Validity of a modified food and nutrition literacy questionnaire in primary school children in Iran

Abstract

The present study aimed to assess the relative validity and reliability of a modified Food and Nutrition Literacy (M-FNLIT) questionnaire in primary school children in the city of Mashhad. The study was conducted in four phases. In the first step, the content and face validity of the questionnaire was evaluated by Delphi consensus as well as interviewing the students. Then, construct validity was examined using Confirmatory Factor Analyses (CFA). The internal consistency and reliability of the questionnaire were also assessed using Cronbach α and Intraclass Correlation Coefficient (ICC), respectively. Finally, a Receiver Operating Characteristic (ROC) analysis was performed to detect the cut-off scores of the M-FNLIT scale. Findings of two rounds of Delphi showed satisfactory levels of Content Validity Ratio (CVR): 0.72 and 0.92, Content Validity Index (CVI): 0.92 and 0.98, respectively. The results of CFA for domains and subscales of M-FNLIT questionnaire including cognitive domain (understanding food and nutrition information and nutritional health knowledge) and skill domain (functional, food choice, interactive, and critical skills) indicated acceptable fit indices. M-FNLIT subscale-specific Cronbach α values ranged between 0.68 to 0.8 and ICC was 0.95 (CI: 0.93-96). The Final questionnaire included 40 items (36 Likert-type and 4 true-false items). FNLIT scores were categorized as low (≤58), medium (>58-<81), and high (≥81). The M-FNLIT questionnaire has a good level of validity and reliability to measure food and nutrition literacy in primary school children. The questionnaire can be applied in the evaluation of nutritional interventions in this age group.

Assessing food and nutrition literacy in children and adolescents: a systematic review of existing tools

“…The 12 tools that assessed FL and NL among children and adolescents are summarized in Table 1. Three of the 12 tools measured FL (26)(27)(28) , 4 tools measured both FL and NL (25,(29)(30)(31) , and the other 5 tools measured NL or subareas of NL (32)(33)(34)(35) . More specifically, 2 of the NL tools assessed critical NL (34,35) , 1 of the tools measured menu board literacy (33) and the other tool assessed food label literacy (36) .…”

“…One tool was developed for school-aged children and adolescents (7-17 years of age) but was only validated among adolescents between ages 13-15 years (29) . While 3 of the studies did not specify a conceptual framework or model on which the measure was based (28,33,36) , 7 of the tools assessing NL (25,(29)(30)(31)(32)34,35) were based on Nutbeam's health literacy model (37) and 2 were based on the models of FL (26,27) by Benn (38) and Vidgen and Gallegos (6) , respectively. Among the 5 tools that focused on NL, the number of constructs assessed in the tools ranged from 2 to 5 and the number of items ranged from 5 to 61.…”

“…Critical NL focuses specifically on critically appraising and understanding nutrition information (34) , while menu board literacy targets understanding of menu board nutrition information (33) and food label literacy measures one's ability to interpret the information on food labels (36) . The studies describing the 12 tools were published between 2012 and 2021 and were developed in 7 geographical regions: 2 from Norway (34,35) , 3 from the USA (28,33) , 1 from Denmark (27) , 1 from Thailand (32) , 3 from Iran (25,30,31) , 1 from Italy (26) and 1 from China (29) . The purpose of most of the studies was to develop and test the validity and/or reliability of a tool that assesses either FL or NL.…”

“…The purpose of most of the studies was to develop and test the validity and/or reliability of a tool that assesses either FL or NL. However, 2 of the studies (27,35) tested the validity and reliability of a previously developed tool, while one study (30) modified and updated a previously existing tool (25) . The tools were generally tailored to a specific population.…”

“…For instance, the TFLAC (28) was developed for low-to-middle income, ethnically and racially diverse school-aged children living in the USA (grades 4-5). One tool was intended for preschoolers (3-6 years of age) (26) , 5 tools were designed for school-aged children (7-12 years of age) (25,28,30,33,36) , and 5 tools were aimed at adolescents (12-18 years of age) (27,31,32,34,35) . One tool was developed for school-aged children and adolescents (7-17 years of age) but was only validated among adolescents between ages 13-15 years (29) .…”