Skip to main content

Open Access 05.02.2024 | Main Article

Toward a representative assessment of competencies for a healthy, physically active lifestyle in the German population: development and validation of a short version of the physical activity-related health competence questionnaire (PAHCO_12)

verfasst von: Dr. Johannes Carl, Dr. Olga Maria Domanska, Dr. Maike Buchmann, Dr. Susanne Jordan, Prof. Dr. Klaus Pfeifer, Prof. Dr. Gorden Sudeck

Erschienen in: German Journal of Exercise and Sport Research

Abstract

Representative studies assessing behavior-oriented determinants for physically active lifestyles in the German adult population are lacking due to the absence of validated assessment instruments. Drawing on the physical activity-related health competence (PAHCO) model, the goal of the present study was to develop and evaluate a short version of PAHCO differentiating between the three sub-competencies ’movement competence’, ’control competence’, and ’self-regulation competence’. In the first step, we reduced the number of items from existing PAHCO-related questionnaires, while adjusting them for a telephone survey mode. In the second step, we validated this 12-item version with N = 3986 adults between 18 and 97 years (57.0 ± 18.2 years; 52.0% male) within the representative survey “German health Update” (GEDA 2023). We also gathered information about participants’ age, gender, education, leisure-time physical activity, and self-reported health. The psychometric analyses revealed satisfactory item statistics. Confirmatory factor analyses suggested a model variant in which two items showed theory-conform parallel loadings on a second sub-competence (comparative fit index [CFI] = 0.924, root mean square error of approximation [RMSEA] = 0.073, standardized root mean square residual [SRMR] = 0.044). The latent sub-competencies were significantly related to physical activity (0.20 ≤ β ≤ 0.27) and health (0.50 ≤ β ≤ 0.65), thus indicating criterion validity. The factor structure turned out to be invariant across age, gender, and educational levels. In summary, this study gained initial insights about the reliability and validity of a 12-item version of the PAHCO questionnaire. We recommend the instrument for use within representative surveys, for initial screening, the reporting of descriptive trends, or secondary outcomes of a trial.
Hinweise

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Introduction

Physical activity in Germany

Physical activity constitutes one of the behaviors that individuals can deliberately influence and that exerts positive effects on multiple aspects of health (Li et al., 2018; Warburton & Bredin, 2017). Unfortunately, the global percentage of individuals meeting established physical activity guidelines (e.g., of at least 150 min of moderate-to-vigorous intensity per week (Bull et al., 2020; Rütten et al., 2016)), is relatively low and has raised concerns among scientists and policymakers (Ding et al., 2020; Guthold, Stevens, Riley, & Bull, 2018; Santos, Willumsen, Meheus, Ilbawi, & Bull, 2023). Specifically, epidemiological data underscored that the physical activity behavior in Germany does not positively differ from the international situation (Guthold et al., 2018). More than half of women (57.4%) and men (51.2%) do not meet the recommendations for aerobic physical activity, and around four in five women (79.5%) as well as three in four men (75.3%) do not meet the recommendations for both aerobic physical activity and muscle-strengthening activities (Finger, Mensink, Lange, & Manz, 2017). In recent years, knowledge about the behavioral patterns of specific age groups and populations has improved substantially, also nourished by representative surveys and large-scale studies with objective physical activity measurements (Leitzmann et al., 2020; Richter et al., 2021; Sudeck et al., 2021). Fueled by the increasing body of evidence about physical inactivity, it is necessary to invest efforts into the effective promotion of physical activity on both the national and the international level (Rütten et al., 2016; World Health Organization, 2018).
However, to inform interventions, researchers are advised to accumulate knowledge about the determinants of physical activity. Ideally, a theoretical approach is chosen that not only explains short-term physical activity (for an overview of theories, see Biddle, Gorely, Faulkner, & Mutrie, 2023; Rhodes, McEwan, & Rebar, 2019) but that considers the adoption or maintenance of a physically active lifestyle as a long-term or sustainable process (Dunton et al., 2022). Therefore, it appears necessary for researchers and practitioners to comprehend physical activity as a behavior habit that must be “learned”. By drawing on conceptions from educational sciences, it makes sense to define “competencies” (Kurz & Gogoll, 2010; Weinert, 2001) as a key prerequisite to lead a physically active lifestyle. The World Health Organization indirectly confirms this claim by repeatedly suggesting to address “competencies” as well as health literacy and physical literacy within its Global Action Plan on Physical Activity 2018–2030 (World Health Organization, 2018). Empirical studies indicate associations between health literacy and physical activity (Buja et al., 2020; Jordan & Hoebel, 2015). Given the need to better comprehend the determinants that lead to healthy, physically active lifestyles, specific concepts and tools at the interface of health literacy and physical activity appear relevant. One of the theoretical approaches that builds on such competencies while integrating quantitative and qualitative aspects for health-enhancing physical activity is the physical activity-related health competence model, which conceptually links ideas of health literacy and physical literacy research (Carl, Sudeck, & Pfeifer, 2020a; Haible et al., 2020).
The physical activity-related health competence (PAHCO) model specifies three sub-competencies to follow a healthy, physically active lifestyle (Carl et al., 2020a; Sudeck, Rosenstiel, Carl, & Pfeifer, 2022): movement competence, control competence, and self-regulation competence (Fig. 1). Movement competence bundles all the directly movement-related qualities (e.g., motor requirements, fitness aspects) to participate in planned exercise and to master activities of daily living (e.g., cycling, shopping). Control competence serves as the qualitative component that aligns all physical activities with individuals’ health, from both a physical (e.g., application of appropriate training loads) and a psychosocial standpoint (e.g., stress and affect regulation through physical activity). Self-regulation competence describes the motivational–volitional requirements to ensure the regularity of physical activity (frequent initiation, perseverance of a session). In line with general assumptions underlying the educational conceptualizations of “competence”, these sub-competencies result from the convergence of “to know”, “to can”, and “to want” (Töpfer & Sygusch, 2014; Weinert, 2001). Accordingly, the sub-competencies represent integrated qualifications, composed of basic elements, that direct individuals toward goal-directed behavior (i.e., a healthy, physically active lifestyle). In this regard, movement competence is formed by the interplay of motor abilities, motor skills, body and movement awareness but also by, at least, a basic level of task-specific self-efficacy (to execute a movement). Moreover, the PAHCO model posits that control competence builds on knowledge about physical activity and its effects as well as appropriate methods for exercising. Ideally, this knowledge is, in concrete situations, nourished by sensory information (ideally drawing on proficient body and movement awareness) and critical reflection processes as the basis of decisions for or against certain physical activities. Finally, self-regulation competence results from individual motive constellations and self-efficacy as motivational sources, complemented through skills of behavioral control which help bridge intention–behavior gaps or maintain effort during planned action (Sudeck & Pfeifer, 2016).
In recent research, scholars have increasingly recognized the value of this framework by employing the PAHCO model among different target groups along the health promotion and rehabilitation spectrum, including children (Lindemann, Gröben, & Braksiek, 2023; Volk et al., 2021), apprentices (Grüne, Popp, Carl, Semrau, & Pfeifer, 2022), graduate students (Carl, Sudeck, & Pfeifer, 2020b), office workers (Blaschke, Carl, Pelster, & Mess, 2023), adults (Holler, Carl, v. Poppel, & Jaunig, 2023), as well as people with non-communicable diseases (Durst, Roesel, Sudeck, Sassenberg, & Krauß, 2020; Schmid et al., 2023). However, all these studies were conducted on the level of segmented populations and, therefore, lack generalizability and representativity to inform policy on the promotion of a physically active lifestyle in the general population. Therefore, adopting a public health perspective, initiatives are needed that allow stakeholders to monitor PAHCO in the German population. More specifically, detailed knowledge about the “competence” of a society to lead physically active lifestyles has the potential to inform a multitude of future interventions in the field of physical activity and health in Germany.

Goals and research questions

The goal of the present study was to develop an assessment instrument on the basis of the PAHCO model that can be integrated within larger telephone-based surveys of the Robert Koch Institute (RKI) for representative assessments in the adult population. Accordingly, the first research question takes a processual perspective with a methodological focus by asking: how is a short version of the PAHCO questionnaire constructed that adequately meets the basic theoretical assumptions of the PAHCO model, on the one hand, and is valid and economic for an assessment via telephone, on the other? Subsequently, the goal was to evaluate the psychometric quality and validity (i.e., factorial validity, criterion validity) of this short version of the questionnaire. Accordingly, the second research question takes a technical perspective by asking: does the short version of the PAHCO questionnaire meet methodological standards to supply valid information about the level of PAHCO in the population of Germany?

Methods

Study design

The Robert Koch Institute (RKI) is Germany’s national Public Health Institute and the central institution of the Federal Government in the field of surveillance, control, and prevention of diseases. The RKI performs regular representative surveys within the adult population titled “German Health Update” (GEDA) [in German: „Gesundheit in Deutschland aktuell“]. It is a telephone-based survey using a random sample of the German-speaking population aged 18 and older in private households that can be reached via landline or mobile phone (for details on the methodology, see Allen et al., 2021; Damerow, Born, Walther, & Wetzstein, submitted). Within the 2023 wave, specific attention has been placed on aspects of physical activity (assessment period January–Mai 2023) with a potential sample size of around 4000 adults aged 18 years and older. In accordance with the increasing importance of the health literacy concept in Germany (Jordan & Hoebel, 2015; Messer, Dadaczynski, & Okan, 2022; Schaeffer, Hurrelmann, Bauer, Kolpatzik, & Altiner, 2018), the RKI aimed to integrate questions that operationalize health-related requirements for active lifestyles, theoretically localized at the interface between health literacy and physical literacy research (Carl et al., 2020a).

Item selection and adjustment process

The PAHCO model conceptually addressed this interface between health literacy and physical literacy, while also providing a standardized assessment instrument with 42 items (Carl et al., 2020b). This specific instrument included ten different scales that could be empirically assigned to the three sub-competencies of PAHCO: movement competence with five scales (n = 21 items), control competence with three scales (n = 15 items), and self-regulation competence with four scales (n = 14 items). The final solution of this questionnaire considered two theory-compatible parallel loadings, meaning that two scales (body and movement awareness; task-specific self-efficacy) and ten items, respectively, loaded on two sub-competences (which explains why simply summing up the values results in a higher number of scales and items). In addition, and in line with initial PAHCO descriptions (Sudeck & Pfeifer, 2016), we considered the measurement of motivational competence in exercise and sport (n = 4 items) (Schorno, Sudeck, Gut, Conzelmann, & Schmid, 2021) to strengthen competence orientation in the operationalization of self-regulation competence.
This total set of 46 items (the 42 items of the PAHCO long version plus the four items of the motivational competence in exercise and sport questionnaire) marked the starting point for the selection process. In accordance with the goal to not only reduce the number of items but also harmonize the entire assessment with a telephone-based mode and a population survey, we organized the adjustment through two complementary expertise perspectives: (a) both experts with an academic background in sport science as well as health-enhancing physical activity and experts with an academic background in public health and health literacy for ensuring theoretical–thematic compatibility, and (b) experts with an academic and professional background in the development of questionnaires as well as population-based (especially telephone-based) surveys for ensuring organizational–methodological compatibility. From a theoretical–thematic perspective, the claim was to maintain the conceptual breadth of PAHCO while not giving up basic psychometric claims or the factorial structure (bandwidth-fidelity dilemma; see Ones & Viswesvaran, 1996). From an organizational–methodological perspective, the entire questionnaire part on physical activity (as one topic among different health behaviors) should not exceed eight minutes in total. It should consist of clear, selective, and unambiguous questions, which should be easily understood via telephone across the educational spectrum to ensure representativity at the population level. In this regard, the selection and adjustment process was informed by the GEDA standards for telephone-based assessments (Allen et al., 2021). The item construction adhered to a pragmatic strategy with successive alterations between both expert groups. More specifically, the expertise group that has undertaken the development of the long version of the PAHCO questionnaire has generated an initial pool of 16 items based on theoretical reflections (“marker items” with a good, broad representation of a construct) and empirical experiences from former studies (e.g., via item reliabilities, item difficulties, sensitivity of change, theoretical “marker”). Subsequently, the expertise group at the RKI (SJ, AL, MB, KM, and OD) identified items whether items could be adopted without change, had to be adjusted, omitted, or replaced with alternative items from the long version. The expertise group, in turn, sent their suggestions and material back to the first team and the alternating proceeding was maintained until both expertise groups recognized quality saturation.

External variables and sociodemographic information

The survey has included one question about the volume of leisure-time physical activity behavior from the European Health Interview Survey—Physical Activity Questionnaire (EHIS-PAQ; Finger et al., 2015): “How many total hours and minutes do you spend in a usual week with sport, fitness, or physical activity during leisure-time?” [German: “Wie viele Stunden und Minuten verbringen Sie insgesamt in einer typischen Woche mit Sport, Fitness oder körperlicher Aktivität in der Freizeit?”]. Afterwards, the interviewer noted participants’ free specification. The self-reported health status was assessed with one item within the Minimum European Health Module (Eurostat, 2013): “Now I want to ask you questions about your health. How is your health status in general?” [German: “Ich möchte Ihnen jetzt Fragen zu Ihrer Gesundheit stellen. Wie ist Ihr Gesundheitszustand im Allgemeinen?”]. The answer options were “very good”, “good”, “fair”, “poor”, and “very poor” [German: “sehr gut”, “gut”, “mittelmäßig”, “schlecht”, “sehr schlecht”].
We determined participants’ age based on the self-reported birth year and month. Interviews were discontinued and participants excluded if the calculated age was under 18 years. Interviewees were asked about their gender identity: “Since not all individuals feel that they belong to their registered gender: Which gender do you feel you belong to?” [German: “Da sich nicht alle Menschen ihrem eingetragenen Geschlecht zugehörig fühlen: Welchem Geschlecht fühlen Sie sich zugehörig?”]. The participants could choose between “male”, “female”, and “others, namely [blank]”. Finally, we extracted education with the CASMIN classification (Brauns, Scherer, & Steinmann, 2003; Schneider, 2015) introducing with the question: “Which highest vocational degree of education or studies do you have?” [German: “Welchen höchsten beruflichen Ausbildungs- oder Hochschul‑/Fachhochschulabschluss haben Sie?”]. The interviewees could choose between ten different options, with the instruction to find an equivalent if qualifications were obtained in other countries.

Overall validation strategy

After the identification of appropriate items for the short version of PAHCO, we undertook psychometric validation with an unweighted dataset involving the following successive stages (as in line with: Bühner, 2021): (1) explorative item analysis; (2) examination of factorial validity and reliability via confirmatory factor analysis (CFA); (3) analysis of associations with indicators of physical activity and health (criterion validity) using structural equation modeling (SEM); and (4) inspection of measurement invariance in regard to age, gender, and education.

Statistics

After the item selection and adjustment, we conducted all statistical analyses (steps 1–4) using the software R (version 4.3.0, R Foundation for Statistical Computing, Vienna, Austria) with the Lavaan package (version 0.6–15; Rosseel, 2021). Within the scope of explorative item analysis (step 1), we examined basic descriptive statistics (mean value and item difficulty, standard deviation, skewness, and kurtosis). In this context, we explicitly permitted various item difficulties (ID) to enable potential differentiations in more extreme ranges (i.e., 0.05 < ID ≤ 0.20 and 0.80 ≥ ID > 0.95) but tolerated this for only one item per scale. Furthermore, we inspected McDonalds’s ω (internal consistency) for each scale (Zinbarg, Revelle, Yovel, & Li, 2005) as well as part-whole correlation coefficients for each item. Shapiro–Wilk tests delivered information about potential deviations from normal distribution (Razali & Wah, 2011).
For the investigation of the factorial structure (step 2), we specified CFA models with robust maximum likelihood estimators (MLRs) to counteract violations against multivariate normality. In terms of the global model fit, we adhered to the recommendations by Hu and Bentler (1998) requesting the report of the comparative fit index (CFI) as a goodness-of-fit indictor as well as the standardized root mean square residual (SRMR) and the root mean square error of approximation (RMSEA) as a badness-of-fit indices. For evaluating the magnitude of these coefficients, we followed common guidelines indicating good (RMSEA ≤ 0.05, SRMR ≤ 0.05, CFI ≥ 0.95) or acceptable/satisfactory (RMSEA ≤ 0.08, SRMR ≤ 0.10, CFI ≥ 0.90) model fits (Schermelleh-Engel, Moosbrugger, & Müller, 2003; Weiber & Mühlhaus, 2015). The participants could choose to not provide information on a single question [German: “keine Angabe”] or answer with “I don’t know” [German: “Ich weiß es nicht”]. In all CFA and SEM procedures, we technically handled such missing values with full information maximum likelihood (FIML) imputation techniques. In line with the validation procedure as undertaken with the long version of the PAHCO questionnaire (Carl et al., 2020b), we calculated two different model variants: one model in which all items just loaded on one sub-competence (simple loading structure) and one model with theory-compatible parallel loadings (parallel loading structure) of two items. The only difference between both model variants is that the parallel loading structure considered body and movement awareness operationalizations as being assigned to both control competence and movement competence as well as task-specific self-efficacy operationalizations as being assigned to both self-regulation competence and movement competence (for previous descriptions of the corresponding PAHCO foundations, see Sect. “The physical activity-related health competence (PAHCO) model”, and for previous descriptions of the same validation approach in the original long version of the questionnaire, see Sect. “Item selection and adjustment process” within this article). These models were contrasted with Akaike’s (AIC) and Bayes’ (BIC) information criteria as well as the Satorra–Bentler scaled chi2 difference test (∆SB-χ2) as an inferential statistical procedure for nested model comparisons. In a next step, we extended the models as mentioned above to SEM by examining associations of the sub-competencies with leisure-time physical activity and the self-reported health status (criterion validity) as theory-conform external variables of metric character (step 3). In this context, we explored potential differences in the magnitude of the associations after applying logarithm-based Fisher’s z transformations. Moreover, we investigated whether there are statistical arguments to compare levels of PAHCO between relevant subgroups (step 4). We undertook classifications that still ensured a power of n ≥ 300 for each class. In this context, we contrasted gender (male and female), formed five different age groups (18–35 years, 35–50 years, 51–65 years, 66–80 years, ≥ 80 years), and used the categorization of CASMIN into three education groups (low, medium, high). Technically, we submitted the short version of PAHCO to an examination of measurement invariance via multigroup comparisons. More specifically, we successively restricted the factor loadings (metric invariance), the intercepts (scalar invariance), and the residuals (strict invariance). We maintained the corresponding next invariance level if the changes in the fit coefficients did not surpass the suggested levels (Chen, 2007): ∆CFI ≤ −0.01, ∆RMSEA ≥ 0.015, and ∆SRMR ≥ 0.03 (for metric invariance) and ∆SRMR ≥ 0.01 (for scalar and strict invariance), respectively. To undertake comparisons with this instrument in the future, we had to record at least scalar invariance within this study (Van de Schoot, Lugtig, & Hox, 2012). Finally, we formed a manifest overall PAHCO score with all items (PAHCO_12), if approved by scale reliability (again via McDonald’s ω) and criterion validity reflecting bivariate associations with leisure-time physical activity and the self-reported health status.

Results

Initial item pool

From an organizational–methodological perspective, the discussions revealed that we could only reserve 10–12 questions on PAHCO for the telephone survey due to a time limit for the overall interview. Concurrently, the thematic conceptualization of the short version of the PAHCO questionnaire was driven by the following claims: (a) the operationalization of movement competence should still be guided by differentiations into whether demands rather referred to endurance, strength, balance, or sensory information (i.e., body awareness); (b) in terms of control competence, we were interested in distinguishing between individual’s alignment with physical health, on the one hand, and with psychological well-being, on the other; (c) self-regulation competence, in turn, should cover both motivational and volitational aspects. The maximum number of items in the survey implied that most of these differentiated aspects could only be represented by a single item. In summary, the selection and adjustment of single items were based on a mixture of psychometric findings from previous projects (item difficulty, factor loadings) as well as evaluations of basic comprehensibility among the general populations. Finally, we generated a total of 12 items, which all have to be answered on a five-point Likert scale. The questions were introduced with “Now, its’s all about exercise. Which answer applies best to you?” [German: “Nun geht es um das Thema Bewegung. Welche Antwort trifft am besten auf Sie zu?”]. The first two questions operationalizing the manageability of endurance and strength demands (as part of movement competence) ranged from 1 = “I can do this without any problems” [German: “Ich kann dies ohne Probleme”] to 5 = “I cannot do this” [German: “Ich kann dies nicht”], and required subsequent inverting. All other questions (n = 10) had answering options from 1 = “does not apply” [German: “trifft nicht zu”] to 5 = “applies very much” [German: “trifft sehr zu”]. All items, answering options, and adjustments in comparison to the long version of the PAHCO questionnaire can be retrieved from Table 1.
Table 1
The items of the PAHCO_12
No.
Aspect
Attributable subcompetencea
Adjustments in comparison to the long version of PAHCO
Item in English language (translated)
Item in German language (as used in PAHCO_12)
1
Manageability of endurance demands
Movement competence
We replaced “running” with “jogging” to specify the movement
I can maintain a slightly exhausting physical activity, which makes me breathe a little faster (e.g., walking, slow jogging or cycling), for 30 min without a break
Ich kann eine etwas anstrengende körperliche Aktivität, bei der ich etwas schneller atmen muss, z. B. Gehen, langsames Joggen oder Radfahren, 30 min ohne Pause durchhalten
2
Manageability of strength demands
Movement competence
We replaced “15 kg” with “10 kg” to lower the physical challenges related to the characteristics of the population; accordingly, we adjusted the examples in the bracket
I can lift an object that is approx. 10 kg several floors upwards (e.g., full shopping bag, filled suitcase, small beverage crate) [Interviewer note: In case of a request, please note: 3 floors]
Ich kann einen ca. 10 kg schweren Gegenstand über mehrere Etagen hochtragen, z. B. volle Einkaufstasche, gefüllter Reisekoffer, kleine Getränkekiste [Interviewerhinweis: Bei Nachfragen erfolgt der Hinweis: 3 Etagen]
Sentence order adjusted for better comprehensibility (examples at the end)
We added an interviewer note to specify the item in case of a request
3
Manageability of balance demands
Movement competence
We adjusted the order of the sentence (i.e., “without losing the balance” was moved at the end of the sentence) for comprehensibility reasons
I can stand on one leg and reach for an object without losing balance
Ich kann auf einem Bein stehen, gleichzeitig nach einem Gegenstand greifen und verliere dabei nicht das Gleichgewicht
4
Movement and body awareness
Movement competence, control competencea
We slightly adjusted the construction of the sentence for comprehensibility reasons (previously without “helps me to master”)
My body awareness helps me to master physically demanding situations well
Mein Körpergefühl hilft mir, körperlich fordernde Situationen gut zu bewältigen
5
Control of physical load
Control competence
We added an interviewer note to take into account that some people (on the population level) may have not exercised before
I am able to adjust my training effort well to my physical condition [Interviewer note: The point is to choose the intensity of the training so that it suits your own physical condition. If people have never exercised before, please tick the answer category “does not apply”]
Ich bin in der Lage, eine Trainingsbelastung gut auf meine körperlichen Voraussetzungen anzupassen [Interviewerhinweis: Es geht darum, die Intensität des Trainings so zu wählen, dass sie zu den eigenen körperlichen Voraussetzungen passt. Wenn Personen noch nie trainiert haben, dann bitte die Antwortkategorie “trifft nicht zu” ankreuzen.]
6
Control of physical load
Control competence
We added an interviewer note to take into account that some people (on the population level) may have not exercised before
I know how to use physical training to improve my endurance in the best possible way [Interviewer note: If people have never exercised, please tick the answer category “does not apply”]
Ich weiß, wie ich mit körperlichem Training meine Ausdauerleistung am besten steigern kann [Interviewerhinweis: Wenn Personen noch nie trainiert haben, dann bitte die Antwortkategorie “trifft nicht zu” ankreuzen.]
7
Control of physical load
Control competence
No changes undertaken
I know what to pay attention to in relation to my body in order to avoid excess load or insufficient load
Ich weiß, worauf ich bei meinem Körper achten muss, damit ich mich nicht über- oder unterfordere
8
Affect regulation
Control competence
In German, we removed the word “wieder” [translated: “again”] for comprehensibility reasons, which had no semantic and verbal consequence for the English version
I am well able to work off pent-up stress and inner tension through exercise
Ich kann aufgestauten Stress und innere Anspannung durch Bewegung gut abbauen
9
Task-specific self-efficacy
Self-regulation competence, movement competencea
We added an interviewer note
I feel capable to perform physical activities that are challenging for me [Interviewer note: This is about the physical activity/movement that you find demanding or challenging]
Ich traue mir zu, für mich anspruchsvolle körperliche Aktivitäten durchzuführen [Interviewerhinweis: Es geht um die körperliche Aktivität/Bewegung, die Sie für sich als anspruchsvoll empfinden oder die Sie vor eine Herausforderung stellt.]
10
Self-control
Self-regulation competence
In German, we removed the word “zu wollen” [translated: “to want”] for comprehensibility reasons, which had no semantic and verbal consequence for the adaptation of the English version
When I decide to do more exercise, I am very disciplined in implementing this plan
Wenn ich mir vornehme, mich mehr zu bewegen, habe ich viel Disziplin bei der Umsetzung
11
Motivational competence for exercise and sport
Self-regulation competence
For comprehensibility reasons, we undertook slight adjustments in German for the last half clause, but this had no consequences for the English translation
I am very able to choose from a variety of exercise and sport activities the one that suits me best
Ich bin sehr gut in der Lage aus einer Vielfalt von Sport- und Bewegungsangeboten das auszuwählen, welches am besten zu mir passt
12
Self-control
Self-regulation competence
In German, we removed the word “körperlich” [translated: “physical”] in “körperlich-sportliche” for comprehensibility reasons, but it had no consequence for the English version (as it is covered by “exercise”)
If I have planned to exercise, I generally follow through on this plan
Wenn ich eine sportliche Aktivität geplant habe, setze ich das in der Regel auch um
If two attributable sub-competences were mentioned per item, the second sub-competence was only included in the second model
aThe present validation contrasted two theory-compatible models via confirmatory factor analysis (see Sect. “Overall validation strategy”)

Participants

The present validations grounded on a total of N = 3986 individuals within this GEDA wave, corresponding to a telephone-based response rate of 19.4% (depending on the wave) in line with the response rate 3 of the American Association for Public Opinion Research (AAPOR) (Gramlich, Liebau, & Schunter, 2019). The participants were on average 57.04 ± 18.19 years old, and the self-reported health status was as follows: very poor 1.6%, poor 6.1%, fair 25.6%, good 49.5%, and very good 17.3%. Slightly more women (53.0%) than men (47.0%) were part of the validation. The participants reported the following educational levels: low 16.2%, moderate 45.1%, and high 38.8%.

Exploratory item analysis

The mean values of the 12 items ranged between 3.40 (item #8 on self-control) and 4.20 (item #1 on the manageability of endurance demands) along the 1–5 Likert scale, corresponding to item difficulties between 0.60 and 0.80 (Table 2). In summary, all items were dominantly located in the upper half, yet still in an acceptable area (ID ≤ 0.80) of the scale. Although all 12 items deviated significantly from normal distribution (0.70 ≤ W ≤ 0.90, p < 0.001), we registered skewness values between −1.46 and −0.34 as well as kurtosis coefficients between −0.77 and 1.10. The proportion of missing values ranged between 0.4% (item #1 on the manageability of endurance demands) and 2.2% (item #4 on movement and body awareness).
Table 2
Results of the exploratory item analyses
No.
Aspect
Item in English language (translated)
Descriptive statistics
Mean value (scale 1–5)
Standard deviation
Item difficulty
Skewness
Kurtosis
1
Manageability of endurance demands
I can maintain a slightly exhausting physical activity, which makes me breathe a little faster (e.g., walking, slow jogging or cycling), for 30 min without a breaka
4.20
1.18
0.80
−1.46
1.10
2
Manageability of strength demands
I can lift an object that is approx. 10 kg several floors upwards (e.g., full shopping bag, filled suitcase, small beverage crate)a
3.98
1.36
0.75
−1.18
0.04
3
Manageability of balance demands
I can stand on one leg and reach for an object without losing balanceb
3.79
1.43
0.70
−0.87
−0.65
4
Movement and body awareness
My body awareness helps me to master physically demanding situations wellb
3.96
1.18
0.74
−0.99
0.11
5
Control of physical load
I am able to adjust my training effort well to my physical conditionb
3.88
1.28
0.72
−0.98
−0.10
6
Control of physical load
I know how to use physical training to improve my endurance in the best possible wayb
3.88
1.28
0.72
−0.99
−0.06
7
Control of physical load
I know what to pay attention to in relation to my body in order to avoid excess load or insufficient loadb
4.19
1.00
0.80
−1.31
1.32
8
Affect regulation
I am well able to work off pent-up stress and inner tension through exerciseb
3.68
1.25
0.67
−0.70
−0.48
9
Task-specific self-efficacy
I feel capable to perform physical activities that are challenging for meb
3.70
1.29
0.68
−0.77
−0.46
10
Self-control
When I decide to do more exercise, I am very disciplined in implementing this planb
3.40
1.22
0.60
−0.34
−0.77
11
Motivational competence for exercise and sport
I am very able to choose from a variety of exercise and sport activities the one that suits me bestb
3.95
1.24
0.74
−1.09
0.19
12
Self-control
If I have planned to exercise, I generally follow through on this planb
3.72
1.24
0.68
−0.78
−0.33
The total number of persons analyzed ranged between n = 3897 and n = 3970 (missing percentage between 0.4 and 2.2%)
aAnswering options (items 1 + 2) subsequent inverted processing: 1 = “I can do this without any problems” [German: “Ich kann dies ohne Probleme”], 2 = “I have some slight problems” [“Ich habe leichte Probleme”], 3 = “I have moderate problems” [“Ich habe mäßige Probleme”], 4 = “I have major problems” [“Ich habe große Probleme”], 5 = “I cannot do this” [“Ich kann dies nicht”]
bAnswering options (items 3–12): 1 = “does not apply” [German: “trifft nicht zu”] … 5 = “applies very much” [“trifft sehr zu”]

Factorial validity

The model with the simple loading structure displayed an insufficient global fit (CFI = 0.870, RMSEA = 0.094 [CI90 = 0.091–0.097], SRMR = 0.058, AIC = 135476, BIC = 135721), with only the SRMR coefficient showing an acceptable value (Fig. 2a). When additionally considering theory-compatible parallel loadings of body and movement awareness as well as task-specific self-efficacy (Fig. 2b), the corresponding model yielded a satisfactory to acceptable global model fit (CFI = 0.924, RMSEA = 0.073 [CI90 = 0.070–0.076], SRMR = 0.044, AIC = 134398, BIC = 134656). In particular, the descriptive values of the CFI and RMSEA improved substantially. Most importantly, the direct comparison between both variants clearly favored the model with the two parallel loadings (∆SB-χ2 = 736.6, ∆df = 2, p < 0.001, ∆AIC = −1078, ∆BIC = −1065). Against this background, we continued the further validation and psychometric examinations with the parallel loading model only.

Reliability

The factor reliabilities (Table 3) of the three PAHCO sub-competencies within the CFA (parallel loading structure) were satisfactory (0.78 ≤ ω ≤ 0.84). Importantly, the factor reliability would not decrease when removing any item. All items without a twofold assignment to a sub-component revealed item loadings λ ≥ 0.60 (Fig. 2). Only the seventh item (an operationalization of control of physical load) had a slightly lower coefficient (λ = 0.54). The two items with parallel loadings shared their variance between the two respective latent factors, yet consistently exceeded loadings λ ≥ 0.30 (Fig. 2).
Table 3
Factor reliability (ω) and criterion validity of the three sub-competences of PAHCO
Sub-competences
Number of items
Reliability aspects
Criterion validity
McDonald’s ω (factor reliability)
Part-whole correlations (item level)
Leisure-time physical activity (as outcome)
Self-reported health (as outcome)
Movement competence
5
0.84
0.57–0.67
β = 0.201, p < 0.001
β = 0.652, p < 0.001
Control competence
5
0.82
0.53–0.71
β = 0.244, p < 0.001
β = 0.551, p < 0.001
Self-regulation Competence
4
0.78
0.51–0.65
β = 0.274, p < 0.001
β = 0.498, p < 0.001
Global model fits of the structural equation model (SEM) when adding the two outcomes: movement competence (CFI = 0.921, RMSEA = 0.067, SRMR = 0.048), control competence (CFI = 0.898, RMSEA = 0.076, SRMR = 0.051), self-regulation competence (CFI = 0.883, RMSEA = 0.082, SRMR = 0.060)

Criterion validity

All three latent sub-competencies of PAHCO correlated significantly with the physical activity behavior (0.201 ≤ β ≤ 0.274, p < 0.001), low-to-moderate in size (Table 3). Similarly, all sub-competencies of PAHCO were related to the self-reported health status, with a consistently high effect size (0.498 ≤ β ≤ 0.652, p < 0.001). We registered variations in the magnitudes of these associations across both outcomes. In exploratory comparisons, self-regulation competence was more strongly associated with leisure-time physical activity than movement competence (z = 3.51, p < 0.001). Movement competence, in turn, was more strongly related to the self-reported health status than self-regulation competence (z = 10.2, p < 0.001).

Measurement invariance

The factor structure of the parallel loading model turned out to be completely invariant for gender (Table 4). We registered acceptable scalar invariance of the measurement model for age. While we found a disproportionate decrease for this step in the CFI coefficient, the changes of the RMSEA and SRMR were still acceptable. Strict invariance could not be maintained for the age variable. The successive restrictions for the education variable could still be maintained until the restriction of intercepts (scalar invariance). While the CFI fell substantially when restricting the residuals, the changes in the two other indicators (RMSEA, SRMR) still suggested strict invariance of the measurement model for education.
Table 4
Analysis of measurement invariance
Variable of interest
Type of invariance
Global model fits
CFI
∆CFI
RMSEA
∆RMSEA
SRMR
∆SRMR
Gender (male: n = 2111, female: n = 1858)
Configural
0.927
0.091
0.045
Metric
0.925
−0.002
0.087
−0.004
0.049
0.004
Scalar
0.913
−0.012
0.090
0.003
0.054
0.005
Strict
0.907
−0.006
0.089
−0.001
0.057
0.003
Age (18–35 years: n = 458, 36–50 years: n = 704, 51–65 years: n = 1257 66–80 years: n = 1098, >80 years: n = 469)
Configural
0.918
0.073
0.048
Metric
0.913
−0.005
0.070
−0.003
0.057
0.009
Scalar
0.890
−0.023
0.074
0.004
0.063
0.006
Strict
0.844
−0.046
0.082
0.008
0.082
0.019
Education (low: n = 644, moderate: n = 1793, high: n = 1542)
Configural
0.920
0.074
0.046
Metric
0.918
−0.002
0.070
−0.004
0.050
0.004
Scalar
0.912
−0.006
0.068
−0.002
0.051
0.001
Strict
0.885
−0.027
0.074
0.006
0.058
0.007
Measurement invariance was only tested for the parallel loading model. The fit indices of the basic CFA model were CFI = 0.924, RMSEA = 0.073, and SRMR = 0.044

Overall score of PAHCO_12 and subscores

In the last step, we converged all 12 items to a single overarching PAHCO factor. All items entered the overall score equally. We ascertained a McDonald’s ω = 0.90 for this scale, with no item causing a reduction in overall reliability. Similar as to the individual sub-competencies, the manifest PAHCO_12 score correlated significantly with leisure-time physical activity (r = 0.233, p < 0.001) and the self-reported health status (r = 0.541, p < 0.001). Table 5 illustrates and summarizes the formula for the sub-competencies and the overall PAHCO score as supported by the present validity findings.
Table 5
Formula for the calculation of the scales as supported by the present validations
Score
Formula
Range of the scale
Lower limit
Upper limit
Movement competence
Item_1INV + Item_2INV + Item_3 + 0.5 * Item_4 + 0.5 * Item_9
0
16
Control competence
0.5 * Item_4 + Item_5 + Item_6 + Item_7 + Item_8
0
18
Self-regulation competence
0.5 * Item_9 + Item_10 + Item_11 + Item_12
0
14
PAHCO_12 (overall PAHCO score)
Item_1INV + Item_2 INV + Item_3 + Item_4 + Item_5 + Item_6 + Item_7 + Item_8 + Item_9 + Item_10 + Item_11 + Item_12
0
48
INVThe items 1 and 2 require inverting. Before scale formation, all items must be transformed from 1–5 to 0–4 (implying a subtraction of 1 for each item)

Discussion

To the best of our understanding, there is currently no study in Germany that has representatively assessed behavior-oriented (i.e., physical, cognitive, motivational) determinants for physically active lifestyles in adulthood. The present analysis marked the technical prerequisite for a further characterization of these determinants on the population level by adjusting a long version of the PAHCO questionnaire and deriving a 12-item short version for a telephone-based assessment: the PAHCO_12. Given the number of items reserved for the implementation into the survey, we had to adequately manage the trade-off between covering the breadth of the concept, on the one hand, and the fulfillment of psychometric qualities, on the other.
According to initial descriptive analyses, all 12 items demonstrated satisfactory characteristics (in terms of item skewness and kurtosis) while also exhibiting favorable item difficulties on the scale. For purposes of differentiation, it may have been desirable to register stronger variations in the difficulty across the items, especially within the operationalized sub-competencies. However, as this short version of PAHCO only intended to maintain the multifaceted nature of the model components (instead of precisely combining different item difficulties), this claim lay beyond the scope of this instrument. Against this background, the descriptive results entitle us to qualify the 12-item instrument as a screening instrument to economically gain insights into PAHCO. Nevertheless, we identified a factor structure that harmonized with the basic postulates of the PAHCO model (Carl et al., 2020a; Sudeck & Pfeifer, 2016). Similar as to the findings of the validation study for the long version of PAHCO (Carl et al., 2020b), the CFAs favored a model variant in which two parallel loading on two sub-components were considered. First, the measurement model considered task-specific self-efficacy as a requirement for the uptake of basic motor activities (i.e., consideration of movement competence in addition to self-regulation competence). In this regard, the results of the nested comparisons stood empirically in line with a meta-analysis indicating that exactly this task-specific interpretation of self-efficacy may play a stronger role for the short-term uptake of actions, whereas behavioral/barrier-specific self-efficacy tended to unfold their potential for long-term physical activity behavior (Higgins, Middleton, Winner, & Janelle, 2014). Second, the body and movement awareness item also loaded on control competence (in addition to movement competence). In summary, this path accounts for scholarly insights that individuals can draw on sensory inputs and interoceptive mechanisms (e.g., estimating the heart rate during movements) to instantly regulate the physical load (e.g., pacing behavior: (Smits, Pepping, & Hettinga, 2014; Thiel, Pfeifer, & Sudeck, 2018)). As a consequence of these two parallel loadings, the item reliabilities were slightly lower than when specifying single loadings, but this could be explained by the reflective measurement model (Hanafiah, 2020) characterizing the items as indicators of the latent constructs (i.e., the sub-competencies; and not the constructs as the result of the composition of different items). When interpreting the scales at the sub-competence level, the reliability analyses uncovered that all items made a significant contribution to their assigned scales. This finding may also be the result of the thematic breadth of the sub-competencies, as the PAHCO items represented idiosyncratic demands relevant for physically active lifestyles.
The present study also accumulated promising hints regarding the criterion validity of the instrument by displaying low-to-moderate relationships with self-reported physical activity during leisure time (as a behavioral variable) and high associations with the self-reported health status (as a trait-like status variable). Interestingly, two studies with multiple sclerosis and vocational education students employing the long versions of PAHCO found similar effect sizes for associations between the sub-competencies of PAHCO and indicators of physical activity and health (Carl, Grüne, Popp, & Pfeifer, 2020; Carl, Hartung, Tallner, & Pfeifer, 2021). Accordingly, the accumulation of empirical data corroborates PAHCO as being localized between research on physical literacy and health (literacy) (Haible et al., 2020; Holler et al., 2023). While health literacy focuses on the ability of individuals dealing with information and applying it to inform healthy decisions, the concept of PAHCO allows to understand different sub-competencies specifically required to engage in a health-oriented physically active lifestyle. Finally, we also investigated whether the shortened questionnaire was invariant across age, gender, and education levels—the sociodemographic variables with the highest relevance for the public health surveillance in Germany (Robert Koch-Institut, 2015). In this regard, this study provided the psychometric basis for a more detailed analysis of PAHCO through a public health lens. Such a public health lens could involve empirical relationships between the 12-item PAHCO version and, for example, the three sociodemographic variables as mentioned above to identify population groups with different needs for physical activity promotion.
The present study has four major limitations. First, the adjustment relied on experts with a theoretical–thematic and methodological–organizational focus. Although the process started with a set of proven items, testing with the target group (e.g., via cognitive interviews) may have added value in terms of the acceptance and comprehensibility of the instrument. Second, we did not empirically test the potential loss in content validity due to the reduction in the number of items. As introduced, it was due to limited time frames (eight minutes within this GEDA wave) not possible to utilize a long(er) version of PAHCO, which induced us to control this validity step by a circular employment of two independent expertise groups (see, e.g., the theoretical elaborations for item selection in Table 1). Third, we embedded the telephone interviews into a clear temporal schedule to ensure organization and feasibility. We cannot exclude that interviewers might have rigorously attached to these schedules, which might have, in single cases, unintentionally pressured individuals with a slower progressing time. Fourth, only one of the four control competence items addressed the alignment of physical activities with psychological health (item #8: “I am well able to work off pent-up stress and inner tension through exercise”). In this regard, the construction process has, as an outcome of the feedback cycles ensuring comprehensibility, indirectly prioritized the alignment with physical health (three items) within the operationalization of this sub-competence.

Conclusion

When designing systematic interventions with a focus on PAHCO or conducting elaborate associative analyses, we would refer to more comprehensive long versions of PAHCO questionnaire including multi-item sets for the sub-competencies of interest. However, the present study provided initial evidence for the reliability and validity of the 12-item, short version of the PAHCO questionnaire, the PAHCO_12. The validated tool delivers an overall score for PAHCO as well as specific information about individual’s movement competence, control competence, and self-regulation competence. Given the modality applied in this survey, we can recommend interested stakeholders of this instrument to perform telephone interviews for the assessment of PAHCO among adults on the population level. When considering the current questionnaire for research projects, we would suggest this instrument as a screening tool, for communicating descriptive trends, or as a secondary outcome of a trial.

Acknowledgements

The authors gratefully acknowledge A.-K. M. Loer’s (AL) contribution in adjusting the PAHCO questionnaire for the short form PAHCO_12. They would also like to thank K. Manz (KM) for their advice on the items regarding physical activity. We would like to thank the study participants who responded to the survey and colleagues from the Robert Koch Institute who helped conduct the GEDA study.

Funding

The survey GEDA was funded by the Robert Koch Institute and the Federal Ministry of Health of Germany. The authors received no funding for this study. We acknowledge financial support by Deutsche Forschungsgemeinschaft (DFG) and Friedrich-Alexander University Erlangen-Nürnberg within the funding program “Open Access Publication Funding”.

Declarations

Conflict of interest

J. Carl, O.M. Domanska, M. Buchmann, S. Jordan, K. Pfeifer and G. Sudeck declare that they have no competing interests.
All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. “German Health Update” (GEDA 2023) strictly complies with the data protection regulations of the German Data Protection Regulation (DSGVO) and the Federal Data Protection Act (BDSG). The ethics committee of the Charité – University Medicine Berlin has reviewed the study and has approved its implementation (application number EA2/201/21). The participation in the study was voluntary and anonymous. Informed consent was obtained from all individual participants included in the study.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Unsere Produktempfehlungen

e.Med Interdisziplinär

Kombi-Abonnement

Für Ihren Erfolg in Klinik und Praxis - Die beste Hilfe in Ihrem Arbeitsalltag

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de.

e.Med Allgemeinmedizin

Kombi-Abonnement

Mit e.Med Allgemeinmedizin erhalten Sie Zugang zu allen CME-Fortbildungen und Premium-Inhalten der allgemeinmedizinischen Zeitschriften, inklusive einer gedruckten Allgemeinmedizin-Zeitschrift Ihrer Wahl.

e.Med Innere Medizin

Kombi-Abonnement

Mit e.Med Innere Medizin erhalten Sie Zugang zu CME-Fortbildungen des Fachgebietes Innere Medizin, den Premium-Inhalten der internistischen Fachzeitschriften, inklusive einer gedruckten internistischen Zeitschrift Ihrer Wahl.

Weitere Produktempfehlungen anzeigen
Literatur
Zurück zum Zitat Biddle, S. J. H., Gorely, T., Faulkner, G., & Mutrie, N. (2023). Psychology of physical activity: a 30-year reflection on correlates, barriers, and theory. International Journal of Sport and Exercise Psychology, 21(1), 1–14.CrossRef Biddle, S. J. H., Gorely, T., Faulkner, G., & Mutrie, N. (2023). Psychology of physical activity: a 30-year reflection on correlates, barriers, and theory. International Journal of Sport and Exercise Psychology, 21(1), 1–14.CrossRef
Zurück zum Zitat Brauns, H., Scherer, S., & Steinmann, S. (2003). The CASMIN educational classification in international comparative research. In J. H. P. Hoffmeyer-Zlotnik & C. Wolf (Eds.), Advances in cross-national comparison: a European working book for demographic and socio-economic variables (pp. 221–244). Springer. https://doi.org/10.1007/978-1-4419-9186-7_11.CrossRef Brauns, H., Scherer, S., & Steinmann, S. (2003). The CASMIN educational classification in international comparative research. In J. H. P. Hoffmeyer-Zlotnik & C. Wolf (Eds.), Advances in cross-national comparison: a European working book for demographic and socio-economic variables (pp. 221–244). Springer. https://​doi.​org/​10.​1007/​978-1-4419-9186-7_​11.CrossRef
Zurück zum Zitat Bühner, M. (2021). Einführung in die Test-und Fragebogenkonstruktion [Introduction into test and questionnaire construction] (4th edn.). Pearson. Bühner, M. (2021). Einführung in die Test-und Fragebogenkonstruktion [Introduction into test and questionnaire construction] (4th edn.). Pearson.
Zurück zum Zitat Buja, A., Rabensteiner, A., Sperotto, M., Grotto, G., Bertoncello, C., Cocchio, S., Baldovin, T., Contu, P., Lorini, C., & Baldo, V. (2020). Health literacy and physical activity: a systematic review. Journal of physical activity & health, 17(12), 1259–1274. https://doi.org/10.1123/jpah.2020-0161.CrossRef Buja, A., Rabensteiner, A., Sperotto, M., Grotto, G., Bertoncello, C., Cocchio, S., Baldovin, T., Contu, P., Lorini, C., & Baldo, V. (2020). Health literacy and physical activity: a systematic review. Journal of physical activity & health, 17(12), 1259–1274. https://​doi.​org/​10.​1123/​jpah.​2020-0161.CrossRef
Zurück zum Zitat Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., & Chou, R. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British journal of sports medicine, 54(24), 1451–1462.CrossRefPubMed Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., & Chou, R. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British journal of sports medicine, 54(24), 1451–1462.CrossRefPubMed
Zurück zum Zitat Chen, F. F. (2007). Sensitivity of goodness of fit indexes to lack of measurement invariance. Structural Equation Modeling: A Multidisciplinary Journal, 14(3), 464–504.MathSciNetCrossRef Chen, F. F. (2007). Sensitivity of goodness of fit indexes to lack of measurement invariance. Structural Equation Modeling: A Multidisciplinary Journal, 14(3), 464–504.MathSciNetCrossRef
Zurück zum Zitat Damerow, S., Born, S., Walther, L., & Wetzstein, M. Data resource profile: German health update (GEDA) & German children’s health update (KIDA)—the health interview survey in Germany. submitted Damerow, S., Born, S., Walther, L., & Wetzstein, M. Data resource profile: German health update (GEDA) & German children’s health update (KIDA)—the health interview survey in Germany. submitted
Zurück zum Zitat Ding, D., Varela, A. R., Bauman, A. E., Ekelund, U., Lee, I.-M., Heath, G., Katzmarzyk, P. T., Reis, R., & Pratt, M. (2020). Towards better evidence-informed global action: lessons learnt from the Lancet series and recent developments in physical activity and public health. British journal of sports medicine, 54(8), 462–468.CrossRefPubMed Ding, D., Varela, A. R., Bauman, A. E., Ekelund, U., Lee, I.-M., Heath, G., Katzmarzyk, P. T., Reis, R., & Pratt, M. (2020). Towards better evidence-informed global action: lessons learnt from the Lancet series and recent developments in physical activity and public health. British journal of sports medicine, 54(8), 462–468.CrossRefPubMed
Zurück zum Zitat Durst, J., Roesel, I., Sudeck, G., Sassenberg, K., & Krauß, I. (2020). Effectiveness of human versus computer-based instructions for exercise on physical activity-related health competence in patients with hip osteoarthritis: randomized non-inferiority cross-over trial. Journal of Medical Internet Research, 22(9), e18233. https://doi.org/10.2196/18233.CrossRefPubMedPubMedCentral Durst, J., Roesel, I., Sudeck, G., Sassenberg, K., & Krauß, I. (2020). Effectiveness of human versus computer-based instructions for exercise on physical activity-related health competence in patients with hip osteoarthritis: randomized non-inferiority cross-over trial. Journal of Medical Internet Research, 22(9), e18233. https://​doi.​org/​10.​2196/​18233.CrossRefPubMedPubMedCentral
Zurück zum Zitat Finger, J. D., Tafforeau, J., Gisle, L., Oja, L., Ziese, T., Thelen, J., Mensink, G. B., & Lange, C. (2015). Development of the European health interview survey-physical activity questionnaire (EHIS-PAQ) to monitor physical activity in the European Union. Archives of Public Health, 73, 1–11.CrossRef Finger, J. D., Tafforeau, J., Gisle, L., Oja, L., Ziese, T., Thelen, J., Mensink, G. B., & Lange, C. (2015). Development of the European health interview survey-physical activity questionnaire (EHIS-PAQ) to monitor physical activity in the European Union. Archives of Public Health, 73, 1–11.CrossRef
Zurück zum Zitat Finger, J. D., Mensink, G. B., Lange, C., & Manz, K. (2017). Health-enhancing physical activity during leisure time among adults in Germany. Journal of Health Monitoring, 2(2), 35.PubMedPubMedCentral Finger, J. D., Mensink, G. B., Lange, C., & Manz, K. (2017). Health-enhancing physical activity during leisure time among adults in Germany. Journal of Health Monitoring, 2(2), 35.PubMedPubMedCentral
Zurück zum Zitat Gramlich, T., Liebau, M., & Schunter, J. (2019). Die Berechnung von Responseraten. In S. H. Häder, M. Häder & P. Schmich (Eds.), Telefonumfragen in Deutschland (pp. 393–404). Springer. Gramlich, T., Liebau, M., & Schunter, J. (2019). Die Berechnung von Responseraten. In S. H. Häder, M. Häder & P. Schmich (Eds.), Telefonumfragen in Deutschland (pp. 393–404). Springer.
Zurück zum Zitat Grüne, E., Popp, J., Carl, J., Semrau, J., & Pfeifer, K. (2022). Examining the sustainability and effectiveness of co-created physical activity interventions in vocational education and training: a multimethod evaluation. BMC Public Health, 22(1), 765.CrossRefPubMedPubMedCentral Grüne, E., Popp, J., Carl, J., Semrau, J., & Pfeifer, K. (2022). Examining the sustainability and effectiveness of co-created physical activity interventions in vocational education and training: a multimethod evaluation. BMC Public Health, 22(1), 765.CrossRefPubMedPubMedCentral
Zurück zum Zitat Haible, S., Volk, C., Demetriou, Y., Höner, O., Thiel, A., & Sudeck, G. (2020). Physical activity-related health competence, physical activity, and physical fitness: analysis of control competence for the self-directed exercise of adolescents. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph17010039.CrossRef Haible, S., Volk, C., Demetriou, Y., Höner, O., Thiel, A., & Sudeck, G. (2020). Physical activity-related health competence, physical activity, and physical fitness: analysis of control competence for the self-directed exercise of adolescents. International Journal of Environmental Research and Public Health. https://​doi.​org/​10.​3390/​ijerph17010039.CrossRef
Zurück zum Zitat Hanafiah, M. H. (2020). Formative vs. reflective measurement model: guidelines for structural equation modeling research. International Journal of Analysis and Applications, 18(5), 876–889. Hanafiah, M. H. (2020). Formative vs. reflective measurement model: guidelines for structural equation modeling research. International Journal of Analysis and Applications, 18(5), 876–889.
Zurück zum Zitat Jordan, S., & Hoebel, J. (2015). Health literacy of adults in Germany: Findings from the German Health Update (GEDA) study. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz, 58, 942–950.CrossRefPubMed Jordan, S., & Hoebel, J. (2015). Health literacy of adults in Germany: Findings from the German Health Update (GEDA) study. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz, 58, 942–950.CrossRefPubMed
Zurück zum Zitat Kurz, D., & Gogoll, A. (2010). Standards und Kompetenzen [Standards and competencies]. In N. Fessler, A. Hummel & G. Stibbe (Eds.), Handbuch Schulsport [Handbook School Sport] (pp. 227–244). Hofmann. Kurz, D., & Gogoll, A. (2010). Standards und Kompetenzen [Standards and competencies]. In N. Fessler, A. Hummel & G. Stibbe (Eds.), Handbuch Schulsport [Handbook School Sport] (pp. 227–244). Hofmann.
Zurück zum Zitat Leitzmann, M., Gastell, S., Hillreiner, A., Herbolsheimer, F., Baumeister, S. E., Bohn, B., Brandes, M., Greiser, H., Jaeschke, L., & Jochem, C. (2020). Körperliche Aktivität in der NAKO Gesundheitsstudie: erste Ergebnisse des multimodalen Erhebungskonzepts. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz, 63(3), 301–311.CrossRefPubMed Leitzmann, M., Gastell, S., Hillreiner, A., Herbolsheimer, F., Baumeister, S. E., Bohn, B., Brandes, M., Greiser, H., Jaeschke, L., & Jochem, C. (2020). Körperliche Aktivität in der NAKO Gesundheitsstudie: erste Ergebnisse des multimodalen Erhebungskonzepts. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz, 63(3), 301–311.CrossRefPubMed
Zurück zum Zitat Li, Y., Pan, A., Wang, D. D., Liu, X., Dhana, K., Franco, O. H., Kaptoge, S., Di Angelantonio, E., Stampfer, M., & Willett, W. C. (2018). Impact of healthy lifestyle factors on life expectancies in the US population. Circulation, 138(4), 345–355.CrossRefPubMedPubMedCentral Li, Y., Pan, A., Wang, D. D., Liu, X., Dhana, K., Franco, O. H., Kaptoge, S., Di Angelantonio, E., Stampfer, M., & Willett, W. C. (2018). Impact of healthy lifestyle factors on life expectancies in the US population. Circulation, 138(4), 345–355.CrossRefPubMedPubMedCentral
Zurück zum Zitat Lindemann, U., Gröben, B., & Braksiek, M. (2023). Adaptation und Validierung von Skalen zur Erfassung der bewegungsbezogenen Gesundheitskompetenz von Kindern und Jugendlichen im Alter von 10–16 Jahren. German Journal of Exercise and Sport Research, 53(1), 89–101.CrossRef Lindemann, U., Gröben, B., & Braksiek, M. (2023). Adaptation und Validierung von Skalen zur Erfassung der bewegungsbezogenen Gesundheitskompetenz von Kindern und Jugendlichen im Alter von 10–16 Jahren. German Journal of Exercise and Sport Research, 53(1), 89–101.CrossRef
Zurück zum Zitat Messer, M., Dadaczynski, K., & Okan, O. (2022). Gesundheitskompetenz in Deutschland–ein Überblick. Public Health Forum., , . Messer, M., Dadaczynski, K., & Okan, O. (2022). Gesundheitskompetenz in Deutschland–ein Überblick. Public Health Forum., , .
Zurück zum Zitat Ones, D. S., & Viswesvaran, C. (1996). Bandwidth-fidelity dilemma in personality measurement for personnel selection. Journal of organizational behavior, 17(6), 609–626.CrossRef Ones, D. S., & Viswesvaran, C. (1996). Bandwidth-fidelity dilemma in personality measurement for personnel selection. Journal of organizational behavior, 17(6), 609–626.CrossRef
Zurück zum Zitat Razali, N. M., & Wah, Y. B. (2011). Power comparisons of shapiro-wilk, kolmogorov-smirnov, lilliefors and anderson-darling tests. Journal of statistical modeling and analytics, 2(1), 21–33. Razali, N. M., & Wah, Y. B. (2011). Power comparisons of shapiro-wilk, kolmogorov-smirnov, lilliefors and anderson-darling tests. Journal of statistical modeling and analytics, 2(1), 21–33.
Zurück zum Zitat Robert Koch-Institut (2015). Gesundheit in Deutschland. Gesundheitsberichterstattung. Gemeinsam getragen von RKI und Destatis. RKI. Robert Koch-Institut (2015). Gesundheit in Deutschland. Gesundheitsberichterstattung. Gemeinsam getragen von RKI und Destatis. RKI.
Zurück zum Zitat Rütten, A., Pfeifer, K., Banzer, W., Ferrari, N., Füzéki, E., Geidl, W., Graf, C., Hartung, V., Klamroth, S., Völker, K., Vogt, L., Abu-Omar, K., Burlacu, I., Gediga, G., Messing, S., & Ungerer-Röhrich, U. (2016). National recommendations for physical activity and physical activity promotion. FAU University Press. Rütten, A., Pfeifer, K., Banzer, W., Ferrari, N., Füzéki, E., Geidl, W., Graf, C., Hartung, V., Klamroth, S., Völker, K., Vogt, L., Abu-Omar, K., Burlacu, I., Gediga, G., Messing, S., & Ungerer-Röhrich, U. (2016). National recommendations for physical activity and physical activity promotion. FAU University Press.
Zurück zum Zitat Santos, A. C., Willumsen, J., Meheus, F., Ilbawi, A., & Bull, F. C. (2023). The cost of inaction on physical inactivity to public health-care systems: a population-attributable fraction analysis. The Lancet Global Health, 11(1), e32–e39.CrossRefPubMed Santos, A. C., Willumsen, J., Meheus, F., Ilbawi, A., & Bull, F. C. (2023). The cost of inaction on physical inactivity to public health-care systems: a population-attributable fraction analysis. The Lancet Global Health, 11(1), e32–e39.CrossRefPubMed
Zurück zum Zitat Schaeffer, D., Hurrelmann, K., Bauer, U., Kolpatzik, K., & Altiner, A. (Eds.). (2018). Nationaler Aktionsplan Gesundheitskompetenz [National Action Plan Health Literacy] (1st edn.). Hertie School of Governance. Schaeffer, D., Hurrelmann, K., Bauer, U., Kolpatzik, K., & Altiner, A. (Eds.). (2018). Nationaler Aktionsplan Gesundheitskompetenz [National Action Plan Health Literacy] (1st edn.). Hertie School of Governance.
Zurück zum Zitat Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online, 8(2), 23–74. Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online, 8(2), 23–74.
Zurück zum Zitat Schorno, N., Sudeck, G., Gut, V., Conzelmann, A., & Schmid, J. (2021). Choosing an activity that suits: development and validation of a questionnaire on motivational competence in exercise and sport. German Journal of Exercise and Sport Research, 51(1), 71–78.CrossRef Schorno, N., Sudeck, G., Gut, V., Conzelmann, A., & Schmid, J. (2021). Choosing an activity that suits: development and validation of a questionnaire on motivational competence in exercise and sport. German Journal of Exercise and Sport Research, 51(1), 71–78.CrossRef
Zurück zum Zitat Sudeck, G., & Pfeifer, K. (2016). Physical activity-related health competence as an integrative objective in exercise therapy and health sports—conception and validation of a short questionnaire. German Journal of Exercise and Sport Research, 46(2), 74–87. https://doi.org/10.1007/s12662-016-0405-4.CrossRef Sudeck, G., & Pfeifer, K. (2016). Physical activity-related health competence as an integrative objective in exercise therapy and health sports—conception and validation of a short questionnaire. German Journal of Exercise and Sport Research, 46(2), 74–87. https://​doi.​org/​10.​1007/​s12662-016-0405-4.CrossRef
Zurück zum Zitat Sudeck, G., Geidl, W., Abu-Omar, K., Finger, J. D., Krauß, I., & Pfeifer, K. (2021). Do adults with non-communicable diseases meet the German physical activity recommendations?: A cross-sectional analysis of the GEDA 2014/2015 Survey. German Journal of Exercise and Sport Research, 51(2), 183–193.CrossRef Sudeck, G., Geidl, W., Abu-Omar, K., Finger, J. D., Krauß, I., & Pfeifer, K. (2021). Do adults with non-communicable diseases meet the German physical activity recommendations?: A cross-sectional analysis of the GEDA 2014/2015 Survey. German Journal of Exercise and Sport Research, 51(2), 183–193.CrossRef
Zurück zum Zitat Sudeck, G., Rosenstiel, S., Carl, J., & Pfeifer, K. (2022). Bewegungsbezogene Gesundheitskompetenz – Konzeption und Anwendung in Gesundheitsförderung, Prävention und Rehabilitation [Physical activity-related health competence—conception and application in health promotion, prevention, and rehabilitation]. In K. Rathmann, K. Dadaczynski, O. Okan & M. Messer (Eds.), Gesundheitskompetenz (Vol. 34, pp. 1–12). Berlin Heidelberg: Springer. https://doi.org/10.1007/978-3-662-62800-3_135-1.CrossRef Sudeck, G., Rosenstiel, S., Carl, J., & Pfeifer, K. (2022). Bewegungsbezogene Gesundheitskompetenz – Konzeption und Anwendung in Gesundheitsförderung, Prävention und Rehabilitation [Physical activity-related health competence—conception and application in health promotion, prevention, and rehabilitation]. In K. Rathmann, K. Dadaczynski, O. Okan & M. Messer (Eds.), Gesundheitskompetenz (Vol. 34, pp. 1–12). Berlin Heidelberg: Springer. https://​doi.​org/​10.​1007/​978-3-662-62800-3_​135-1.CrossRef
Zurück zum Zitat Töpfer, C., & Sygusch, R. (2014). Gesundheitskompetenz im Sportunterricht. In S. Becker (Ed.), Aktiv und Gesund – Interdisziplinäre Perspektiven auf den Zusammenhang zwischen Sport und Gesundheit (pp. 153–179). Wiesbaden: Springer. Töpfer, C., & Sygusch, R. (2014). Gesundheitskompetenz im Sportunterricht. In S. Becker (Ed.), Aktiv und Gesund – Interdisziplinäre Perspektiven auf den Zusammenhang zwischen Sport und Gesundheit (pp. 153–179). Wiesbaden: Springer.
Zurück zum Zitat Van de Schoot, R., Lugtig, P., & Hox, J. (2012). A checklist for testing measurement invariance. European journal of developmental psychology, 9(4), 486–492.CrossRef Van de Schoot, R., Lugtig, P., & Hox, J. (2012). A checklist for testing measurement invariance. European journal of developmental psychology, 9(4), 486–492.CrossRef
Zurück zum Zitat Volk, C., Rosenstiel, S., Demetriou, Y., Krustrup, P., Thiel, A., Trautwein, U., Wagner, W., Höner, O., & Sudeck, G. (2021). Effects of a physical education intervention programme for ninth-graders on physical activity-related health competence: findings from the GEKOS cluster randomised controlled trial. Psychology of Sport and Exercise, 55(7), 101923. https://doi.org/10.1016/j.psychsport.2021.101923.CrossRef Volk, C., Rosenstiel, S., Demetriou, Y., Krustrup, P., Thiel, A., Trautwein, U., Wagner, W., Höner, O., & Sudeck, G. (2021). Effects of a physical education intervention programme for ninth-graders on physical activity-related health competence: findings from the GEKOS cluster randomised controlled trial. Psychology of Sport and Exercise, 55(7), 101923. https://​doi.​org/​10.​1016/​j.​psychsport.​2021.​101923.CrossRef
Zurück zum Zitat Weiber, R., & Mühlhaus, D. (2015). Strukturgleichungsmodellierung – Eine anwendungsorientierte Einführung in die Kausalanalyse mit Hilfe von AMOS, SmartPLS und SPSS [Structure Equation Modeling—An application-oriented introduction into causal analysis using AMOS, SmartPLS, and SPSS] (2nd edn.). Weiber, R., & Mühlhaus, D. (2015). Strukturgleichungsmodellierung – Eine anwendungsorientierte Einführung in die Kausalanalyse mit Hilfe von AMOS, SmartPLS und SPSS [Structure Equation Modeling—An application-oriented introduction into causal analysis using AMOS, SmartPLS, and SPSS] (2nd edn.).
Zurück zum Zitat Weinert, F. E. (2001). Concept of competence: a conceptual clarification. In D. S. Rychen & Sagalnik (Eds.), Defining and selecting key competencies (pp. 45–66). Hogrefe & Huber. Weinert, F. E. (2001). Concept of competence: a conceptual clarification. In D. S. Rychen & Sagalnik (Eds.), Defining and selecting key competencies (pp. 45–66). Hogrefe & Huber.
Zurück zum Zitat World Health Organization (2018). More active people for a healthier world: Global action plan on physical activity 2018–2030. World Health Organization. World Health Organization (2018). More active people for a healthier world: Global action plan on physical activity 2018–2030. World Health Organization.
Metadaten
Titel
Toward a representative assessment of competencies for a healthy, physically active lifestyle in the German population: development and validation of a short version of the physical activity-related health competence questionnaire (PAHCO_12)
verfasst von
Dr. Johannes Carl
Dr. Olga Maria Domanska
Dr. Maike Buchmann
Dr. Susanne Jordan
Prof. Dr. Klaus Pfeifer
Prof. Dr. Gorden Sudeck
Publikationsdatum
05.02.2024
Verlag
Springer Berlin Heidelberg
Erschienen in
German Journal of Exercise and Sport Research
Print ISSN: 2509-3142
Elektronische ISSN: 2509-3150
DOI
https://doi.org/10.1007/s12662-024-00943-9

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.