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Liu KSN, Chen JY, Sun KS, Tsang JPY, Ip P, Wong CKH, Lam CLK. The Knowledge, Attitudes, and Practices of Healthy Eating Questionnaire: a pilot validation study in Chinese families. Front Public Health 2024; 12:1355638. [PMID: 39086814 PMCID: PMC11288980 DOI: 10.3389/fpubh.2024.1355638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Identifying the knowledge, attitudes, and practices (KAP) gaps of healthy eating can inform the design of effective interventions. This study aimed to test the validity and psychometric properties of a KAP of Healthy Eating Questionnaire (KAP-HEQ) tailored to the Chinese culture. Methods The dimensions and potential items of each KAP scale were identified from published KAP and health literacy questionnaires, which were supplemented by the findings of a previous qualitative healthy eating study. Content validity of the KAP-HEQ was evaluated by eight experts and eight Chinese parent-adolescent dyads in Hong Kong through content validity ratio (CVR), content validity index (CVI), and qualitative feedback. The feasibility, construct validity, reliability, and sensitivity of the KAP-HEQ were evaluated in this pilot study among 60 adolescent-parent dyads (120 persons) through an online survey. The first 30 dyads who completed the KAP-HEQ were invited to repeat the KAP-HEQ 2 weeks later to assess the test-retest reliability. Results The final 44-item KAP-HEQ was completed in 10-15 min by both adolescents and their adult parents. The CVR ranged from -0.38 to 1, and the CVI ranged from 0.56 to 1. Over 80% of the items achieved convergent validity (a significantly positive correlation with its hypothesized scale) and discriminant validity (a higher correlation with its hypothesized scale than with the other two scales). Cronbach's alpha for the internal consistency of the Overall, Attitude, and Practice scales was >0.7, while that of the Knowledge scale was 0.54. The intraclass correlation coefficient (ICC) on test-retest reliability of the Overall and individual scales were all >0.75 except that of the Knowledge scale (ICC = 0.58). The significant differences in KAP scale scores with small to large effect sizes were found between known groups as hypothesized, except the Attitude score between groups by household income, which supported the sensitivity of the KAP-HEQ. Conclusion The KAP-HEQ has shown good validity, reliability, and sensitivity among Chinese adolescents and adults, which can be applied to evaluate KAP status and gaps to inform the design and assess the effectiveness of healthy eating interventions.
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Affiliation(s)
- Kiki S. N. Liu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Julie Y. Chen
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Family Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Kai-Sing Sun
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Joyce P. Y. Tsang
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- School of Health Sciences, Saint Francis University, Hong Kong, Hong Kong SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Carlos K. H. Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- Department of Infectious Disease Epidemiology and Dynamics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cindy L. K. Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Family Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
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Mo Z, Li X, Zhai Y, Men Y, Tang Y, Qiao J, Jia X, Huang Y, Wang B. Reliability and validity of a questionnaire measuring knowledge, attitude and practice regarding "oil, salt and sugar" among canteen staff. Sci Rep 2023; 13:20442. [PMID: 37993625 PMCID: PMC10665314 DOI: 10.1038/s41598-023-47804-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023] Open
Abstract
Excessive intake of oil, salt and sugar is closely associated with the prevalence of non-communicable chronic diseases (NCDs). Canteen staff's knowledge, attitude and practice (KAP) about oil, salt and sugar directly affect the content in dishes and the consumers' intake. However, no valid questionnaire is used to assess KAP among canteen staff about the "oil, salt and sugar". Therefore, the present study aimed to establish and validate a questionnaire to evaluate the KAP of canteen staff about the "oil, salt and sugar". This cross-sectional study was conducted among canteen staff randomly selected from three college canteens. Participants completed the questionnaire and retested it two weeks later. Internal and test-retest reliability were assessed using Cronbach's α and Pearson correlation coefficients, respectively. Validity was assessed using the exploratory factor analysis. 100 participants finished the questionnaire, of which 66% were females with a mean age of 40.3 ± 10.5 years. The Cronbach's α coefficients of the total questionnaire and Knowledge, Attitude and Practice dimensions were 0.822, 0.830, 0.752 and 0.700, respectively. The test-retest reliability coefficient was 0.968. In exploratory factor analysis, nine common factors were extracted, with 26 items, and the cumulative contribution rate was 70.9%. The questionnaire had a satisfactory property for measuring the KAP of the "oil, salt and sugar" among canteen staff in China.
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Affiliation(s)
- Zhenhan Mo
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, 44, WenhuaXi Street, Jinan, 250012, Shandong Province, People's Republic of China
| | - Xiaofan Li
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250011, Shandong Province, People's Republic of China
| | - Yuting Zhai
- Zhaoyuan Center for Disease Control and Prevention, Zhaoyuan, 265400, Shandong, People's Republic of China
| | - Yanyan Men
- Qilu Medical University, Zibo, 255300, Shandong, People's Republic of China
| | - Yuying Tang
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, 44, WenhuaXi Street, Jinan, 250012, Shandong Province, People's Republic of China
| | - Jiarui Qiao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, 44, WenhuaXi Street, Jinan, 250012, Shandong Province, People's Republic of China
| | - Xue Jia
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, 44, WenhuaXi Street, Jinan, 250012, Shandong Province, People's Republic of China
| | - Yujie Huang
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, 44, WenhuaXi Street, Jinan, 250012, Shandong Province, People's Republic of China
| | - Baozhen Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, 44, WenhuaXi Street, Jinan, 250012, Shandong Province, People's Republic of China.
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Socioeconomic, intrapersonal and food environmental correlates of unhealthy snack consumption in school-going adolescents in Mumbai. BMC Public Health 2022; 22:1129. [PMID: 35668419 PMCID: PMC9171983 DOI: 10.1186/s12889-022-13449-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Unhealthy snacking habits in adolescents are typically triggered by obesogenic food environments and possibly perpetuated through interactions between socio-environmental factors and personal perceptions, attitudes, and motivations to change eating behaviors. This study attempted to address the knowledge gap regarding the association of intrapersonal, socioeconomic, and food environmental characteristics with unhealthy snack consumption in Indian adolescents, presenting several targets for effective interventions. Methods A representative sample of 10–12 years old adolescents (n 712) completed a cross-sectional survey including eating habits, characteristics of school and home food environments, and perceptions related to affordability, convenience, and barriers within the food environments. The frequency of unhealthy snack consumption was assessed using a validated qualitative food frequency questionnaire. Multivariate regression analyses determined the associated factors of unhealthy snack consumption in adolescents attending private and public schools. Results The mean age of adolescents was 10.9 (1.1) years, 48.2% were girls and 53.9% attended private schools. The most frequently consumed unhealthy snacks were biscuits/ cookies (5.2d/wk) followed by wafers (3.4d/wk) and Indian fried snacks- samosa/ vada pav (2.8 d/wk). Among the public-school adolescents, the odds of unhealthy snack consumption were 0.89 times lower when meals were had frequently at the dinner table and 4.97 times higher when the perceived barriers related to the affordability of healthy snacks were greater. Maternal education (OR 0.78, 95% CI 0.66–0.82, p < 0.001), family income (OR 2.15, 95% CI 1.98–2.32, p < 0.001), availability of unhealthy snacks (OR 2.98, 95% CI 1.36–3.46, p < 0.001) and fruits (OR 0.57, 95% CI 0.49–0.69, p < 0.001) at home, having evening meals together (OR 0.71, 95% CI 0.63–0.81, p 0.031), and perceived parental control during mealtimes (OR 0.67, 95% CI 0.62–0.72, p < 0.001) were associated with unhealthy snack consumption in adolescents attending private schools. Conclusions The results highlighted a pervasiveness of unhealthy snacks in adolescents’ food environments. Improving provisions and affordability of fruits and healthy snacks at schools, encouraging family mealtimes, and limiting the availability of unhealthy snacks at home whilst addressing the perceived barriers within food environments, and inculcating self-efficacy skills can improve snacking habits in Indian adolescents, irrespective of socioeconomic backgrounds. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13449-6.
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Garrido-Fernández A, García-Padilla FM, Ramos-Pichardo JD, Romero-Martín M, Sosa-Cordobés E, Sánchez-Alcón M. Attitude towards the Promotion of Healthy Eating among Secondary School Teachers—Construction and Validation of a Questionnaire. Nutrients 2022; 14:nu14112271. [PMID: 35684071 PMCID: PMC9183166 DOI: 10.3390/nu14112271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Health promotion activities in secondary schools are scarce and have little involvement of the teaching staff. Most often, activities are developed from the curriculum that appears in school materials, with little capacity for adaptation and innovation. The aim of this study was to construct and validate a tool to find out teachers’ attitudes towards activities to promote healthy eating in secondary schools. For this purpose, a descriptive study was conducted. The total sample of the study consisted of 200 teachers from secondary schools. Internal consistency was determined by Cronbach’s alpha coefficient globally and by dimension, and with the corrected item–test correlation. The construct validity of the questionnaire was assessed by means of an exploratory factor analysis, for which the principal components method with Varimax rotation was used. A Likert-type scale with nine items and four response options about attitude was designed. The exploratory factor analysis showed a nine-factor solution, of which two had eigenvalues greater than 1. These two factors explained 63.4% of the variance. The Cronbach’s alpha internal consistency index obtained for the global scale was 0.81, and 0.75 and 0.85 for each component. The results obtained with this structure confirmed an adequate reliability and validity of the questionnaire.
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Moitra P, Madan J. Impact of screen time during COVID-19 on eating habits, physical activity, sleep, and depression symptoms: A cross-sectional study in Indian adolescents. PLoS One 2022; 17:e0264951. [PMID: 35259203 PMCID: PMC8903250 DOI: 10.1371/journal.pone.0264951] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/13/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study attempted to address the limited knowledge regarding the impact of screen time (ST) on lifestyle behaviors in Indian adolescents during the ongoing COVID-19 pandemic. The objectives were to 1) evaluate frequency and duration of using screens, and screen addiction behaviors in 10-15 years old adolescents in Mumbai during the COVID-19 pandemic and 2) examine the association of ST with lifestyle behaviors- eating habits, snacking patterns, physical activity (PA) levels, sleep quality and depression symptoms. METHODS An online survey was completed between January and March 2021. Eating habits, snacking patterns, time spent in different screen-based activities, and screen addiction behaviors were reported. The PA levels, sleep quality, and depression symptoms were evaluated using the Physical Activity Questionnaire for Children/Adolescents (PAQ C/A), Pittsburg Sleep Quality Index (PSQI), and Patient Health Questionnaire-2 (PHQ-2) respectively. Multiple linear regression analyses were performed to determine the impact of ST on lifestyle behaviors. RESULTS Adolescents (n = 1298, Mage 13.2(1.1), 53.3% boys) reported the mean weekday and weekend ST as 442.3 (201.5) minutes/d and 379.9 (178.2) minutes/d respectively. Overall, 33.4% spent > 6hours/d for studying or doing homework, 65.4% used social networking sites for at least 2-3 hours/d, and 70.7% agreed that ST had taken up the majority of their leisure time. Only 12% engaged in moderate to vigorous PA (PAQ C/A scores <2). More than half (52.5%) reported PSQI >5 indicating poor sleep quality and 8.6% scored ≥ 3 on PHQ-2 to suggest a risk of depression. A higher ST was associated with lower PA and increased sleep problems and a greater screen addiction was inversely associated with the eating habit, PA, and sleep-related variables. CONCLUSION The study draws attention to a high prevalence of excess ST and its impact on eating habits, PA levels, and sleep quality in Indian adolescents during the COVID-19 pandemic. Targeted health promotion interventions that encourage judicious use of screens for education and entertainment and emphasize the adverse health effects of excess ST are required.
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Affiliation(s)
- Panchali Moitra
- Department of Food, Nutrition & Dietetics, Sir Vithaldas Thackersey College of Home Science (Autonomous), SNDT Women’s University, Santacruz West, Mumbai, Maharashtra, India
| | - Jagmeet Madan
- Department of Food, Nutrition & Dietetics, Sir Vithaldas Thackersey College of Home Science (Autonomous), SNDT Women’s University, Santacruz West, Mumbai, Maharashtra, India
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Moitra P, Madan J, Verma P. Independent and combined influences of physical activity, screen time, and sleep quality on adiposity indicators in Indian adolescents. BMC Public Health 2021; 21:2093. [PMID: 34781921 PMCID: PMC8591930 DOI: 10.1186/s12889-021-12183-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Inadequate physical activity (PA), excess screen time (ST), and sub-optimal sleep quality tend to co-occur during adolescence. Yet, little is known about the associations of these behaviors as a cluster with adiposity indicators in Indian adolescents. This study aimed to evaluate the independent and combined influences of PA, ST, and sleep quality on body mass index (BMI) and waist to height ratio (WHtR) in 10-15 years old adolescents in Mumbai, India. A secondary aim was to explore if these influences vary between sexes. METHODS Cross-sectional study. Adolescents (n = 772, mean age 13.2 (1.4) years) reported frequency and duration of moderate to vigorous PA (MVPA) and time spent using screens on a previously validated instrument. Sleep quality was estimated using the Pittsburg Sleep Quality Index (PSQI). Weight, height, and waist circumference were measured. Mixed effect logistic regression analyses were performed to explore associations between adiposity indicators (BMI z scores > +1SD and WHtR > 0.5) and unhealthy behaviors (PA < 60 min/d, ST > 120 min/d and PSQI scores > 5), stratified by sex. RESULTS The combined prevalence of overweight and obesity was 38.3%. Overall, 62.0 and 85.0% reported MVPA< 60 min/d and ST > 120 min/d respectively. Girls reported higher ST (218.21 (69.01) min/d) as compared to boys (165.3 (101.22) min/d, p < 0.001). Clustering of low PA and excess ST was observed in 69.2% and of all three unhealthy behaviors in 18.8%. Among girls, MVPA < 60 min/d (OR = 1.78, 95% CI 1.54-1.92, p < 0.001) and PSQI scores > 5 (OR = 2.01, 95% CI 1.78-2.25, p < 0.001) predicted increased BMI. The odds of overweight/obesity were 2.10 times higher in boys reporting low PA and 4.13 times higher in those with low PA+ ST > 120 min/d. Clustering of all three unhealthy behaviors increased prevalence of obesity in both sexes. CONCLUSIONS The results indicated a co-existence of multiple unhealthy lifestyle factors of obesity and that clustering of these behaviors can further aggravate obesity risk as compared to their independent effects. Integrated interventions that leverage the cumulative benefits of being active, less sedentary and sufficient sleep are warranted to facilitate greater improvements in obesity risk behaviors.
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Affiliation(s)
- Panchali Moitra
- Department of Food, Nutrition & Dietetics, Sir Vithaldas Thackersey College of Home Science (Autonomous), SNDT Women’s University, Santacruz West, Mumbai, Maharashtra 400049 India
| | - Jagmeet Madan
- Department of Food, Nutrition & Dietetics, Sir Vithaldas Thackersey College of Home Science (Autonomous), SNDT Women’s University, Santacruz West, Mumbai, Maharashtra 400049 India
| | - Preeti Verma
- Department of Special Education, Department of Interdisciplinary Studies, SNDT Women’s University, Santacruz West, Mumbai, Maharashtra 400049 India
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Impact of a behaviourally focused nutrition education intervention on attitudes and practices related to eating habits and activity levels in Indian adolescents. Public Health Nutr 2021; 24:2715-2726. [PMID: 33468283 DOI: 10.1017/s1368980021000203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a behaviourally focused nutrition education (NE) intervention based on the Health Belief Model (HBM) to improve knowledge, attitudes and practices (KAP) related to eating habits and activity levels in 10–12-year-old adolescents in Mumbai, India. DESIGN School-based cluster randomised controlled trial. The experimental group (EG) received weekly NE and three parent sessions over 12 weeks; no sessions were conducted for the control group (CG). The theoretical framework of HBM and focus group discussion results guided the development of behaviour change communication strategies and NE aids. KAP were measured using a validated survey instrument, administered at baseline and endline in EG and CG. Paired and independent t tests determined within-group and between-group changes in pre–post scores. SETTING Two aided and two private schools that were randomly allocated to either an EG or CG. PARTICIPANTS Adolescent boys and girls (n 498; EG n 292 and CG n 206). RESULTS EG reported improvements in mean knowledge (39·3%), attitude (7·3 %), diet (9·6 %) and activity practice (9·4%) scores from pre to post intervention. No significant changes were observed in CG. Significant improvements in scores associated with perceived benefits, barriers and self-efficacy, breakfast and vegetable consumption, and moderate-to-vigorous activities were observed in EG. CONCLUSIONS Integrating NE into the academic curriculum and adopting evidence-based lessons that entail targeted information delivery and participatory activities can improve knowledge, foster right attitudes and facilitate better eating and activity-related practices in Indian adolescents.
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