Interrater Reliability of the ENERGY Photo-Rating Instrument for School Environments Related to Physical Activity and Eating

in Journal of Physical Activity and Health
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $115.00

1 year subscription

USD  $153.00

Student 2 year subscription

USD  $218.00

2 year subscription

USD  $285.00


The school environment can play an important role in the prevention of childhood overweight and obesity. Photos of the school environment may contribute to more adequate measurement of the school environment, as photos can be rated by different assessors. We aimed to examine the interrater reliability for rating characteristics of primary school environments related to physical activity and eating.


Photos taken at 172 primary schools in 7 European countries were rated according to a standardized protocol. Briefly, after categorizing all photos in subsections of physical activity or eating opportunities, 2 researchers independently rated aspects of safety, functionality, aesthetics, type of food/drinks advertised, type/variety of foods provided. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) and Cohen’s kappa.


Six subsections of the photo-rating instrument showed excellent (ICC or Cohen’s kappa ≥0.81) or good (ICC or Cohen’s kappa 0.61 to 0.80) interrater reliability. Outdoor physical activity facilities (ICC = 0.54) showed moderate, and school canteens (Cohen’s kappa = 0.05) and vending machines showed poor (Cohen’s kappa = 0.16) interrater reliability.


Interrater reliability of the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) photo-rating instrument was good-to-excellent for 6 out of 9 characteristics of primary school environment components related to physical activity and eating.

Altenburg ( and Chiu are with the Dept of Public and Occupational Health; Velde and Brug are with the Dept of Epidemiology & Biostatistics; VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Moschonis and Manios are with the Dept of Nutrition and Dietetics; Harokopio University, Athens, Greece. De Bourdeaudhuij is with the Dept of Movement and Sports Sciences, Ghent University, Gent, Belgium. Vik is with the Dept of Public Health, Sport, and Nutrition, University of Agder, Kristiansand, Norway. Lien is with the Dept of Nutrition, University of Oslo, Oslo, Norway. Chinapaw is with the Dept of Public and Occupational Health, EMGO Institute, Amsterdam, The Netherlands.