three (FHC-PA) factor model. These models were cross-validated with random sample II and demonstrated an acceptable fit FHC-PA: χ(2)=222.69, df=74, p<.01; χ(2)/df=3.01; CFI=.96; SRMR=.04; RMSEA=.07, CI .06/.08; FHC-NU: χ(2)=278.30, df=113, p<.01, χ(2)/df=2.46, CFI=.96; SRMR=.04; RMSEA=.06, CI .05/.07. The perception of FHC correlated (p<.01) with the intrinsic motivation of healthy eating (r=.42) and physical activity (r=.56). Moreover, parental perceptions of FHC-NU correlated with household soft drink availability (r=-.31) and perceptions of FHC-PA with the frequency of joint physical activities with the child (r=.51). These patterns were found on the intraindividual and interindividual level. CONCLUSIONS: Two valid instruments measuring the FHC within families were developed. The use of different informants' ratings demonstrated that the FHC is a family level variable. The results confirm the high relevance of the FHC for individuals' health behaviour. The FHC and the measurement instruments are useful for examining health-related aspects of the family environment.