Clustering of Obesity-Related Risk Behaviors Among Families With

Preschool Children Using a Socioecological Approach: Cross-Sectional Study

Yes No Unclear Not
applicable
1. Were the criteria for inclusion in the sample clearly
defined?
Apakah criteria untuk dimasukkan dalam
sampeldidefinisikandenganjelas?

Para penulisharusmemberikankriteriainklusidaneksklusi
yang jelas yang
merekakembangkansebelumperekrutanpesertapenelitian.
Kriteriainklusi / eksklusiharusditentukan (misalnya, risiko,
tahapperkembanganpenyakit) dengancukup detail
dansemuainformasipenting yang diperlukanuntukpenelitian. √ □ □ □
Comment : Yes
In this journal explained related inclusion. Sample is
mothers with preschool-aged children (ages 2 to 5 years)
who participated in the online Home Obesogenic Measure
of Environments (HOMES). To be eligible, panel members
had to be female, 18 to 45 years of age, English speaking,
have at least one preschool child (aged 2 to 5 years), and be
the main house hold food gate keeper (ie,make most orall
food purchasing and meal decisions).

2. Were the study subjects and the setting described in detail?

Apakahsubjekpenelitiandanlatar yang dijelaskansecararinci?

Sampelpenelitianharusdijelaskansecaracukuprincisehinggap
enelitilaindapatmenentukanapakahitusebandingdenganpopul
asi yang menarikbagimereka. Para
penulisharusmemberikandeskripsi yang
jelastentangpopulasidari mana √ □ □ □
pesertapenelitiandipilihataudirekrut, termasukdemografi,
lokasi, danperiodewaktu.

Comment: Yes
Mothers with preschool-aged children (ages 2 to 5 years)
who participated in the online Home Obesogenic Measure
of Environments (HOMES) in the United States

3. Was the exposure measured in a valid and reliable way?

Apakahpaparandiukurdengancara yang valid
dandapatdiandalkan?

Penelitianharussecarajelasmenggambarkanmetodepengukur
anpaparan. Menilaivaliditasmensyaratkanbahwa √ □ □ □
'standaremas' tersediauntukukuran yang dapatdibandingkan.
Validitaspengukuranpaparanbiasanyaberhubungandenganap
akahukuransaatinisesuaiatauapakahukuranpaparanmasalalud
 iperlukan.
Reliabilitasmengacupada proses yang
termasukdalamstudiepidemiologiuntukmemeriksapengulang
anpengukuraneksposur. Inibiasanyatermasukreliabilitas
intra-observer danreliabilitas inter-observer.

Comment : Yes
Details on the development and content of the online
HOMES survey and research protocol are described else
where. In brief, the HOMES cross-sectional survey was
developed by researchers at Rutgers University as part of a
larger research study exploring obesity risk in mothers of
young children and included an array of valid, reliable
measures that focused on mother’s sociodemographic, health-
related, intrapersonal, social, and home physical environment
characteristics. Measures were selected to yield an
understanding of socioecological factors pertaining to diet
and physical activity.
The survey was posted online using Qualtrics platform and
pilot-tested with 48 participants to gauge completion time,
identify further refinements needed to improve clarity and
ease of completion, ensure protocols for scoring of scales
were accurate, and conduct preliminary psychometric
analyses. Administration of an online format was chosen for
ease of data collection and convenience to participants, to
help reduce the potential for social desirability bias that can
occur during in-person administration, and to increase
researcher ability to reach individuals who would be other
wise difficult to access (ie, distance from researchers or
limited time to meet in-person). Multimedia Appendix 1
lists the variables used in this secondary analysis of the
online survey including number of items, possible score
range, scale type, and internal consistency (Cronbach alpha
when applicable)

4. Were objective, standard criteria used for measurement of

the condition?
Apakahobyektif, kriteriastandar yang
digunakanuntukmengukurkondisi?

Pentinguntukmenentukanapakahpasiendilibatkandalampenel
itianberdasarkan diagnosis ataudefinisi yang ditentukan.
Inilebihcenderungmenurunkanrisiko bias.
Karakteristikadalahpendekatanlain yang
bergunauntukmencocokkankelompok, danstudi yang √ □ □ □
tidakmenggunakanmetodediagnostiktertentuataudefinisiharu
smemberikanbuktitentangpencocokanolehkarakteristikkunci
.
Comment : Yes
Mothers with preschool-aged children (ages 2 to 5 years)
who participated in the online Home Obesogenic Measure
of Environments (HOMES) survey were examined in
clustering of four healthy recommended behaviors (ie,
mother’s fruit and vegetable intake ≥5 perday, sedentary
screen time <4 hours perday, sugar-sweetened beverage
 intake <1 time/day, and increased physical activity level).

5. Were confounding factors identified?

Apakahfaktorpembaurteridentifikasi?

Perancutelahterjadi di mana
efekpaparanintervensidiperkirakan bias
olehadanyabeberapaperbedaanantarakelompokpembanding
(terlepasdaripaparan yang diteliti / menarik). Perancu yang
khastermasukkarakteristikdasar, faktorprognostik,
ataueksposurbersamaan (misalnyamerokok).
Perancuadalahperbedaanantarakelompokpembandingdanitu
mempengaruhiarahhasilpenelitian.
Sebuahpenelitianberkualitastinggipadatingkatdesainkohorta
kanmengidentifikasipembaurpotensialdanmengukurnya
(jikamemungkinkan). Inisulituntukstudi di mana
faktorperilaku,
sikapataugayahidupdapatberdampakpadahasil. √ □ □ □
Comment: Yes
Taking as implistic approach can obscure true inter
relationships between health behaviors. Considering the
complexity of behaviors is important when developing
obesity prevention interventions; however, it is also
important to note that cluster analysis is an exploratory
technique. The cluster profiles observed in our study may
have differed with the inclusion of different variables,
clustering algorithm, or sample. Other limitations are the
cross-sectional design that limits theability to make
interferences of causality from the observed associations,
and the potential for reporting error and bias given all
information was self-reported by participants.

6. Were strategies to deal with confounding factors stated?

Strategiuntukmenanganiefekfaktorperancudapatditanganidal
amdesainpenelitianataudalamanalisis data.
Denganmencocokkanataumengelompokkansampelpeserta,
efekdarifaktorperancudapatdisesuaikan.
Ketikaberhadapandenganpenyesuaiandalamanalisis data,
nilaistatistik yang digunakandalampenelitian.
Sebagianbesarakanmenjadibeberapabentukanalisisregresimu
ltivariatuntukmemperhitungkanfaktorpembaur yang diukur.
√ □ □ □
Comment: Yes
Ward’s hierarchical analysis revealed two-cluster solution
for the participants using the four standardized measures (ie,
mother’s physical activity level, sedentary screen time, daily
fruit and vegetable intake, and sugar-sweetened beverage
intake). The two clusters of mothers were broadly divided as
less healthy/inactive moms (n=280) and health
conscious/active moms(n=216).

7. Were the outcomes measured in a valid and reliable way? √ □ □ □

Apakahhasildiukurdengancara yang valid
dandapatdiandalkan?

Baca bagianmetodekertas.
Jikamisalnyakankerparudinilaiberdasarkandefinisi yang
adaataukriteriadiagnostik,
makajawabanataspertanyaaninikemungkinanbesaradalahya.
Jikakankerparudinilaimenggunakanpengamat yang
dilaporkan, atauskala yang dilaporkansendiri,
risikopelaporanberlebihanatau di bawahmeningkat,
danobjektivitasdikompromikan. Yang penting,
tentukanapakahalatukur yang digunakanadalahinstrumen
yang
divalidasikarenainimemilikidampaksignifikanpadavaliditasp
enilaianhasil.
Setelahmenetapkanobyektivitasinstrumenpengukuranhasil
(mis. Kankerparu),
pentinguntukmenentukanbagaimanapengukurandilakukan.
Apakahmereka yang terlibatdalammengumpulkan data yang
dilatihataudididikdalampenggunaaninstrumen / s?
(misalnyaradiografer). Jikaadalebihdarisatupengumpul data,
apakahmerekaserupadalamhaltingkatpendidikan,
pengalamanklinisataupenelitian,
atautingkattanggungjawabdalambagianpenelitian yang
dinilai?

Comment: Yes
Frequencies and percents of clustering variables were
examined to describe the sample of mother’s meeting these
defined fruit and vegetable intake, sugar-sweetened
beverage intake, sedentary screen time, and physical activity
level behaviors. Before clustering, correlations among the
four cluster variables were examined to determine
significant associations using Spearman rank order
correlations. For cluster analysis, the clustering variables
were standardized (z scores) to permit comparisons of
means and variances. The four clustering variables
(ie,mother’sphysicalactivitylevel, sedentary screen time,
daily fruit and vegetable intake, and sugar-sweetened
beverage intake) were considered as continuous variables in
the model. Ward’s method with squared Euclidean distances
was used for the cluster analysis using the standardized
continuous variables mentioned previously.
The number of clusters that emerged was identified by
visually inspecting the dendogram and noting the point at
which the scree graph angled most sharply upward.
To further establish how the two clusters differed from one
another, variables used in the cluster analysis as well as
intrapersonal, social environment, and home physical
environment variables not used in defining the clusters,
were examined using independent t-tests for continuous
variables and chi-square analysis for categorical variables.
Given the large number of tests, P values were reduced to
P<.010 to be considered statistically significant.All analyses
were performed using SPSS version24.
8. Was appropriate statistical analysis used?
Apakahanalisisstatistik yang sesuaidigunakan?

Sepertihalnyapertimbangananalisisstatistik,
pertimbanganharusdiberikankepadaapakahadametodestatisti
kalternatif yang lebihtepat yang dapatdigunakan.
Bagianmetodeharuscukuprinciuntukpeninjauuntukmengiden √ □ □ □
tifikasiteknikanalitis yang digunakan (khususnya,
regresiataustratifikasi)
danbagaimanapembaurspesifikdiukur.√

Comment: Yes
This journal has used statistics, such as diagrams, data
tables

Overall appraisal: Include √ Exclude □ Seek further info □

Comments : Based on the assessment of critical appraisal checklist for analytical cross sectional
studies, it can be concluded that the results of this cross sectionall study have been fully accepted. The
results of this study also explain the results clearly.