**Background:** Childhood obesity is a global health challenge, with prevalence rising from 4% in 1975 to 18% in 2016. In Europe, 1 in 3 children is overweight or obese, and by 2030, over 250 million children worldwide are projected to be obese. In Spain, more than 50% of adults are overweight, and an estimated 18.6% of children aged 5–9 will be obese by 2030. The preschool period (2–6 years) is critical because it precedes the adipose rebound (around age 6), and risk factors during this period are largely modifiable and related to parental attitudes and habits. Existing instruments in Spain focus on one or two risk factors or measure behaviors rather than attitudes. The PRELSA Scale was developed to comprehensively measure parental attitudes across feeding, physical activity/lifestyle, and sleep practices.
**Methods:** The study was conducted in two phases. Phase 1 involved designing the scale based on a literature review and expert consensus among a four-member research team (a pediatrician, a physician, a statistician, and a researcher). The initial version (v-1) contained 69 items across three constructs: Feeding Practices and Attitudes (four dimensions: parental control, feeding structure, quality/variety of diet, and parent perception of child's weight), Physical Activity and Lifestyle Attitudes (including screen time and sedentary behavior), and Sleeping Practices and Attitudes (two dimensions: knowledge of sleep modification and caregiver–child sleep interaction). Items were rated on a 5-point Likert scale. The questionnaire also included 27 sociodemographic questions and 23 habit/behavior questions. Phase 2 was a descriptive, cross-sectional pilot test. First, 50 parents of children aged 2–6 years were recruited via convenience sampling from a health center; 26 completed the survey (52% completion rate). Parents could indicate if they did not understand an item and provided open-text feedback. Items were flagged for review if >80% of responses fell in a single category or if ≥2 respondents selected "Not understood/Confused." Second, 25 experts (physicians, nurses, psychiatrists, psychologists, and university researchers with ≥3 years of experience in pediatrics/obesity) evaluated the v-2 scale using a 14-item content validity questionnaire covering adequacy, construction, feasibility, and redundancy.
**Key Results:** In the parent pilot, the mean age of respondents was 36.5 years, 88.3% were women, 57.6% had university education, and 53.8% had monthly income >2000 euros. Nine items had ≥2 "Not understood/Confused" responses, and 11 items had >80% of responses in a single category. Overall, 20 items were reviewed. Seven items were eliminated (4 too obvious, 3 too confusing), 10 were reworded, and 3 were kept unchanged, reducing the scale from 69 to 62 items. Overall satisfaction was high/very high for 57.7% of parents. In the expert phase, 72% rated overall adequacy as excellent, 76% rated construction as excellent, 36% rated feasibility as excellent (60% good), and 24% rated redundancy information as excellent (72% good). Feasibility concerns centered on completion time (>15 minutes). Three redundant items were eliminated, and one item was added (activity stimulation), resulting in a final v-3 scale of 60 items.
**Clinical Implications:** The PRELSA Scale is a novel, comprehensive instrument for measuring parental attitudes across multiple obesogenic domains in preschool children. Unlike existing tools that focus on single risk factors or behaviors, this scale covers feeding, physical activity, sedentary behavior, and sleep attitudes. Once fully validated, it could be used by health and educational institutions to identify specific parental attitudes that increase obesity risk, enabling targeted interventions. The authors plan to derive a brief version from the full scale for use in time-constrained settings like primary care. Limitations include a small, non-representative parent sample (predominantly female, high education/income) and the long completion time, which may affect response rates in larger field tests.