Content Validity of the 24-Hour Activity Behavior Instrument and Influencing Factors among Preschool Students in Malaysia: Analysis of I-CVI and S-CVI by Experts Panel

Abstract

Integrated 24-hour movement behaviours encompassing physical activity, sedentary behaviour, and sleep are increasingly recognised as critical indicators of early childhood health. However, evidence on the content validity of instruments measuring these behaviours among preschool children in the Malaysian context remains limited. This study aimed to evaluate the content validity of an adapted questionnaire and a complementary semi-structured interview guide designed to assess 24-hour movement behaviours among preschool children aged 3 and 4 years. The questionnaire was adapted from the SUNRISE Global Study and contextualised to reflect local cultural practices and early childhood education settings. Content validation employed a Content Validity Index (CVI) approach with three purposively selected experts in early childhood education. Each item was rated using a four-point relevance scale, from which Item-level (I-CVI) and Scale-level (S-CVI) Content Validity Index values were computed. Most items achieved I-CVI values of ≥0.78, while S-CVI values were 0.95 for the questionnaire and 0.97 for the interview guide, indicating excellent overall content validity. Items failing to meet the recommended thresholds were revised based on expert feedback to enhance clarity and contextual appropriateness. These findings confirm that both instruments demonstrate strong content validity and are suitable for pilot testing and subsequent psychometric evaluation, providing a robust methodological foundation for large-scale research on 24-hour movement behaviours among Malaysian preschool children.