Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 2 - Apr/Jun - 2019

Original Article Imprimir 

Páginas 7 a 15


Reproducibility of the printed version of the Webcas Quiz

Reproductividad de la versión impresa del Webcas Quiz

Reprodutibilidade da versao impressa do Questionário Webcas

Autores: Rosimeide Francisco Santos Legnani1; Elto Legnani2; Rafael Alexandre Quentino3; Michael Pereira da Silva4; Eliane Denise Araujo Bacil5; Wagner de Campos6

1. Doctorate in Physical Education by the Federal University of Paraná (UFPR). Teacher of the State University of Ponta Grossa (UEPG). Ponta Grossa, PR, Brazil
2. Doutorate in Physical Education by the Federal University of Paraná (UFPR). Teacher of the Federal Technological University of Paraná (UTFPR). Curitiba, PR, Brazil
3. Mastering in Physical Education by the Federal Technological University of Paraná ·(UTFPR). Curitiba, PR, Brazil
4. Doutorate in Physical Education by the Federal University of Paraná (UFPR). Teacher by the Midwest State University (UNICENTRO). Guarapuava, PR, Brazil
5. Doutorate in Physical Education by the Federal University of Paraná (UFPR). Teacher by the Positivo University (UP). Curitiba, PR, Brazil
6. Post-doctoral in Motor Development and Sports Studies by the Pittsburgh University (PITT - EUA). Teacher by the Federal University of Paraná (UFPR). Curitiba, PR, Brasil

Correspondência:
Rosimeide Francisco Santos Legnani
Universidade Estadual de Ponta Grossa - Campus Uvaranas - Departamento de Educaçao Física
Av. General Carlos Cavalcanti, no 4748
Ponta Grossa, PR, Brasil. CEP 84030-900
(legnanirosi@gmail.com)

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Keywords: Reproducibility of results; Questionnaires; Students.
Palabra Clave: Reproductividad de los test; Cuestionarios; Estudiantes.
Descritores: Reprodutibilidade dos testes; Questionários; Estudantes.

Abstract:
OBJECTIVE: To analyze the reproducibility of the printed version of the WebCas VI questionnaire.
METHODS: For the test and retest of the study participated 255 students between 9 and 15 years old, intentionally selected at a public educational institution in Curitiba-PR. The WebCas VI consists of seven sections: sociodemographic variables, sleep time, physical activity, transport to/from school, frequency of food consumption, consumption of alcoholic beverages and cigarettes, and socioeconomic factors.
DATA SYNTHESIS: The data analysis was performed using the percentage of agreement, Kappa PABAK (KP) and agreement correlation coefficient.
RESULTS: Students presented a mean age of 13.2 (± 1.1) years and an estimated caloric expenditure of 2261.6 (± 591.5) MET's. The percentages of concordance ranged from 40.8% to 99.3%. The lowest KP value was observed for sweet consumption variable (0.59, 95% CI: 0.51 - 0.67) and the highest for the cigarette consumption variable (1.00, 95% CI 0.93-1, 00). No variable had weak or poor KP values. For the continuous variables, the highest correlation coefficient value was 0.83 (95% CI: 0.42-0.65) and the lowest was 0.11 (95% CI: 0.02 - 0.13). Only two variables had weak concordance correlation coefficients (r <0.40).
CONCLUSION: The indicators of reproducibility of the items of the WebCas VI questionnaire were considered adequate for both categorical and continuous variables.

Resumen:
OBJETIVO: Analizar la reproductividad de la versión impresa del cuestionario WebCas VI. Métodos: Para el test y re-test del estudio participaron 255 estudiantes entre 9 y 15 años, intencionalmente seleccionados en una institución de enseñanza pública de Curitiba-PR. El WebCas VI está compuesto por siete secciones: variables sociodemográficas, hora de sueño, actividad física, desplazamiento a la escuela, frecuencia de consumo de alimentos, consumo de bebidas alcohólicas y cigarro y cuestiones socioeconómicas.
SINTESIS DE DATOS: El análisis de los datos fue realizado por medio del porcentaje de concordancia, Kappa PABAK (KP) y coeficiente de correlación de concordancia.
RESULTADOS: Los estudiantes presentaron promedio de edad de 13,2 (±1,1) años y gasto calórico estimado de 2261,6 (±591,5) MET's. Los porcentajes de concordancia variaron de 40,8% a 99,3%. El menor valor KP fue observado en la variable dulces (0,59; IC 95%: 0,51 - 0,67) y el mayor en la variable consumo de cigarros (1,00; IC 95%: 0,93 - 1,00). Ninguna variable presentó valores de KP débil o pobre. Para las variables continuas, el mayor valor de coeficiente de correlación de concordancia fue de 0,83 (IC 95%: 0,42 -0,65) y el menor fue de 0,11 (IC 95%: 0,02 -0,13). Solamente dos variables analizadas presentaron coeficientes de correlación de concordancia débil (r < 0,40).
CONCLUSION: Los indicadores de reproductividad de los ítems del cuestionario WebCas VI fueron considerados adecuados tanto para las variables categóricas como para las continuas.

Resumo:
OBJETIVO: Analisar a reprodutibilidade da versao impressa do questionário WebCas VI.
MÉTODOS: Para o teste e reteste do estudo participaram 255 estudantes entre 9 e 15 anos, intencionalmente selecionados em uma instituiçao de ensino pública de Curitiba-PR. O WebCas VI é composto por sete seçoes: variáveis sociodemográficas, hora de sono, atividade física, deslocamento à escola, frequência de consumo de alimentos, consumo de bebidas alcoólicas e cigarro e questoes socioeconômicas.
SINTESE DE DADOS: A análise dos dados foi realizada por meio do percentual de concordância, Kappa PABAK (KP) e coeficiente de correlaçao de concordância.
RESULTADOS: Os estudantes apresentaram média de idade de 13,2 (±1,1) anos e gasto calórico estimado de 2261,6 (±591,5) MET's. Os percentuais de concordância variaram de 40,8% a 99,3%. O menor valor KP foi observado na variável doces (0,59; IC 95%: 0,51 - 0,67) e o maior na variável consumo de cigarros (1,00; IC 95%: 0,93 - 1,00). Nenhuma variável apresentou valores de KP fraco ou pobre. Para as variáveis contínuas, o maior valor de coeficiente de correlaçao de concordância foi de 0,83 (IC 95%: 0,42 -0,65) e o menor de foi de 0,11 (IC 95%: 0,02 -0,13). Somente duas variáveis analisadas apresentaram coeficientes de correlaçao de concordância fraco (r < 0,40).
CONCLUSAO: Os indicadores de reprodutibilidade dos itens do questionário WebCas VI foram considerados adequados tanto para as variáveis categóricas quanto para as contínuas.

INTRODUCTION

The health-related behaviors (CRS) of children and adolescents may be totally different, and although many researchers study this variable, much research remains to be done. CRS tends to change according to a number of factors: culture, ethnicity and customs can be influenced outside from childhood extending throughout life. Thus, CRS, such as physical activity level (NAF), sufficient sleep, healthy eating, no alcohol and cigarette consumption can be related to the numerous health benefits in children and adolescents1,2. However, measuring these variables in this age group still has a number of limitations for health researchers, especially due to the fragility in the process of construction, testing and validation of questionnaires3.

When considering these limitations, the use of printed questionnaires is widely used in data collection and monitoring of these behaviors in different geographic regions and contexts, mainly due to the possibility of gathering a lot of information with low cost and easy application2,4. Even if the instrument already exists and has adequate psychometric characteristics, it is necessary to test these qualities for use in a different context from the one in which it was constructed, which implies performing the procedures of validity, reliability and reproducibility5,6.

In Brazil, few studies have proposed to elaborate instruments to evaluate the CRS in adolescents3,7,8. Even so, there does not seem to be a questionnaire to assess CRS in adolescents that include the variable "sleep habits", as well as to propose to evaluate Physical Habitual Practice (PHAF) based on the Compendium of Physical Activities9. Thus, the objective of this study was to perform the validity and reproducibility procedures of the Printed Webcas Questionnaire (VI of Webcas).


METHODS

Data collection was performed in August and September 2014 (cross-sectional survey) by a trained team from the Center for Studies of Physical Activity and Health of the Federal University of Paraná (UFPR), supervised by the main researcher. The study was approved by the UFPR Human Research Ethics Committee, under the number of opinion: 684.147/2014 of June 11, 2014.

The sample consisted of 255 intentionally selected students, ages 9 to 15, of both sexes, enrolled in the daytime of a public school in the urban area of Curitiba, Paraná. The instrument was developed to evaluate the CRS, its elaboration and reproducibility process in students in two stages: elaboration of the printed version and reproducibility procedures of WebCas VI.

WebCas VI structure was elaborated by adapting sections extracted from instruments used in international studies. The questionnaire was divided into seven sections: sociodemographic variables: student code, school, city, shift, date of birth, school system (private, municipal, state, federal), body mass, height, gender and day to remember; sleep time of the previous day; reminder of the activities performed on the previous day; type of transport used when traveling to school; eating habits (frequency of food consumption); sleep habits; consumption of alcohol and cigarettes; socioeconomic questionnaire. The objective of the first section was to investigate the anthropometric and sociodemographic variables of the participants, and the second section evaluates the duration of sleep the night before.

In the third section are listed 244 physical activities (PA) with 35% of metabolic equivalent (MET) values from research with children and adolescents, the remainder comes from PA listed in the adult compendium and corrected for application to adolescents9. Each listed activity9 is equivalent to a MET value, which represents its relative intensity in multiples of the Metabolic Resting Rate (RMR) set at 1.0 Kcal/kg (weight/hour). This was represented by a six digit code where the first digit refers to the AF type; the second digit to the body position during activity, the third digit represents the context for each AF- being specific to each category of AF. PA, the fourth and fifth digits describe the specificity of each activity and the sixth digit describes the intensity reported during PA10,11.

To facilitate the interpretation of these codes for WebCas VI respondents, eight PA domains were created: Arts; Domestic activities; Personal cares; Dance; Fitness; Student activities and work; Sports; Leisure and recreation. In addition, three categories of intensity were highlighted: weak, moderate and strong, as well as possibilities of their accomplishment according to the body positions (lying, sitting and standing), making an analogy with the list of PA presented to the students, and their respective values in MET's. All AF listed in the compendium were included in one of the domains according to the body intensity and position category.

This information allowed to calculate the daily energy expenditure (GED), fractionated every fifteen minutes. Energy expenditure (GE) is represented by a continuous variable in MET, measured in kilocalories per day (Kcal/day), or categorical, in the case of PA (NAF) level classified as sedentary, low active, active and very active

To calculate the EG of a young person in relation to a given PA, the values in MET's must be multiplied by the young man's TMR, proceeding as follows: Kcal = MET X value TMR X body mass, duration of PA. Of which: TMR = Kcal.kg -1 min -1; body mass (MC) = kg, time = minutes11. TMRs were calculated by the equations: TMR = 0.084 X MC + 2.122 (for boys) and TMR 0.047 X MC + 2.951 (for girls) 12. These results are expressed in MJ/day, and to determine the value in kilocalories per day (Kcal/day) multiply the RMR result by 239 (constant).

In order to identify the GED, we used to record all activities performed during a day, then calculations were performed for each activity performed during the remembered day. After calculating the RMR and GED, the students' NAF was calculated according to the following equation: GED in kilocalories divided by basal caloric expenditure, resulting in an estimated proportion up to two and a half times above the RMR, according to the classification: sedentary [1-1.39], poorly active [1.4-1.59], active [1.6-1.89] and very active [1.9-2.5] 13.

Sections four and five refer to the habits of walking (home/school/home), eating and sleeping, where the last week was used as a reference. Five groups were considered for the frequency of food consumption: fruits; vegetables; salty foods, chips, chips or hot dogs; candies, stuffed cookies or chocolates; soft drinks or juices with added sugar.

The option to study these types of food is due to the greater availability of information from other surveys involving the same age group and most of these items are included in the surveys conducted by WHO4,14, in addition to having a direct relationship with health represent significantly the eating habits of adolescents.

Sleep habits were investigated with the questions related to: daytime sleepiness, nap or nap, time that usually wakes up and sleep. Section six gathered information regarding the frequency of alcohol consumption in the last 30 days, number of doses per occasion and cigarette consumption, and was referenced seven days prior to the survey15,16.

The last section of WebCas VI refers to the classification of participants' socioeconomic status. The socioeconomic level was evaluated following the recommendations of the Brazilian Association of Research Companies17, using the classification criterion; the ownership of movable property and the educational level of the head of household, which classified students in classes A, B1, B2, C1, C2, D and E. For this study, the samples were stratified into three classes: high (A + B1); average (B2 + C1 + C2); and low (D + E).

During the WebCas VI test and retest procedures the researchers made four visits to the school. At first they presented the research project, its objectives to the students, distributing the Informed Consent Form (FICF) and the Free Informed Consent Form (TALE). ). On Monday, the students who agreed to participate presented the signed TALE and the informed consent form, duly signed by their parents, and then participated in an anthropometric evaluation, using a scale (Plena brand) with a capacity of 150 kilograms and a precision of 100 grams and a measuring tape. fixed to the wall and a wooden bulkhead, placed at the vertex of the skull. On the third visit to the school, the first WebCas VI application (test) was performed. Seven days later the retest procedures were performed. There was a sample loss of 111 (44.7%) students.

Before the students began the test, the questionnaire was presented in full multimedia (Datashow), along with the AF compendium, printed on A3 paper, colored and delivered separately from the questionnaire. At this moment, the methodological procedures pertinent to the PA recall, which should be noted in the questionnaire, were explained. A 24-hour chart was presented (subdivided into hours and these into four 15-minute parts), emphasizing students to remember the activities performed the day before. For this, they were instructed to consult first the domain in which that activity was allocated (in the PA list), then the type of activity and its value in MET's, for subsequent annotation of each activity performed at 15-minute intervals.

Following the presentation and explanation of the remaining sections of WebCas VI, students were allowed to complete one question at a time until all items were completed. As students completed this completion, they were instructed to move on to the other sections: type of transportation to school, frequency of food consumption, alcohol and cigarette consumption, sleep habits, and the socioeconomic questionnaire. WebCas VI was applied by the principal researcher and two assistants in about 35 - 40 minutes.

Regarding the analysis of quantitative data, descriptive statistics procedures (mean, standard deviation and frequency distribution) were performed. Reproducibility was assessed by the Kappa agreement percentage adjusted for variables in ordinal scale (PABAK-OS), or simply PABAK (K), which can be used to calculate reliability between two applications of the same instrument when analyzing a variable in an ordinal scale of three, four, five, six or seven categories18. The K analisys were performed directly at http://www.singlecaseresearch.org.

Continuous variables were analyzed using the concordance correlation coefficient (CCCρc) technique19. The CCCρc presents one measure of precision (ρ) and one of accuracy (Cb). Where: ρ is the Pearson's correlation coefficient and Cb is a bias correction factor that measures how much the best-fit line deviates from the 45° line through the origin, thus being an accuracy measure. The values suggested for the interpretation of the Concordance Coefficients (ρc) indicate the strength of the agreement are: <0.90 = poor; 0.90 - 0.95; moderate; 0.95 - 0.99, substantial and> 0.99 = Nearly Perfect20. For variables that did not present normal distribution, data were normalized in the Medcalc15.2 statistical program for Windows, where the significance level was set at 5% (p <0.05).


RESULTS

In the reproducibility process between WebCas VI replicas, 141 students were evaluated, whose average age was 13.2 years (± 1.1), body mass of 50.3kg (± 9.9), height 1.56cm (0,07), body mass index 20.4 cm/m2 (3.34) and estimated caloric expenditure of 2261.6 MET's (591.5). Table 1 presents the sociodemographic characteristics of the study participants.




The results regarding the reproducibility procedures of the questionnaire are presented in Table 2. The percentages of agreement ranged from 40.8% to 99.3%, where higher values were observed between the variables related to cigarette consumption 99.3% (141) and alcohol (doses) with 90.1% (128), and lower values among the variables related to the frequency of food consumption (fruits and vegetables), soda consumption 40.8% (58) and sweets 43.0 % (61).




When considering the entire sample, it was found that the highest values of K were observed in: commuting to school (K = 0.84; CI: 0.77 - 0.90), alcohol and cigarette consumption (alcohol consumption > 5 doses; drunkenness); and daytime sleepiness, nap or nap. No variable presented weak or poor Kappa values.

After categorizing the analisys by gender, it was found that the highest K values were among boys in: cigarette consumption (K = 0.98; CI: 0.90 - 1.07) and nap or nap (K = 0.96; CI: 0.87 - 1.04), with the lowest values among girls in the variables fruit consumption (K = 0.56; CI: 0.43 - 0.69) and sweets (K = 0 .58; IC: 0.45 - 0.70).

When considering the entire sample (continuous variables), the highest CCCP values were observed at: weekend waking time (r = 0.70; CI: 0.42 - 0.65) and waking time today (r = 0.70; 95% CI = 0.60 - 0.77). The highest agreement value was observed in the variable wakes up Monday to Friday, (r = 0.87) for boys and (r = 0.75) for girls.

In the analisys related to Cb indicators, the variables that presented the largest indicators were: time that woke up today; time to wake up Monday to Friday; sleeping hours Monday to Friday; wakes up weekend and GEDA (Cb≥0.99), demonstrating an accuracy classified as almost perfect. These indicators remained among boys in the same variables and suffered small reductions among girls. In the analysis related to P, the highest correlation value observed was in the variable, time that wakes up Monday to Friday, both among boys (r = 0.87) and among girls (r = 0.76). Table 3 provides further details on these indicators.




DISCUSSION

The evaluation of CRS in children and adolescents is of great importance to public health, given its strong relationship with short and long term implications for youth health. Among the main results of WebCas VI reproducibility procedures, it can be highlighted that of the 12 categorical variables analyzed, nine presented agreement percentages greater than 50%; From the analyzed by the Weighted Kappa (Pabak), seven (58.33%) presented very good agreement values (K≥0.84), being: trip to school, alcohol consumption 30 days; alcohol consumption> 5 doses; intoxication; cigarette consumption; daytime sleepiness and nap moderate. Pabak values were observed in the variables that analyzed the frequency of consumption of sweets, fruits and vegetables (K = 0.61 to K = 0.65).

The reproducibility indicators observed in this study were higher than those found in the literature21 in Santa Catarina students (K = 0.23 to K = 0.58) and similar to those found by Farias Júnior3, who identified moderate to strong Kappa values in most variables related to eating habits (K = 0.44 to K = 0.69). On the other hand, when analyzing the reproducibility of the Brazilian version of the Youth Risk Behavior Survey (YRBS) instrument, the authors identified that 91% of the items presented moderate or substantial Kappa values, and these values supported the use of this version in Brazilian adolescents7.

In the analysis discriminated by sex, among 12 variables analyzed in boys, seven variables (school trip, 30-day alcohol consumption; 5-alcohol consumption; drunkenness; cigarette consumption; daytime sleepiness, nap) presented Kappa values >0.80 Among girls, this was observed in six variables (30-day alcohol consumption; alcohol consumption> 5 doses; drunkenness; cigarette consumption; daytime sleepiness and napping). The lowest Kappa values were found for the consumption of sweets (K = 0.59) and vegetables (K = 0.63) among boys, while for girls it was found in the variables fruit consumption (K = 0.56) and, candy consumption (K = 0.58).

This information can be corroborated because the reproducibility indicators can vary widely among studies (r = 0.20 to r = 0.98) 3. The divergences observed between the results of the analyzed studies may be related to the different methodologies adopted, both in data collection and treatment. In general, the questionnaires show better test and retest reproducibility than the validity indicators3,9,10,21.

Correlation values between Webcas VI application replicas for EG were r = 0.59 and reproducibility accuracy values were r = 0.99. The correlation value found in this study is lower when analyzing the reproducibility of the PAQ-C and PAQ-A22 questionnaires (r = 0.68 and r = 0.88) and when testing the agreement between the replicas of the IPAQ questionnaire application in adolescents22.

Of the eight continuous variables analyzed and considering the entire sample, five (62.5%) showed strong (> 0.70) correlation coefficients of agreement, and among boys, four variables (50%). In the analisys related to Cb indicators, seven variables presented substantial or almost perfect accuracy values (Cb≥0.98). However, among boys, these same indicators were observed in six variables, while in girls only in four variables.

In the reproducibility analysis of continuous variables, sleep habits and EG (Kcal / day), seven (87.5%) of the eight analyzed variables presented substantial or almost perfect accuracy values (Cb> 0.95). On the other hand, about 60% of the variables presented correlation values between strong (r> 0.70) and moderate (r> 0.40 <0.70). The highest correlation values were found when investigating the variables waking up and sleeping hours Monday to Friday (r = 0.80; r = 0.76). These indicators demonstrate that WebCas VI has a good ability to assess sleep habits. However, in relation to the variables sleeping time yesterday (r = 0.17) and sleeping weekend time (r = -0.03) presented the lowest correlations, demonstrating limitation of the instrument in identifying and evaluating the sleeping time in students.

In the analisys related to P indicators, it was observed that three of the eight variables analyzed presented strong correlation values (> 0.70). Among boys, these values were observed in four variables, while among girls only in one of eight variables.

WebCas VI's proposal, based on several instruments previously designed and tested in other regions and countries, may have contributed to the good reproducibility indicators observed in this study. Furthermore, the incorporation of variables related to the identification of sleep habits, as well as the use of the proposed list of activities9, can be considered as very relevant aspects of this instrument.

The intentional sample selection, the imbalance between the sample strata (63.4% boys and 36.6% girls), as well as the fact that 95% of the sample consisted of students from socioeconomic strata C + D + E, may be considered the major limitations of the study. Similarly, the scarcity of such studies, especially those that used similar statistical analisys, made the process of discussion of the results difficult. A reproducibility study with high socioeconomic students is suggested.


CONCLUSION

The instrument presented satisfactory reproducibility indicators in both variables (categorical and continuous). However, it should be noted that in relation to analisys discriminated by sex, these indicated that boys had more consistent test and retest reproducibility indicators than girls. Therefore, the authors recommend the use of WebCas in Brazilian students, especially in the Southern Region.


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