Health competencies are essential for developing children’s numerous skills at their older age, supporting school readiness, and long-term success in independent life. Health competencies are a range of abilities including nutrition, motor skills, sanitary/hygienic skills, mental/physical skills, and the ability to find time for regular meals and a good rest. Despite the growing emphasis on early childhood health, existing tools for measuring health competencies often lack comprehensive content validity – the extent to which an instrument accurately represents the construct it aims to measure. Thus, this study aimed to measure the content validity of a new pictorial instrument, designed to assess children’s health competencies.

The instrument, incorporating relevant pictures, initially included seven domains (150 items) to assess:
(1) nutrition,
(2) physical activity,
(3) body awareness,
(4) injury prevention and safety,
(5) risk-averse behavior,
(6) mental/emotional and social health, and
(7) personal hygiene and communal health.

The instrument used a 3-point scale (0 = incorrect choice, 1 = correct choice, and 2 = correct explanation). This study involved six pedagogy and early childhood education experts and ten preschool teachers. Six experts completed an online survey including objectives and a theoretical framework for assessing health competencies, rating criteria, and a questionnaire with related pictures. Content validity was confirmed by Inter-Rater Reliability (IRR), the Content Validity Index (CVI), the Factorial Validity Index (FVI), and face validity. Findings showed that some items required revisions in language, clarity, and comprehensiveness. The authors revised specific language and restructured items for clarity. Out of 150 items, seven were removed due to repetitiveness and poor construction. After revision, the instrument (143 items) showed an acceptable IRR (k* = 0.72), meeting the recommended value (k* = 0.70) for the IRR, supporting the relevance and representativeness of items in the questionnaire. The CVI (0.82) exceeded the commonly accepted value (CVI > 0.80), demonstrating the items were clear and comprehensive in measuring children’s health competencies. For the FVI, items scored one if experts identified the right item for the right factor, and zero if not. Based on experts’ consensus, the average FVI showed (20) for all items, indicating each item was correctly assigned to its relevant factor in the health competencies assessment. Then, the revised instrument was sent to ten preschool teachers to identify any confusing items, comment on whether each image was easy for preschool children to understand, and rate the relevance of the images on a 4-point scale. Based on their feedback, 80% of the participants agreed that the images and items were clear, age-appropriate, and engaging. Then, some teachers’ minor suggestions were adjusted to certain images to improve visual clarity and relatability, regarding items focused on injury prevention and risk-averse behaviors. Thus, the study introduces a new pictorial instrument which is reliable in content validity for measuring children’s health competencies, addressing a critical gap in early childhood health measurement. This instrument provides a model for future health competencies assessments in young children, supporting more accurate and comprehensive evaluations of this concept.

Keywords: Health competencies, early childhood, assessment, content validity, inter-rater reliability.