Reliability and relative validity of a child nutrition questionnaire to simultaneously assess dietary patterns associated with positive energy balance and food behaviours, attitudes, knowledge and environments associated with healthy eating

Annabelle M Wilson, Anthea M Magarey, Nadia Mastersson, Annabelle M Wilson, Anthea M Magarey, Nadia Mastersson

Abstract

Background: Food behaviours, attitudes, environments and knowledge are relevant to professionals in childhood obesity prevention, as are dietary patterns which promote positive energy balance. There is a lack of valid and reliable tools to measure these parameters. The aim of this study was to determine the reliability and relative validity of a child nutrition questionnaire assessing all of these parameters, used in the evaluation of a community-based childhood obesity prevention project.

Methods: The development of the 14-item questionnaire was informed by the aims of the obesity prevention project. A sub-sample of children aged 10-12 years from primary schools involved in the intervention was recruited at the project's baseline data collection (Test 1). Questionnaires were readministered (Test 2) following which students completed a 7-day food diary designed to reflect the questionnaire. Twelve scores were derived to assess consumption of fruit, vegetables, water, noncore foods and sweetened beverages plus food knowledge, behaviours, attitudes and environments. Reliability was assessed using (a) the intra class correlation coefficient (ICC) and 95% confidence intervals to compare scores from Tests 1 and 2 (test-retest reliability) and (b) Cronbach's alpha (internal consistency). Validity was assessed with Spearman correlations, bias and limits of agreement between scores from Test 1 and the 7-day diaries. The Wilcoxon signed rank test checked for significant differences between mean scores.

Results: One hundred and forty one students consented to the study. Test 2 (n = 134) occurred between eight and 36 days after Test 1. For 10/12 scores ICCs ranged from 0.47-0.66 (p < 0.001) while for two scores ICCs were < 0.4 (p < 0.05). Spearman correlations ranged from 0.34-0.48 (p < 0.01) and Cronbach's alpha 0.50-0.80. Three scores were modified based on this analysis. The Wilcoxon signed rank test found no evidence of a difference between means (p > 0.05) for 10/12 (test-retest reliability) and 3/7 (validity) scores.

Conclusion: This child nutrition questionnaire is a valid and reliable tool to simultaneously assess dietary patterns associated with positive energy balance, and food behaviours, attitudes and environments in Australian school children aged 10-12 years. Thus it can be used to monitor secular changes in these parameters and measure the effectiveness of this and other obesity prevention projects with similar aims.

Figures

Figure 1
Figure 1
Key messages, settings and strategies of the eat well be active Community Programs.

References

    1. Magarey AM, Daniels LA, Boulton JC. Prevalence of overweight and obesity in Australian children and adolescents: reassessment of 1985 and 1995 data against new standard international definitions. Med J Aust. 2001;174:561–564.
    1. Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev. 2004:4–85. doi: 10.1111/j.1467-789X.2004.00133.x.
    1. Booth M, Okely A, Denny-Wilson E, Hardy L, Yang B, Dobbins T. NSW Schools Physical Activity and Nutrition Survey (SPANS) 2004: Full Report. Sydney: NSW Department of Health; 2006. Overweight and obesity; pp. 27–35.
    1. World Health Organisation . Report on a WHO consultation of obesity Geneva 3–5 June 1997. Geneva: World Health Organisation; 1998. Obesity: preventing and managing the global epidemic.
    1. Summerbell CD, Waters E, Edmunds LD, Kelly S, Brown T, Campbell K. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews. 2005;3 Art. No.: CD001871. DOI:10.1002/14651858.CD001871.pub2.
    1. National Institute for Health and Clinical Excellence Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children London. 2006.
    1. World Health Organisation . World Health Assembly Global Strategy on Diet, Physical Activity and Health. Geneva; World Health Organisation; 2004.
    1. International Obesity Taskforce & European Association for the Study of Obesity Obesity in Europe, The Case For Action London. 2002.
    1. Department of Health and Ageing . Healthy Weight Australia's Future, The National Action Agenda for Children, Young People and their Families. Canberra: Australian Government Publishing Service; 2003.
    1. Mastersson N, Hawke M. Developing obesity prevention interventions in partnership with local communities and organisations [abstract] Obes Rev. 2006;7:PO0570.
    1. Swinburn B, Bell C, King L, Magarey A, O'Brien K, Waters E. Obesity prevention programs demand high quality evaluations. Aust NZ J Pub Hlth. 2007;31:305–307. doi: 10.1111/j.1753-6405.2007.00075.x.
    1. McPherson RS, Hoelscher DM, Alexander M, Scanlon KS, Serdula MK. Dietary assessment methods among school-aged children: validity and reliability. Prev Med. 2000;31:S11–S33. doi: 10.1006/pmed.2000.0631.
    1. Persson LA, Carlgren G. Measuring children's diets: evaluation of dietary assessment techniques in infancy and childhood. Int J Epidemiol. 1984;13:506–517. doi: 10.1093/ije/13.4.506.
    1. Serdula MK, Alexander MP, Scanlon KS, Bowman BA. What are preschool children eating? A review of dietary assessment. Annu Rev Nutr. 2001;21:475–498. doi: 10.1146/annurev.nutr.21.1.475.
    1. Rockett HR, Colditz GA. Assessing diets of children and adolescents. Am J Clin Nutr. 1997;65:116S–1122S.
    1. Randall E. Measuring food use in school aged children. J Am Diet Assoc. 1991;61:201–203.
    1. Kristal A, Shattuck A, Henry H. Patterns of dietary behavior associated with selecting diets low in fat: reliability and validity of a behavioral approach to dietary assessment. J Am Diet Assoc. 1990;90:214–220.
    1. Peat JK. Health Science Research: A handbook of quantitative methods. Crows Nest: Allen & Unwin; 2001.
    1. Bell AC, Kremer PJ, Magarey AM, Swinburn BA. Contribution of 'noncore' foods and beverages to the energy intake and weight status of Australian children. Eur J Clin Nutr. 2005;59:639–645. doi: 10.1038/sj.ejcn.1602091.
    1. Magarey AM, Daniels LA, Smith A. Fruit and vegetable intakes of Australians aged 2–18 years: an evaluation of the 1995 National Nutrition Survey data. Aust and N Z J of Public Health. 2001;25:155–161.
    1. Hoelscher DM, Day SR, Kelder SH, Ward JL. Reproducibility and validity of the secondary level School-Based Nutrition Monitoring student questionnaire. J Am Diet Assoc. 2003;103:186–194. doi: 10.1053/jada.2003.50031.
    1. Australian Bureau of Statistics . 1995 National Nutrition Survey (NNS 95) [Confidentialized Unit Record File (CURF) on CD-ROM] Canberra: ABS; 1999.
    1. McLennan W, Podger A. National Nutrition Survey User's Guide 1995. Canberra: Australian Government Publishing Service; 1998.
    1. Smith A, Kellett E, Schmerlaib Y. The Australian Guide to Healthy Eating. Canberra: Commonwealth Department of Health and Family Services; 1998.
    1. National Health and Medical Research Council . Food for Health: Dietary Guidelines for Children and Adolescents. Canberra: Commonwealth of Australia; 2003.
    1. Cole T, Bellizi M, Flegal K, Dietz W. Establishing a standard definition for childhood overweight and obesity worldwide: international survey. Br Med J. 2000;320:1–6. doi: 10.1136/bmj.320.7244.1240.
    1. Pallant J. SPSS Survival Manual. Crows Nest: Allen & Unwin; 2004.
    1. Golan M, Weizman A. Reliability and validity of the family eating and activity habits questionnaire. Eur J Clin Nutr. 1998;52:771–777. doi: 10.1038/sj.ejcn.1600647.
    1. Weber Cullen K, Baranowski T, Rittenberry L, Cosart C, Hebert D, de Moor C. Child-reported family and peer influences on fruit, juice and vegetable consumption: reliability and validity of measures. Health Educ Res. 2001;16:187–200. doi: 10.1093/her/16.2.187.
    1. Bourdeaudhuij ID, Klepp KI, Rodrigo CP, Almeida MDV, Wind M, Krolner R, Sandvik C, Brug J. Reliability and validity of a questionnaire to measure personal, social and environmental correlates of fruit and vegetable intake in 10–11 -year-old children in five European countries. Pub Health Nutr. 2005;8:189–200. doi: 10.1079/PHN2004673.
    1. Bere E, Klepp K-I. Reliability of parental and self-reported determinants of fruit and vegetable intake among 6th graders. Pub Health Nutr. 2003;7:353–356. doi: 10.1079/PHN2003529.
    1. Finch M, Begley A, Sutherland R, Harrison M, Collins C. Development and reproducibility of a tool to assess school food-purchasing practices and lifestyle habits of Australian primary school-aged children. Nutrition and Dietetics. 2007;64:86–92. doi: 10.1111/j.1747-0080.2007.00148.x.
    1. Andersen LF, Bere E, Kolbjornsen N, Klepp K-I. Validity and reproducibility of self-reported intake of fruit and vegetable among 6th graders. Eur J Clin Nutr. 2004;58:771–777. doi: 10.1038/sj.ejcn.1601875.
    1. Emmons L, Hayes M. Accuracy of 24-hr. recalls of young children. J Am Diet Assoc. 1973;62:409–15.
    1. Feskanich D, Rockett HR, Colditz GA. Modifying the Healthy Eating Index to assess diet quality in children and adolescents. J Am Diet Assoc. 2004;104:1375–1383. doi: 10.1016/j.jada.2004.06.020.
    1. Kremer PJ, Bell AC, Swinburn BA. Calibration and reliability of a school food checklist: a new tool for assessing school food and beverage consumption. Asia Pac J Clin Nutr. 2006;15:465–473.
    1. Magarey A, Gehling R, Wood K. Dietitians Association of Australia 22nd National Conference: 20–22 May 2004; Melbourne. Dietitians Association of Australia; 2004. Assessing fat and food group intake in 5–10 year old children; p. 133.
    1. Matheson DM, Hanson KA, McDonald TE, Robinson TN. Validity of children's food portion estimates. Arch Pediatr Adolesc. 2002;156:867–871.
    1. Baranowski T, Domel SB. A cognitive model of children's reporting of food intake. Am J Clin Nutr. 1994. pp. 212S–217S.
    1. Bland M, Altman D. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135–160. doi: 10.1191/096228099673819272.
    1. Margetts B, Nelson M. Design concepts in nutritional epidemiology. Oxford: Oxford University Press; 1997.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera