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: X-2 = 222.69, df = 74, p <.01; X-2/df = 3.01; CFI =.96; SRMR =.04; RMSEA =.07, Cl.06/.08; FHC-NU: X-2 = 278.30, df = 113, p <.01,X-2/df = 2.46, CFI =.96; SRMR =.04; RMSEA =.06, Cl.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.