Assessing factorial and convergent validity and reliability of a food behaviour checklist for Spanish-speaking participants in US Department of Agriculture nutrition education programmes

Objective—To assess convergent validity, factorial validity, test–retest reliability and internal consistency of a diet quality food behaviour checklist (FBC) for low-literate, low-income Spanish speakers. Design—Participants (n 90) completed three dietary recalls, the Spanish-language version of the US Department of Agriculture (USDA) Household Food Security Survey Module (HFSSM) and the Spanish-language FBC. Factor structure was examined using principal component analysis. Spearman correlation coefficients between FBC item responses and nutrient intakes from 24 h recalls were used to estimate convergent validity. Correlation coefficients were also calculated between FBC item responses at two time points in another group of participants (n 71) to examine test–retest reliability. Cronbach's α coefficient was determined for items within each sub-scale. Setting—Non-profit community agencies serving low-income clients, migrant farm worker camps and low-income housing sites in four California counties. Subjects—Spanish-speaking women (n 161) who met income eligibility for the SNAP-Ed (Supplemental Nutrition Assistance Program–Education). Results—Factor analysis resulted in six sub-scales. Responses to nineteen food behaviour items were significantly correlated with hypothesized 24 h recall data (with a maximum correlation of 0·44 for drinking milk and calcium) or the USDA HFSSM (0·42 with the food security item). Coefficients for test–retest reliability ranged from 0·35 to 0·79. Cronbach's α ranged from 0·49 for the diet quality sub-scale to 0·80 for the fruit and vegetable sub-scale. Conclusions—The twenty-two-item FBC and instruction guide will be used to evaluate USDA community nutrition education interventions with low-literate Spanish speakers. This research contributes to the body of knowledge about this at-risk population in California

Assessing Face Validity of a Food Behavior Checklist for Limited-resource Filipinos

Diet-related chronic health conditions are prevalent in the Filipino American community; however, there is a lack of rigorously validated nutrition education evaluation tools in Tagalog for use in this population. This study aimed to develop and evaluate the face validity of a Tagalog-language food behavior checklist (FBC). A multi-step method was used, involving translation of questionnaire text from English to Tagalog by a team of professionals, creation of accompanying color photographs, cognitive testing with the target population, final review by the team of professionals, and assessment of readability. Subjects for cognitive testing were men (n=6) and women (n=14) 18 years or older in Hawai‘i who received or were eligible to receive Supplemental Nutrition Assistance Program (SNAP) benefits, self-identified as Filipino, and preferred Tagalog rather than English. Participants were recruited from churches, the Filipino Center, and other community sites. Cognitive interviews revealed several issues with text and photographs, such as preferences for specific terms, and images that did not adequately illustrate the text. Image changes were made to reflect items most commonly consumed. The team of professionals agreed with participant suggestions. Assessment of readability revealed a reading level appropriate for a low-literacy population of grade 5.9. The multi-step process, which allowed members of the target audience to reveal the appropriateness of the questionnaire, yielded a Tagalog-language FBC found to have adequate face validity. After further evaluation of validity and reliability, this tool may be used to evaluate behavior change resulting from the United States Department of Agriculture’s (USDA) nutrition education programs

Assessing Face Validity of a Physical Activity Questionnaire for Spanish-Speaking Women in California

To create a culturally appropriate assessment, the study reported here developed and evaluated the face validity of a visually enhanced Spanish-language physical activity questionnaire. A professional translated the English version of the International Physical Activity Questionnaire (IPAQ), and an expert panel subsequently reviewed it. Photos of individuals engaged in physical activity behaviors were added. Cognitive interviews were completed with low-income Spanish-speaking women in California (n=20). Questionnaire text was modified and then reviewed by translation experts (n=7). With a high readability score of 98, the questionnaire demonstrates adequate face validity and is ready for further validation

Misreporting of Dietary Intake Affects Estimated Nutrient Intakes in Low-Income Spanish-Speaking Women

Misreporting of dietary intake affects the validity of data collected and conclusions drawn in studies exploring diet and health outcomes. One consequence of misreporting is biological implausibility. Little is known regarding how accounting for biological implausibility of reported intake affects nutrient intake estimates in Hispanics, a rapidly growing demographic in the United States. Our study explores the effect of accounting for plausibility on nutrient intake estimates in a sample of Mexican-American women in northern California in 2008. Nutrient intakes are compared with Dietary Reference Intake recommendations, and intakes of Mexican-American women in a national survey are presented as a reference. Eighty-two women provided three 24-hour recalls. Reported energy intakes were classified as biologically plausible or implausible using the reported energy intakes to total energy expenditure cutoff of 1.24, with low-active physical activity levels used to estimate total energy expenditure. Differences in the means of nutrient intakes between implausible (n=36) and plausible (n=46) reporters of energy intake were examined by bivariate linear regression. Estimated energy, protein, cholesterol, dietary fiber, and vitamin E intakes were significantly higher in plausible reporters than implausible. There was a significant difference between the proportions of plausible vs implausible reporters meeting recommendations for several nutrients, with a larger proportion of plausible reporters meeting recommendations. Further research related to misreporting in Hispanic populations is warranted to explore the causes and effects of misreporting in studies measuring dietary intake, as well as actions to be taken to prevent or account for this issue

Acculturation, physical activity and television viewing in Hispanic women: findings from the 2005 California Women's Health Survey

Objective—To assess the relationship of acculturation with physical activity and sedentary behaviours among Hispanic women in California. Design—Data from the 2005 California Women's Health Survey (CWHS) – a cross-sectional telephonic survey of health indicators and health-related behaviours and attitudes – were used. Setting—Using a random-digit dialling process, data were collected monthly from January to December 2005. Subjects—A total of 1298 women aged ≥18 years in California who self-identified as Hispanic. Results—Of the participants included in the analysis, 49% were adherent to physical activity recommendations (with 150 min of weekly activity signifying adherence). There was no significant association between language acculturation and moderate or vigorous physical activity after controlling for potential confounders such as smoking, age and employment status. There was also no association between duration of residence in the USA and moderate or vigorous physical activity. Language acculturation was positively associated with television (TV) viewing, with highly acculturated women reporting more hours of TV viewing compared with women with an intermediate acculturation score (P=0.0001), and those with an intermediate score reporting more hours of TV viewing compared with those with a low score (P=0.003). This relationship persisted after inclusion of smoking, employment status, age and education in the model. Conclusions—Higher levels of language acculturation may be associated with increased sedentary behaviours because of the influence of US culture on those women who have assimilated to the culture. Acculturation is an important factor to be taken into account when designing health education interventions for the Hispanic female population

Interaction matters: Strategies to promote engaged learning in an online introductory nutrition course

Fostering interaction in the online classroom is an important consideration in ensuring that students actively create their own knowledge and reach a high level of achievement in science courses. This study focuses on fostering interaction in an online introductory nutrition course offered in a public institution of higher education in Hawai‘i, USA. Interactive features included synchronous discussions and polls in scheduled sessions, and social media tools for sharing of information and resources. Qualitative student feedback was solicited regarding the new course features. Findings indicated that students who attended monthly synchronous sessions valued live interaction with peers and the instructor. Issues identified included technical difficulties during synchronous sessions, lack of participation on the part of fellow students in discussion and inability to attend synchronous sessions due to scheduling conflicts. In addition, few students made use of the opportunity to interact via social media. While students indicated that the interactive components of the course were valuable, several areas in which improvement may be made remain. Future studies may explore potential solutions to issues identified with new features to further promote interaction and foster learning in the course. Recommendations for instructors who are interested in offering online science courses in higher education are provided

Using Qualitative Methods to Improve Questionnaires for Spanish Speakers: Assessing Face Validity of a Food Behavior Checklist

Development of outcome measures relevant to health nutrition behaviors requires a rigorous process of testing and revision. Whereas researchers often report performance of quantitative data collection to assess questionnaire validity and reliability, qualitative testing procedures are often overlooked. This report outlines a procedure for assessing face validity of a Spanish-language dietary assessment tool. Reviewing the literature produced no rigorously validated Spanish-language food behavior assessment tools for the US Department of Agriculture’s food assistance and education programs. In response to this need, this study evaluated the face validity of a Spanish-language food behavior checklist adapted from a 16-item English version of a food behavior checklist shown to be valid and reliable for limited-resource English speakers. The English version was translated using rigorous methods involving initial translation by one party and creation of five possible versions. Photos were modified based on client input and new photos were taken as necessary. A sample of low-income, Spanish-speaking women completed cognitive interviews (n=20). Spanish translation experts (n=7) fluent in both languages and familiar with both cultures made minor modifications but essentially approved client preferences. The resulting checklist generated a readability score of 93, indicating low reading difficulty. The Spanish-language checklist has adequate face validity in the target population and is ready for further validation using convergent measures. At the conclusion of testing, this instrument may be used to evaluate nutrition education interventions in California. These qualitative procedures provide a framework for designing evaluation tools for low-literate audiences participating in the US Department of Agriculture food assistance and education programs

Predictors of Change in Physical Activity and Fruit and Vegetable Intake in a Multiethnic Population in Hawaii at 6 and 12 Months Follow-up

Health-promoting behaviors have been shown to co-exist, but it is unknown if decisional balance with regards to one health behavior may predict change in another behavior. The objective of this study was to examine the relationship between benefits (pros) and costs (cons) of fruit and vegetable (FV) intake and physical activity (PA) and behavior over time, both within behaviors and transbehaviorally. This longitudinal study was conducted in multiethnic adults in Hawaii (n = 700; 63% female; mean age = 47 years; mean BMI = 25.9; mean education = 14.5 years, average household income = $45,000/year). Questionnaires assessed PA and FV pros/cons on a 5-point Likert Scale, PA (MET-min/wk), and FV intake (servings/day). Multiple regression was used to examine the relationship between pros/cons for PA and FV intake and behavior at 6- and 12-month follow-up. At baseline, average FV pros were 4.08 (.91), and average FV cons were 1.88 (.90). Average baseline PA pros were 4.07 (.89), and average PA cons were 1.71 (.77). Multiple regressions revealed that baseline FV pros and cons predicted FV intake, FV cons also predicted PA, and PA pros and cons were not predictive of PA or of FV intake. Study findings provide some support for decisional balance as a useful core construct used in leading theories of behavior change. Improving decisional balance for FV intake may have a beneficial effect on FV intake and potentially PA, indicating a potential gateway effect of decisional balance for FV intake on other behaviors

Influence of Parenting Practices on Eating Behaviors of Early Adolescents during Independent Eating Occasions: Implications for Obesity Prevention

Among early adolescents (10–14 years), poor diet quality along with physical inactivity can contribute to an increased risk of obesity and associated biomarkers for chronic disease. Approximately one-third of United States (USA) children in this age group are overweight or obese. Therefore, attention to factors affecting dietary intake as one of the primary contributors to obesity is important. Early adolescents consume foods and beverages during eating occasions that occur with and without parental supervision. Parents may influence eating behaviors of early adolescents during eating occasions when they are present or during independent eating occasions by engaging in practices that affect availability of foods and beverages, and through perceived normative beliefs and expectations for intake. Therefore, the purpose of this article was to describe the influence of parenting practices on eating behaviors in general and when specifically applied to independent eating occasions of early adolescents. This information may be helpful to inform parenting interventions targeting obesity prevention among early adolescents focusing on independent eating occasions