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      Cross-cultural adaptation, content validity, and feasibility of the school physical activity and nutrition environment tool Translated title: Adaptación transcultural, validación de contenido y factibilidad de una herramienta para evaluar los entornos de actividad física y nutrición en las escuelas

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          Abstract Objective To perform a cross-cultural adaptation, content validity and feasibility of The School Physical Activity and Nutrition Environment Tool (SPAN-ET) for the Spanish context. It is a valuable tool for making comprehensive assessments of school environments in three environmental categories: policy, situation/social, and physical. Method We followed the cross-cultural adaptation guidelines which consist of a five-stage methodological approach: 1) forward translation, 2) synthesis, 3) back translation, 4) adaptation to the Spanish context, and 5) pilot testing. In addition, an expert panel performed a content validity analysis to assess the level of comprehensibility, applicability, and cultural appropriateness of the SPAN-ET for its use in Spain. The pilot test was carried out in five schools to assess the feasibility of the tool in the Spanish context. Results After applying the guidelines for the translation and cultural adaptation of the SPAN-ET into the Spanish context, the new tool (SPAN-ET-ES) preserves the main dimensions of the original document to evaluate school environments in Spain. The evaluation of the SPAN-ET-ES, done by an expert panel, concluded that items included in the revised version of the SPAN-ET-ES were relevant (S-CVI/Ave=0.96), clear (S-CVI/Ave=0.96), simple (S-CVI/Ave=0.98), and non-ambiguous (S-CVI/Ave=0.98) for the Spanish context. Finally, the pilot test offered empirical evidence for the feasibility and content validity of the SPAN-ET-ES at assessing school environments in Spain. Conclusions SPAN-ET-ES is a feasible tool for assessing nutrition and physical activity environments at schools in Spain.

          Translated abstract

          Resumen Objetivo Realizar una adaptación transcultural, validación de contenido y factibilidad de una herramienta para evaluar los entornos de actividad física y nutrición en las escuelas (SPAN-ET, School Physical Activity and Nutrition Environment Tool) en el contexto español. Se trata de una valiosa herramienta para realizar evaluaciones exhaustivas del microentorno escolar en tres categorías: física, situacional y de políticas. Método A partir de las directrices de adaptación transcultural se aplicó un enfoque metodológico de cinco etapas: 1) traducción, 2) síntesis, 3) retrotraducción, 4) adaptación al contexto español, y 5) prueba piloto. Además, un panel de expertos realizó un análisis de validez del contenido para evaluar el nivel de comprensibilidad, aplicabilidad y adecuación cultural de la SPAN-ET para su uso en España. Finalmente, se realizó una prueba piloto en cinco escuelas para evaluar la factibilidad de la herramienta en el contexto español. Resultados Tras seguir las directrices para la traducción y la adaptación cultural de SPAN-ET, la nueva herramienta (SPAN-ET-ES) conserva las principales dimensiones del documento original para evaluar los entornos escolares en España. La validación de contenido de SPAN-ET-ES, realizada por un panel de expertos, concluyó que los elementos incluidos eran relevantes (S-CVI/Ave=0,96), claros (S-CVI/Ave=0,96), simples (S-CVI/Ave=0,98) y no ambiguos (S-CVI/Ave=0,98) para el contexto español. Finalmente, la prueba piloto ofreció evidencia empírica de su factibilidad para evaluar los microentornos escolares en España. Conclusiones SPAN-ET-ES es una herramienta factible para evaluar los entornos de nutrición y actividad física en las escuelas en España.

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          Determination and Quantification Of Content Validity

          MARY LYNN (1986)
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            Effectiveness of school food environment policies on children’s dietary behaviors: A systematic review and meta-analysis

            Background School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear. Objective To systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children. Methods We systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children’s dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg’s and Egger’s test evaluated potential publication bias. Results From 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified. Conclusions Specific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health.
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              Physical activity during school recess: a systematic review.

              Interest has increased in examining the physical activity levels of young people during school recess. Identifying correlates of their recess physical activity behaviors is timely, and would inform school-based physical activity programming and intervention development. The review examined the correlates of children's and adolescent's physical activity during school recess periods. A systematic search of six electronic databases, reference lists, and personal archives identified 53 studies (47 focused on children) published between January 1990 and April 2011 that met the inclusion criteria. Data were analyzed in 2011. Correlates were categorized using the social-ecological framework. Forty-four variables were identified across the four levels of the social-ecological framework, although few correlates were studied repeatedly at each level. Positive associations were found of overall facility provision, unfixed equipment, and perceived encouragement with recess physical activity. Results revealed that boys were more active than girls. Providing access to school facilities, providing unfixed equipment, and identifying ways to promote encouragement for physical activity have the potential to inform strategies to increase physical activity levels during recess periods. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                gs
                Gaceta Sanitaria
                Gac Sanit
                Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS) (Barcelona, Barcelona, Spain )
                0213-9111
                October 2022
                : 36
                : 5
                : 459-467
                Affiliations
                [2] Barcelona Cataluña orgnameUniversitat Ramon Llull orgdiv1Blanquerna Faculty of Health Science Spain
                [1] Santa Coloma de Gramenet Barcelona orgnameUniversity of Barcelona, Campus de l'Alimentació de Torribera orgdiv1Faculty of Pharmacy orgdiv2Department of Nutrition, Food Science, and Gastronomy, XaRTA - INSA Spain
                [3] Corvallis Oregon orgnameOregon State University orgdiv1College of Public Health and Human Sciences United States
                Article
                S0213-91112022000500009 S0213-9111(22)03600500009
                10.1016/j.gaceta.2021.03.007
                34172312
                5af5b148-f64b-475b-806b-b52d827352a0

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 21 January 2021
                : 19 March 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 9
                Product

                SciELO Spain

                Categories
                Original Articles

                Evaluation,School environment,SPAN-ET,Cross-cultural adaptation,Evaluación,Entorno escolar,Adaptación transcultural

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