The Relationship Between the Stanford Leisure-Time Activity Categorical Item and the Godin Leisure-Time Exercise Questionnaire Among Rural Intervention Participants of Varying Health Literacy Status

in Journal of Physical Activity and Health
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Background: A pragmatic, self-reported physical activity measure is needed for individuals of varying health literacy status. Methods: This study is a secondary analysis of a 6-month behavioral intervention for rural Appalachian adults developed using health literacy strategies. We examined the relationship and responsiveness of the Stanford Leisure-Time Activity Categorical Item (L-Cat) and adapted Godin Leisure-Time Exercise Questionnaire (GLTEQ) and determined if baseline health literacy status moderates intervention effects. Results: Of 301 enrolled participants, 289 completed the L-Cat at baseline and 212 at 6 months. Approximately 33% were low health literate and 43% reported annual income of ≤$14,999. There was high agreement (84.1%) between the L-Cat and adapted GLTEQ for classifying individuals as meeting physical activity recommendations with little differences by health literacy level (low literacy 80.4% and high literacy 85.9%). The primary source of incongruent classification was the adapted GLTEQ classified almost 20% of individuals as meeting recommendations, whereas the L-Cat classified them as not meeting recommendations. There were differences in responsiveness between measures, but baseline health literacy status did not moderate change in any L-Cat or adapted GLTEQ measures. Conclusion: Implications and recommendations for using the L-Cat 2.3 and GLTEQ among individuals of varying health literacy status are discussed.

Kružliaková and Hedrick are with the Dept of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA. Estabrooks is with the Dept of Health Promotion, Social & Behavioral Health, University of Nebraska Medical Center, Omaha, NE. You is with the Dept of Agricultural and Applied Economics, Virginia Tech, Blacksburg, VA. Porter and Zoellner are with the Dept of Public Health Sciences, School of Medicine, University of Virginia, Christiansburg, VA. Porter and Zoellner are also with UVA Cancer Center Without Walls, Christiansburg, VA. Kiernan is with Stanford University School of Medicine, Stanford, CA.

Zoellner (Jz9q@virginia.edu) is corresponding author.
  • 1.

    Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012;2(2):1143–1211. PubMed

  • 2.

    US Department of Health and Human Services. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: US Department of Health and Human Services; 2008.

    • Search Google Scholar
    • Export Citation
  • 3.

    Strath SJ, Kaminsky LA, Ainsworth BE, et al. Guide to the assessment of physical activity: clinical and research applications: a scientific statement from the American Heart Association. Circulation. 2013;128(20):2259–2279. PubMed doi:10.1161/01.cir.0000435708.67487.da

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    US Department of Health and Human Services. Early Release of Selected Estimates Based on Data from the 2015 National Health Interview Survey. Leisure Time Physical Activity. Washington, DC: US Department of Health and Human Services; 2016.

    • Search Google Scholar
    • Export Citation
  • 5.

    Bauman AE, Reis RS, Sallis JF, et al. Correlates of physical activity: why are some people physically active and others not? Lancet. 2012;380(9838):258–271. PubMed doi:10.1016/S0140-6736(12)60735-1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    von Wagner C, Steptoe A, Wolf MS, Wardle J. Health literacy and health actions: a review and a framework from health psychology. Health Educ Behav. 2009;36(5):860–877. PubMed doi:10.1177/1090198108322819

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies; 2004.

  • 8.

    Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107. PubMed doi:10.7326/0003-4819-155-2-201107190-00005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Allen K, Zoellner J, Motley M, Estabrooks PA. Understanding the internal and external validity of health literacy interventions: a systematic literature review using the RE-AIM framework. J Health Commun. 2011;16(suppl 3):55–72. doi:10.1080/10810730.2011.604381

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Taggart J, Williams A, Dennis S, et al. A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Fam Pract. 2012;13:49. PubMed doi:10.1186/1471-2296-13-49

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Bennett JS, Boyle PA, James BD, Bennett DA. Correlates of health and financial literacy in older adults without dementia. BMC Geriatr. 2012;12:30. PubMed doi:10.1186/1471-2318-12-30

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Dominick GM, Dunsiger SI, Pekmezi DW, et al. Moderating effects of health literacy on change in physical activity among Latinas in a randomized trial. J Racial Ethn Health Disparities. 2015;2(3):351–357. PubMed doi:10.1007/s40615-014-0080-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Geboers B, de Winter AF, Luten KA, Jansen CJM, Reijneveld SA. The association of health literacy with physical activity and nutritional behavior in older adults, and its social cognitive mediators. J Health Commun. 2014;19(suppl 2):61–76. doi:10.1080/10810730.2014.934933

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Kobayashi LC, Wardle J, Wolf MS, von Wagner C. Health literacy and moderate to vigorous physical activity during aging, 2004–2013. Am J Prev Med. 2016;51(4):463–472. PubMed doi:10.1016/j.amepre.2016.02.034

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Wolf MS, Gazmararian JA, Baker DW. Health literacy and health risk behaviors among older adults. Am J Prev Med. 2007;32(1):19–24. PubMed doi:10.1016/j.amepre.2006.08.024

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Al Sayah F, Johnson ST, Vallance J. Health literacy, pedometer, and self-reported walking among older adults. Am J Public Health. 2016;106(2):327–333. PubMed doi:10.2105/AJPH.2015.302901

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Adams RJ, Piantadosi C, Ettridge K, et al. Functional health literacy mediates the relationship between socio-economic status, perceptions and lifestyle behaviors related to cancer risk in an Australian population. Patient Educ Couns. 2013;91(2):206–212. PubMed doi:10.1016/j.pec.2012.12.001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    von Wagner C, Knight K, Steptoe A, Wardle J. Functional health literacy and health-promoting behaviour in a national sample of British adults. J Epidemiol Community Health. 2007;61(12):1086–1090. PubMed doi:10.1136/jech.2006.053967

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Sallis JF, Haskell WL, Wood PD, et al. Physical activity assessment methodology in the Five-City Project. Am J Epidemiol. 1985;121(1):91–106. PubMed doi:10.1093/oxfordjournals.aje.a113987

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Wendel-Vos GCW, Schuit AJ, Saris WH, Kromhout D. Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol. 2003;56(12):1163–1169. PubMed doi:10.1016/S0895-4356(03)00220-8

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Glasgow RE, Riley WT. Pragmatic measures: what they are and why we need them. Am J Prev Med. 2013;45(2):237–243. PubMed doi:10.1016/j.amepre.2013.03.010

  • 22.

    van Poppel MN, Chinapaw MJ, Mokkink LB, van Mechelen W, Terwee CB. Physical activity questionnaires for adults: a systematic review of measurement properties. Sports Med. 2010;40(7):565–600. PubMed doi:10.2165/11531930-000000000-00000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Helmerhorst HJF, Brage S, Warren J, Besson H, Ekelund U. A systematic review of reliability and objective criterion-related validity of physical activity questionnaires. Int J Behav Nutr Phys Act. 2012;9:103. PubMed doi:10.1186/1479-5868-9-103

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Silsbury Z, Goldsmith R, Rushton A. Systematic review of the measurement properties of self-report physical activity questionnaires in healthy adult populations. BMJ Open. 2015;5(9):008430. PubMeddoi:10.1136/bmjopen-2015-008430

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Kimberlin CL, Winterstein AG. Validity and reliability of measurement instruments used in research. Am J Health Syst Pharm. 2008;65(23):2276–2284. PubMed doi:10.2146/ajhp070364

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Kiernan M, Schoffman DE, Lee K, et al. The Stanford leisure-time activity categorical item (L-Cat): a single categorical item sensitive to physical activity changes in overweight/obese women. Int J Obes. 2013;37(12):1597–1602. doi:10.1038/ijo.2013.36

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Godin G. The Godin-Shephard leisure-time physical activity questionnaire. Health Fitness J Can. 2011;4(1):18–22.

  • 28.

    Amireault S, Godin G, Lacombe J, Sabiston CM. Validation of the Godin-Shephard leisure-time physical activity questionnaire classification coding system using accelerometer assessment among breast cancer survivors. J Cancer Surviv. 2015;9(3):532–540. PubMed doi:10.1007/s11764-015-0430-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985;10(3):141–146. PubMed

  • 30.

    Amireault S, Godin G. The Godin-Shephard leisure-time physical activity questionnaire: validity evidence supporting its use for classifying healthy adults into active and insufficiently active categories. Percept Mot Skills. 2015;120(2):604–622. PubMed doi:10.2466/03.27.PMS.120v19x7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Jacobs DR Jr, Ainsworth BE, Hartman TJ, Leon AS. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc. 1993;25(1):81–91. PubMed doi:10.1249/00005768-199301000-00012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    American College of Sports Medicine. Godin leisure-time exercise questionnaire. Med Sci Sports Exerc. 1997;26:S36–38.

  • 33.

    Zoellner J, Chen Y, Davy B, et al. Talking health, a pragmatic randomized-controlled health literacy trial targeting sugar-sweetened beverage consumption among adults: rationale, design & methods. Contemp Clin Trials. 2014;37(1):43–57. PubMed doi:10.1016/j.cct.2013.11.003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–1327. PubMed doi:10.2105/AJPH.89.9.1322

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211. doi:10.1016/0749-5978(91)90020-T

  • 36.

    Zoellner JM, Hedrick VE, You W, et al. Effects of a behavioral and health literacy intervention to reduce sugar-sweetened beverages: a randomized-controlled trial. Int J Behav Nutr Phys Act. 2016;13:38. PubMed doi:10.1186/s12966-016-0362-1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Estabrooks PA, Smith-Ray RL, Almeida FA, Hill J, Gonzales M, Patti S, Van Den Berg R. Move More: translating an efficacious group dynamics physical activity intervention into effective clinical practice. Int J Sport Exerc Psychol. 2011;9(1):4–18. doi:10.1080/1612197X.2011.563123

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Zoellner J, Cook E, Chen Y, You W, Davy B, Estabrooks P. Mixed methods evaluation of a randomized control pilot trial targeting sugar-sweetened beverage behaviors. Open J Prev Med. 2013;3(1):51–57. PubMed doi:10.4236/ojpm.2013.31007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Porter K, Chen Y, Estabrooks P, Noel L, Bailey A, Zoellner J. Using teach-back to understand participant behavioral self-monitoring skills across health literacy level and behavioral condition. J Nutr Educ Behav. 2016;48(1):20–26.e1. doi:10.1016/j.jneb.2015.08.012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Estabrooks PA, Glasgow RE, Xu S, et al. Building a multiple modality, theory-based physical activity intervention: the development of CardiACTION! Psychol Sport Exerc. 2011;12(1):46–53. PubMed doi:10.1016/j.psychsport.2010.04.012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Corda K. The Preliminary Examination of the Integration of an Indoor-Walking DVD in NJ SNAP-Ed and EFNEP Nutrition Education Classes [PhD thesis]. New Brunswick, NJ: Rutgers University Electronic Theses and Dissertations; 2012:84, 120–124.

    • Search Google Scholar
    • Export Citation
  • 42.

    Popkin BM, Armstrong LE, Bray GM, Caballero B, Frei B, Willett WC. A new proposed guidance system for beverage consumption in the United States. Am J Clin Nutr. 2006;83(3):529–542. PubMed

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Hedrick V, Davy B, You W, Porter K, Estabrooks P, Zoellner J. Dietary quality changes in response to a sugar-sweetened beverage-reduction intervention: results from the talking health randomized controlled clinical trial. Am J Clin Nutr. 2017;105:824–833. PubMed doi:10.3945/ajcn.116.144543

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Robert Wood Johnson Foundation. County health rankings. Compare Counties. 2015. http://www.countyhealthrankings.org/app/virginia/2015/compare/snapshot?counties=51_105%2B51_071%2B51_155%2B51_191%2B51_077%2B51_195%2B51_197%2B51_121. Accessed June 5, 2016.

    • Export Citation
  • 45.

    Pollard K, Jacobsen LA. The Appalachian Region: A Data Overview from the 2010–2014 American Community Survey. Population Reference Bureau. Washington, DC: Appalachian Regional Commission; 2016:35–76.

    • Search Google Scholar
    • Export Citation
  • 46.

    Estabrooks P, You W, Hedrick V, Reinholt M, Dohm E, Zoellner J. A pragmatic examination of active and passive recruitment methods to improve the reach of community lifestyle programs: the Talking Health Trial. Int J Behav Nutr Phys Act. 2017;14(1):7. PubMed doi:10.1186/s12966-017-0462-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3(6):514–522. PubMed doi:10.1370/afm.405

  • 48.

    Amireault S, Godin G, Lacombe J, Sabiston CM. The use of the Godin-Shephard leisure-time physical activity questionnaire in oncology research: a systematic review. BMC Med Res Methodol. 2015;15:60. PubMed doi:10.1186/s12874-015-0045-7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Bernstein M, Sloutskis D, Kumanyika S, Sparti A, Schutz Y, Morabia A. Data-based approach for developing a physical activity frequency questionnaire. Am J Epidemiol. 1998;147(2):147–154. PubMed doi:10.1093/oxfordjournals.aje.a009427

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Altschuler A, Picchi T, Nelson M, Rogers JD, Hart J, Sternfeld B. Physical activity questionnaire comprehension: lessons from cognitive interviews. Med Sci Sports Exerc. 2009;41(2):336–343. PubMed doi:10.1249/MSS.0b013e318186b1b1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Doma K, Speyer R, Leicht AS, Cordier R. Comparison of psychometric properties between usual-week and past-week self-reported physical activity questionnaires: a systematic review. Int J Behav Nutr Phys Act. 2017;14(1):10. PubMed doi:10.1186/s12966-017-0470-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Chang L, Krosnick JS. Measuring the frequency of regular behaviors: comparing the “Typical Week” to the “Past Week”. Sociol Methodol. 2003;33:55–80. doi:10.1111/j.0081-1750.2003.t01-1-00127.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 53.

    Finger JD, Tafforeau J, Gisle L, et al. Development of the European health interview survey—physical activity questionnaire (EHIS-PAQ) to monitor physical activity in the European Union. Arch Public Health. 2015;73:59. PubMed doi:10.1186/s13690-015-0110-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Laird NM, Ware JH. Random-effects models for longitudinal data. Biometrics. 1982;38(4):963–974. PubMed doi:10.2307/2529876

  • 55.

    Rubin DB. Multiple Imputations for Nonresponse in Surveys. New York, NY: Wiley; 1987.

  • 56.

    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–174. PubMed doi:10.2307/2529310

  • 57.

    Willis G. Cognitive Interviewing: A Tool for Improving Questionnaire Design. Thousand Oaks, CA: Sage Publications; 2005.

  • 58.

    Sattelmair J, Pertman J, Ding EL, Kohl HW 3rd, Haskell W, Lee IM. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation. 2011;124(7):789–795. PubMed doi:10.1161/CIRCULATIONAHA.110.010710

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    Pandey A, Garg S, Khunger M, et al. Dose–response relationship between physical activity and risk of heart failure: a meta-analysis. Circulation. 2015;132(19):1786–1794. PubMed doi:10.1161/CIRCULATIONAHA.115.015853

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60.

    Wahid A, Manek N, Nichols M, et al. Quantifying the association between physical activity and cardiovascular disease and diabetes: a systematic review and meta-analysis. J Am Heart Assoc. 2016;5(9): e002495. doi:10.1161/JAHA.115.002495

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 61.

    Shephard RJ. Limits to the measurement of habitual physical activity by questionnaires. Br J Sports Med. 2003;37(3):197–206; discussion 206. PubMed doi:10.1136/bjsm.37.3.197

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 62.

    Tudor-Locke CE, Myers AM. Challenges and opportunities for measuring physical activity in sedentary adults. Sports Med. 2001;31(2):91–100. PubMed doi:10.2165/00007256-200131020-00002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63.

    Watts AS, Vidoni ED, Loskutova N, Johnson DK, Burns JM. Measuring physical activity in older adults with and without early stage Alzheimer’s disease. Clin Gerontol. 2014;36(4):356–374. doi:10.1080/07317115.2013.788116

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 64.

    Prochaska JJ, Nigg CR, Spring B, Velicer WF, Prochaska JO. The benefits and challenges of multiple health behavior change in research and in practice. Prev Med. 2010;50(1–2):26–29. doi:10.1016/j.ypmed.2009.11.009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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