Physical Activity/Healthy Food Efficacy Scale for Children (PAHFE-C)

Abstract

The Physical Activity/Healthy Food Efficacy Scale for Children (PAHFE-C) is a standardized psychometric instrument designed to evaluate pediatric self-efficacy regarding physical exertion and nutritional decision-making. Developed by Perry, De Ayala, Lebow, and Haydon (2008), the scale operationalizes the core tenets of Social Cognitive Theory for upper elementary school-aged youth, predominantly children in grades three through six (ages 8 to 12). Comprising 20 distinct task- and barrier-specific items, the PAHFE-C is bifurcated into two primary behavioral domains: Physical Activity (10 items) and Healthy Eating (10 items). Each behavioral domain is further differentiated into two distinct self-regulatory subscales: Goal-Setting (2 items per domain) and Decision-Making (8 items per domain reflecting barrier-coping and situational self-efficacy).

Items are rated on an anchored 5-point Likert-type scale ranging from 1 (Not Sure) to 5 (Completely Sure), capturing a child’s subjective confidence in planning, initiating, and sustaining health-promoting behaviors in the face of physiological, psychological, and environmental impediments (e.g., inclement weather, emotional distress, peer presence, media consumption, and access to hyperpalatable foods). Extensive psychometric validation through both classical test theory and confirmatory factor analytic approaches indicates robust structural validity, high internal consistency reliability coefficients (Cronbach’s alphas typically ranging from .73 to .88 across subscales), and established convergent validity with objective and self-reported behavioral indices of physical exertion and dietary intake. The PAHFE-C serves as a vital diagnostic and evaluative tool for public health researchers, pediatric psychologists, and school-based interventionists working to mitigate childhood obesity and cultivate lifelong self-regulatory competencies.

Keywords

PAHFE-C, physical activity, healthy eating, self-efficacy, pediatric assessment, Social Cognitive Theory, childhood obesity, goal-setting, barrier self-efficacy, nutritional decision-making, psychometrics, upper elementary children

Authors

The Physical Activity/Healthy Food Efficacy Scale for Children was conceptualized, operationalized, and psychometrically validated by a multidisciplinary team of behavioral science, educational psychology, and psychometric measurement specialists:

• Carolyn M. Perry, Ph.D. — Primary investigator and behavioral health researcher; affiliated with the Department of Educational Psychology and community health intervention initiatives at the University of Nebraska–Lincoln.
• Rafael J. De Ayala, Ph.D. — Professor of Quantitative, Qualitative, and Psychometric Methods in the Department of Educational Psychology at the University of Nebraska–Lincoln; an internationally recognized authority on Item Response Theory (IRT) and measurement modeling.
• Richard Lebow, M.S. — Biostatistician and research methodologist collaborating on pediatric preventive health initiatives and psychometric evaluation.
• Elizabeth Haydon, Ph.D. — Developmental and health psychologist specializing in youth health-risk behaviors, preventive interventions, and childhood health promotion.

Inquiries regarding the theoretical formulation, measurement lineage, and psychometric properties are typically directed through institutional repositories or academic communications associated with the original 2008 publication in Health Education & Behavior and subsequent anthologies of evidence-based assessment.

Purpose

The primary purpose of the PAHFE-C is to provide an empirically grounded, developmentally calibrated measurement tool capable of assessing perceived self-efficacy for both physical activity engagement and nutritional self-regulation among upper elementary school children. With the escalating worldwide prevalence of childhood obesity and related metabolic and psychological comorbidities, public health paradigms have shifted heavily toward school- and community-based preventive interventions. However, the efficacy of these interventions hinges upon our ability to reliably measure the specific cognitive and self-regulatory mechanisms that mediate health behavior adoption and long-term maintenance.

Historically, pediatric assessment tools frequently aggregated health behaviors into oversimplified, omnibus constructs or relied upon adult-derived self-efficacy instruments that suffered from cognitive developmental mismatch. Younger children possess distinct cognitive limitations in prospective memory, abstract temporal estimation, and executive functioning, rendering complex, conditional survey queries unreliable. The PAHFE-C addresses these methodological deficits by using concrete, everyday scenarios familiar to children aged 8 to 12. Rather than merely asking whether a child enjoys exercise or fruit, the scale interrogates two critical self-regulatory components:

• Autonomous Goal-Setting: The child’s confidence in their agency to formulate proactive health objectives independently or with minimal adult scaffolding.
• Barrier-Overcoming Decision-Making: The child’s confidence in executing healthy choices when confronted with competing hedonic alternatives (e.g., video games, television, junk food availability), adverse affect (e.g., bad mood, feeling lazy), social pressures (e.g., peer influences), or environmental barriers (e.g., homework loads, extreme heat or cold).

In clinical, research, and educational contexts, the PAHFE-C functions as:

• A Diagnostic Baseline: Identifying specific self-regulatory vulnerabilities in individual children or target cohorts before initiating lifestyle interventions.
• A Mechanism-of-Action Evaluator: Determining whether pediatric lifestyle interventions successfully alter the hypothesized psychological mediator (self-efficacy) prior to measurable shifts in anthropometric variables (such as Body Mass Index or adiposity).
• A Tailoring Tool for Health Educators: Guiding school counselors, physical educators, and pediatricians in formulating personalized, mastery-based behavioral prescriptions that target specific situational deficits (such as low efficacy during emotional distress versus low efficacy under homework constraints).

Psychological Construct

The psychological construct assessed by the PAHFE-C is domain-specific perceived self-efficacy. As defined by Albert Bandura, self-efficacy refers to an individual’s subjective beliefs in their capability to organize and execute the courses of action required to produce given attainments. Crucially, self-efficacy is neither a global personality trait nor an omnibus self-esteem index; rather, it is highly differentiated, context-dependent, and situationally contingent. The PAHFE-C measures self-efficacy across four correlated yet conceptually discrete subscales:

1. Goal-Setting for Physical Activity (GSPA)

This dimension operationalizes the proactive, executive planning facet of exercise-related self-regulation. Comprising two targeted items, it assesses a child’s perceived agency to intentionally establish behavioral targets to increase physical exertion (e.g., deciding to walk, bike, or play sports) and, fundamentally, to do so autonomously with minimal parental or adult intervention. Autonomous goal formulation represents an advanced stage of self-regulation wherein health goals transition from external compliance to internalized behavioral self-direction.

2. Decision-Making for Physical Activity (DMPA)

Composed of eight contextualized items, this dimension reflects coping or barrier self-efficacy within the physical activity domain. Physical exertion in pediatric populations is frequently impeded by environmental hurdles, physiological discomfort, competing recreational attractions, and negative psychological states. The DMPA dimension evaluates a child’s confidence in remaining physically active across diverse real-world stressors: everyday continuity, peer presence, weather extremes (excessive cold or heat), negative emotional states (“in a bad mood”), amotivation (“feeling lazy” or “don’t feel like it”), and academic workload constraints (“when you have homework”).

3. Goal-Setting for Healthy Food Choices (GSHFC)

Parallel to its physical activity counterpart, this two-item subscale measures a child’s conviction that they can delineate explicit nutritional goals for themselves—specifically centered around consuming fruits, vegetables, and nutrient-dense options—and sustain these intentions independently without constant adult reinforcement. This captures the child’s emergent self-monitoring and dietary intentionality.

4. Decision-Making for Healthy Food Choices (DMHFC)

Consisting of eight situationally anchored items, this subscale captures nutritional coping efficacy in the modern obesogenic environment. Because food consumption among children is rarely driven strictly by homeostatic hunger, this dimension examines self-regulatory capacity across major non-homeostatic eating drivers:

• Sedentary Media Consumption: Eating while watching television, DVDs, or playing video games—contexts notoriously associated with mindless hypercaloric snacking.
• Affective Dysregulation: Managing dietary impulses when bored or experiencing negative emotional states (“in a bad mood”).
• Environmental Food Cues: Choosing nutritious foods during transitional periods (after-school snacks) and resisting peer influences or the ubiquitous presence of ultra-processed snacks (“when junk food is around”).

Theoretical Framework

The PAHFE-C is explicitly grounded in Albert Bandura’s Social Cognitive Theory (SCT), particularly the model of triadic reciprocal causation. In this theoretical architecture, human functioning is the product of continuous, dynamic interactions among three reciprocal forces: intrapsychic cognitive/biological factors (e.g., self-efficacy expectations, outcome expectations, biological maturity), behavioral patterns (e.g., habitual sedentary behavior, dietary patterns), and external environmental influences (e.g., parental modeling, home food environment, weather conditions, school curricula).

Sources of Self-Efficacy and Self-Regulation

According to Social Cognitive Theory, individuals acquire self-efficacy beliefs through four primary informational vectors:

1. Mastery Experiences: Direct, successful execution of a behavior, which serves as the most potent builder of efficacy.
2. Vicarious Experiences: Observing social models, particularly peer models with similar characteristics, successfully navigating challenges.
3. Social and Verbal Persuasion: Encouragement, verbal coaching, and reinforcement provided by significant others such as parents, teachers, and coaches.
4. Physiological and Affective States: Interpreting somatic arousal, fatigue, or stress (e.g., breathlessness during exercise or hunger cravings during emotional distress) as manageable cues rather than signs of personal inability.

In pediatric lifestyle interventions, knowledge alone is rarely sufficient to produce sustained behavioral change. A child may know that vegetables are beneficial and that screen time should be limited, but without perceived self-efficacy, that knowledge remains behaviorally inert. The PAHFE-C captures the cognitive pivot point wherein knowledge is transformed into executable behavior through the mechanisms of proximal goal setting and barrier-specific coping strategies.

Developmental Considerations in Social Cognitive Theory

Applying SCT to upper elementary children requires careful calibration to their cognitive developmental stage, corresponding roughly to Jean Piaget‘s period of concrete operational thought. At this developmental nexus (ages 8 to 12), children are developing increasing metacognitive awareness and autonomous self-regulation, yet their executive control remains vulnerable to strong emotional and environmental temptations. The PAHFE-C respects these developmental parameters by operationalizing Bandura’s abstract construct into concrete, episodic contingencies (e.g., having homework, feeling lazy, playing video games) that accurately mirror a child’s lived behavioral landscape.

Validity

The psychometric evaluation of the PAHFE-C conducted by Perry et al. (2008) and replicated in subsequent developmental health research demonstrates robust evidence across multiple forms of validity:

1. Content and Face Validity

During initial instrument development, items were constructed following qualitative focus groups with upper elementary students, developmental psychologists, and physical education specialists. This process ensured that the contextual barriers (e.g., bad mood, homework, video games, junk food ubiquity) represented the most salient impediments encountered by youth. Cognitive pretesting and reading-level analyses confirmed that the wording was fully comprehensible to children reading at or above a third-grade standard.

2. Construct and Structural Validity

Construct validity was evaluated using a rigorous measurement modeling approach. Confirmatory factor analysis (CFA) demonstrated that a four-factor oblique model—separating Goal-Setting from Decision-Making across both Physical Activity and Healthy Eating—exhibited superior fit compared to rival unidimensional models or two-factor models (which conflated goal-setting with barrier decision-making). The four-factor specification confirmed that while goal-setting and decision-making are correlated within their respective behavioral domains, they represent psychologically distinct competencies.

3. Convergent and Criterion-Related Validity

Convergent validity has been repeatedly corroborated against both subjective and objective behavioral metrics:

• Scores on the Physical Activity subscales (GSPA and DMPA) correlate positively and significantly with objective accelerometer-measured moderate-to-vigorous physical activity (MVPA), participation in organized sports, and standardized fitness testing (e.g., PACER shuttle runs).
• Scores on the Healthy Eating subscales (GSHFC and DMHFC) demonstrate statistically significant positive correlations with validated Food Frequency Questionnaire (FFQ) measures of daily fruit, vegetable, and dietary fiber consumption, alongside inverse correlations with sugary beverage intake and frequent ultra-processed snack consumption.

4. Discriminant Validity

The PAHFE-C displays adequate discriminant validity from generalized global self-concept or omnibus self-esteem inventories (such as the Piers-Harris Children’s Self-Concept Scale), proving that it measures domain-specific operational capabilities rather than non-specific positive self-regard.

Reliability

The PAHFE-C exhibits strong psychometric reliability across internal consistency and temporal stability metrics:

Internal Consistency Reliability

In the foundational validation study by Perry et al. (2008) involving a diverse cohort of upper elementary students, internal consistency was evaluated via Cronbach’s coefficient alpha across all four subscales:

• Decision-Making for Physical Activity (DMPA): Cronbach’s α = .84 to .88, reflecting excellent internal consistency across its 8 contextual barrier items.
• Decision-Making for Healthy Food Choices (DMHFC): Cronbach’s α = .81 to .85, demonstrating high coherence among its 8 dietary barrier items.
• Goal-Setting for Physical Activity (GSPA): Cronbach’s α = .73 to .78; while comprised of only 2 items, it comfortably exceeds the standard .70 reliability threshold for short subscales.
• Goal-Setting for Healthy Food Choices (GSHFC): Cronbach’s α = .72 to .77, likewise displaying acceptable internal reliability given its 2-item structure.

Composite reliability coefficients and McDonald’s omega (ω) values reported in subsequent structural equation modeling studies have corroborated these internal consistency estimates, showing minimal item-redundancy and high true-score variance.

Test-Retest Stability

Temporal stability assessments conducted across a two-week test-retest interval in non-intervention control cohorts yielded intraclass correlation coefficients (ICCs) ranging from .76 to .84 across the subscales. These findings demonstrate that while the scale is sufficiently sensitive to reflect true intervention-induced cognitive shifts, it maintains strong stability in the absence of targeted experiential or educational changes.

Factor Analysis

The structural dimensionality of the PAHFE-C was evaluated by Perry et al. (2008) utilizing both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), supported by Item Response Theory (IRT) diagnostic procedures to confirm item discrimination and threshold operating characteristics.

Exploratory Factor Analysis (EFA)

Initial principal axis factoring with promax (oblique) rotation was conducted to allow theoretical correlations between underlying dimensions. Scree plot examination, parallel analysis, and Kaiser’s eigenvalue-greater-than-one criterion uniformly pointed to a four-factor solution accounting for the preponderance of total variance:

• Factor 1: Decision-Making for Physical Activity (items 3a through 3h of the PA section), with standardized factor loadings ranging from .58 to .81.
• Factor 2: Decision-Making for Healthy Food Choices (items 3a through 3h of the HE section), with factor loadings spanning .52 to .79.
• Factor 3: Goal-Setting for Physical Activity (items 1 and 2 of the PA section), with salient primary loadings above .75.
• Factor 4: Goal-Setting for Healthy Food Choices (items 1 and 2 of the HE section), with factor loadings exceeding .72.

Cross-loadings across divergent behavioral domains were minimal (< .20), confirming clean factor demarcation.

Confirmatory Factor Analysis (CFA)

A rigorous CFA was executed to test competing structural models: a unidimensional model, a two-factor domain-specific model (PA vs. HE), and the hypothesized four-factor correlated model. The four-factor oblique model exhibited excellent goodness-of-fit indices across standard evaluation criteria:

• Comparative Fit Index (CFI): > .95
• Tucker-Lewis Index (TLI): > .94
• Root Mean Square Error of Approximation (RMSEA): .046 (90% CI [.038, .054]), well below the standard .06 cutoff for good fit.
• Standardized Root Mean Square Residual (SRMR): .042

Inter-factor correlations revealed that while GSPA and DMPA were moderately correlated (r ≈ .55), and GSHFC and DMHFC were similarly linked (r ≈ .58), cross-domain correlations between physical activity and nutrition were lower (r ≈ .32 to .41), confirming that children treat physical movement and dietary discipline as interrelated yet distinct spheres of self-regulation.

Instrument / Measurement Tool

• Instrument Name: Physical Activity/Healthy Food Efficacy Scale for Children (PAHFE-C)
• Authors: Carolyn M. Perry, Rafael J. De Ayala, Richard Lebow, and Elizabeth Haydon (2008)
• Target Population: Upper elementary school students, typically grades 3 through 6 (ages 8 to 12 years).
• Administration Format: Paper-and-pencil questionnaire or interactive computerized survey; self-administered individually or via classroom group administration with standardized verbal instructions.
• Completion Time: Approximately 8 to 12 minutes.
• Total Item Count: 20 operational items divided equally between two behavioral modules:
  • Physical Activity Module (10 items total): 2 Goal-Setting items + 8 Barrier Decision-Making sub-items.
  • Healthy Eating Module (10 items total): 2 Goal-Setting items + 8 Barrier Decision-Making sub-items.
• Subscales (4 distinct dimensions):
  1. Goal-Setting for Physical Activity (GSPA) — 2 items
  2. Decision-Making for Physical Activity (DMPA) — 8 items
  3. Goal-Setting for Healthy Food Choices (GSHFC) — 2 items
  4. Decision-Making for Healthy Food Choices (DMHFC) — 8 items
• Response Scale: 5-point Likert-type response format:
  • 1 = Not Sure
  • 2 = Not Too Sure
  • 3 = Sure
  • 4 = Very Sure
  • 5 = Completely Sure
• Scoring Procedures:
  • All items are framed in a positive, self-efficacious direction; therefore, no reverse scoring is required.
  • Subscale scores are calculated by computing the arithmetic mean of the items within each subscale (range: 1.00 to 5.00), with higher scores reflecting higher levels of perceived self-efficacy.
  • Domain composite scores can be derived by averaging all 10 items for Physical Activity and all 10 items for Healthy Eating, respectively.
  • Researchers and clinicians should avoid creating an omnibus grand mean across all 20 items, as preserving the distinction between goal-setting and barrier decision-making yields superior diagnostic sensitivity.

Permissions & Fee and Test Year

The Physical Activity/Healthy Food Efficacy Scale for Children (PAHFE-C) was developed and validated in 2008 by Carolyn M. Perry and colleagues, with foundational psychometric findings published in the peer-reviewed journal Health Education & Behavior. The full instrument and its scoring taxonomy were subsequently anthologized in Simmons and Lehmann’s (2013) Tools for Strengths-Based Assessment and Evaluation published by Springer (pp. 494–497).

The instrument is considered an open-access, non-commercial assessment tool for academic research, educational evaluations, and public health programming. No licensing fee is required for non-profit scholarly or school-based clinical use. Researchers and practitioners utilizing the scale are expected to cite the primary validation publication (Perry et al., 2008) and adhere to standard professional and ethical test administration guidelines. Any commercial distribution or integration into proprietary fee-based software platforms requires formal written authorization from the copyright holders and publishing entities.

References

• Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall, Inc.
• Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman and Company. WorldCat
• Perry, C. M., De Ayala, R. J., Lebow, R., & Haydon, E. (2008). A validation and reliability study of the Physical Activity and Healthy Food Efficacy Scale for Children (PAHFE-C). Health Education & Behavior, 35(3), 346–360. https://doi.org/10.1177/1090198106294892
• Perry, C. M., De Ayala, R. J., Lebow, R., & Haydon, E. (2013). Physical Activity/Healthy Food Efficacy Scale for Children. In C. A. Simmons & P. Lehmann (Eds.), Tools for strengths-based assessment and evaluation (pp. 494–497). Springer Publishing Company. https://doi.org/10.1007/978-1-4614-5871-5
• Simmons, C. A., & Lehmann, P. (Eds.). (2013). Tools for strengths-based assessment and evaluation. Springer Publishing Company. SpringerLink

13. Items of the Scale (Questionnaire)