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. 2025 Jan;30(1):157-174.
doi: 10.1177/13591045241286223. Epub 2024 Sep 30.

The healthy habits questionnaire (HHQ): Validation of a measure designed to assess problematic influential behaviours amongst families of children living with obesity or a risk of developing obesity

Bríd Áine Davis  1 , Claire O'Dwyer  1 , Adele Keating  2 , John Sharry  2 , Eddie Murphy  3 , Alan Doran  4 , Finiki Nearchou  1 , Alan Carr  1
Affiliations

The healthy habits questionnaire (HHQ): Validation of a measure designed to assess problematic influential behaviours amongst families of children living with obesity or a risk of developing obesity

Bríd Áine Davis et al. Clin Child Psychol Psychiatry. 2025 Jan.

Abstract

The 48-item Healthy Habits Questionnaire (HHQ-48) was developed to (1) monitor positive changes in family lifestyles following engagement in the Parents Plus Healthy Families (PP-HF) parent training programme and (2) be utilised as a standalone measure in clinical settings to identify and track problematic influential behaviours amongst families of children in weight-management services. This study aimed to develop and validate a brief version of the HHQ-48. The scale was administered to a cross-sectional community sample (n = 480), and on two occasions to a control sample (n = 50) and an experimental sample (n = 40) from a randomised controlled trial (RCT) of the PP-HF programme to assess test-retest reliability and sensitivity to change respectively. Exploratory and confirmatory factor analysis showed that a 23-item, 4-factor version of the HHQ (i.e., the HHQ-23) best fit the data. The scale and factor subscales had good internal consistency and test-retest reliability. They also had good concurrent and construct validity shown by significant correlations with another scale that assessed lifestyle issues, and scales that assessed parenting satisfaction, family functioning, and children's strengths and difficulties. The HHQ-23 was sensitive to change following parents completing the PP-HF programme. The HHQ-23 may, therefore, be used to monitor positive changes in family lifestyles following engagement in the PP-HF parent training programme. The HHQ-23 also shows promising potential as a standalone screening measure or as part of a larger battery of screening assessments in paediatric weight-management services.

Keywords: Healthy lifestyle; diet; family environment; obesity; paediatric; parental modelling; physical activity; screentime; sedentary; sleep.

Plain language summary

This study aimed to develop a brief version of the 48-item Healthy Habits Questionnaire (HHQ-48), which assesses how parents encourage healthy lifestyles in their children and evaluates the effectiveness of the 8-session Parents Plus – Healthy Families (PP-HF) program aimed at preventing childhood obesity. The HHQ-48 items are grouped into eight categories reflecting the PP-HF sessions: empowering parents, family connection, healthy food routines, healthy meals, active play, managing technology, restful sleep, and a happy, healthy mind. To create a shorter version of the HHQ, 480 parents completed the HHQ-48 and additional family life questionnaires online. Factor analysis identified 23 items grouped into four clusters: Screens and Routines, Activity, Parent-Child Connection, and Healthy Food & Good Example, forming the HHQ-23.The HHQ-23 showed strong correlations with the HHQ-48 and moderate correlations with other established questionnaires on children's lifestyles, parenting satisfaction, family functioning, and children's strengths and difficulties. In a test with 50 parents over eight weeks, HHQ-23 scores were stable. Scores increased for 41 parents who completed the HHQ-23 before and after the PP-HF program, demonstrating the HHQ-23's sensitivity to change.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Results of confirmatory factor analysis of HHQ (n = 240). All factor loadings are standardised.
See this image and copyright information in PMC

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