A measurement scale to assess responsive feeding among Cambodian young children

Abstract

The caregiver–child interaction during mealtime, which refers to responsive feeding (RF), influences child's dietary intake. In Cambodia, given the level of malnutrition, getting better knowledge of RF among young children is essential, but to do so, using an appropriate assessment tool is necessary. We aim to develop and to validate a measurement tool to assess RF in two different situations (before and after an intervention) among children 6–23 months old. This research is part of a larger trial assessing the impact of nutrition education combined or not with the provision of complementary foods on child nutritional status. The “Opportunistic Observation Form” from the Process for the Promotion of Child Feeding package was used to collect data on RF through direct observations of child's meal episodes. Data were used to define an initial scale composed of four constructs and 15 indicators. Confirmatory factor analyses (CFA) and Hancock and Mueller's H reliability indices were computed to assess the validity and reliability of the scale. The final tool was applied to baseline and endline data. At baseline, the sample included 243 pairs and, at endline, 248 pairs. The final scale included two latent constructs (RF and active feeding) that comprise three indicators for active feeding and five for RF. Criteria for fit indices of CFA were met for both constructs though better at baseline. Reliability coefficients were above 0.80 for each construct at baseline and endline. This research proposes a scale that could be used to assess active feeding and RF. Further validation is warranted in different contexts.

Responsive Feeding, Infant Growth, and Postpartum Depressive Symptoms during 3 Months Postpartum

“…We decide to use the full scale score rather than the sub-scale score since the full score has more variability, owing to its higher number of items than the subscale score. However, responsive feeding is a multi-dimensional concept and was measured differently across studies [ 3 , 4 ]. Some dimensions are not included in the current scale, for example, indulgent feeding, maternal sensitivity to infant cues, and uninvolved feeding.…”

“…Responsive feeding is crucial to the formation of life-long healthy eating behavior [ 1 ] and is an important protective element for infant health, well-being, and development [ 2 , 3 ]. Most studies on responsive feeding thus far have been conducted in Western cultures [ 4 ] and few have examined maternal responsive feeding and associated factors in a Chinese population.…”

“…Recently, Sall et al (2020) designed a responsive feeding scale for children 6–23 months old. Though the scale showed acceptable reliability and validity in Cambodian children [ 3 ], use of the scale among infants younger than 6 months in a high-income Asian country, such as Taiwan, needs further validation. To the best of our knowledge, none of the responsive feeding scales have been validated in Taiwan.…”

Can a pragmatic responsive feeding scale be developed and applied globally?

“…In their pioneer study, Sall et al (2020) addressed several of the shortcomings identified in the review by Heller and Mobley by developing and validating an abbreviated and pragmatic RF scale that has potential to be used in community studies and population surveys. The scale was developed using data routinely collected among 6‐ to 23‐month‐old children in rural Cambodia through the ‘Opportunistic Observation Form’ from the Process for the Promotion of Child Feeding (ProPAN) package (PAHO, WHO, & UNICEF, 2013).…”

“…Moving forward, and given the complexity of attempting to measure all possible aspects of RF through a pragmatic scale suitable for field and populations studies, it is key that researchers ask themselves first which aspects of RF they want to focus on and why, and if they also need to incorporate abbreviated scales to measure other aspects of responsive parenting directly linked with infant and young child feeding, including sleep, soothing and physical activity (Pérez‐Escamilla et al, 2017). Lastly, because as highlighted by Sall et al (2020), different definitions of RF have been used, hence it is important to reach consensus on a single definition of this complex construct to help move this research area forward.…”