A Mixed-Method Approach to Develop and Validate an Integrated Food Literacy Tool for Personalized Food Literacy Guidance

Measurement of food literacy among the adult population in urban Uganda and Kenya: development and validation of an East African food literacy scale

OBJECTIVE

Food literacy (FL) is a potential approach to address the nutrition transition in Africa, but a validated tool is lacking. We developed and validated a scale to assess FL among Ugandan and Kenyan adult populations.

DESIGN

A mixed-method approach was applied: (1) item development using literature, expert and target group insights, (2) independent country-specific validation (content, construct, criterion and concurrent) and (3) synchronisation of the two country-specific FL-scales. Construct validity was evaluated against the prime dietary quality score (PDQS) and healthy eating self-efficacy scale (HEWSE).

SETTING

Urban Uganda and Kenya.

PARTICIPANTS

Two cross-sectional cross-country surveys, adults >18 years (n = 214) and university students (n = 163), were conducted.

RESULTS

The initial development yielded a forty-eight-item FL-scale draft. In total, twenty-six items were reframed to fit the country contexts. Six items differed content-wise across the two FL-scales and were dropped for a synchronised East African FL-scale. Weighted kappa tests revealed no deviations in individuals' FL when either the East African FL-scale or the country-specific FL-scales are used; 0·86 (95 % CI: 0·83, 0·89), Uganda and 0·86 (95 % CI: 0·84, 0·88), Kenya. The FL-scale showed good reliability (0·71 (95 % CI: 0·60, 0·79), Uganda; 0·78 (95 % CI: 0·69, 0·84), Kenya) and positively correlated with PDQS (r = 0·29 P = 0·003, Uganda; r = 0·26 P < 0·001, Kenya) and HEWSE (r = 0·32 P < 0·001, Uganda; r = 0·23, P = 0·017, Kenya). The FL-scale distinguishes populations with higher from those with lower FL (β = 14·54 (95 % CI: 10·27, 18·81), Uganda; β = 18·79 (95 % CI: 13·92, 23·68), Kenya).

CONCLUSION

Provided culture-sensitive translation and adaptation are done, the scale may be used as a basis across East Africa.

Self-perceived food literacy in relation to the quality of overall diet and main meals: A cross-sectional study in Japanese adults

This cross-sectional study aimed to assess the relationship between self-perceived food literacy (SPFL) and quality of overall diet and main meals in Japanese adults. In total, 5998 adults aged 20-79 years were included in this analysis. The SPFL was assessed using the Japanese version of the 29-item Dutch SPFL scale (score range 1-5). Using validated dietary information, the Healthy Eating Index-2015 (HEI-2015) was calculated (score range 0-100). The mean SPFL was 3.18; the internal consistency of the overall scale was considered good (Cronbach's alpha: 0.80). The mean HEI-2015 for overall diet was 50.4. The SPFL was significantly and positively associated with the HEI-2015. Using multiple linear regression, one point increase of SPFL corresponded to an increase in HEI-2015 by a point of 4.8 for overall diet, 6.2 for breakfast, 4.6 for lunch, and 3.6 for dinner (all P < 0.0001). Six of the eight domains of SPFL (i.e., food preparation skills, resilience and resistance, healthy snack styles, examining food labels, healthy budgeting, and healthy food stockpiling) were significantly associated with the HEI-2015 for overall diet. When the HEI-2015 for each meal was examined, the domains showing significant associations with all three meals included food preparation skills, healthy snack styles, and healthy budgeting. The healthy food stockpiling was associated with the HEI-2015 for breakfast and lunch, but not dinner. The social and conscious eating and daily food planning were associated with the breakfast HEI-2015 only, with the resilience and resistance associated with the dinner HEI-2015 only. In conclusion, the SPFL was cross-sectionally associated with the quality of overall diet and main meals in Japanese adults. Further observation and intervention studies are needed to confirm the associations observed here.

Development and psychometric analysis of a new tool to assess food literacy in diabetic patients

Background

One of the factors affecting self-care in diabetic patients is food literacy, which helps said patients in following a healthy diet. Thus, it is crucial to analyze food literacy in diabetic patients through suitable and reliable instruments. 

Objective

The current study aimed to design a questionnaire for food literacy assessment in diabetic patients and analyze its psychometric features.

Method

The present study was a cross-sectional descriptive analysis carried out in 2021. Firstly, the concepts of food literacy in diabetic patients were identified and the questionnaire was deigned based on them. Secondly, its face and content validities and its reliability were analyzed. Finally, the construct validity was analyzed by exploratory factor analysis. The study was carried out on 300 diabetic participants chosen at random via stratified cluster sampling from Health service centers. The exploratory factor analysis was carried out by extracting the main factors and using varimax rotation with eigenvalue values more than 1.

Results

A five-pronged structure accounted for 52.745% of food literacy variance. This included the ability to read food facts, practical ability to group foods, the ability to identify the caloric content of different foods, the ability to understand the effect of food on health, and the ability to prepare a healthy meal. Items with an impact score below 1.5 were discarded. Additionally, items with CVR scores below 0.62 and CVI scores below 0.79 were deleted too. The Kaiser-Meyer-Okin measurement was 0.836 (p < 0.001). Alpha Cronbach Scale dimension was 0.610–0.951.

Conclusion

The results of this study showed that the exploratory dimensions of the current study were consistent with health literacy measurements, such as functional, interactive, and critical food literacy. This scale has acceptable reliability and validity. Health professionals can use this scale to analyze and improve food literacy in diabetic patients. This is a new instrument and thus far no questionnaire has been made to evaluate food literacy in diabetic patients.

Development and Validation of a Food and Nutrition Literacy Questionnaire for Chinese Adults

The purpose of this study aimed to develop and validate the Food and Nutrition Literacy Questionnaire for Chinese adults (FNLQ). The dimensions and core components of Food and Nutrition Literacy were constructed though literature review and qualitative consensus study. A cross-sectional survey of 8510 participants was conducted. The reliability of the questionnaire was determined by internal consistency, the construct validity was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and the content validity was assessed by the Pearson correlation coefficient. From the literature review and qualitative methods, 20 core components and 50 questions of the FNLQ were developed, including 1 dimension of knowledge and 3 practice dimensions (ability of selection, preparing food and eating). The overall FNLQ questionnaire had good reliability and validity (Cronbach’s α = 0.893, χ2/DF = 4.750, RMSEA = 0.048, GFI = 0.891 and AGFI = 0.876). The average FNLQ score of all participants was (64.08 ± 12.77), and the score for the knowledge and understanding dimension was higher than that for the practice dimensions. In addition, 80 was set as the nutritional literacy threshold, and only 12.2% met this threshold in this survey. Sociodemographic and health status characteristics were predictors of FNLQ (R2 = 0.287, F = 244.132, p < 0.01). In conclusion, the FNLQ built in this study had good validity and reliability. It could be considered as a reliable tool to assess Food and Nutrition Literacy of Chinese adults.