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Assessment of critical thinking skills in a low-income population: Development of a methodology

Ingrid Karen Richards Adams
Assistant Extension Professor
University of Kentucky

Suzanne Hendrich
Professor
Iowa State University

Cheryl O. Hausafus
Associate Professor
Iowa State University

Abstract

Developing critical thinking skills in adults empowers them to make sound decisions. Seventy-one parents in a low-income preschool program took part in a study to develop their critical thinking skills. A two-group (experimental, control) randomized, pretest-posttest design was used. The experimental group participated in two 45-minute sessions about vegetables and physical activity. The development of a methodology to assess critical thinking included a context-specific definition, problem solving, and the use of scenarios. After the intervention, parents in the experimental group showed improvement in problem solving, especially in areas of problem identification, gathering relevant information to solve the problem, and providing solutions to the problem. Little change was seen in areas of providing rationale and judging the soundness of decisions. Interventions of longer duration could lead to a change in these higher levels of critical thinking. The development of critical thinking skills seems plausible in informal educational settings with low-income audiences.

Keywords: critical thinking, assessment, low-income, scenarios, vegetables, physical activity

Introduction

Adults confront complex and value-laden choices daily (Thomas and Litowitz 1986; Contento 1981). Which foods should they purchase, prepare, and consume, and how should they engage in physical activity given their time constraints? Brookfield (1987) states that adults, by reason of their many experiences, are predisposed to critical thought. However, having the predisposition to think critically does not guarantee sound decision-making, and individuals must be provided with opportunities to develop skills that would promote critical thinking. Norris (1985) asserts that many young people and adults do not have the critical thinking skills necessary for sound decision-making, reasoning, initiative-taking, and problem-solving. Research shows that, with instruction, anyone can improve his or her critical thinking skills (Brookfield 1987; D’Angelo 1971; Halpern 1993; Norris 1985).

Critical thinking is viewed as an intellectual function of adulthood (Thompson et al. 2003), and developing critical thinking skills in adults enables them to make sound decisions. The development of such critical thinking skills requires the conceptualization of a critical thinking methodology (Nitzke, Harwood, and Way 1992), which includes decisions about (a) how critical thinking should be defined, (b) what skills and abilities should characterize the definition of critical thinking, and (c) what instruments should be used to determine the attainment of critical thinking skills. Assessing critical thinking skills is an important aspect of developing a critical thinking methodology but the assessment of any thinking process is never an easy task (Laster 1998). The purpose of this research was to (1) develop a critical thinking methodology for the assessment of critical thinking and (2) determine if there were changes in critical thinking skills after a brief intervention related to vegetable offerings and physical activity.

Review of literature

Definition of critical thinking

The literature is replete with critical thinking definitions that are often varied and inharmonious. Some definitions focus on the nature of the thought process (Halpern 1996; Lipman 1988; Norris 1985), while others equate critical thinking with the use of logic or the science of correct reasoning, such as asking the right question, identifying fallacies in a line of reasoning, proposing lucid arguments, and evaluating ideas and claims (Dauer 1989; Epstein 2000). Other definitions concentrate on the processes that comprise critical thinking, such as problem-solving, (Kurfiss 1988; Mayer 1992), decision-making (Dawes 1988), and reflection (Halpern 1996, 1998). The conception of critical thinking definitions is based to a large extent on the context and the discipline from which the definition originates (Brookfield 1987; McPeck 1981). Bissell and Lemons (2006) suggested that selecting a definition that meets our needs is more important than obtaining consensus.

In this study, the intervention focused on low-income parents making decisions to increase vegetable offerings and physical activity in their 3- to 5-year-old children. Within this context, and based on the tasks that needed to be performed, the author developed a critical thinking definition: Critical thinking was defined as the process whereby individuals analyze and evaluate information, a situation, or their behaviors in order to make fully informed decisions while reflecting on their thought processes.

Critical thinking skills and abilities

Several lists of critical thinking skills exist in the literature (American Psychological Association, Burnard 1989; D’Angelo 1971; Darkenwald and Merriam 1982; Dressel and Mayhew 1954; Kurfiss 1988). Our study used skills and abilities, such as defining the problem, selecting pertinent information for the solution of a problem, selecting relevant and promising hypotheses, drawing valid conclusions, and judging the validity of inferences. These skills and abilities reflected the tasks that study participants needed to perform in order to increase physical activity and offer specific vegetables to their children.

Instruments to assess critical thinking

After deciding which skills and abilities to include in assessing critical thinking, the next step was to choose an instrument for evaluation. Preexisting instruments may not be appropriate for every situation (Brookfield 2006; Laster 1998; McPeck 1981). Laster (1981) suggested that an effective approach would be to refine or develop instruments for assessing thinking. Kerka (1992) pointed out that scenario analysis is one of the newer forms of evaluation determining higher order thinking skills, and other authors agree (Halpern 1993; Paul 1993; Reicks et al. 1994; Stone 2002). This study focused on the role of scenarios in evaluating the critical thinking skills of low-income individuals.

Methodology

Parents whose children participated in the Drake University Head Start (DUHS) program within Polk County, Iowa, were recruited for the study. DUHS serves low-income families through 16 centers under six different program options. Researchers used the six programs to randomly assign the 16 centers to either the experimental or control groups. The study was approved by Iowa State University and Drake University Institutional Review Boards: Human Subjects.

Parents in the experimental group completed pretest and posttest questionnaires at the beginning and end of the study, and were exposed to the intervention. Parents in the control group also completed pretest and posttest questionnaires but were not exposed to the intervention. The intervention consisted of two 45-minute sessions—one session per week for two consecutive weeks. During each session, parents received information on vegetables and physical activity. Lesson One focused on what parents should do regarding increasing offerings of specific vegetables in their children’s diets and the importance of physical activity in the lives of children. Lesson Two was similar to Lesson One, but focused on the positive environment in which to offer vegetables, the benefits of physical activity, and ways to overcome barriers to physical activity. At the end of each session participants prepared two food items, and ideas for physical activity were shared.

A six-part critical thinking model consisting of stimulus, empowerment, critical response, outcome, action, and reflection was developed by the researcher and guided the development of the lessons and the implementation of the intervention. The critical thinking model and other aspects of the intervention are discussed in details elsewhere (Adams, Hausafus, and Hendrich, 2010).

Instrument

Researchers used two scenarios (one related to vegetables and the other to physical activity), and five questions to collect pretest and posttest data on parents’ problem-solving. The vegetable scenario stated, “At the WIC clinic, Joan was told that she needed to offer her children more vegetables. Joan mentioned that she is afraid that she would not have enough money to do this.” The series of questions included (1) What is Joan’s problem? (2) What other information will you need to know about Joan’s situation if you are to help her? (3) What can Joan do to offer her children more vegetables? (4) What do you think is the best way to solve Joan’s problem? (5) Why do you think that solution is the best?

The physical activity scenario stated, “Henry enjoys watching television and playing computer games. He spends at least 4 hours a day on these activities. His father tells him to turn off the television and be active. Henry complains that he does not want to be active.” The five questions related to physical activity included (1) What is Henry’s problem? (2) What other information do you need to know about Henry’s situation if you are to help him? (3) Suggest some things that Henry’s dad can do to make Henry more active. (4) What do you think is the best solution to Henry’s problem? (5) Why do you think that solution is the best?

The scenarios were ill-defined and characterized as having no single correct answer, making them suitable for assessing critical thinking (Huba and Reed, 2000; Kurfiss 1988; Laster 1998). The five questions that followed each scenario were hierarchical in terms of the level of thinking required. See Table 1.

Validity

Four experts not involved with the study reviewed the scenarios for content validity. Four low-income individuals who were not part of the study provided feedback in terms of readability, clarity, and time taken to complete the questionnaire.

Data analysis

Measures

Researchers used both quantitative and qualitative methodologies to analyze the data (Abrahamson 1983; Berg 1998; Smith 1975). Quantitative measures included word count of responses and a count of the number of times respondents did not provide a response to a question. Content analysis was used as the qualitative measure.

Word count analysis. A word count was derived by tallying the entire phrase or sentence participants provided. This method was undertaken to determine changes in the number of words parents used to describe the problem. The assumption was that as critical thinking skills and abilities increased, parents would use more words to describe or provide solutions to the problem.

No response. To determine if differences existed in the number of no responses between the control and experiment groups following the intervention, researchers recorded and analyzed the number of questions that respondents left blank.

The quantitative data was analyzed using SPSS computer software (version 14.0, for Windows). We used Analysis of Covariance (ANCOVA) on posttest scores with word count and with number of no responses. To determine if the observed number of no responses for each question was due to chance, we analyzed the number of no responses for each question using chi-square and a p value less than or equal to .05 as the level of significance.

The open-ended responses from the vegetable and physical activity scenarios were analyzed using content analysis (Berg 1998; Krueger 1997). Two reviewers read the responses to identify reoccurring themes, and the themes were categorized and tallied.

Findings and discussion

Responses from 71 individuals were included in the analysis, 28 from the experimental and 43 from the control group. The experimental group had fewer individuals because they had to attend two sessions of the intervention. Difficulties in recruitment, high attrition, and fluidity are often observed when working with low-income populations (Treiman, Freimuth, and Damron 1996).

Word count for vegetable and physical activity responses

Parents in the experimental group used more words to solve problems related to the vegetable scenario after the intervention, F(1, 44) = 5.42, p ≤ .05, h² = .11. No difference existed in mean posttest scores in the experimental and control groups for the word count for physical activity, F(1, 45) = 2.50, p ≥ .05, h² = .05. See Table 2 for results of means and standard deviations.

Count of number of no responses

There was no significant difference in mean overall posttest scores between the experimental and control groups for no responses related to both vegetable and physical activity following the intervention. See Table 2 for results.

Content analysis of vegetable responses

Question 1: What is Joan’s problem?

Individuals in both the control and experimental groups identified money issues as being the main source of Joan’s problem at pretest and posttest. Individuals in the experimental group also included a lack of knowledge and a range of other contextual factors, such as “she needs to look at prices more,” “she does not know all the resources,” “lack of transportation,” and “she does not know that veggies can be economical,” as the source of Joan’s problem after the intervention. This range of responses was not observed in the control group. A higher percentage of individuals in the control group did not respond to this question in the posttest. See Table 3.

Question 2: What other information will you need to know about Joan’s situation if you are to help her?

Both groups stated they needed information on Joan’s income, her budget, government assistance, and her likes and dislikes. The control group suggested the need for information on the number of kids and Joan’s shopping habits. After the intervention, the experimental group suggested a need for a range of information such as “Is she working?” “what she has tried before,” and “what worked for her.” The control group did not give this range of responses. See Table 3.

Question 3: What can Joan do to offer her children more vegetables?

Purchasing, serving, cooking, and other strategies were mentioned by individuals in both the control and experimental groups as ways Joan can offer her children more vegetables. After the intervention, more individuals in the experimental group suggested purchasing, serving, and cooking strategies. See Table 3.

Question 4: What do you think is the best way to solve Joan’s problem?

Both groups suggested getting assistance from the government or charitable organizations, budgeting, and teaching shopping and cooking skills as the best ways to solve Joan’s problem. Again, the experimental group suggested more options after the intervention. Some of these included “education,” “help her menu plan,” “she could try growing her own,” “find a job,” and so on. See Table 3.

Question 5: Why do you think that solution is the best?

Responses were similar in both the control and experimental groups. Participants thought their solutions were best because they would provide food or vegetables for Joan and/or the children, meet her needs, provide money or money management skills, improve the health of her children, or develop cooking or shopping skills. See Table 3.

Content analysis of physical activity responses

Question 1: What is Henry’s problem?

Responses for both the experimental and control groups included (1) too much TV or computer, (2) laziness, and (3) lack of interest or motivation. Responses were similar between the groups. There were a higher number of no responses in the control group in the posttest. See Table 4.

Question 2: What other information do you need to know about Henry’s situation if you are to help him?

Parents in both groups suggested that they needed to know information on Henry’s likes and dislikes, his parents’ activities, reasons for his inactivity, time available for activity, his environment, his age, and his health, diet, or weight if they were to help him. Few differences were seen in the answers for both groups. See Table 4.

Question 3: Suggest some things that Henry’s dad can do to make Henry more active.

Most individuals in both groups suggested that Henry’s dad should engage in activities with him, take away or limit the TV, and increase his level of physical activity. More parents in the experimental group suggested the need for Henry’s parents to increase his level of activity after the intervention. See Table 4.

Question 4: What do you think is the best solution to Henry’s problem?

Responses in both groups included increased activity, parental involvement, setting limits, taking away the TV, and motivation or education. Parents in the control group also suggested motivation or education as the best solution to Henry’s problem. See Table 4.

Question 5: Why do you think that solution is the best?

Parents in both groups stated that the solution was the best because it would lead to family involvement, an increase in Henry’s level of activity, and an improvement in his health. Parents in the control group also suggested that the solution was best because it would motivate Henry to be more active or that it would lead to less conflict. See Table 4.

Discussion

In developing a critical thinking methodology, we need a clear contextual definition, a list of skills that characterize the definition, and an appropriate means for assessment. Critical thinking has an identifiable meaning, and the criteria for its correct application vary from field to field. In addition, the way critical thinking is defined is based on the context or situation (Brookfield 1987; McPeck 1981). For example, Facione (1996) defined critical thinking based on the fast-paced nature of the nursing profession. She viewed critical thinking as higher order reasoning used in reaching professionally informed judgments in high-stakes, time-constrained, and, many times, novel problem situations. Likewise, in nutrition, we need to define critical thinking based on the tasks we need to accomplish and the problems that are unique to the profession (Adams, Hausafus, Hendrich 2010). For example, recent statistics showed that one-third of all adults, and one in three children, are overweight or obese; less than five percent of adults participate in 30 minutes of physical activity each day, and seven out of ten deaths are a result of chronic disease such as heart disease, stroke, cancer, and diabetes (Flegal, Carroll, Ogden, Curtin 2010; Ogden et al. 2010; U.S. Department of Health and Human Services 2010). Our study used a context specific definition based on the tasks low-income parents needed to accomplish. It is, therefore, suited for the problems and challenges we encounter in nutrition.

The scenarios used in this study presented situations similar to those encountered in the real world and served as a means for the development of critical thinking. Additionally, the use of both quantitative and qualitative methodologies provided a more accurate assessment of critical thinking. Future interventions assessing critical thinking skills should also use multiple measures to provide a more accurate assessment of thinking skills.

This intervention showed that individuals are capable of suggesting solutions to problems relating to offering their children vegetables and increasing their level of physical activity. Their responses reveal their predisposition to critical thoughts. In addition, the study demonstrated that critical thinking skills can be developed with instruction. After the intervention, parents in the experimental group showed an increase in their problem-solving skills for each of the first three questions in the vegetable scenario. For example, they expanded their knowledge about the contextual factors that have an impact on the problem (Question 1). A common theme in the posttest responses in the experimental group was that vegetables are inexpensive. Participants stated, “She needs to look at prices more; vegetables are very inexpensive,” and “She doesn’t know that vegetables can be economical.” After the intervention the experimental group also identified the need for additional information to solve the problem (Question 2). They wanted to know “Is she working?” “what she tried before,” “what worked for her,” reasons for lack of money,” “if she is interested in buying more vegetables when shopping,” and so on. After the intervention, the experimental group also suggested more creative problem-solving approaches such as substituting vegetables for unhealthy snacks, purchasing different forms of vegetables, and using creative ways of cooking and serving vegetables.

As questions (4 and 5) increased in complexity, however, the responses between the groups tended to be similar. More time may be needed to bring about changes at higher levels of critical thinking. For example, changes in the level of critical thinking were evident after a 19-hour unit designed to help students develop practical reasoning skills (Laster 1998; Martin 1998).

Few differences existed between the control and experimental group for the physical activity questions. The physical activity information was presented after the information on vegetables in the intervention. Even though participants had less time for the physical activity information, we were optimistic that parents would transfer knowledge gained from the vegetable problem-solving to that of physical activity problems. However, transfer of thinking skills requires the use of a variety of problem situations so that individuals can make cognitive connections across different contexts (Halpern 1998). As a result, it is necessary to plan specific interventions to achieve transfer, which requires a longer time commitment.

The limitation here is that the intervention was of a short duration. Parents in the experimental group had only two sessions relating to nutrition and physical activity. However, the intervention showed some changes in parents’ problem-solving after a short time frame, especially in areas of identification of the problem, gathering relevant information to solve the problem, and problem solution. Little change was apparent in areas of providing rationale and judging the soundness of decisions. Interventions of longer duration could lead to change in these higher levels of critical thinking.

Implication for research and practice

The development of critical thinking skills seems reasonable and feasible in informal educational settings with low-income audiences where the goal is to have individuals make sound decisions regarding their children’s health.

Sufficient time must be allowed for the development of critical thinking skills, and interventions of longer duration should be undertaken. Future interventions should also determine the length of time needed for the acquisition of higher-order thinking skills. One important goal in the teaching of critical thinking is to see the transfer of thinking from one situation to the next. Developing interventions that allow for the transfer of critical thinking is also an important target for future interventions.

When developing programs to improve critical thinking skills the following is recommended:

One goal of nutrition education is to provide adequate knowledge and skills necessary for critical thinking regarding diet and health so that individuals can make appropriate food choices from an increasing array of contextual factors (Devine 1980). A critical-thinking approach provides individuals with opportunities to develop decision-making, reasoning, and problem-solving skills and should be an integral part of nutrition intervention and programming.

Table 1: Problem-solving scenarios, questions, and level of thinking

[Table 1 Summary: Outline of vegetable and physical activity scenario, questions, and the level of thinking involved.]

Table 1: Problem-solving scenarios, questions, and level of thinking

Vegetable scenario

Questions

Level of thinking

At the WIC clinic, Joan was told that she needed to offer her children more vegetables. Joan mentioned that she is afraid that she would not have enough money to do this.

1. What is Joan’s problem?

Problem identification

2. What other information will you need to know about Joan’s situation if you are to help her?

Gathering relevant information for problem solving

3. What can Joan do to offer her children more vegetables?

Problem solution

4. What do you think is the best way to solve Joan’s problem?

Providing rationale for decision

5. Why do you think that solution is the best?

Judging the soundness of decision

Physical activity scenario

Questions

Level of thinking

Henry enjoys watching television and playing computer games. He spends at least 4 hours a day on these activities. His father tells him to turn off the television and be active.

1. What is Henry’s problem?

Problem identification

2. What other information do you need to know about Henry’s situation if you are to help him?

Gathering relevant information for problem solving

3. Suggest some things that Henry’s dad can do to make Henry more active.

Problem solution

4. What do you think is the best solution to Henry’s problem?

Providing rationale for decision

5. Why do you think that solution is the best?

Judging the soundness of decision

Table 2: Results of word count and no responses for vegetable and physical activity scenarios

[Table 2 Summary: Significant differences were observed for word count for the vegetable scenario. No change was seen in word count for the physical activity scenario and both no response for vegetable and physical activity.]

Descriptor

Control

Intervention

Significance

N

Mean

SD

N

Mean

SD

F

p value

Word count for vegetable scenario

25a

30

22

22b

39

27

5.42

*

.11

Word count for physical activity scenario

25a

37

22

23b

36

22

2.50

n.s.

.05

No response for vegetable questions

43

1

1

28

1

1

1.21

n.s.

.02

No response for physical activity questions

43

1

1

28

1

1

.02

n.s.

.00

*p ≤ .05. n.s. = non significant

a= number of individuals in the experimental group who responded to both pre- and posttest.

b= number of individuals in the control group who responded to both pre- and posttest.

Table 3. Summary of responses based on questions 1–5 of the Vegetable Critical Thinking Scenario.

Table 3. Categories of Response Based on Questions 1–5 of the Vegetable Critical Thinking

Scenario: At the WIC clinic, Joan was told that she needed to offer her children more vege­tables. Joan mentioned that she is afraid that she would not have enough money to do this

Questions

Experimental group Pretest (n=28)

Experimental group Posttest (n=28)

Control group Pretest (n=43)

Control group Posttest (n=43)

1. What is Joan’s problem

Money = 14

Budget/money management = 6

No response = 6

Other = 2

-Lazy

-Does not like veggies

Money = 12

Budget/money management = 4

Lack of knowledge = 3

No response = 8

Other = 11

-Look at prices more

-Does not know all the resources

-Lack of transportation

-She does not know veggies can be conomical, etc.

Money= 27

Budget= 4

No response= 5

Lack of knowledge = 3

Other= 4

-Go to Famer’s market

-Buy frozen, they are cheaper

-Not offering

-Economic situation

Money= 18

No response = 22

Other = 3

-Buy canned veggies

-Other programs

-Buy veggies instead of snacks

2. What other information you will need to know about Joan’s situation if you are to help her?

Income = 10

Budget = 6

Government programs= 2

Likes and dislikes = 3

No response = 7

Other = 6

-Number of kids=1

-Reasons why she might not afford it

-Is she interested in work?

-If she has job transportation, etc.

Income = 5

Budget = 4

Government programs = 1

Likes and dislikes = 1

No response = 9

Number of kids-3

Shopping habits-2

Other = 12

-If she checks the season specials

-Is she working?

-what she tried; what worked for her

-If she is interested in working to get more money etc

Income = 11

Budget = 8

Government programs = 2

Likes and dislikes = 2

No response = 8

Number of kids = 6

Shopping habits = 4

Other = 5

-Does she have a yard?

Her needs, etc.

Income = 6

Budget = 4

Government programs = 4

Likes and dislikes = 1

No response = 22

Number of kids = 3

shopping habits = 2

Other = 3

-Background information

-Why no money, etc.

- Information on importance of vegetables

3. What can Joan do to offer her children more vegetables?

Purchasing strategies=5

Serving/cooking strategies=7

Offer more=3

Budget=1

Substitution=2

Resources=2

No response=7

Other=0

Purchasing strategies=7

Serving/cooking strategies=10

Offer more=2

Budget=0

Income=2

Substitution=2

Resources=2

No response=10

Other=1

Purchasing strategies=11

Serving/cooking strategies=9

Offer more=4

Budget=2

Income=2

Substitution=0

Resources=9

Grow a garden=7

No response=8

Other=3

role model=2

Purchasing strategies=4

Serving/cooking strategies=3

Offer more=4

Budget=1

Income=2

Substitution=1

Resources=7

No response=21

Other=4

grow a garden =2

make food interesting=2

4. What do you think is the best way to solve Joan’s problem?

Provide resources = 8

Budgeting = 5

shopping/cooking skills= 4

No response= 11

Other = 3

-education

-job

-give information

Resources = 4

Budget = 1

Shopping/cooking skills = 3

Keep offering = 2

No response = 8

Other = 15

Provide resources = 6

Budgeting = 1

shopping/cooking skills= 6

Garden=1

Offer more=4

Education=2

No response=8

Other = 7

Provide resources = 10

Budgeting =6

shopping/cooking skills= 1

Garden=2

Offer more=1

Education=3

No response=24

Other = 0

5. Why do you think that solution is best?

Will provide veggies/food=4

Will meet needs=2

Help with money/money mgt= 4

Improve health=0

Develop skills=1

Other=5

No response=12

Will provide veggies/food=6

Will meet needs=1

Help with money/money mgt= 4

Improve health=1

Develop skills=0

Other=3

No response=9

Will provide veggies/food=5

Will meet needs=5

Help with money/money management= 10

Improve health=2

Develop skills=2

Other=13

No response=6

Will provide veggies/food=4

Will meet needs=3

Help with money/money mgt= 4

Improve health=3

Develop skills=0

Other=5

No response=26

Table 4. Summary of responses based on questions 1–5 of the Physical Activity Critical Thinking Scenario

Table 4. Categories of Response Based on Questions 1–5 of the Physical Activity Critical Thinking

Scenario: Henry enjoys watching tele­vision and playing computer games. He spends at least 4 hours a day on these activities. His father tells him to turn off the television and be active. Henry complains that he does not want to be active.

Questions

Experimental
group

Pretest (n=28)

Experimental
group

Posttest (n=28)

Control
group

Pretest (n=43)

Control
group

Posttest (n=43)

1. What are Henry’s problems?

TV/computer
= 12

Inactivity= 8

Lazy= 3

Lack of interest/
motivation= 1

Other= 4

No response= 4

TV/computer
= 10

Inactivity= 5

Lazy= 2

Lack of interest/
motivation= 0

Other= 2

No response= 7

TV/computer
= 13

Inactivity= 13

Lazy= 4

Lack of interest/
motivation=5

Other= 12

No response= 4

TV/computer
= 7

Inactivity= 8

Lazy= 2

Lack of interest
/motivation= 3

Other= 1

No response= 20

2. What other information do you need to know about Henry’s situation if you are to help him?

Likes and
dislikes=5

Parents’
activities=4

Reasons for
inactivity=3

Time available for activity=2

Built
environment=2

Age=3

Health/weight/
diet=2

Other=2

No response=8

Likes and
dislikes=6

Parents’
activities=0

Reasons for
inactivity=2

Time available for activity=6

Built
environment=1

Age=1

Health/weight/
diet=3

Other=0

No response=10

Likes and dislikes=12

Parents’
activities=4

Reasons for
inactivity=4

Time available for activity=2

Built
environment=1

Age=0

Health/weight/
diet=5

Other=9

No response=9

Likes and
dislikes=6

Parents’
activities=1

Reasons for
inactivity=2

Time available
for activity=1

Built
environment=1

Age=0

Health/weight/
diet=3

Other=4

No response=22

3. Suggest some things that Henry’s dad can do to make Henry more active.

Parental involvement=13

Take away
TV=6

Increase
activity=3

Limit TV=2

Other=4

No response=4

Parental involvement=9

Take away
TV=2

Increase
activity=8

Limit TV=3

Other=2

No response=8

Parental involvement=28

Take away
TV=2

Increase activity=5

Limit TV=3

Other=7

No response=2

Parental
involvement=10

Take away
TV=0

Increase
activity=9

Limit TV=2

Other=3

No response=21

4. What do you think is the best solution to Henry’s problem?

Increase
activity=6

Parental involvement=7

Set limits=4

Take away
TV=2

Motivation/
Education=0

Other=3

No response=5

Increase
activity=9

Parental involvement=7

Set limits=2

Take away
TV=1

Motivation/
Education=0

Other=1

No response=9

Increase activity=11

Parental involvement=11

Set limits=9

Take away
TV=3

Motivation/
Education=2

Other=4

No response=6

Increase
activity=7

Parental
involvement=6

Set limits=5

Take away
TV=3

Motivation/
Education=2

Other=2

No response=23

5. Why do you think that solution is best?

Lead to family involvement=4

Increase
activity=4

Improve health=5

Less conflict=0

Motivation=0

Limit TV=0


Other=7

No response=9

Lead to family involvement=4

Increase
activity=6

Improve health=2

Role model=2

Motivation=1

It’s what I would do =1

Other=5

No response=9

Lead to family involvement=10

Increase activity=4

Improve health=2

Less conflict =2

Motivation=3

Limit TV=3


Other=5

No response=10

Lead to family involvement=5

Increase activity=4

Improve health=5

Role model=2

Motivation=1

It’s what I would do=3

Other=5

No response=24

Acknowledgement

We thank the Director of Drake University Head Start, Georgia Sherrif, Ph.D., for her invaluable assistance and support; the program assistants for their help with the intervention; and the parents of Head Start for their participation in the study.

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