Reliability and validity of nutrition knowledge questionnaire for adults

Health Belief Model Predicts Likelihood of Eating Nutrient-Rich Foods among U.S. Adults

Despite decades of messaging, most Americans still consume excess fats and sugars, but inadequate fiber, potassium, and calcium. Nutrient-rich foods (NRFs) have a high density of favorable nutrients related to calories. Choosing NRFs could lower risk of nutrition-related chronic diseases and aid in their control. We hypothesized that having greater knowledge of NRFs, the presence of a nutrition-related chronic disease or risk factor, and positive Health Belief Model (HBM) views would be predictive of the likelihood of eating NRFs. Through a national online survey panel, 976 adults aged 18-80 completed demographic, health, NRF knowledge, attitudes, and HBM construct questions. Participants were 77% White, 52% women, and 55% had a nutrition-related disease or risk factor. Multivariable HBM scales were generated by theory, principal components, and reliability analysis. NRF knowledge was significantly higher for women, Whites, households without children, and persons without a nutrition-related disease (all p ≤ 0.015). 'Likelihood of eating NRFs' was significantly higher for persons with a nutrition-related disease, Whites, married participants, main food shoppers, and households with children (all p ≤ 0.022). Regressing demographic and HBM constructs on the 'likelihood of eating NRFs' resulted in R2 of 0.435. Nutrition-related disease and HBM constructs of self-efficacy, perceived benefits, and cues to action were predictive of the likelihood of eating NRFs, but higher NRF knowledge was negatively associated.

Assessing the Performance of a Nutrition Knowledge Questionnaire With a Low Socioeconomic Status Population Using Rasch Analysis

Parents and preschool teachers play a key role in shaping children's dietary behaviors. Knowledge of nutrition and healthy dietary choices is a key component to improve dietary habits and reduce the prevalence of obesity and associated co-morbidities. Using valid and reliable instruments is necessary for accurate assessment of knowledge to tailor interventions and measure effectiveness specific to the population of interest. The objectives of this paper are to (1) identify potential gaps in the baseline nutrition knowledge among parents and teachers using a previously validated questionnaire prior to a preschool obesity prevention intervention; and (2) assess the instrument's reliability and construct validity for a low socioeconomic status population using a post hoc Rasch analysis. Participants included 177 parents and 75 teachers who participated in a Head Start intervention study. Knowledge scores, instrument reliability, and item fit and difficulty were assessed using a Rasch analysis; t-tests were used to determine differences in scores between parents and teachers. Parents answered 38% of questions correctly while teachers correctly answered 46% of the questions. Adequate item fit and reliability were indicated for Sections 1 and 2 of the Nutrition Knowledge Questionnaire (NKQ). Section 3 demonstrated less adequate reliability. The items were found to adequately and reliably define the unidimensional measures of the three components of knowledge represented in this instrument, providing evidence of construct validity. However, Rasch measures indicated the NKQ overall was difficult for participants. Recommendations for improving the instrument for nutrition education/intervention and research practice areas related to obesity and obesity-related conditions are addressed.

Nutrition knowledge and influence on diet in the carer-client relationship in residential care settings for people with intellectual disabilities

People with intellectual disabilities generally have poorer health outcomes compared with those who do not, including outcomes related to nutrition-related non-communicable diseases. Carers support people with intellectual disabilities in many aspects including habitual shopping and preparation of food, but their own nutrition knowledge and the influence this may have on dietary intakes of clients is unknown. We explored the nutrition knowledge of carers of people with intellectual disabilities in residential care settings, their dietary habits and their influence on clients' food shopping and preparation and therefore the diet consumed by their clients. Ninety-seven carers belonging to a large independent care sector organisation specialising in the care of people with an intellectual disability completed a validated general nutrition knowledge and behaviour questionnaire. Seventeen carers from the residential care settings were interviewed to contextualise practice. Knowledge about key dietary recommendations scored highly. Carers who had more work experience were found to have higher scores in 'making everyday food choices' (p = 0.034). Daily consumption of fruit and vegetables (at least one portion per day) was observed (for fruit by 46% of the carers and for vegetables by 60% of the carers), whilst most carers reported avoiding consuming full-fat dairy products, sugary foods and fried foods. The concept of a healthy diet; typical dietary habits of clients; role in food acquisition; and training in nutrition emerged as themes from the interviews. Carers discussed various topics including the importance of a balanced diet, cooking fresh foods and control of food portion sizes for clients relative to the care philosophy of a client-centred approach, which encapsulates client autonomy. Gaps in knowledge around specific nutrients, making healthy choices and cooking skills remain. Carers have an influence on clients' dietary choices; they are able to provide healthy meals and share good dietary habits with clients. Further training in nutrition is recommended for impact on clients' health.

Nutritional Health Knowledge and Literacy among Pregnant Women in the Czech Republic: Analytical Cross-Sectional Study

Adequate nutrition and the nutritional status of pregnant women are critical for the health of both the mother and the developing foetus. Research has shown a significant impact of nutrition on the child's health and the future risk of developing chronic noncommunicable diseases (NCDs), such as obesity, diabetes, hypertension, and cardiovascular disease. There is currently no data on the level of nutritional knowledge of Czech pregnant women. This survey aimed to evaluate their level of nutritional knowledge and literacy. An analytical cross-sectional study was conducted in two healthcare facilities in Prague and Pilsen between April and June 2022. An anonymous self-administered paper-form questionnaire for assessing the level of nutritional knowledge (40 items) and the Likert scale for assessing nutrition literacy (5 items) were used. A total number of 401 women completed the questionnaire. An individual's nutritional knowledge score was calculated and compared with demographic and anamnestic characteristics using statistical methods. The results showed that only 5% of women achieved an overall nutritional score of 80% or more. University education (p < 0.001), living in the capital city (p < 0.001), experiencing first pregnancy (p = 0.041), having normal weight and being overweight (p = 0.024), and having NCDs (p = 0.044) were statistically significantly associated with a higher nutritional knowledge score. The lowest knowledge scores were found in the areas of optimal energy intake, optimal weight gain, and the role of micronutrients in diet during pregnancy. In conclusion, the study shows limited nutrition knowledge of Czech pregnant women in some areas of nutrition. Increasing nutritional knowledge and nutrition literacy in Czech pregnant women is crucial for supporting their optimal course of pregnancy and the future health of their offspring.

Questionnaire development on measuring parents’ anxiety about their children’s education: Empirical evidence of parental perceived anxiety data for primary and secondary school students in China

Background

With the implementation of the “double reduction” policy in China, parents of primary and secondary school students are experiencing a growing trend of educational anxiety that needs to be alleviated.

Objective

To manage the education anxiety risk of parents of primary and secondary school students, a measurement questionnaire of parents’ anxiety about their children’s education (MQPAE) was developed and its reliability and validity were evaluated.

Methods

A self-administered MQPAE was developed. An online crowdsourcing questionnaire platform was used to collect data on parents’ anxiety about their children’s education (PAE), and parents of primary and secondary school students in Hefei, China, were selected as the study population. The randomly extracted 5,747 questionnaires were gradually screened by discrete trend method, t-test, and Pearson’s correlation coefficient method for the initial screening of PAE items, based on which exploratory factor analysis (EFA) was conducted for the final screening of questionnaire items and the reliability of the questionnaire. The reliability of the questionnaire was assessed by internal consistency and Pearson’s correlation coefficient analysis. Confirmatory factor analysis (CFA) was conducted using 639 pre-selected data to investigate the validity of the questionnaire. Structural equation modeling was used to investigate the structural validity of the questionnaire, and average variance extracted (AVE), combined reliability (CR), and maximum of shared squared variance (MSV) were used to test for convergent and discriminant validity.

Results

Exploratory factor analysis extracted five factors with a cumulative variance contribution of 65.66%. The CFA showed that χ²/df = 4.306, CFI = 0.920, NFI = 0.898, RMSEA = 0.072<0.08, AGFI = 0.839>0.80, PNFI = 0.793 and PGFI = 0.708. The overall Cronbach’s α coefficient of the questionnaire was 0.956, and the factors’ Cronbach’s α coefficients were 0.926, 0.857, 0.913, 0.901, and 0.768, respectively. Repeated measurements of Pearson’s correlation coefficients were 0.908, 0.911, 0.873, 0.891, 0.907 and 0.885 (all p < 0.001). The AVE was greater than 0.5 and the CR was greater than 0.7, and the value of the MSV was less than the corresponding AVE.

Conclusion

The MQPAE has good reliability and validity and can be used in studies related to PAE of primary and secondary school students.

Development and test–retest reliability of the Combat Sports Post-Career Health Questionnaire (CSPCHQ)

The long-term impact of weight cycling on health status, eating habits, physical activity and the lifestyle of former combat sports athletes is still insufficiently explored. Therefore, a novel questionnaire in English, Portuguese, Spanish and Croatian language was constructed. To determine the reliability and the content/face validity, a total of 110 participants filled the questionnaire on two occasions. With the majority of intra-class correlation coefficient values above 0·75, the questionnaire items were shown to be very stable. Additionally, according to κ values, the questionnaire has fair test–retest reliability, with only one coefficient being labelled as poor (Q40 in ESP). All questionnaire sub-scales showed moderate to very good internal consistency when the overall sample was observed (α ranging from 0·605 to 0·802). Poor α values were found only in Godin-Shephard Leisure-Time Physical Activity Questionnaire for CRO and ESP samples. Wilcoxon’s signed rank test showed significant differences only in the Mindful Eating Questionnaire sub-scale scores (overall: P = 0·002, effect size = −0·208 [moderate]; CRO: P = 0·005, effect size = 0·303 [moderate]). It can be concluded that the newly developed questionnaire had strong test–retest reliability. Further validity research in a larger sample of former combat sports athletes should be considered.

Subhealth Risk Perception Scale: Development and Validation of a New Measure

Background

To develop an individual's physical subhealth risk perception scale and evaluate its reliability and validity, so as to provide a measurement tool for individual physical health risk.

Methods

A questionnaire on the perception risk of physical subhealth was developed. Using a random sampling method, 785 people in the Anhui provincial physical examination centre were selected as the research participants. Of the questionnaires returned, 770 were valid, giving an effective rate of 98%. Firstly, the Pearson correlation coefficient method was used to study the correlation of 35 items in the initial scale, and then, polychoric factor structure analysis was carried out by using the Pratt D matrix to optimize the item structure. The Cronbach'α coefficient method was used to test the internal consistency reliability, and a structural equation model was used to explore the construct validity of the scale. The discriminant validity of the scale was obtained by factor analysis. A general linear model was used to analyse the relationship between the clinical manifestations of physical subhealth and the level of risk perception, and the convergent validity of the scale was evaluated.

Results

All the data of 35 items were significantly correlated at the 0.01 level. The correlation coefficients between a1 and a2, a3 and a4, b1 and b2, b2 and b3, c4 and c5, c5 and c6, c6 and c7, c8 and c9, d1 and d2, d2 and d3, e5 and e6, g1 and g2, g2 and g3, and g2 and g4 were greater than 0.6. The items with correlation coefficients greater than 0.6 were reduced by a Pratt D matrix. The resulting physical subhealth risk perception scale covers five factors with a total of 18 items. The Cronbach'α coefficient of the scale was 0.889, and the Cronbach'α coefficients of the five factors F1-F5 were 0.780, 0.825, 0.801, 0.736, and 0.704, respectively. Structural equation model analysis showed that χ²/df = 3.43, p < 0.001, RMSEA = 0.08, GFI = 0.88, NFI = 0.84, AGFI = 0.84, and CFI = 0.88. Factor analysis showed that factors F1–F5 had significant correlations (p < 0.01), and the correlation coefficients were less than the corresponding square root value of AVE. Based on the subhealth clinical manifestations of the participants, the general linear model was used to explore the convergent validity of the scale, and the results indicated that the scale passed the convergent validity test.

Conclusions

We propose a physical subhealth risk perception scale amounting to 18 items, which includes five dimensions: health knowledge (2 items), risk perception (5 items), trust selection (4 items), information channel (4 items), and social groups (3 items). The reliability and validity of the physical subhealth risk perception scale are acceptable. Applying the scale into practice has potential to improve the overall public health level.

Price sensitivity testing as a basic tool for strategic pricing decisions

Background: Data-driven decisions in each functional area of management, through all of the strategic levels, in the present time of dynamic changes in geopolitical and market conditions are necessary to achieve corporate (economic and social) goals, in line with securing future business success and sustainability. Because of this business need, we will focus in our research paper on price management, which can be seen as a supportive tool for strategic decisions, where competent decisions should be based on data-driven pricing decisions. Purpose: The aim of the research study is to identify what price consumers are prepared to pay for a new food product in a relatively saturated foreign market. The research study was conducted in the milk chocolate bar market segment. Study design: We applied the van Westendorp price sensitivity test to identify the range of acceptable prices for a product that is willing to enter a new foreign market. For this purpose, we used a milk chocolate bar product currently unknown in the Slovak market. Findings: In addition to the van Westendorp price sensitivity measurement, we used a non-parametric Mann Whitney U test to confirm the hypothesis that chocolate tasting will increase the likelihood of customers to pay a higher price for the tested product. The hypothesis mentioned above was statistically confirmed. Limitations: It is necessary to monitor customer reactions to a given price level and be prepared to optimize it. We did not address this part of the analysis in identifying a price that would be acceptable to consumers in terms of value perception, due to the scope of the study.

Development and Validity of a General Nutrition Knowledge Questionnaire (GNKQ) for Chinese Adults

Nutrition knowledge refers to understanding concepts and processes related to nutrition and health, proven to be an essential determinant of healthy eating. However, partially due to the lack of nutrition knowledge and unhealthy eating patterns, more and more Chinese people face overweight, obesity, and a high risk of suffering from various chronic diseases. This study aimed to develop a general nutritional knowledge questionnaire (GNKQ) in a Chinese context to diagnose and improve nutrition knowledge education for Chinese people. The newly adapted questionnaire was based on the Turkey version of GNKQ, and absorbed dietary recommendations in a Chinese context. It was first validated by four nutrition experts, then tested by eleven volunteers (one public nutritionist, one preventive medicine graduate student, and nine psychology graduate students). Finally, the questionnaire was tested by 278 participants, including 175 adults, to determine internal consistency, content validity, and convergent validity. Moreover, the construct validity was evaluated by comparing the differences between 50 students in nutrition-related majors and 53 students in nutrition-unrelated majors. The final Chinese version of GNKQ kept 32 questions with 68 items after deleting some questions based on item difficulty and discrimination. The data showed that the overall internal consistency coefficient was 0.885, and the test-retest reliability was 0.769, p < 0.001. Students majoring in nutrition had larger scores than in nutrition-unrelated majors. The convergent validity for each demographic variable was consistent with previous studies, such as larger nutrition knowledge scores for females and those with a higher education. Therefore, the revised Chinese version of GNKQ showed good reliability and validity, indicating that it could be an effective tool to assess the nutrition knowledge of Chinese adults.

Knowledge of chronic intestinal failure among US gastroenterologists: Cause for concern and learning opportunity

BACKGROUND

Chronic intestinal failure (CIF) is an ultrarare disease, with an estimated national prevalence of ∼25,000 cases. There is a suspicion of widespread lack of expertise in CIF care, but no formal assessment tool or data exist. We developed and validated a knowledge test in CIF and now report our preliminary results from testing CIF knowledge in a cohort of US gastroenterologists.

METHOD

We developed a 20-question knowledge test in CIF, covering four key components of IF. After internal testing, refinement, and revision, we administered the test to a convenience sample of experts and nonexperts in IF. We then deployed the validated test to a cohort of 100 US gastroenterologists.

RESULTS

The test had a Cronbach alpha of 0.74, suggesting a reliable test, with a threshold score to discriminate experts and nonexperts of 13.4 (maximum 20) and with a sensitivity of 81.3% and specificity of 86.4%. The overall mean score of 8.2 for the 100 US gastroenterologists was at the level of nonexperts in our convenience sample.

CONCLUSION

The preliminary results of our validated knowledge test in IF among a broad group of US gastroenterologists demonstrate lack of knowledge in IF.

Associations between lifestyle factors and body mass index in African-American community college students

The goal was to examine associations between body mass index (BMI) and lifestyle factors in African American community college students. Methods: Young adults, 18-25, who identified as African American were eligible to participate from 3/17 to 11/17. BMI, body image, discrimination, social roles, emotional and informational support, nutrition knowledge, and physical activity were assessed. Results: Data from 323 students were analyzed. The mean age was 20.1 ± 2.0 years. There were no significant differences between individuals with BMI ≥ 25 and BMI < 25 on social role satisfaction, discrimination, and emotional or informational support. Overweight/obese individuals rated themselves higher on body image than normal weight individuals. The association between ideal body image and BMI sustained after adjusting for various factors. Conclusions: This is a unique population and they have unique needs in weight loss interventions. The strong relationship between body image and BMI suggests that incorporating body image into intervention design may assist in weight loss.

Development and Validation of the Military Eating Behavior Survey

OBJECTIVE

To describe the Military Eating Behavior Survey (MEBS), developed, and validated for use in military populations.

DESIGN

Questionnaire development using a 6-phase approach that included item generation, subject matter expert review, cognitive interviewing, factor analysis, test-retest reliability testing, and parallel forms testing.

SETTING

US Army soldiers were surveyed at 8 military bases from 2016 to 2019 (n = 1,561).

MAIN OUTCOME MEASURE

Content, face, and construct validity and reliability of the MEBS.

ANALYSIS

Item variability, internal consistency, and exploratory factor analysis using principal coordinates analysis, orthogonal varimax rotation, and scree test (correlation coefficient and Cronbach alpha), as well as consistency and agreement (intraclass correlation coefficient) of test-retest reliability and parallel forms reliability.

RESULTS

Over 6 phases of testing, a comprehensive tool to examine military eating habits and mediators of eating behavior was developed. Questionnaire length was reduced from 277 items to 133 items (43 eating habits; 90 mediating behaviors). Factor analysis identified 14 eating habit scales (hunger, satiety, food craving, meal pattern, restraint, diet rigidity, emotional eating, fast/slow eating rate, environmental triggers, situational eating, supplement use, and food choice) and 8 mediating factor scales (body composition strategy, perceived stress, food access, sleep habits, military fitness, physical activity, military body image, and nutrition knowledge).

CONCLUSIONS AND IMPLICATIONS

The MEBS provides a new approach for assessing eating behavior in military personnel and may be used to inform and evaluate health promotion interventions related to weight management, performance optimization, and military readiness and resiliency.

Validity and Reliability of a Nutrition Knowledge Questionnaire for High School-Aged Adolescents

OBJECTIVE

To determine the validity and reliability of a nutrition knowledge questionnaire for adolescents.

METHODS

An adult questionnaire was administered to 4 high school student convenience samples with and without known prior nutrition education. Questionnaire refinement was determined by item-total correlation, item discrimination, and item difficulty. Mean percentage of correct answers was calculated, and the group difference was assessed using an independent samples t test. A post hoc regression analyzed the association between mean percentage of correct answers and group while controlling for school.

RESULTS

The questionnaire, with 1 question eliminated, had good internal consistency reliability (Cronbach α = 0.83). The nutrition education group (n = 174) demonstrated significantly (P < 0.0001) higher mean percentage of correct answers compared with the no nutrition education group (n = 136). The association between mean percentage of correct answers and the group remained with school controlled.

CONCLUSIONS AND IMPLICATIONS

Results suggest that the questionnaire is valid and reliable for measuring nutrition knowledge in high school-aged adolescents.

Development of the Impact of a Preschool Obesity Prevention Intervention Enhanced With Positive Behavioral Supports for Mississippi Head Start Centers

OBJECTIVE

To describe the methodology of the Impact of a Preschool Obesity Prevention intervention enhanced with positive behavioral supports.

DESIGN

The social ecological model serves as the conceptual framework for this study, which has a within- and between-subjects design with an intervention group and a delayed intervention control group. This 3-year project will use formative methods to pretest materials in Year 1, collect data pre- and postintervention with a follow-up at 4 months in Years 2 and 3, and conduct summative and process evaluation in Year 3.

SETTING

Head Start centers in Southern and East-Central Mississippi counties.

PARTICIPANTS

Three hundred parents with 3-year-old children enrolled in 9 Head Start centers (53 classrooms) and 75 Head Start teachers.

INTERVENTIONS

During Year 2, Hip Hop to Health Jr., Parent-Child Interaction Therapy, and Positive Behavior Interventions and Supports will be implemented.

MAIN OUTCOME MEASURES

Primary outcomes include changes in parenting and teacher practices. Secondary outcomes include parent feeding styles as well as weight status and dietary intake. Variables will be measured using anthropometrics and validated surveys.

ANALYSIS

The primary analysis will be a multilevel 2 × 3 mixed ANOVA.

Development of a National Dietary Behaviors Questionnaire for EFNEP Adult Participants

OBJECTIVE

Develop and establish the reliability and validity of dietary behavior evaluation questions for the Expanded Food and Nutrition Education Program (EFNEP).

DESIGN

A mixed-methods study using cognitive interviews, expert panels, test/retest reliability, and pretests/posttests.

SETTING

14 states across the US.

PARTICIPANTS

A convenience sample of low-income EFNEP or EFNEP-eligible participants for cognitive interviews (n = 111), reliability testing (n = 181), and sensitivity to change testing (n = 382).

MAIN OUTCOMES MEASURES

Indicators of face and content validity, temporal reliability, and sensitivity to change.

ANALYSIS

Questions interpreted as intended in cognitive interviews, intraclass correlation coefficient and Spearman rank-order correlation for reliability testing; paired t tests or Wilcoxon signed-rank tests for sensitivity to change; and exploratory factor analyses to identify possible scales.

RESULTS

Cognitive interviews resulted in 3 rounds of question revisions; reliability value ranges were 0.48-0.77 for intraclass correlation coefficient and 0.43-0.77 for Spearman rank-order correlation. For sensitivity to change, 9 items had evidence of change (P < 0.05) between pretests and posttests, whereas 5 items had evidence for change after removing those with little room to change. Two scales were identified: diet quality and non-cheese dairy.

CONCLUSIONS AND IMPLICATIONS

The EFNEP's new dietary behavior evaluation questions demonstrated face and content validity, moderate to strong reliability, and sensitivity to detect self-reported behavior changes among low-income, diverse populations (culturally, racially/ethnically, and level of education) across 14 states. Nutrition education programs targeting similar behaviors with English speaking clients could consider this dietary behavior questionnaire.

Reliability and validity of Arabic version of revised general nutrition knowledge questionnaire on university students

OBJECTIVE

The current study evaluated the reliability and validity of the Arabic version of the revised general nutrition knowledge questionnaire (GNKQ-R) for adults.

DESIGN

The eighty-eight-item English GNKQ-R was adapted into an eighty-six-item Arabic version. Four validation studies were conducted for internal (n 805) and external (n 106) reliability, construct validity between participants with (n 84) and without (n 88) nutrition background, convergent validity for associations between nutrition knowledge and demographic characteristics (n 750) and responsiveness to online nutrition information (n 55).

SETTING

United Arab Emirates University in United Arab Emirates and Hashemite University in Jordan.

PARTICIPANTS

Undergraduate students aged 18 years and above, enrolled in any programme at the two universities, were recruited.

RESULTS

Overall, internal reliability (Cronbach's α = 0·91) and external reliability (P = 0·350; intra-class correlation coefficient = 0·84) were high. Significantly higher GNKQ-R scores of students with (66·0 (10·6)) v. without (38·0 (10·7), P < 0·001; d = 2·6) nutrition background indicated high construct validity. Significantly higher GNKQ-R scores among females v. males, older and senior students v. younger and junior students and students in health discipline v. non-health discipline reflected good convergent validity. Significant differences in GNKQ-R scores with nutrition information (time 1 = 37·8 (10·5) and time 2 = 47·7 (9·1), P < 0·001; d = 1·0) indicated high responsiveness to nutrition intervention.

CONCLUSIONS

The Arabic GNKQ-R showed high reliability and validity in the young adult Arab population. Besides the reliability of the overall questionnaire, each section demonstrated adequate reliability. Further studies are warranted to establish the generalisability and applicability of the Arabic GNKQ-R in older adults and in different middle-eastern Arab countries.

Validation of a revised General Nutrition Knowledge Questionnaire for Australia

OBJECTIVE

This study aimed to validate a nutrition knowledge questionnaire appropriate for use in Australia.

DESIGN

Nutrition knowledge is essential in establishing and maintaining strategies that reduce the burden of disease and promote wellbeing. The General Nutrition Knowledge Questionnaire (GNKQ) was developed in the United Kingdom in 1999 and validated for Australia in 2008. Changes in national nutrition recommendations and food availability prompted the redevelopment and revalidation of the UK questionnaire in 2016. However, the Australian questionnaire had not been subsequently updated.

SETTING

Australia.

PARTICIPANTS

Content validity was determined using a sample of academic dietitians in Australia (n 8). Face validity was undertaken with retail employees (n 11) whose highest level of education was secondary school. Ninety-three undergraduate nutrition and engineering students at Queensland University of Technology completed the questionnaire for construct validity, and nineteen students were contacted a week later for test-retest reliability.

RESULTS

In the 117-scored questionnaire, nutrition students scored consistently higher in each of the four sections and overall (87 %, M 102, IQR 95, 107) compared with engineering students (77 %, M 82, IQR 76, 87·25, P < 0·01). Internal reliability of the questionnaire was high (α = 0·92) as was test-retest reliability (rs = 0·96, ICC2,1 = 0·99). AUS-R NKQ determined significant differences between individuals with known higher levels of nutrition knowledge and obtained high validity, reliability and consistency within an Australian sample.

CONCLUSIONS

AUS-R NKQ refined through this research is valid and would be an appropriate questionnaire for assessing the effectiveness of nutrition knowledge-based interventions for public health programmes, clinicians and researchers.

Reliability and validity of a General Nutrition Knowledge Questionnaire for adults in a Romanian population

Background

Nutritional knowledge assessment is an important component in nutrition research, and a prerequisite for the implementation of many policies and programs aimed at improving eating behavior. In order to generate objective results, validated tools for a given population must be employed. The aim of this study was to determine the validity and reliability of a nutrition knowledge questionnaire for Romanian adults.

Methods

Kleimann’s version of a General Nutrition Knowledge Questionnaire, was translated and adapted to Romanian language, culture, and cuisine. The final format was developed in several steps and used four components: internal and external reliability were assessed in a general population sample (n1 = 412), respectively in a subgroup (n2 = 46) from Component 1; Component 3 assessed construct validity (n3 = 96) using the “known-groups” method; Component 4 (convergent validity, n4 = 508) tested the association between socio-demographic characteristics and nutrition knowledge.

Results

The overall internal reliability was 0.878 and the external reliability was >0.880 in all sections, and overall. Specialists had higher scores than nonspecialists, with a very large effect size. In the general population, females scored higher than males, and middle-aged and older adults scored higher than young adults. Higher scores were associated with higher levels of education. The characteristics of individuals prone to giving wrong answers were: males (beta = 0.170), high school or less (beta = 0.167), and no training in nutrition (beta = 0.154).

Conclusions

The Romanian version of the General Nutrition Knowledge Questionnaire is a reliable and valid tool for measuring nutrition knowledge in adults.

Development and validation testing of a weight management nutrition knowledge questionnaire for adults

Background/Objectives

Because no validated tool exists to assess nutrition knowledge regarding weight management we developed and tested the Weight Management Nutrition Knowledge Questionnaire (WMNKQ).

Subjects/Methods

The questionnaire assesses nutrition knowledge in these categories: energy density of food, portion size/serving size, alcohol and sugar sweetened beverages, how food variety affects food intake, and reliable nutrition information sources. In total 60 questions were reviewed by 6 experts for face validity and quantitative analysis was used to assess item difficulty, item discrimination, internal consistency, inter-item-correlation, test-retest reliability, construct validity, criterion validity, and convergent validity.

Results

The final WMNKQ contained 43 items. Experts removed 3 of the original 60 questions and modified 41. Eighteen items did not meet criteria for item difficulty, item discrimination, and/or inter-item correlation; 4 were retained. The WMNKQ met criteria for internal consistency (Cronbach's alpha = 0.88), reliability (test-retest correlation ρ = 0.90, P < 0.0001), construct validity (known groups comparison) - dietitians scored 16% better (p < 0.0001) than information technology workers, and criterion validity (pre- to post-intervention improvement in knowledge scores = 11.2% (95% CI 9.8–12.5, p < 0.0001)). Participants younger than age 55 scored significantly better than those over age 55 (convergent validity).

Conclusions

The WMNKQ measures how well nutrition principles of weight management are understood.

Development and validation of a knowledge, attitude, and practice questionnaire on nutrition-related cancer prevention for Iranian women

Background:

Designing cancer prevention programs needs information on knowledge, attitude, and practice of the community. Unfortunately, this information is not available in Iran.

Materials and Methods:

We developed a questionnaire (NUTCANKAPQ) to assess the knowledge, attitude, and practice of Iranian women regarding cancer prevention dietary habits. We recruited women who had referred to public health-care centers in Tehran, Iran. To assess validity, we applied face, content, and construct validity methods. We performed test–retest approaches to assess reliability, and internal consistency of the questionnaire was assessed through Cronbach's alpha and intraclass correlation coefficients (ICCs).

Results:

Qualitative content validity was carried out by an expert panel, and internal consistency was deemed satisfactory (Cronbach's alpha, >0.6). We also observed high reliability in the questionnaire (ICC = 0.85). The mean (± standard deviation) scores for knowledge, attitude, and practice of study participants were 28.3 (±14.1), 67.1 (±18.9), and 53.7 (±8.3), respectively. The result of exploratory factor analysis, Kaiser–Meyer–Olkin (KMO), implied that the model was reasonably fit (KMO > 0.6). The final questionnaire included seventy items.

Conclusion:

NUTCANKAPQ is a valid and reliable tool for the assessment of cancer-related nutrition knowledge, attitude, and practice among the Iranian population. Application of NUTCANKAPQ may provide important clues for policy-making and improvement of cancer prevention programs among the Iranian population.

Perceptions Towards Healthy Diet of the Portuguese According to Area of Work or Studies

Introduction

A healthy diet is crucial for the maintenance of health. Therefore, the aim of this work is to evaluate the perceptions towards a healthy diet among the participants with work or studies in areas related to diet and nutrition and those who did not.

Methods

Anonymous questionnaire data was collected in a cross-sectional study on a non-probabilistic sample of 902 participants living in Portugal.

Results

The results showed that the participants’ perceptions were, in general, compliant with a healthy diet. However, significant differences were found between gender (p=0.004), between the different civil state groups (p=0.016), between the participants who were responsible for buying their own food and those who were not and also regarding the living environment. The variable area of work or studies also showed significant differences (p=0.001), so that people who had work or studies related to agriculture obtained a higher score. Regarding this variable, the mean values of nutrition and agriculture areas were not statistically different between them, but were statistically different from the mean values of psychology and health areas. The participants who had work or studies in areas showing diet and nutrition-related issues achieved a higher mean score (0.72±0.35) when compared to the participants who did not (0.58±0.30).

Conclusion

However, despite the results, it is important to continue developing campaigns that better communicate nutritional aspects, so that people can increase their knowledge on this subject.

Parental and family predictors of fruits and vegetables in elementary school children's home-packed lunches across a school week

Home-packed lunches have been found to be of lower nutritional quality than school-bought lunches, yet little is known about family-based factors associated with lunch packing. The current exploratory study examines parental and family predictors of fruits and vegetables packed in lunches, hypothesizing parents' nutrition knowledge and authoritative parenting as well as children's involvement in lunch decisions would relate to packing more fruits and vegetables, while financial difficulties would relate to packing fewer. Ninety parent-child dyads from 4th-6th grade participated for 5 consecutive school days. Lunch contents were recorded using a digital imaging procedure to capture the number of days a fruit or vegetable was packed, and servings of fruits and vegetables in lunches each day. Parents completed family and parenting questionnaires and daily reports of child involvement in lunch decisions. Count-based regression models and longitudinal analyses within a multilevel modeling framework were used to examine predictors of lunch contents. Higher nutrition knowledge was associated with packing more fruit across the week and more vegetables on Monday. Authoritative parenting was associated with packing fewer vegetables on Monday, but more servings across the week. Financial stress was related to higher rates of never packing vegetables and when vegetables were packed including fewer servings, while child involvement in lunch decisions was associated with packing more fruits across the week, packing vegetables on more days and more servings of vegetables on Monday. Findings suggest parental and family factors impact the foods in packed lunches, with implications for children's dietary intake at school. Outreach programs can help parents pack more fruits and vegetables by providing nutrition education and suggestions for affordable, healthy lunch options as well as encouraging child involvement in the lunch packing process.

Development and validation of a questionnaire to self-assess patient knowledge of direct oral anticoagulants (KODOA-test)

Objective

Few studies have examined associations between patient knowledge of direct oral anticoagulants (DOAC) and clinical outcomes, mostly because of the lack of validated questionnaires for assessing knowledge. The aim of this study was to develop and validate a questionnaire to self-assess knowledge of DOAC.

Methods

Twelve anticoagulation experts participated in the questionnaire development process to ensure content validity. The Knowledge Of Direct Oral Anticoagulants (KODOA)-test was submitted to patients on DOAC and to pharmacists to assess construct validity. Responsiveness was evaluated after educational counseling. Test-retest reliability was assessed to ensure stability over time, and Cronbach's α was calculated for internal reliability. Index of difficulty and item discrimination (D-value) were calculated to assess the performance of single items.

Results

The KODOA-test contains 15 items with multiple-choice answers. Each correct answer scores 1 point (max. score of 15). The KODOA-test was administered to 32 patients on DOAC and 28 pharmacists. Pharmacists scored significantly higher than patients at baseline (median score 13.3 vs 10.0; p<0.001), supporting construct validity. Patient scores increased significantly after educational counseling (median score 11 [interquartile range 2] vs 14 [interquartile range 3]; p<0.001). Test-retest and Cronbach's α were acceptable with a Pearson's correlation of 0.8 and an α of 0.67. The index of difficulty for most items was satisfactory (0.38-0.72) and the mean D-value was 42.5%.

Conclusion

The KODOA-test is a brief, valid, and reliable knowledge self-assessment questionnaire that may be used in clinical trials to investigate associations between knowledge increase and patient-related outcomes.

Validity and Reliability of a Nutrition Knowledge Questionnaire in an Adult Student Population

OBJECTIVE

To assess the validity and reliability of the Kuwait Adult Nutrition Knowledge Questionnaire (KANKQ) in adult students as an initial step to validation in the general adult population.

METHODS

Participants (n = 253; aged ≥21 years) were categorized based on academic background and designated into groups known to differ in nutrition knowledge. Participants completed the questionnaire twice. Independent-samples t test, Pearson correlation coefficients, and Cronbach α were used to assess reliability and validity (P < .05).

RESULTS

Participants with health-related (n = 144) and nutrition-training backgrounds (n = 58) scored significantly higher than did those without them (n = 109 and 178, respectively; P < .001), indicating good construct validity of the KANKQ. Test-retest reliability (r = .67; P < .001) and internal consistency (α = .81) of the questionnaire were moderate to high.

CONCLUSIONS AND IMPLICATIONS

Further testing of the KANKQ in workplaces and public areas is required for validation in the general adult population. Applicability to neighboring countries of similar background is warranted.

Pregnant women's knowledge and awareness of nutrition

The purpose of this study was to investigate effectiveness of an educational intervention on pregnant women's nutritional knowledge. Despite national guidelines, women face personal and healthcare barriers to adequate nutrition education. This quasi-experimental study involved a convenience sample of pregnant women (n=27). The Nutrition Knowledge Questionnaire (NKQ) was utilized for pre and post-tests. Additionally, participants were asked open-ended questions. Data analysis was performed using paired t-tests, linear regression, and qualitative thematic analysis. The mean pre-test and post-test scores on the NKQ were 30.0 and 38.96 respectively, representing a statistically significant increase (p≤0.00). Six qualitative themes emerged including nutrition as "important" and "a real eye opener." This study validates the use of an educational intervention based on MyPlate guidelines to increase pregnant women's knowledge of nutrition.

Developing and validating a nutrition knowledge questionnaire: key methods and considerations

Objective

To outline key statistical considerations and detailed methodologies for the development and evaluation of a valid and reliable nutrition knowledge questionnaire.

Design

Literature on questionnaire development in a range of fields was reviewed and a set of evidence-based guidelines specific to the creation of a nutrition knowledge questionnaire have been developed. The recommendations describe key qualitative methods and statistical considerations, and include relevant examples from previous papers and existing nutrition knowledge questionnaires. Where details have been omitted for the sake of brevity, the reader has been directed to suitable references.

Results

We recommend an eight-step methodology for nutrition knowledge questionnaire development as follows: (i) definition of the construct and development of a test plan; (ii) generation of the item pool; (iii) choice of the scoring system and response format; (iv) assessment of content validity; (v) assessment of face validity; (vi) purification of the scale using item analysis, including item characteristics, difficulty and discrimination; (vii) evaluation of the scale including its factor structure and internal reliability, or Rasch analysis, including assessment of dimensionality and internal reliability; and (viii) gathering of data to re-examine the questionnaire’s properties, assess temporal stability and confirm construct validity. Several of these methods have previously been overlooked.

Conclusions

The measurement of nutrition knowledge is an important consideration for individuals working in the nutrition field. Improved methods in the development of nutrition knowledge questionnaires, such as the use of factor analysis or Rasch analysis, will enable more confidence in reported measures of nutrition knowledge.

Development and Validation of a Brief Instrument to Measure Knowledge About the Energy Content of Meals

OBJECTIVE

To develop and validate a brief scale to assess knowledge about the energy content of meals for adults in Switzerland.

METHODS

Based on a random sample, the scale was developed using a Rasch model approach. To assess validity and reliability, the model was replicated and scores were compared with another nutrition knowledge measure and with dietitian trainees' scores. A test-retest was performed.

RESULTS

Survey studies included 477, 505, and 136 participants from the general population and 59 dietician trainees. The Rasch scale consisted of 11 multiple-choice items ranging from easy to difficult and correlated with general nutrition knowledge (r = .47; P < .001; r² = .22). Dietitian trainees achieved higher scores (P < .001; d = 2.17) than did people from the general population; test-retest reliability results were r = .73, P < .001, and r² = .53.

CONCLUSIONS AND IMPLICATIONS

Results showed that the scale is efficient, valid, and reliable for use in the general population in Switzerland.

Validity and Reliability of General Nutrition Knowledge Questionnaire for Adults in Uganda

This study sought to develop and validate a general nutrition knowledge questionnaire (GNKQ) for Ugandan adults. The initial draft consisted of 133 items on five constructs associated with nutrition knowledge; expert recommendations (16 items), food groups (70 items), selecting food (10 items), nutrition and disease relationship (23 items), and food fortification in Uganda (14 items). The questionnaire validity was evaluated in three studies. For the content validity (study 1), a panel of five content matter nutrition experts reviewed the GNKQ draft before and after face validity. For the face validity (study 2), head teachers and health workers (n = 27) completed the questionnaire before attending one of three focus groups to review the clarity of the items. For the construct and test-rest reliability (study 3), head teachers (n = 40) from private and public primary schools and nutrition (n = 52) and engineering (n = 49) students from Makerere University took the questionnaire twice (two weeks apart). Experts agreed (content validity index, CVI > 0.9; reliability, Gwet’s AC1 > 0.85) that all constructs were relevant to evaluate nutrition knowledge. After the focus groups, 29 items were identified as unclear, requiring major (n = 5) and minor (n = 24) reviews. The final questionnaire had acceptable internal consistency (Cronbach α > 0.95), test-retest reliability (r = 0.89), and differentiated (p < 0.001) nutrition knowledge scores between nutrition (67 ± 5) and engineering (39 ± 11) students. Only the construct on nutrition recommendations was unreliable (Cronbach α = 0.51, test-retest r = 0.55), which requires further optimization. The final questionnaire included topics on food groups (41 items), selecting food (2 items), nutrition and disease relationship (14 items), and food fortification in Uganda (22 items) and had good content, construct, and test-retest reliability to evaluate nutrition knowledge among Ugandan adults.

The Role of Race and Gender in Nutrition Habits and Self-Efficacy: Results from the Young Adult Weight Loss Study

Overweight and obesity are a massive public health problem and young adults are at high risk for gaining weight once they enter a college. This study sought to examine gender and race as they relate to nutrition habits and self-efficacy in a population of diverse young adults from the Young Adult Weight Loss Study. Participants (N = 62) were 29% males, 38.7% white, 33.8% Asian, and 12.9% African American. Males had lower self-efficacy for healthy eating (mean score = 92.5, SD = 17.1) compared to females (mean = 102.3, SD = 13.7, p = 0.02). Males had higher consumption of sodium compared to females (4308 versus 3239 milligrams/day, p = 0.01). There were no significant differences across racial subgroups in self-efficacy for healthy eating (p = 0.67) or self-efficacy for exercise (p = 0.61). Higher self-efficacy scores for healthy eating were significantly associated with less total sodium (r = -0.37, p = 0.007), greater fruit consumption, and less saturated fat. Our results indicate that weight loss interventions should be individualized and that there may be specific areas to target that are different for men and women. Additional larger studies should be conducted to confirm if racial differences exist across nutrition habits and self-efficacy and to confirm gender differences noted in this study.

Development and validation of a nutrition knowledge questionnaire for a Canadian population

Objective

The present study aimed to develop and validate a nutrition knowledge questionnaire in a sample of French Canadians from the province of Quebec, taking into account dietary guidelines.

Design

A thirty-eight-item questionnaire was developed by the research team and evaluated for content validity by an expert panel, and then administered to respondents. Face validity and construct validity were measured in a pre-test. Exploratory factor analysis and covariance structure analysis were performed to verify the structure of the questionnaire and identify problematic items. Internal consistency and test–retest reliability were evaluated through a validation study.

Setting

Online survey.

Subjects

Six nutrition and psychology experts, fifteen registered dietitians (RD) and 180 lay people participated.

Results

Content validity evaluation resulted in the removal of two items and reformulation of one item. Following face validity, one item was reformulated. Construct validity was found to be adequate, with higher scores for RDv. non-RD (21·5 (sd2·1)v. 15·7 (sd3·0) out of 24,P<0·001). Exploratory factor analysis revealed that the questionnaire contained only one factor. Covariance structure analysis led to removal of sixteen items. Internal consistency for the overall questionnaire was adequate (Cronbach’sα=0·73). Assessment of test–retest reliability resulted in significant associations for the total knowledge score (r=0·59,P<0·001).

Conclusions

This nutrition knowledge questionnaire was found to be a suitable instrument which can be used to measure levels of nutrition knowledge in a Canadian population. It could also serve as a model for the development of similar instruments in other populations.

Nutrition knowledge and Mediterranean diet adherence in the southeast United States: Validation of a field-based survey instrument

The Mediterranean diet (MD) can reduce chronic disease risk and is a recommended diet for prevention and management of diabetes. Adherence to the MD in the southeast United States where obesity and diabetes are highly prevalent is unknown. The purpose of the present study was to: 1) construct a survey instrument relevant to the general population integrating both MD related nutrition knowledge and adherence questions from previously validated instruments, and 2) assess MD related nutrition knowledge and adherence in a sample population in the southest United States. Adherance was assessed using the validated short MD Adherence Screener (MEDAS). A MD nutrition knowledge (MDNK) questionnaire was developed from previously validated general nutrition knowledge questionnaires and was validated using 127 university students enrolled in three courses with varying levels of nutrition education. Cronbach's α for internal validity of MDNK was acceptable for a short questionnaire (0.653). Test-retest reliability was established (r = 0.853). Field validation of the three-part survey instrument (MEDAS, MDNK and demographic questions) was subsequently performed in 230 adults shopping at supermarkets and farmers markets in eastern Alabama. Total MDNK and MEDAS scores were significantly higher in students with formal nutrition education and in patrons of farmers markets. Greater MD adherence, assessed by dividing MEDAS scores into thirds, was found with increasing formal nutrition education in university students (p = 0.002) and in farmers market participants (p < 0.001). There was a weak but significant association between MDNK and MEDAS scores within university students and participants in the field. Together, the MDNK-MEDAS survey instrument is an effective tool for assessing baseline knowledge and adherence and can be used to target nutritional interventions to improve MD adherence for prevention and management of diabetes and other chronic disease.

Workplace nutrition knowledge questionnaire: psychometric validation and application

Workplace dietary intervention studies in low- and middle-income countries using psychometrically sound measures are scarce. This study aimed to validate a nutrition knowledge questionnaire (NQ) and its utility in evaluating the changes in knowledge among participants of a Nutrition Education Program (NEP) conducted at the workplace. A NQ was tested for construct validity, internal consistency and discriminant validity. It was applied in a NEP conducted at six workplaces, in order to evaluate the effect of an interactive or a lecture-based education programme on nutrition knowledge. Four knowledge domains comprising twenty-three items were extracted in the final version of the NQ. Internal consistency of each domain was significant, with Kuder-Richardson formula values>0·60. These four domains presented a good fit in the confirmatory factor analysis. In the discriminant validity test, both the Expert and Lay groups scored>0·52, but the Expert group scores were significantly higher than those of the Lay group in all domains. When the NQ was applied in the NEP, the overall questionnaire scores increased significantly because of the NEP intervention, in both groups (P<0·001). However, the increase in NQ scores was significantly higher in the interactive group than in the lecture group, in the overall score (P=0·008) and in the healthy eating domain (P=0·009). The validated NQ is a short and useful tool to assess gain in nutrition knowledge among participants of NEP at the workplace. According to the NQ, an interactive nutrition education had a higher impact on nutrition knowledge than a lecture programme.

Development and Initial Reliability Testing of NAK-50+: A Nutrition Attitude and Knowledge Questionnaire for Adults 50+ Years of Age

PURPOSE

Few questionnaires to test nutrition knowledge and attitudes of older adults living independently in the community have been developed and tested to assess self-management tools such as Nutri-eSCREEN and other education programs. This study is a first step in the development of a questionnaire designed to evaluate the nutrition knowledge and attitudes of independent older adults (NAK-50+).

METHODS

The steps involved in this study were: (i) drafting initial questions based on the content of the Nutri-eSCREEN education material, (ii) using cognitive interviewing to determine if these questions were understandable and relevant (n = 9 adults ≥50 years of age), and (iii) completing test-retest reliability in a convenient community sample (n = 60 adults ≥50 years of age). Intra-class coefficients (ICC) and kappa were used to determine reliability.

RESULTS

A 33-item questionnaire resulted from this development and analysis. ICC for the total score was 0.68 indicating good agreement and thus initial reliability.

CONCLUSIONS

NAK-50+ is a face valid and reliable questionnaire that assesses nutrition knowledge and attitudes in independent adults aged ≥50 years. Further work to determine construct validity and to refine the questionnaire is warranted. Availability of the questionnaire for this age group will support rigorous evaluation of education and self-management interventions for this segment of the population.