Cognitive Testing of Items Measuring Movement Behaviours in Young Children Aged Zero to Five Years: Development of the Movement Behaviour Questionnaires for -Baby (MBQ-B) and -Child (MBQ-C)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants and Recruitment
2.2. Movement Behaviour Questionnaire-Baby (MBQ-B) and Movement Behaviour Questionnaire-Child (MBQ-C)
2.3. Cognitive Interview Protocol
2.4. Data Analysis
3. Results
3.1. Participants
3.2. Interviews and Modifications
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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MBQ-B * | ||
---|---|---|
Item | Main findings | Modifications and actions |
1a Thinking about the past week, how many times EACH DAY did you usually place your infant on their tummy for play (tummy time on their stomach while awake)? 1b How long did each “tummy time” usually last? | General comprehension: Respondent questioned the applicability of this item for children aged 12 months or older age: “I know you’re asking for… it’s just that this is hard because he’s not this little, so technically this doesn’t apply… he’s one and he, we don’t do tummy time”. | Nil at this stage; decision made by research team continue with interviews before making changes to this item |
2a Thinking about the past week, how many times EACH DAY did you usually do some active play with your infant? Active play could be lying on the floor with your infant on your legs and lifting, dancing with your infant, flying and lowering your infant so they are upside down. 2b How long did each “active play time” usually last? | General comprehension: Examples of active play considered unclear “lying on the floor with your infant on your legs and lifting... (participant reads again) lying on the floor with your infant on your legs and lifting... Okay, that’s a little bit unclear”. | Examples of active play revised: Active play could be lying on the floor with your infant on your legs, lifting, dancing with your infant, or playing action games like pat-a-cake or peek-a-boo. |
3 Thinking about the past week, on a typical day (24 hours) how much time did your infant spend watching television programs, videos/internet clips or movies on a television, computer or portable/mobile device such as tablet or smartphone? (e.g., 2 h 15 min) | General comprehension: Inclusion of (24 h) was not considered helpful or necessary “I think it’s pretty straightforward. I wouldn’t necessarily need the 24 hours. I would just assume that it’s for the full day”. Decision process: Draw on family rules related to devices when considering time on each device. E.g., Participant quickly came to a response of zero “my one-year-old doesn’t really, he doesn’t do screen time at all, but he’s one. Ask me about my five-year-old! [laughing]”. | Redundancy of 24 h noted, but nil changes at this stage; continue with interviews |
4 Thinking about the past week, on a typical day (24 h) how much time did your infant spend playing games or using apps on electronic devices such as a computer or laptop, videogame console, iPad, tablet, smartphone, or any electronic gaming device? (e.g., 2 h 15 min) | General comprehension: well understood with nil concerns noted. | Nil modifications; continue with interviews |
5 Thinking about your infant’s sleep during the past week, how much time did your infant spend in sleep during the NIGHT (between 7 in the evening and 7 in the morning)? (e.g., 2 h 15 min) | General comprehension: The phrase ‘spend in sleep’ was unclear “That’s a bit funny there… how much time did your infant spend in sleep during the night?” Response process: Participant preferred closed ended responses to open “it was easy just to see it there and select something that might be appropriate, as opposed to overthinking and calculating” | Concerns with wording noted, but nil modifications at this stage; continue with interviews |
6 Thinking about your infant’s sleep during the past week, how much time did your infant spend in sleep during the DAY (between 7 in the morning and 7 in the evening)? (e.g., 2 h 15 min) | General comprehension: As above “it’s just unnatural for me to say that... How much time did you spend in sleep?” | Concerns with wording noted, but nil modifications at this stage; continue with interviews |
MBQ-C * | ||
Item | Main findings | Modifications and actions |
1 Thinking about the past week, on a typical weekday (24 h) how much time did your child spend playing outdoors? | General comprehension: “I didn’t feel the need for the 24 h” Decision process: Participants recalled usual family routine to determine time spent outside “Well just given his awake time… he sleeps for two hours in the middle of the day. And then we’ve got the morning and afternoon are two sessions and then you’d have to average it out so”. “Our days are sort of broken up a little bit into chunks… before (younger sibling’s) nap, and then when he’s napping, and then when he’s up. So, I guess... set chunks of time” Response process: Parents reporting any time spent outside—item not capturing time spent in active play or vigorous activities, could lead to overestimate of time in play. | Item revised to specify ‘active play’ + examples. Sub-item about vigorous play added. 1a Thinking about the past week, on a typical weekday (24 h) how much time did your child spend in active play outdoors, which includes walking, running, dancing, climbing, playing with balls, riding bikes or scooters, swimming? 1b Of this time, how much was spent doing vigorous activities such as running, jumping, dancing, riding bikes or scooters? Item tested in iteration 2 |
2 Thinking about the past week, on a typical weekend day (24 h) how much time did your child spend playing outdoors? | General comprehension: Participants generally reported there was more time for physical activity on the weekend—weekdays are constrained by work commitments, “our weekends are more free to spend time with (child)”; “the kid’s dad is home and he’s super active, so usually we’d be spending time outside”. Decision process: Similar cognitive processes for weekend day as weekday—referring to usual routine “Again, I think my strategy like the weekdays would be just really breaking up into chunks of time”. But lack of work-related routine sometimes made it more difficult to estimates time spent outdoors “This is a little bit trickier because... it’s a bit more fluctuating with what we’ll do on the weekend. But generally, I’d say probably similar to during the week, maybe a little bit more”. Response process: Participants varied in their preference for open versus closed responses. While some felt it improved accuracy by having choices available, others felt that parents would choose quickly and without much thought, thereby decreasing accuracy. “I tend to use multiple choice answers as a process of elimination. Not generally trying to find the answer, trying to eliminate the wrong ones. And with these questions where I do know the answer, for me, I just find worded answers far easier to come to, than sifting through multiple choice questions”. | Same modifications made as per weekday item |
3 Thinking about the past week, on a typical weekday (24 h) how much time did your child spend watching television programs, videos/internet clips or movies on a television, computer or portable/mobile device such as tablet or smartphone? | General comprehension: No specific concerns noted “(it) takes a bit of brain power... but I think everything is quite clear there if you read through the question thoroughly”. Decision process: Participants think about their child’s routine, as well as family rules about access to devices, to determine total time spent “I would be starting from the morning and thinking through the two times we let him watch screen time, and I’d be able to easily come to an answer”. “Because our daughter who’s three, doesn’t do any form of the technology outside of the TV”. Decision process: Participant wonders how to calculate an answer when child does not have screen time most days. She defaults to calculating an average rather than describing a ‘typical’ day—when interviewer asks “is the question difficult to answer?” participant responds “Ah, well only because she doesn’t watch it, every day. Then you’ve got to average out… how many minutes on days where some days are zero?” | Nil at this stage; continue with interviews; research team to consider how participants interpret ‘typical’ in subsequent rounds. |
4 Thinking about the past week, on a typical weekend day (24 h) how much time did your child spend watching television programs, videos/internet clips or movies on a television, computer or portable/mobile device such as tablet or smartphone? | Response process: preference for open vs. closed response options varied for this item also. For one participant that preferred an open-ended option earlier, now preferred closed. “I don’t know, it’s kind of the opposite of what I said to the physical activity (question), but, um, I guess I find it easier to quickly come to an answer... But, then again, I might be more confident that I had a more accurate answer possibly…” | Nil at this stage; continue with interviews |
5 Thinking about the past week, on a typical weekday (24 h), how much time did your child spend playing games or using apps on electronic devices such as a computer or laptop, videogame console, iPad, tablet, smartphone, or any electronic gaming device? | Decision Process: Participants referred to their household rules and limits regarding these activities. Most children were not allowed to play games and participants could quickly and confidently answer ‘zero’, “We try not to let him on the computer or have an iPad or anything like that”. | Nil; continue with interviews |
6 Thinking about the past week, on a typical weekend day (24 h), how much time did your child spend playing games or using apps on electronic devices such as a computer or laptop, videogame console, iPad, tablet, smartphone, or any electronic gaming device? | Decision Process: As above, participants referred to their household rules and limits regarding these activities. Lack of work-related routine on weekends. | Nil; continue with interviews |
7 Thinking about the past week, how much time did your child spend in sleep during the NIGHT? (e.g., 2 h 15 min) | Decision Process: Numeracy skills required—participants refer to child’s bedtime, then waketime and calculate the difference: “she goes down at about seven and wakes up at about five. So maybe about 10 h”. | Nil; continue with interviews |
8 Thinking about the past week, how much time did your child spend in sleep during the DAY? (e.g., 2 h 15 min) | Decision Process: Participants could come to an answer quickly because they monitor their child’s sleep. Adequacy of sleep was a commonly reported concern of parents: “I tend to be fairly aware of their sleep”. | Nil; continue with interviews |
9 In a typical week, how often does your child have a regular bedtime routine (e.g., bath, story)? e.g., 5 nights | Decision Process: All participants answered this quickly, with no apparent difficulties in interpretation. | Nil; continue with interviews |
MBQ-B * | ||
---|---|---|
Item | Main findings | Modifications and actions |
1a Thinking about the past week, how many times EACH DAY did you usually place your infant on their tummy for play (tummy time on their stomach while awake)? 1b How long did each “tummy time” usually last? | General comprehension: The two participants questioned the relevance of this item to infants who can crawl: “it’s a little bit difficult, this one, because he’s on his tummy a lot, but at the same time, he’s very mobile... when he was pretty little, he couldn’t crawl, I would put him (down for) tummy time” | Nil at this stage; decision made by research team continue with interviews before making changes to this item |
MBQ-C * | ||
Item | Main findings | Modifications and actions |
1a Thinking about the past week, on a typical weekday (24 h) how much time did your child spend in active play outdoors, which includes walking, running, dancing, climbing, playing with balls, riding bikes or scooters, swimming? 1b Of this time, how much was spent doing vigorous activities such as running, jumping, dancing, riding bikes or scooters? | General comprehension: Addition of examples and sub item was well received. Decision process: Sub item successfully prompted participants to recall activities of different intensities. “Of this time, how much was spent doing vigorous activities? I would say like 80 to 90% of that… she doesn’t stop… except there’s sometimes she likes to sit and play with rocks. So, but that usually doesn’t last for too long. So, I just minus that particular activity off”. Explanation of decision process revealing numeracy skills required “So, of this time, how much time is spent doing vigorous activity? I’d say probably one hour of that in a day… It’s around about a half an hour or so that she would be doing scootering in the afternoon… And then she just does little bursts of play, where they’ll play tag for 10 min or hide and seek where they’re running around the backyard”. | Nil; continue with interviews |
2a Thinking about the past week, on a typical weekend day (24 h) how much time did your child spend in active play outdoors, which includes walking, running, dancing, climbing, playing with balls, riding bikes or scooters, swimming? 2b Of this time, how much was spent doing vigorous activities such as running, jumping, dancing, riding bikes or scooters? | General comprehension: Addition of sub item was well received | Nil; continue with interviews |
3 Thinking about the past week, on a typical weekday (24 h) how much time did your child spend watching television programs, videos/internet clips or movies on a television, computer or portable/mobile device such as tablet or smartphone? | General comprehension: participants understood that the intent of the items was to capture time when the child is not moving. This resulted in them thinking about whether children were moving between sitting and standing “I would question… wonder whether... I guess she does a bit standing up… um… Looking at those devices, so I’d wonder whether that counts or not”. | Addition of ‘standing time’ sub item 3b Of this time, how much time did they watch an electronic device while standing? (e.g., 0 h 30 min), with a warning that the time provided must be less than the previous answer. |
4 Thinking about the past week, on a typical weekend day (24 h) how much time did your child spend watching television programs, videos/internet clips or movies on a television, computer, or portable/mobile device such as tablet or smartphone? | Decision process: Participants referring to their altered routine on the weekend “Zero time on the weekend. They tend to not remember even about the iPad and... they don’t play on our phones, but because we’re all together. They don’t tend to not use them on the weekends.” | As above, addition of ‘standing time’ sub item. |
MBQ-B * | ||
---|---|---|
Item | Main findings | Modifications and actions |
1a Thinking about the past week, how many times EACH DAY did you usually place your infant on their tummy for play (tummy time on their stomach while awake)? 1b How long did each “tummy time” usually last? | General comprehension: Further querying of whether item applicable now that infant is crawling. “He is... already passed that time that I need to, um…actively or proactively put him on tummy... these tummy time questions don’t really apply to my baby anymore because he can actually crawl, really, really fast”. “he’s um, sitting and crawling and everything... he doesn’t need tummy time anymore. He wouldn’t stay there even if I tried to”. General comprehension: No clear preference for the term ‘baby’ versus ‘infant’. Response process: Tummy time was challenging to recall because it was done frequently throughout the day but briefly. “I would have to calculate it… too hard! … yeah, I’d have to calculate it and sort of add up every time she’s on the ground. So, she’s not walking yet, so she’ll sit up and then she’ll roll, you know, onto her tummy and play. So, I mean, at a guess it’s probably not going to be that accurate… oh my god, I don’t know how to answer that question.” | Branching logic added to software: Does your baby crawl (yes/no)? If the baby has reached their ‘crawling’ milestone, parents were directed to answer item; if not, this item was deemed ‘not applicable’ and parents –skipped this item and were directed to next item. Terminology revised to ‘baby’ across all items in the infant version to enhance readability of questionnaire. Daily frequency replaced with weekly frequency. Item as well as open- and closed-ended responses revised. 1. This question is about the times when your baby is awake and placed on their tummy for playtime while you are watching them. Thinking about the past week, on how many days did you place your baby on their tummy for play? |
2a Thinking about the past week, how many times EACH DAY did you usually do some active play with your infant? Active play could be laying on the floor with your infant on your legs, lifting, dancing with your infant, or playing action games like pat-a-cake or peek-a-boo. 2b How long did each “active play time” usually last? | Decision process: Participants struggling with recall due to the short duration but high frequency of these activities “Again, it’s difficult to say a set amount of times, because you do a lot of these things without even realizing you’re doing it” “When we do something like that, it is quick. It’s me just kind of picking him up and quickly having a little game while we’re moving from one place to another... rather than, you know, it being a kind of deliberate, sit down, um, ‘let’s play a game Alex’. It’s... something that spontaneously happens every now and then, throughout a day” | Daily frequency and duration changed to total duration on typical day. Examples revised: 2 Thinking about the past week, on a TYPICAL DAY, how much time in total did you do some active play with your baby? Active play can be playing with toys or objects while lying or sitting on the floor, crawling on the floor or through tunnels, or pulling up to a standing position while holding on to furniture. |
3 Thinking about the past week, on a typical day (24 h) how much time did your infant spend watching television programs, videos/internet clips or movies on a television, computer, or portable/mobile device such as tablet or smartphone? (e.g., 2 h 15 min) | General comprehension: consistently reporting that ’24 h’ not required. Decision process: Refer to usual routine “it tends to be a very specific, like an episode of a TV show or something like that, where it runs for a certain amount of time and you tend to know how long it runs for and maybe you only let your kids watch like, one episode of something or two”? Decision Process: Concern that example “(e.g., 2 h 15 min)” could introduce social desirability bias if parents perceive this as the ‘acceptable’ amount of time. | ‘24 h’ and example response removed. 3 Thinking about the past week, on a TYPICAL DAY, how much time did your baby spend watching television programs, videos/internet clips or movies on a television, computer, or portable/mobile device such as iPad, tablet or smartphone? |
4 Thinking about the past week, on a typical day (24 h) how much time did your infant spend playing games or using apps on electronic devices such as a computer or laptop, videogame console, iPad, tablet, smartphone, or any electronic gaming device? (e.g., 2 h 15 min) | Decision process: Participants felt infants were too young to play with games or apps, and quickly came to a response of zero, but were unsure whether to include video chatting, “the thing that’s excluded is FaceTime, when you’re face timing relatives or friends... do you want people to count that?” Indicates that examples are not capturing how infants interact with screens. Response process: preference for open vs. closed responses remains mixed across participants.“I preferred being able to put in the answer that was exactly what I wanted to say, rather than having to choose an answer option that was close, but not quite correct”. | ‘Playing games or using apps’ changed to ‘looking at photos, or video chatting (e.g., FaceTime, Zoom, Skype) on a screen-based device’. As for previous item, ‘24 h’ and example times removed. 4 Thinking about the past week, on a TYPICAL DAY, how much time did your baby spend playing games, looking at photos, or video chatting (e.g., FaceTime, Zoom, Skype) on a screen-based device such as a computer or laptop, video game console, iPad, tablet, or smartphone? |
5 Thinking about your infant’s sleep during the past week, how much time did your infant spend in sleep during the NIGHT (between 7 in the evening and 7 in the morning)? (e.g., 2 h 15 min) | General comprehension: Defining day and night was not needed or helpful—participants understood what these meant. General comprehension: The phrase ‘in sleep’ was intended to prompt participants to calculate the time their infant was asleep minus wakefulness, however, it continued to create confusion during this round. | ‘Spend in sleep’ changed to ‘sleep in total’; addition of ‘on a typical night’; definition of night removed, and example times removed. 5 Thinking about the past week, on a typical night, how many hours/minutes did your baby sleep in total during the night? |
6 Thinking about your infant’s sleep during the past week, how much time did your infant spend in sleep during the DAY (between 7 in the morning and 7 in the evening)? (e.g., 2 h 15 min) | General comprehension as per item 5. | ‘Spend in sleep’ changed to ‘sleep in total’; addition of ‘on a typical day’, definition of day and example times removed. 6 Thinking about the past week, on a typical day, how many hours/minutes did your baby sleep in total during the day? |
MBQ-C * | ||
Item | Main findings | Modifications, actions, and item taken forward to validation study |
1a Thinking about the past week, on a typical weekday (24 h) how much time did your child spend in active play outdoors, which includes walking, running, dancing, climbing, playing with balls, riding bikes or scooters, swimming? 1b Of this time, how much was spent doing vigorous activities such as running, jumping, dancing, riding bikes or scooters? | General Comprehension: Participants found examples useful as prompts to distinguish between active play and play that is sedentary “often the girls will come out in the morning around morning-teatime, and they’ll play outside... they’ll often do fairly active games... but one of the things that they do (is) potter outside... playing in their cubby house and in the sand pit, which are not quite as active... Those weren’t included (in the examples so) I’d probably maybe reduce that to two hours”. General question: Question excludes time spent in active play indoors. Parents understood this, but item may not capture all active play “The weather’s quite cold and not always conducive with outdoor play... we still try and get out there... on average, I would say about two hours outside on a weekday”. Decision Process: Most parents did not read ’24 h’ out loud and reported use of ‘(24 h)’ as redundant “I don’t really know of any children that are playing outside overnight anyway”. | Given participants clearly articulated their thought process i.e., calculate how many hours the child was awake, then take way time spent in other activities to calculate active play, this demonstrated they are considering the full 24 h period, including activities after dark. Therefore ‘(24 h)’ and ‘outdoor’ removed. 1a Thinking about the past week, on a TYPICAL WEEKDAY, how much time did your child spend in active play? Active play includes activities such as walking, running, dancing, climbing, playing with balls, riding bikes or scooters, or swimming. 1b Of this time, how much was spent doing vigorous activities such as running, jumping, dancing, riding bikes or scooters? |
3a Thinking about the past week, on a typical weekday (24 h) how much time did your child spend watching television programs, videos/internet clips or movies on a television, computer, or portable/mobile device such as tablet or smartphone? 3b Of this time, how much time did they watch an electronic device while standing? | General Comprehension: Addition of sub-item about standing was well received; however, ‘electronic device’ did not prompt participants to think about television. “...an electronic device, I straightaway think of a tablet or smartphone something portable. So, my head... didn’t automatically go to thinking about television”. Another participant initially said zero in response to sub-item, for the same reason “That’s why I said zero, but if we’re talking about the actual TV while standing. James is a bit of a mover and a groover, so he will stand up, he’ll jump on the couch, he’ll lie down. So, he might be standing for a small portion of that time... maybe 30 min... he’s standing during that two-hour period”. Decision Process: Participants were confident of their child’s preference to either sit or stand, which resulted in a quick and confident response to the sub-item. “It could be sitting playing with toys in front of the TV. It’s... not just sitting on the couch, but he’s rarely up and about when something’s on”. Response process: Closed screen time response options required additional choices to accommodate higher screen time estimates “He’s very much into TV. Basically, so he could watch that hour in the morning, possibly an hour in the afternoon, and then even a movie in the evening with us or with his brother or something like that. So, it could be to my disgust about four hours on a weekend.” Suggested modifications to wording: Participants preferred questions related to standing as opposed to “... how much time did they watch and electronic device while sitting”. Asking about the exception to the rule made sense to participants. | ‘(24 h)’ removed. Sub-item revised—‘electronic device’ replaced with television programs, videos/internet clips, or movies. Additional closed response options added, Between 2 and 3 h per day’ and ‘More than 3 h per day’. 3a Thinking about the past week, on a typical weekday, how much time did your child spend watching television programs, videos/internet clips or movies on a television, computer, or portable/mobile device such as iPad, tablet or smartphone? 3b Of this time, how much time did they spend watching television programs, videos/internet clips, or movies while standing? |
4a Thinking about the past week, on a typical weekend day (24 h) how much time did your child spend watching television programs, videos/internet clips or movies on a television, computer, or portable/mobile device such as tablet or smartphone? 4b Of this time, how much time did they watch an electronic device while standing? | Suggested modifications to wording: Participants reported that the types of screens asked about in the question were adequate. Could not provide additional examples to add. | Modifications made as per weekday items 3a and 3b |
5a Thinking about the past week, on a typical weekday (24 h), how much time did your child spend playing games or using apps on electronic devices such as a computer or laptop, videogame console, iPad, tablet, smartphone, or any electronic gaming device? 5b Of this time, how much time did they play with an electronic device while standing? | Decision Process: Some participants were unsure of whether to include screen-based communication like FaceTime or to include the use of electronic toys, e.g., imitation laptops with musical buttons “he’s got some toys that are electronic, that make noise and things, but I probably wouldn’t put it in that same category that you’re after”. Response Process: As with 3a and 3b, parents indicated closed screen time response options required additional choices to accommodate higher screen time estimates. | ‘(24 h)’ removed. ‘Electronic device’ replaced with screen-based device and examples revised to include looking at photos and video chat. Two more closed options added to responses:
5b Of this time, how much time did they spend playing games, looking at photos, or video chatting (e.g., FaceTime, Zoom, Skype) while standing? |
6a Thinking about the past week, on a typical weekend day (24 h), how much time did your child spend playing games or using apps on electronic devices such as a computer or laptop, videogame console, iPad, tablet, smartphone, or any electronic gaming device? 6b Of this time, how much time did they play with an electronic device while standing? | Decision process for these items consistent with 5a and 5b. | 6a Thinking about the past week, on a typical weekend day, how much time did your child spend playing games, looking at photos, or video chatting (e.g., FaceTime, Zoom, Skype) on a screen-based device such as a computer or laptop, video game console, iPad, tablet, or smartphone? 6b Of this time, how much time did they spend playing games, looking at photos, or video chatting (e.g., FaceTime, Zoom, Skype) while standing? |
7 Thinking about the past week, how much time did your child spend in sleep during the NIGHT? (e.g., 2 h 15 min) | General comprehension: The example response is not relevant to night-time sleep “(I need to) come up with a number that reflects all seven nights, and then the number at the end is throwing me because it says two hours, you know, for example two hours and 15 min”. The phrase ‘spend in sleep’ continued to create confusion. Decision Process: Consistent with previous rounds, participants referred to the child’s bedtime, then waketime and calculated the difference “he goes to bed normally about 7.30 and then he sleeps until most days until 6.30. So, um, I would say, what’s that? I’m just trying to work that out, maybe between 10- and 11-h sleep”. Response process: Some participants interpreted the question as asking about the total amount of sleep over the week i.e., adding up seven nights worth of sleep, rather than a typical night “if we’re talking about during the night, each night he sleeps for about nine or 10 h, and if it’s talking about the last week, am I giving a weekly amount?” Having closed responses aided with the interpretation of the question—the range of options available made it clearer that the question was asking for an estimate for one night, not the total for the week “it’s a lot easier to give an answer, having those options to choose from”. | ’Spend in sleep’ changed to ‘sleep in total’, ‘on a typical night’ added, and example times removed. 7 Thinking about the past week, on a TYPICAL NIGHT, how many hours/minutes did your child sleep in total during the night? |
8 Thinking about the past week, how much time did your child spend in sleep during the DAY? (e.g., 2 h 15 min) | General comprehension: The phrase ‘spend in sleep’ continued to create confusion. | ‘Spend in sleep’ changed to ‘sleep in total’, ‘on a typical day’ added, and example times removed to avoid social desirability bias in reporting, e.g., if participants perceive this is an ideal sleep duration, they may alter their response accordingly. 8 Thinking about the past week, on a TYPICAL DAY, how many hours/minutes did your child sleep in total during the day? |
MBQ-B * | ||
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Item | Main findings | Modifications, actions and item taken forward to validation study |
1 This question is about the times when your baby is awake and placed on their tummy for playtime while you are watching them. Thinking about the past week, on how many days did you place your baby on their tummy for play? | General comprehension: Participants noting that tummy time is less relevant once infant is rolling. Response process: Requirement to recall over the duration of a week resulting in ceiling effect | Branching logic about crawling which was added to software after third round of interviews modified to: Does your baby roll? Yes/No If the baby has reached their ‘rolling’ milestone, parents were directed to answer item; if not, this item was deemed ‘not applicable’ and parents skipped this item and were directed to next item. Responses revert to daily frequency. 1 Thinking about the past week, how many times EACH DAY did you usually place your baby on their tummy for play? |
2 Thinking about the past week, on a TYPICAL DAY, how much time in total did you do some active play with your baby? Active play can be playing with toys or objects while lying or sitting on the floor, crawling on the floor or through tunnels, or pulling up to a standing position while holding on to furniture. | General comprehension: Participant consistently misinterpreted the definition of active play as reflected in their decision-making process. “it has made me think maybe what I considered active play, isn’t what was being asked” “it depends on how the mums’ interpret active play” Decision process: Participants recalled their daily routine to come to an answer, and systematically recalled active play as all time that their child was not sleeping or eating. “I tend to work backwards... taking away that overnight sleep time, to starting like a whole day. Um, hours per day, and then I’m taking off... naptime and then other sedentary time, where they’re not doing anything (like in the car)” Some participants also included time spent in highchairs and prams depending on what the child was doing “so if he’s sitting in the pram or car but is playing with a toy, that could be counted here?” “24 h, minus the 11 h sleeping, then it will be 13 plus nap time, it will be 11, plus eating, maybe nine to 10 h... if he’s awake and not eating then he would be like, doing all this (referring to examples in question)” “He’s just active, just go all the time”. Response Process: Due to the misinterpretation of the definition of active play, several participants overestimated time when presented with the open option. For example, one participant chose seven hours for an open response, and was then surprised to see the upper limit of closed responses offered was ‘more than 2 h per day’, “I’m a little surprised that, that more than two hours per day is maybe the top, the highest answer option”. Another, when asked if the response she wanted to provide was there, replied “Um, I guess technically no, but five hours is more than two hours per day, so, yes.” | Examples revised to be consistent with Australian physical activity and sedentary behaviour guidelines which emphasis supervised interactive play. 2 Thinking about the past week, on a TYPICAL DAY, how much time in total did you do some active play with your baby? Active play could be crawling on the floor with your baby, rolling around the floor with your baby, playing at the park, dancing with your baby, chasing your baby. Item related to restraint time added. 3 Thinking about the past week, on a TYPICAL DAY, how much time in total did your baby spend in a baby carrier or sling, car seat or capsule, stroller or pram, highchair, bouncer, jolly jumper or play pen? |
3 Thinking about the past week, on a TYPICAL DAY, how much time did your baby spend watching television programs, videos/internet clips or movies on a television, computer or portable/mobile device such as iPad, tablet or smartphone? | Decision process: Participants refer to usual routine, or the length of their child’s favourite television show to derive an answer “I try to limit him, like maybe 15 min in the morning, when I’m trying to get ready... I get him changed, and he still wants me, he still wants to cling on to me. Then I just put him in front of the TV and just play that show so I can get myself ready... give him like 10 to 15 min, play a few songs and yeah”. Response Process: preference for open versus closed responses varied. “I feel like I can give a precise response there, rather than giving a range where I’m somewhere within that range... I was like, being precise so, I like the (open response)”. “I think for timewise (it’s) always easier to be given a range to pick from because... it’s harder to figure out a definite answer for time”. | Nil modifications. Item taken forward to validation study as is. |
4 Thinking about the past week, on a TYPICAL DAY, how much time did your baby spend playing games, looking at photos, or video chatting (e.g., FaceTime, Zoom, Skype) on a screen-based device such as a computer or laptop, video game console, iPad, tablet, or smartphone? | General comprehension: Participants understood the term ‘video chatting’ and examples “I think they’re good examples”. Decision process: Participants found this more challenging to quantify than the previous question as watching television tends to happen daily, while these activities are not “this one’s probably less regular than just the TV, um, because he, he’s just still so little”. For these activities which happened infrequently, e.g., once per week, participants proceeded to mentally average the time over seven days, rather than consider what might happen on a ‘typical day’. “I can’t give an answer there because (we) don’t video chat with… anyone every single day. Maybe video chat once a week with my parents because they’re overseas and with my husband’s parents for around 10 to 15 min... Because I don’t do it every day... I can’t give an average time that my son (would) do it every day, on a typical day. Participant: “Five minutes” DB: “How do you come to that answer?” Participant: “Average out the time spent... if he’s on 30 min each week. Then I average it out to seven days” | Nil modifications to item, but definition of a ‘typical day’ added to instructions for the questionnaire as a whole “A typical day is something your child does on most days”. |
5 Thinking about the past week, on a TYPICAL NIGHT, how much time did your baby sleep in total during the night? | Nil concerns noted in this round. | Nil modifications. Item taken forward to validation study as is. |
6 Thinking about the past week, on a TYPICAL DAY, how much time did your baby sleep in total during the day? | Response Process: In this round, participants reported a preference for closed response options which provide a range, rather than having to decide on fixed number for the open response “It’s hard to have a definite, definite answer for time, because we’re human, we don’t... have a strict schedule but it’s hard to actually have like a definite answer for time, because it can be different every day. That’s why I think having a range is easier”. | Nil modifications. |
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© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Byrne, R.; Terranova, C.O.; Chai, L.K.; Brookes, D.S.K.; Trost, S.G. Cognitive Testing of Items Measuring Movement Behaviours in Young Children Aged Zero to Five Years: Development of the Movement Behaviour Questionnaires for -Baby (MBQ-B) and -Child (MBQ-C). Children 2023, 10, 1554. https://doi.org/10.3390/children10091554
Byrne R, Terranova CO, Chai LK, Brookes DSK, Trost SG. Cognitive Testing of Items Measuring Movement Behaviours in Young Children Aged Zero to Five Years: Development of the Movement Behaviour Questionnaires for -Baby (MBQ-B) and -Child (MBQ-C). Children. 2023; 10(9):1554. https://doi.org/10.3390/children10091554
Chicago/Turabian StyleByrne, Rebecca, Caroline O. Terranova, Li Kheng Chai, Denise S. K. Brookes, and Stewart G. Trost. 2023. "Cognitive Testing of Items Measuring Movement Behaviours in Young Children Aged Zero to Five Years: Development of the Movement Behaviour Questionnaires for -Baby (MBQ-B) and -Child (MBQ-C)" Children 10, no. 9: 1554. https://doi.org/10.3390/children10091554