Development and Psychometric Testing of the Perceived Environment and Muscle-Strengthening Exercise Questionnaire in Adults

Introduction: Despite the health benefits of performing regular muscle-strengthening exercise (MSE), prevalence rates of meeting the public health guidelines for MSE remain low. Understanding barriers to MSE participation may aid in health promotion efforts and intervention design. Thus, the purpose of this study was to develop and test the psychometric properties of the Perceived Environment and Muscle Strengthening Exercise Questionnaire (PEMSE-Q), a tool that measures environmental effects on MSE. Methods: The questionnaire included 77 items measuring physical environment, home MSE equipment accessibility, and MSE social support. This study was conducted in a combined national sample of two independent groups using an online research participant recruitment tool, Prolific: 1) healthy adults (n = 237 (female: n = 125; male: n = 111; intersex: n = 1), mean age +/- standard deviation (SD) = 36.1 +/- 10.7 yr) and 2) type 2 diabetes (T2D) (n = 221 (female: n = 122; male: n = 99), mean age +/- SD = 46.5 +/- 10.9 yr). The factor structure, internal consistency, test-retest reliability, criterion validity, construct validity, and concurrent validity of PEMSE-Q were determined using exploratory factor analyses, Cronbach's alpha, intraclass correlation coefficients (ICC), regression analyses, chi-square tests of association and logistic regression, and Pearson correlation and logistic regression, respectively. Results: PEMSE-Q had good to excellent test-retest reliability (ICC = 0.83-0.94), acceptable criterion validity evidence (all P values <0.001, standard error = 0.033-12.043), moderate concurrent validity (r = 0.449-0.469), and apparent construct validity for public MSE facilities (chi(2) = 5.991, P = 0.01). Conclusion: PEMSE-Q is a valid and reliable tool for assessing MSE home equipment and accessibility, convenient public MSE facilities, and social support. This tool could be used by researchers, public health professionals, and clinicians to aid in identifying barriers and facilitators to MSE participation.