Details & Validation Information for Survey Tools

WEIGHT & HEIGHT

All student research assistants were provided with measurement protocols and trained on how to use the equipment and record the data. Weight was measured using electronic scales (Seca 770; Seca, Columbia, MD) and height was measured with a portable stadiometer (Schorr Productions, Olney, MD). Study protocols required at least two weight and height assessments be collected for every participant. Assessments were repeated until the difference in the measurements were < 1 pound for weight and less than ¼ inch for height. The official height and weight measurements were determined by averaging the closest two numbers. Height was assessed at baseline only.

Weight was assessed by trained research assistants at baseline and at 6 months using the 2 assessment protocols. The study interventionist assessed weight at the beginning of each session with a single weight measurement.

STRESS

Stress levels were measured using two instruments. The first instrument, the Perceived Stress Questionnaire (PSQ),is a 30-item self-administered questionnaire with high internal consistency (α = > 0.90) that assesses the respondent’s appraisal of life events in the previous month. Respondents are asked to reply to all items using a 4-point likert-type scale. Specifically, questions address how often a person has experienced negative emotions or feelings like harassment, overload, irritability, lack of joy, fatigue, worry or tension. The index ranges from 0.0 – 1.0 with higher scores being associated with higher levels of stress. 

MULTIPLE CAREGIVING ROLE

The Multiple Caregiving Measurement Instrument (MCMI) developed by Samuel-Hodge et al. (2005) (α = 0.72 – 0.76, by subscale) was used to assess barriers to engaging in healthy behaviors associated with the multiple-caregiver role. The full instrument consists of 10 questions using a 4-point likert-type rating scale ranging from “disagree a little” to “agree a lot”. Results from the full instrument can be reported as two sub-scores. The first score (7 questions, possible score range 6-24) captures the degree to which the respondent identifies with common characteristics of the MCR. The second score (3 questions possible score range 3-24) assesses barriers associated with the MCR. Our questionnaire only included the 3 questions assessing barriers.

THE SUPERWOMAN ROLE

An 11-item selection (of 34 total questions) of the Stereotypic Roles for Black Women Scale (SRBWS) developed by Thomas et al. (2004) was used to assess how much respondents relate with stereotypical behaviors associated by the SR. Participants were asked how much they agree or disagree with a series of statements using a 5-item likert scale ranging from “strongly disagree” to “strongly agree”. Examples of statements from the “Superwoman” subscale include “Black women have to be strong to survive” and “If I fall apart, I will be a failure”.

USING FOOD TO COPE

The use of unhealthy eating behaviors as a coping response to stress was measured using the 7-item Giscombe-Woods “Using Food to Cope Scale” (UFTCS). This measure is not designed to assess more severe, pathological eating behaviors such as binge eating, but rather to capture the more commonplace, stress coping responses involving food. Examples of behaviors captured in this scale include: treating yourself to comfort foods to relieve stress; eating in the absence of hunger; and eating prepared foods due to perceived lack of time to cook. The tool assesses the frequency of specific behaviors over the past month using a 5-point likert scale. The scale has been demonstrated to have good internal reliability among adult African American women (α = 0.82) as well as adult African American men and women with pre-diabetes (α = 0.82). 

DIETARY RISK ASSESSMENT

Dietary habits were assessed using the Dietary Risk Assessment (DRA) tool. The DRA is a brief, self-administered questionnaire designed to rapidly identify adults at risk of poor dietary habits that contribute to chronic disease. The validation study published in BMC Health Services Research (Gans et al., 2013) evaluated the DRA tool against established dietary measures and found it to be both reliable and valid for use in primary care settings. The DRA effectively captures key dietary behaviors—such as fruit and vegetable intake, consumption of high-fat foods, and use of added sugars—within a short time frame suitable for routine clinical use. The study concluded that the tool could help healthcare providers efficiently assess diet-related health risks and guide nutritional counseling without requiring detailed dietary records.

PHYSICAL ACTIVITY

​A modified and validated version of the RESIDE questionnaire originally developed by Giles-Cortes et al. (2006) was used to evaluate self-report time spent doing light, moderate and vigorous activities. The RESIDE questionnaire captures both leisure-time activities as well as activities of daily living. A total physical activity score is derived from 5 subs-cores, which capture the amount of time spent doing the following activities: (1) walking for non-work activities, (2) walking for work activities, (3) moderate leisure time activities (other than walking), (4) vigorous leisure time activities (other than walking) and (5) vigorous activities during the workday.​​

SOCIAL SUPPORT FOR DIET AND EXERCISE

The Sallis Social Support Surveys for Diet (SS-D) and Exercise (SS-E) Behaviors204 are widely-used 23-item, self-administered questionnaires with acceptable internal consistency (α = 0.80 – 0.87 (friend support for diet, by subscale), α = 0.83 – 0.87 (family support for diet, by subscale), α = 0.84 (friend support for exercise), α = 0.61 – 0.91 (family support for exercise, by subscale). The surveys have been used in several studies with African American women.