2.1. The PRELSA Scale

This study shows the results of the field test of the PRELSA Scale. This instrument was previously validated in a pilot test, in which its content validity and initial conceptual framework could be assured [33]. In this first study, a research team with a pediatrician (B.C.F-M.), a physician (M.D-R.), a doctor in statistics (J.L.G-C.), a researcher in statistics (J.C-B.), and a researcher in health sciences (C.P-M.) created an initial version of the instrument by analyzing existing scales and incorporating items and dimensions that were considered necessary. The instrument obtained in this pilot test consisted of 60 items divided into 13 dimensions.

The items in these dimensions came from already validated scales regarding feeding practices (Child Feeding Questionnaire and Feeding Practices and Structure Questionnaire [34,35]), physical activity and sedentary practices (Parenting Strategies for Eating and Activity Scale (PEAS) and Preschool Physical Activity Parenting Practices Scale [36,37]), screen viewing [38] and sleep routines (Sleep Attitudes and Beliefs Scale (SABS) and Parent–Child Sleep Interactions Scale (PSIS) [39,40]), as well as other self-developed items. The aim was to cover the dimensions that the team considered fundamental regarding obesogenic attitudes, expanding on some items that our team considered important in the current context and the situation of parental attitudes in our country. Figure 1 shows the conceptual framework developed after the pilot test and the instruments from which the items originated.

Initial conceptual framework of the PRELSA Scale. The numbers in parentheses indicate the number of items in each dimension.

The original scales were used as the basis of the items while respecting the original meanings. However, the way of expressing them was transformed so that they were all associated with parental beliefs and attitudes and not with concrete actions. The original version of the scale in Spanish with 60 items and the translation for this paper in English can be found in the Supplementary Material. The response categories in the scale items are in Likert format with values ranging from one to five, with one being disagree and five being agree, except in the Child’s Weight Concern dimension, where one indicates not at all concerned and five indicates very concerned. Most items are formulated so that a score of five is the appropriate response in terms of attitude or habit. However, some items are formulated in reverse to avoid repetitive response bias.

The complete questionnaire used in this field test consisted of two other sections. The first section consisted of 24 questions in which the parents or caregivers responded to physical characteristics (sex, age, weight, height, or number of family members), socio-economic status (family income, level of studies, work situation, or marital status), and characteristics of their environment (square meters of the home, outdoor spaces, or location of the home). The last section comprised 26 questions, where we asked about the children’s specific behaviors and habits, such as the intake of sugary foods, duration of physical activity, screen-viewing hours, or hours of night-time sleep. These questions were formulated by considering the fundamental guidelines of the World Health Organization (WHO) to prevent childhood obesity [41].