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

Published online by Cambridge University Press:  14 May 2021

Fatemeh Khorramrouz
Affiliation:
Student Research Committee, Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Azam Doustmohammadian
Affiliation:
Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
Maryam Amini
Affiliation:
Department of Nutrition Research, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Somayeh Pourhosein Sarivi
Affiliation:
Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Majid Khadem-Rezaiyan
Affiliation:
Clinical Research Development Unit of Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Mohammad Reza Shadmand Foumani Moghadam
Affiliation:
Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran
Maryam Khosravi*
Affiliation:
Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Department of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
*
*Corresponding author: Maryam Khosravi, email Khosravim@mums.ac.ir
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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 were evaluated by Delphi consensus as well as interviewing the students. Then, construct validity was examined using Confirmatory Factor Analysis (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 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: 0·72 and 0·92, Content Validity Index (CVI): 0·92 and 0·98, respectively. The results of CFA for domains and subscales of the 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 and 0·8 and ICC was 0·95 (95 % CI 0·93, 96). The final questionnaire included forty items (thirty-six Likert-type and four 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.

Information

Type
Research Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Nutrition Society
Figure 0

Fig. 1. Study flow chart.

Figure 1

Table 1. Demographic characteristics of 9–12-year-old students participated in construct validity study in the city of Mashhad, 2018 and 2019(Mean values and standard deviations, n 319)

Figure 2

Fig. 2. First-order confirmatory factor analysis factor loadings construct validity study for modified Food and Nutrition Literacy (M-FNLIT) scale of 9–12-year-old students in the city of Mashhad, 2018 and 2019. n 319; all factor loadings are standardised and are statistically significant, P < 0·001.

Figure 3

Fig. 3. First-order confirmatory factor analysis factor loadings construct validity study for modified Food and Nutrition Literacy (M-FNLIT) scale of 9–12-year-old students in the city of Mashhad, 2018 and 2019. n 319; all factor loadings are standardised and are statistically significant, P < 0·001.

Figure 4

Fig. 4. Second-order confirmatory factor analysis factor loadings construct validity study for modified Food and Nutrition Literacy (M-FNLIT) scale of 9–12-year-old students in the city of Mashhad, 2018 and 2019. n 319; all factor loadings are standardised and are statistically significant, P < 0·001.

Figure 5

Table 2. Results of confirmatory factor analysis of modified Food and Nutrition Literacy (M-FNLIT) scale in 9–12-year-old primary schoolchildren in city of Mashhad, 2018 and 2019

Figure 6

Table 3. Results of internal consistency and test–retest reliability of modified Food and Nutrition Literacy (M-FNLIT) scale in 9–12-year-old primary schoolchildren in the city of Mashhad, 2018 and 2019

Figure 7

Fig. 5. High cut-off receiver operating characteristic (ROC) curves of modified Food and Nutrition Literacy (M-FNLIT) scale of 9–12-year-old students in the city of Mashhad, 2018 and 2019.

Figure 8

Fig. 6. Low cut-off receiver operating characteristic (ROC) curves of modified Food and Nutrition Literacy (M-FNLIT) scale of 9–12-year-old students in the city of Mashhad, 2018 and 2019.

Figure 9

Table 4. Results of receiver operating characteristic (ROC) analyses for the high cut-off and low cut-off of the modified Food and Nutrition Literacy (M-FNLIT) scale in 9–12-year-old primary schoolchildren in the city of Mashhad, 2018 and 2019

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