Reliability and validity of rapid assessment tools for measuring 24-hour movement behaviours in children aged 0–5 years: the Movement Behaviour Questionnaire Baby (MBQ-B) and child (MBQ-C)

Background The development of validated “fit-for-purpose” rapid assessment tools to measure 24-hour movement behaviours in children aged 0–5 years is a research priority. This study evaluated the test-retest reliability and concurrent validity of the open-ended and closed-ended versions of the Movement Behaviour Questionnaire for baby (MBQ-B) and child (MBQ-C). Methods 300 parent-child dyads completed the 10-day study protocol (MBQ-B: N = 85; MBQ-C: N = 215). To assess validity, children wore an accelerometer on the non-dominant wrist (ActiGraph GT3X+) for 7 days and parents completed 2 × 24-hour time use diaries (TUDs) recording screen time and sleep on two separate days. For babies (i.e., not yet walking), parents completed 2 × 24-hour TUDs recording tummy time, active play, restrained time, screen time, and sleep on days 2 and 5 of the 7-day monitoring period. To assess test-retest reliability, parents were randomised to complete either the open- or closed-ended versions of the MBQ on day 7 and on day 10. Test-retest intraclass correlation coefficients (ICC’s) were calculated using generalized linear mixed models and validity was assessed via Spearman correlations. Results Test-retest reliability for the MBQ-B was good to excellent with ICC’s ranging from 0.80 to 0.94 and 0.71–0.93 for the open- and closed-ended versions, respectively. For both versions, significant positive correlations were observed between 24-hour diary and MBQ-B reported tummy time, active play, restrained time, screen time, and sleep (rho = 0.39–0.87). Test-retest reliability for the MBQ-C was moderate to excellent with ICC’s ranging from 0.68 to 0.98 and 0.44–0.97 for the open- and closed-ended versions, respectively. For both the open- and closed-ended versions, significant positive correlations were observed between 24-hour diary and MBQ-C reported screen time and sleep (rho = 0.44–0.86); and between MBQ-C reported and device-measured time in total activity and energetic play (rho = 0.27–0.42). Conclusions The MBQ-B and MBQ-C are valid and reliable rapid assessment tools for assessing 24-hour movement behaviours in infants, toddlers, and pre-schoolers. Both the open- and closed-ended versions of the MBQ are suitable for research conducted for policy and practice purposes, including the evaluation of scaled-up early obesity prevention programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-024-01596-5.


TARGET POPULATION
For babies from 0 years who are yet to reach their walking milestone.

HOW IT IS MEASURED
• 6 items • Open-ended questions

DIRECTIONS
This survey will ask you questions about your baby's movement behaviours (activity, screen time, and sleep) on a typical day.
A typical day is a day when your baby does things they normally do.
For questions about how much time your baby spends in these behaviours, please provide an answer to both hours and minutes, e.g., 2 hours 0 minutes, 0 hours 30 minutes.
Please respond to all the questions as best as you can.
How old is your baby?
◯ 12 months or older [3] Does your baby roll?
Q1A.This question is about the times when your baby is awake and placed on their tummy for playtime while you are watching them.
Thinking about the past week, how many times EACH DAY did you usually place your baby on their tummy for play?times Q1B.How long did each tummy time usually last?minutes Q2.Thinking about the past week, on a TYPICAL DAY, how much time in total did you do some active play with your baby?Active play could be crawling on the floor with your baby, rolling around the floor with your baby, playing at the park, dancing with your baby, chasing your baby.

hours minutes
This section is about your baby's tummy time and active play Q3A.Thinking about the past week, on a TYPICAL DAY, how many times did you place your baby in a baby carrier or sling, car seat or capsule, stroller or pram, highchair, bouncer, jolly jumper or play pen? times Q3B.When your baby was in one of those devices, how long were they usually in it?

Truncation of extreme values
Implausible or extreme values for the following outcome variables are truncated (that is recoded) to the value equivalent of the 95th percentile from the validation study dataset.

TARGET POPULATION
For babies from 0 years who are yet to reach their walking milestone.

HOW IT IS MEASURED
• 6 items A typical day is a day when your baby does things they normally do.
Please respond to all the questions as best as you can.
How old is your baby?
Q1A.This question is about the times when your baby is awake and placed on their tummy for playtime while you are watching them.
Thinking about the past week, how many times EACH DAY did you usually place your baby on their tummy for play?
Q1B.How long did each tummy time usually last?

Truncation of extreme values
Implausible or extreme values for the following outcome variables are truncated (that is recoded) to the value equivalent of the 95th percentile from the validation study dataset.

Outcome variable Truncated value
Total tummy time 180 minutes per day Total restrained time 360 minutes per day

Adherence to Guidelines Physical Activity
Tummy time (for babies who are yet to roll)at least 30 minutes of tummy time per day.
Active Play (for babies who can roll)at least 30 minutes of active play per day.

Restrained Time
Not more than 60 minutes (1 hour) at a time of restrained time (such as in a stroller, car seat or highchair).

Screen time
No screen time for babies/children under 2 years.
Age = 12 months or older: At least 660 minutes (11 hours) per day.

24-hour movement guidelines
For babies who are yet to roll: meets all 3 guidelines for tummy time, screen time and sleep.
For babies who can roll meets all 3 guidelines for active play, screen time and sleep.TARGET POPULATION

MBQ Index variable
• For children aged up to 5 years who can walk.

HOW IT IS MEASURED
• 9 items • Open-ended questions A typical day is a day when your child does things they normally do.
For questions about how much time your child spends in these behaviours, please provide an answer to both hours and minutes, e.g., 2 hours 0 minutes, 0 hours 30 minutes.
Please respond to all the questions as best as you can.
How old is your child?
Q1A.  TARGET POPULATION • For children aged up to 5 years who can walk.

HOW IT IS MEASURED
• 9 items

DIRECTIONS
This survey will ask you questions about your child's movement behaviours (activity, screen time, and sleep) on a typical day.
A typical day is a day when your child does things they normally do.
Please respond to all the questions as best as you can.
How old is your child?
Q1A. Thinking about the past week, on a TYPICAL WEEKDAY, how much time did your child spend in active play?Active play includes activities such as walking, running, dancing, climbing, playing with balls, riding bikes or scooters, or swimming.This section is about your child's physical activity This section is about your child's screen time

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The MBQ is a validated rapid assessment tool for measuring movement behaviours in children aged 0 -5 years.•The MBQ-B measures tummy time or active play, restrained time, screen time and sleep.

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Calculation TUMMY TIME AND ACTIVE PLAY Tummy time index IF 'Total tummy time' > 40, Tummy time index = 100 IF 'Total tummy time' <= 40, Tummy time index = ('Total tummy time' /40) x 100 Active Play index IF 'Total Active Play' > 40, Active Play index = 100 IF 'Total Active Play' <= 40, Active Play index = ('Total Active Play' /40) x 100 RESTRAINED TIME Restrained time index IF Q3B = 1, Restrained time index = 100 IF Q3B = 2, Restrained time index = 95 IF Q3B = 3, Restrained time index = 85 IF Q3B = 4, Restrained time index = 75 IF Q3B = 5, Restrained time index = 50 IF Q3B = 6, Restrained time index = 25 IF Q3B = 7, Restrained time index = 0 SCREEN TIME Non-interactive screen time index IF Q4 = 0, Non-interactive screen time index = IF Q4 = 1, Non-interactive screen time index = IF Q4 = 2, Non-interactive screen time index = IF Q4 = 3, Non-interactive screen time index = IF Q4 = 4, Non-interactive screen time index = IF Q4 = 5, Non-interactive screen time index = IF Q4 = 6, Non-interactive screen time index = Interactive screen time index IF Q5 = 0, Interactive screen time index = 100 IF Q5 = 1, Interactive screen time index = 75 IF Q5 = 2, Interactive screen time index = 50 IF Q5 = 3, Interactive screen time index = 25 IF Q5 = 4, Interactive screen time index = 10 IF Q5 = 5, Interactive screen time index = 5 IF Q5 = 6, Interactive screen time index = 0 SLEEP Sleep index raw score IF baby is aged 0 to 3 months [1].Sleep index raw score = (('Total sleep' -300)/ 720) *100 (Index = 100 when Total Sleep is 17 hours or more) 100 when Sleep is 13 hours or more) Sleep index IF Sleep index raw score > 100, Sleep index = 100 IF Sleep index raw score <= 100, Sleep index = Sleep index raw score MBQ Index -Summary Score MBQ-B index summary score MBQ Index summary score is based on the average of index scores for each behaviour.IF baby is yet to roll [0]: MBQ-B index summary score = Mean (Tummy time index, Restrained time index, Non-interactive screen time index, Interactive screen time index, Sleep index) IF baby can roll [1]: MBQ-B index summary score = Mean (Active play index, Restrained time index, Non-interactive screen time index, Interactive screen time index, Sleep index) The MBQ is a validated rapid assessment tool for measuring movement behaviours in children aged 0 -5 years.• The MBQ-C measures active play, screen time and sleep.

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Thinking about the past week, on a TYPICAL NIGHT, how much time did your child sleep in total during the night?hours minutes Q8.Thinking about the past week, on a TYPICAL DAY, how much time did your child sleep in total during the day?hours minutes Q9.In a TYPICAL WEEK, how often does your child have a regular bedtime routine (e.g., bath, The MBQ is a validated rapid assessment tool for measuring movement behaviours in children aged 0 -5 years.• The MBQ-C measures active play, screen time and sleep.
Thinking about the past week, on a TYPICAL DAY, how much time did your baby spend watching television programs, videos/internet clips or movies on a television, computer or portable/mobile device such as iPad, tablet or smartphone?
hours minutesQ5 Thinking about the past week, on a TYPICAL DAY, how much time did your baby spend playing games, looking at photos, or video chatting (e.g.FaceTime, Zoom, Skype) on a screen-based device such as a computer or laptop, video game console, iPad, tablet, or smartphone?hours minutesQ6.Thinking about the past week, on a TYPICAL NIGHT, how much time did your baby sleep in total during the night?
Thinking about the past week, on a TYPICAL WEEKDAY, how much time did your child spend watching television programs, videos/internet clips or movies on a television, computer, or portable/mobile device such as iPad, tablet or smartphone?Of this time, how much time did they spend playing games, looking at photos, or video chatting (e.g.FaceTime, Zoom, Skype) while standing?Please note, the time provided must be less than your previous answer.Thinking about the past week, on a TYPICAL WEEKEND DAY, how much time did your child spend playing games, looking at photos, or video chatting (e.g.FaceTime, Zoom, Skype) on a screen-based device such as a computer or laptop, video game console, iPad, tablet, or smartphone?
Thinking about the past week, on a TYPICAL WEEKDAY, how much time did your child spend in active play?Active play includes activities such as walking, running, dancing, climbing, playing with balls, riding bikes or scooters, or swimming.hours minutes If you answered 0 hours/min → Skip to question 2A Q1B.Of this time, how much was spent doing vigorous activities such as running, jumping, dancing, riding bikes or scooters?Please note, the time provided must be less than your previous answer.Q4A.Thinking about the past week, on a TYPICAL WEEKEND DAY, how much time did your child spend watching television programs, videos/internet clips or movies on a television, computer, or portable/mobile device such as iPad, tablet or smartphone?hours minutes If you answered 0 hours/min → Skip to question 5A Q4B.Of this time, how much time did they spend watching television programs, videos/internet clips, or movies while standing?Please note, the time provided must be less than your previous answer.hours minutes Q5A.Thinking about the past week, on a TYPICAL WEEKDAY, how much time did your child spend playing games, looking at photos, or video chatting (e.g.FaceTime, Zoom, Skype) on a screen-based device such as a computer or laptop, video game console, iPad, tablet, or smartphone?hours minutes If you answered 0 hours/min → Skip to question 6A Q5B.
Thinking about the past week, on a TYPICAL WEEKEND DAY, how much time did your child spend in active play?Active play includes activities such as walking, running, dancing, climbing, playing with balls, riding bikes or scooters, or swimming.Of this time, how much was spent doing vigorous activities such as running, jumping, dancing, riding bikes or scooters?Please note, the time provided must be less than your previous answer. Q2A.
Thinking about the past week, on a TYPICAL WEEKEND DAY, how much time did your child spend watching television programs, videos/internet clips or movies on a television, computer, or portable/mobile device such as iPad, tablet or smartphone?Of this time, how much time did they spend playing games, looking at photos, or video chatting (e.g.FaceTime, Zoom, Skype) while standing?Please note, the time provided must be less than your previous answer.Thinking about the past week, on a TYPICAL WEEKEND DAY, how much time did your child spend playing games, looking at photos, or video chatting (e.g.FaceTime, Zoom, Skype) on a screenbased device such as a computer or laptop, video game console, iPad, tablet, or smartphone?Of this time, how much time did they spend playing games, looking at photos, or video chatting (e.g.FaceTime, Zoom, Skype) while standing?Please note, the time provided must be less than your previous answer.In a TYPICAL WEEK, how often does your child have a regular bedtime routine (e.g., bath, story)?Weekday passive screen time -Weekday passive screen time while standing NOTE.If weekday passive screen time while standing exceeds total passive screen time, 'Weekday passive screen time' should be used to calculate the weighted average for Weekday SEDENTARY passive screen time.If weekend day passive screen time while standing exceeds total passive screen time, 'Weekend day passive screen time' should be used to calculate the weighted average for Weekend day SEDENTARY passive screen time.