Psychometric Evaluation of the Preschool Health Examination at German Steiner Schools. Results of IPSUM, a Multicentre Cross-Sectional Validation Study

Background: School readiness, which is assessed as part of the obligatory preschool health examination (PHE), may be an important predictor of educational and health outcomes during primary school. As part of the IPSUM research project “Age at school entry and health outcomes”, we developed a standardized PHE suitable for German Steiner schools (Waldorf schools). Objective: The aim of the present study was to validate the items and scales of the PHE in order to determine how well they measure school readiness. Methods: The PHE instrument comprised 35 items assessing cognitive, sensory, and motor skills as well as anthropometric measures and was validated in 93 German Steiner schools using a cross-sectional study design. 4,789 preschoolers (mean age: 6.1 years; 46.3 % girls) who were examined by the PHE school teams were included. Results: Analysis of the factor structure identified 6 factors covering anthropometric measures, second dentition, gross and fine motor skills, auditory memory, and cognitive/sensory skills. With a few exceptions, results showed satisfactory internal consistency (.62-.86), discriminatory power (.30-.78), and inter-rater reliability (.66-1.0). Linear and logistic regression analyses demonstrated that with the exception of fine motor skills, all factors were significantly related to age at the PHE and school readiness as determined by the school team. Conclusion: The proposed PHE instrument is generally reliable and valid. We suggest some adaptations to further improve the quality of the PHE at German Steiner schools.