Validity of the toddler feeding questionnaire for measuring parent authoritative and indulgent feeding practices which are associated with stress and health literacy among Latino parents of preschool children

Abstract

Understanding the contribution of parental feeding practices to childhood obesity among Latino children is a solution-oriented approach that can lead to interventions supporting healthy childhood growth and lowering rates of obesity. The purpose of this study was to confirm the reliability and validity of the Toddler Feeding Questionnaire (TFQ) to measure parental feeding practices among a sample of Spanish-speaking parent-preschool child pairs (n = 529), and to test the hypothesis that parent characteristics of body mass index (BMI), stress, and health literacy are associated with more indulgent and less authoritative feeding practices. Standardized parent-report questionnaires were completed during baseline interviews in a randomized controlled trial of an obesity prevention intervention. The TFQ includes subscales for indulgent practices (11 items), authoritative practices (7 items), and environmental influences (6 items) with response options scored on a 5-point Likert scale and averaged. Factor analysis confirmed a three-factor structure. Internal consistency was good for indulgent (α = 0.66) and authoritative (α = 0.65) practices but lower for environmental (α = 0.48). Spearman correlation showed indulgent practices and environmental influences were associated with unhealthy child diet patterns, whereas authoritative practices were associated with a healthier child diet. Multivariate linear regression showed higher parent stress was associated with higher indulgent and lower authoritative scores; higher parent health literacy was positively associated with indulgent scores. These results indicate the TFQ is a valid measure of authoritative and indulgent parent feeding practices among Spanish-speaking parents of preschool-age children and that stress and health literacy, potentially modifiable parent characteristics, could be targeted to support healthy feeding practices.

Keywords: Childhood Obesity; Latinos; Parent feeding practices; Toddler feeding.

Copyright © 2017 Elsevier Inc. All rights reserved.

Figures

Fig. 1 -

Consort Diagram. The larger randomized controlled trial from which our analytic sample was drawn included 610 minority parent–child pairs. The study sample included 555 Latino parent–child pairs. Participants were excluded from the analysis if they were English speaking (N = 55), if they did not respond to more than 1 item on any of the Toddler Feeding Questionnaire subscales (N = 3; 0.5% missing) or if they did not have complete data on the parent characteristics of interest (BMI, stress, or health literacy, N = 19; 3%).

Fig. 2 -

Correlations between Subscales of the Toddler Feeding Questionnaire and Measures of Healthy and Unhealthy Child Dietary Patterns. The pattern of Spearman Correlations indicates Environmental Influences and Indulgent Practices are associated with mostly unhealthy child diet indicators, whereas Authoritative Practices are mostly associated with healthy diet indicators. R+ items were reverse coded so that unhealthy behaviors (i.e., higher fat, higher kcals, more dessert, and more sugary drinks) had negative correlations with the Toddler Feeding Questionnaire subscales; *P < .05; **P < .001.