Construction and validation of a Health Promoting School Index (HPSI) to measure the capacity of school environments to promote physical activity and healthy eating
Abstract
Objective: To construct and validate a Health Promoting School Index (HPSI) assessing the capacity of Middle Eastern schools to provide environments conducive to healthy eating and physical activity. Methods: Forty-seven items concerning the physical, programmatic, social and equity dimensions of school environments were extracted from a school survey and coded to construct the HPSI. Content validity was assessed by mapping HPSI components against the World Health Organization’s recommendations. Construct validity was evaluated by answering: Does the HPSI (1) give maximum scores to schools representing high quality health-promoting environments, (2) distinguish between schools with known differences, and (3) measure health-promoting quality independent of school tuition? Internal consistency was measured using Cronbach’s alpha (α). Results: HPSI gives maximum mean scores to exemplary schools. T-test shows significant differences between government accredited and un-accredited schools (p=0.03). Independence between index scores and tuition was revealed (rho=0.013, p=0.90). Cronbach’s α was high (0.84). Conclusion: Our findings reveal HPSI as a multi-dimensional, consistent and valid instrument to evaluate school health environments in Middle Eastern countries. As a guiding tool for health-promoting policies, we encourage its larger use.