Development and content validation of a questionnaire of activities in health promotion for primary and secondary education: PromoACTIVA-CE.

Abstract

<h4>Background</h4>This study aimed to develop, refine, and assess content validity of the PromoACTIVA-CE questionnaire, designed to assess health promotion activities in primary and secondary education. The tool addresses the need for a culturally and contextually relevant instrument to systematically evaluate and support health promotion initiatives in schools.<h4>Methods</h4>Questionnaire development followed a five-phase process that included the following phases: (1) conceptualization; (2) item generation, structure and format; (3) content validation; (4) comprehensibility and semantic fit testing; and (5) pilot testing.<h4>Results</h4>The PromoACTIVA-CE questionnaire was successfully developed and validated, resulting in a reliable tool with 37 items classified into eight health promotion action areas. Minor floor effects were observed, but no ceiling effects were detected.<h4>Conclusions</h4>The PromoACTIVA-CE questionnaire is a valid and reliable tool for assessing health promotion activities in primary and secondary schools. Its development leveraged existing evidence-based practices while ensuring cultural and contextual relevance. The tool facilitates systematic assessment and operationalization of health promotion activities, contributing to the sustainability and effectiveness of health promotion initiatives in educational settings. Future research should explore the questionnaire's sensitivity to changes over time and its applicability in diverse school contexts.