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

Abstract

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.

Design and Implementation Content Validity Study: Development of an instrument for measuring Patient-Centered Communication

“…Difficulty level of items, desired suitability and relationship between items and the main objective of an instrument, ambiguity and misinterpretations of items, and/or incomprehensibility of the meaning of words are the issues discussed in the interviews. 41 Although content experts play a vital role in content validity, instrument review by a sample of subjects drawn from the target population is another important component of content validation. These individuals are asked to review instrument items because of their familiarity with the construct through direct personal experience.…”

A systematic review of brief dietary questionnaires suitable for clinical use in the prevention and management of obesity, cardiovascular disease and type 2 diabetes

“…Age, gender, socio-economic status (SES), education, disease state and ethnicity 129 may all impact on the results of a relative validation study. 32 As such the sample profiles 130 were categorised. 131…”

“…10, 18, 42, 54 236 Fourteen reported being evaluated in some way for acceptability to check that wording was 237 clear, questions were relevant and the general lay-out of the tool was appropriate. Four 238 employed cognitive interviewing, 29,32,43,51,68 3 used survey methods, 7, 50, 55 5 used 239 unspecified qualitative interviews 10, 18, 42, 53, 58 and 2 used unspecified pilot testing. 20,59 Only 240 the FBC-T and the visual versions derived from it were evaluated for reading 241 comprehension.…”

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

“…These instruments have a low respondent burden, are easy to administer in a group setting and assess eating behaviours that have known associations with risk of chronic disease contained within sub-scales (8,9,11,15) .…”