Research Research and Professional Briefs| Volume 113, ISSUE 8, P1069-1075, August 2013

Reliability of the Hospital Nutrition Environment Scan for Cafeterias, Vending Machines, and Gift Shops


      According to ecological models, the physical environment plays a major role in determining individual health behaviors. As such, researchers have started targeting the consumer nutrition environment of large-scale foodservice operations when implementing obesity-prevention programs. In 2010, the American Hospital Association released a call-to-action encouraging health care facilities to join in this movement and improve their facilities' consumer nutrition environments. The Hospital Nutrition Environment Scan (HNES) for Cafeterias, Vending Machines, and Gift Shops was developed in 2011, and the present study evaluated the inter-rater reliability of this instrument. Two trained raters visited 39 hospitals in southern California and completed the HNES. Percent agreement, kappa statistics, and intraclass correlation coefficients were calculated. Percent agreement between raters ranged from 74.4% to 100% and kappa statistics ranged from 0.458 to 1.0. The intraclass correlation coefficient for the overall nutrition composite scores was 0.961. Given these results, the HNES demonstrated acceptable reliability metrics and can now be disseminated to assess the current state of hospital consumer nutrition environments.


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      C. P. Winston is manager of food and nutrition strategic initiatives, Partnership for a Healthier America, Alexandria, VA; at the time of the study, she was a DrPH candidate, Division of Health Promotion and Behavioral Science, University of Texas Health Science Center at Houston, School of Public Health, Houston.


      J. F. Sallis is distinguished professor, Family and Preventive Medicine, and chief, Division of Behavioral Medicine, University of California, San Diego.


      M. D. Swartz is an assistant professor, Division of Biostatistics, University of Texas Health Science Center at Houston, School of Public Health, Houston.


      D. M. Hoelscher is John P. McGovern Professor in Health Promotion and director, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin.


      M. F. Peskin is associate director of evaluation, University of Texas Prevention Research Center, and assistant professor, University of Texas Health Science Center, School of Public Health, Houston.