Is the online ‘creating healthy eating and active environments survey' (CHEERS) tool reliable for early childhood educators in Alberta, Canada: a randomized crossover trial

BACKGROUND: The creating healthy eating and active environments survey (CHEERS) is an audit tool used to assess the nutrition and physical activity environment in early childhood education and care (ECEC) centres. Availability of the tool has been limited to paper-based versions. Digital health initiatives offer improved reach and immediacy of support for community-based clients through novel technology products. In order to provide increased access to the CHEERS tool, an online version was developed. The objective of this study was to assess the reliability of an online version of CHEERS. METHODS: Utilizing a randomized crossover design, ECEC educators completed either a paper-based or online-based survey and then the opposite mode with a two to three-week interval. The intraclass correlation coefficient (ICC, with 95% confidence interval) was used to determine the reliability between test and retest. Absolute index of reliability in the original measurement was assessed through the standard error of measurement (SEM = SD × √1-ICC). The smallest amount of change not due to inherent variation was assessed by determining minimal detectable change at the 95% confidence level (MDC(95) = SEM × 1.96 ×√2; MDC(95)% = MDC(95)/mean ×100). RESULTS: Test–retest reliability was good to excellent for the online-based CHEERS total score (ICC = 0.86) and for each of the four subscales: food served (ICC = 0.82), healthy eating environment (ICC = 0.76), program planning (ICC = 0.76), and physical activity environment (ICC = 0.79). The SEM, MDC(95,) and MDC(95)% for the CHEERS overall score were 0.79, 2.19, and 9.6%, respectively. CONCLUSIONS: The results of this study demonstrate that the online-based and paper-based versions of the CHEERS audit tool share comparable accuracy. The CHEERS tool can be reliably implemented in an online environment and this provides users an alternative means to complete the centre-based health assessment. The advantage of the online-based version includes user accessibility and the potential to develop a feedback response for participants using digitally collected data. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13690-023-01036-z.