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Background: The present research aims to validate and discuss the reliability of Comprehensive Feeding Practices Questionnaire (CFPQ). Materials and Methods: In this cross-sectional study, 150 mothers with 3-6 year old children in the city of Rasht were selected through cluster random sampling from the public and private kindergartens in 2010. After being confident about the translation validity, the degree of validation (content and structure) and validity (test-retest reliability and internal consistency) of the questionnaire was examined. Results: The degree of validation of questionnaire content, except questions 2, 16 and 46, was at a high level and these three questions were omitted. The method of the consistency of factors and total scores of the questionnaire was used to study the validation of structure, which was satisfactory and varied between 0.30-0.72. The validity of questionnaire was examined through test-retest and Cronbach's alpha methods. The Intraclass Correlation Coefficient (ICC) was between 0.80-0.91 and Cronbach's alpha was between 0.80-0.90. Conclusion: In general, the Comprehensive Feeding Practices Questionnaire (CFPQ) was proved to be valid and with respect to the results obtained from the present research, it can be used in the research on child diet.
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42
Zahedan Journal of Research in Medical Sciences
Journal homepage: www.zjrms.ir
Validating and Investigating Reliability of Comprehensive Feeding Practices
Questionnaire
Saeid Doaei,P
*1
P Naser Kalantari,P
2
P Maryam Gholamalizadeh,P
3
P Bahram RashidkhaniP
2
P
1. Department of Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid
Beheshti University of Medical Sciences, Tehran, Iran
2. Department of Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3. Department of Nutrition, School of health, Isfahan University of Medical Sciences, Isfahan, Iran
Article information
Abstract
Article history:
Received: 21 Apr 2011
Accepted: 11 July 2011
Available online: 30 Oct 2012
ZJRMS 2013; 15(3): 42-45
Background: The present research aims to validate and discuss the reliability of
Comprehensive Feeding Practices Questionnaire (CFPQ).
Materials and Methods: In this cross-sectional study, 150 mothers with 3-6 year old
children in the city of Rasht were selected through cluster random sampling from the
public and private kindergartens in 2010. After being confident about the translation
validity, the degree of validation (content and structure) and validity (test-retest reliability
and internal consistency) of the questionnaire was examined.
Results:
The degree of validation of questionnaire content, except questions 2, 16 and 46,
was at a high level and these three questions were omitted. The method of the consistency
of factors and total scores
of the questionnaire was used to study the validation of
structure, which was satisfactory and varied between 0.30-
0.72. The validity of
questionnaire was examined through test-retest and Cronbach's
alpha methods. The
Intraclass Correlation Coefficient (ICC) was between 0.80-0.91 and Cronbach's alpha was
between 0.80-0.90.
Conclusion: In general, the Comprehensive Feeding Practices Questionnaire (CFPQ) was
proved to be valid and with respect to the results obtained from the present research, it can
be used in the research on child diet.
Copyright © 2013 Zahedan University of Medical Sciences. All rights reserved.
Keywords:
Validity
Reliability
Questionnaire
Preschool Child
*Corresponding author at:
Students’ research committee,
National Nutrition and Food
Technology Research
Institute, Faculty of Nutrition
Sciences and Food
Technology, Shahid Beheshti
University of Medical
Sciences, Tehran, Iran.
E-mail: sdoaee@yahoo.com
Introduction
he children nutrition may be impressed by parents,
friends, media and personal preferences of children
at pre-school ages [1, 2]. The influence of parents,
who play the role of providers, executors and models for
child nutrition at the early stages of childhood, has been
recognized as the most important effective factor [3, 4].
During the pre-school ages, parents are considered the
main individuals in charge for food choices of children
and they feed their child using different methods. The
methods used by parents are one of the important ways of
influence on child nutrition. Studies indicated that the
methods of children nutrition by parents relate directly to
child’s ability to regulate food consumption according to
the internal signals of hunger and satiety [2] and his/her
food preferences [6] with the level of energy consumption
and body weight [7].
Parents use a wide range of methods to control their
children nutrition as per the different social, economic
and cultural methods [8, 5-11]. With respect to the extent
of approaches used by parents to feed children, the results
of research carried out on the effect of these activities on
diet and health of children were contradictory. The
majority of studied behaviors in researches included
limiting children’s diet, forcing them to eat food and
controlling them explicitly [7, 8, 10]. Topics such as
modeling for children, training healthy nutrition for
children, using food as a reward, and controlling
children’s emotions by foodstuff have not been discussed
much, while they might be of paramount importance.
Various tools are used to evaluate children’s feeding
methods [7, 8, 10, 12, 13].
Comprehensive Feeding Practices Questionnaire
(CFPQ) is a self-administered test, which is designed to
study the different aspects of children’s feeding methods
and it seems to be more completed than the rest of
available tools. This questionnaire was first designed by
Musher-Eizenman et al. in America in 2007 [12]. This
questionnaire was designed aiming to collect and study all
the information related to the pre-school parents-children
dietary interactions. The main questionnaire had 49
questions, which studied children feeding methods
through 12 different aspects. As there is a rather high risk
of malnutrition among the Iranian children and the rate of
children obesity is increasing, having a tool, which
evaluates the methods used in children nutrition from
different aspects, can help us understand the differences
in children’s nutritional condition. Meanwhile, we have
never had a tool to evaluate feeding methods used by
parents in our country. Therefore, the present research
aims to discuss the validation and reliability of the 49-
question Comprehensive Feeding Practices Questionnaire
(CFPQ) to make possible the use of one of the most
modern and completed tools for evaluation of children
nutrition in the country, in case the results are favorable.
T
Validating of child feeding questionnaire Doaei S et al.
43
Materials and Methods
In this research which is carried out in a cross-sectional
approach, 150 mothers with 3-5 year old children enrolled
in Rasht kindergartens in 2010 were selected through the
second-stage cluster random sampling. First, 15
kindergartens were selected among all the kindergartens
of Rasht and then 10 children were selected randomly
from each kindergarten. To fill out the questionnaires,
written consent forms were taken from mothers. The
questionnaires were handed over to mothers in envelopes
through the kindergarten manager. They were asked to
put the questionnaire in the envelope after filling out and
give it back to kindergarten manager. This research uses a
49-question form of Comprehensive Feeding Practices
Questionnaire (CFPQ).
This questionnaire discusses mothers’ behavior related
to children nutrition from 12 different aspects including
child authority, emotion regulation, encourage balance
and variety, environment, using food as reward,
involvement, modeling, monitoring, pressure, restriction
for health, restriction for weight control and teaching
about nutrition. The questions were answered in a five-
point Likert scoring method. The options for questions 1-
13 are “Never” to “Always” and for questions 14-49 are
“completely agree” to “completely disagree”. The
structural analysis of this questionnaire has been
performed by Musher-Eizenman et al. in 2007. The 49-
question form has been executed on a sample including
33 couples (husband and wife) with 4-6 year old children.
Consequently, 12 factors were obtained, which reflect 12
aspects of the methods used by parents in connection with
children nutrition.
To make the questionnaire applicable in Iran, first, it
was translated into Persian and then, confirmed by two
child nutrition specialists. Subsequently, the translated
form was translated again into English by a bilingual
person. In a meeting held between the researchers and the
translator, it was compared with the original
questionnaire. Comparison of these two English texts
indicated that the translation is correct. After insuring the
validity of translation, the content validity, construct
validity, and questionnaire reliability were examined. To
measure the content validity, the opinions of child
nutrition specialists about the questions of the
questionnaire were collected in writing and measured
using Content Validity Ratio (CVR).
The internal consistency method of each factor with
total scores of the questionnaire was used to study the
construct validity. In the internal consistency method,
high consistencies indicate the convergence of factors
with the total scores of the questionnaire. The validity of
this questionnaire was determined by both test-retest
method and internal consistency. For this purpose, the
interclass Correlation Coefficient and Cronbach's alpha
were used. In order to determine the validity of
questionnaire’s test-retest, the mothers were studied again
three weeks after the first round of completion of the
questionnaire.
Results
The clarity and simplicity of the questions were
examined and challenges were resolved using
consultation with child nutrition specialists.
Questionnaire Validity: To examine the tool validity,
the content validity and construct validity were studied. In
content validity, we obtained the opinions of 5 child
nutrition specialists about the questionnaire. The Content
Validity Ratio (CVR) above 0.6 is considered favorable
[16]. The CVR of all the questions, except for the
questions 2, 16 and 46 were reported as satisfactory. To
be confident about the results of the content validity, the
Content Validity Index (CVI) was also obtained which
confirmed the results of CVR. Therefore, the questions
with low content validity were omitted from the
questionnaire and the next steps of the research were
performed on the remaining 46 questions. Table 1
represents the results of the content validity. The Internal
Consistency Method of each factor with the total scores of
the questionnaire was used to study the construct validity.
In the Internal Consistency Method, the consistencies
above 0.3 indicate micro convergence of tests with the
total score of the questionnaire [17]. Table 2 represents
the results. As table 2 shows, the consistencies at the
confidence level of 0.99 are significant. The validity of
this questionnaire was determined by test-retest Method
as well as Internal Consistency. For this purpose, the
Interclass Correlation Coefficient and Cronbach's alpha
were used, respectively.
Test-retest: In order to determine the test-retest validity
of the questionnaire, 90 mothers with 3-6-year-old
children were selected in a cluster-randomized manner.
They were studied again 3 weeks after the first round of
completion of the questionnaire. The Interclass
Correlation Coefficient (ICC) of the whole questionnaire
and each factor were calculated separately. The
coefficients above 0.7 are interpreted as significant [18]
and they were at a high level of significance for all the
questions.
Internal Consistency: Cronbach's alpha was used to
measure the internal consistency of the questionnaire. The
coefficients above 0.7 are interpreted as significant [19]
and the obtained results were completely satisfactory at a
high level of significance (Table 4).
Discussion
In general, the results of the present study indicate that
the Comprehensive Feeding Practices Questionnaire
(CFPQ) enjoys favorable validity. In this study, the
validity coefficient of test-retest of the questionnaire and
Cronbach's alpha were obtained as 0.88 and 0.88,
respectively. On the measurement of the validity of
questionnaire, the content validity and construct validity
were evaluated. The content validity of the questions of
questionnaire, except for 3 questions, was reported at a
high level (0.6-1) and the questions with low level of
content validity were omitted.
Zahedan J Res Med Sci 2013 Mar; 15(3): 42-45
44
Table 1. Content Validity Ratio (CVR) of the questions of comprehensive questionnaire on children feeding methods
Table 2. Internal consistency of each factor with the total score of the questionnaire
Factors
p-Value
Factors
Internal consistency
p-Value
1
0.01
7
0.366
0.01
2
0.01
8
0.296
0.01
3
0.01
9
0.671
0.01
4
0.01
10
0.722
0.01
5
0.01
11
0.580
0.01
6
0.01
12
0.356
0.01
Table 3. Interaclass Correlation Coefficient (ICC)
Factors
ICC
Monitoring
0.84
Pressure to eat
0.83
Restriction for health
0.83
Restriction for weight control
0.91
Modeling 0.85
Teaching about nutrition
0.84
Total score of the questionnaire
0.88
Child authority
0.85
Emotion regulation
0.87
Encourage balance and variety
0.81
Environment
0.85
Using food as reward
0.85
Involvement
0.83
Table 4. Total internal consistency of questionnaire and factors
Factors
Cronbach's alpha
Modeling
0.85
Monitoring
0.84
Pressure to eat
0.83
Restriction for health
0.83
Restriction for weight control
0.90
Teaching about nutrition
0.80
Total score of the questionnaire
0.88
Child authority
0.85
Emotion regulation
0.87
Encourage balance and variety
0.81
Environment
0.83
Using food as reward
0.85
Involvement
0.83
The psychometric experts believe that the correlation
between subtests of one test with the total scores of the
questionnaire indicates the internal integrity and content
validity of a test [17]. To study the content validity of the
present study, the correlation of subtests of the
questionnaire with the total scores of the questionnaire
were studied. The correlations between them were
reported 0.296-0.722, which were significant.
This questionnaire has recently been designed to
remove the shortcomings of the earlier questionnaires.
Due to having several characteristics including execution
simplicity, objectivity and measuring different aspects
related to children nutrition, it can help us understand the
personal differences between children nutritional
condition and the reasons of these differences. As the
present questionnaire discusses feeding methods from 12
different aspects, it seems to be more complete than other
questionnaires such as Child Feeding Questionnaire [13],
which evaluates children feeding methods only through 3
aspects (direct control, indirect control, and forcing to
eat).
In general, these evidences confirm the validity and
reliability of the 46-question Comprehensive Feeding
Practices Questionnaire (CFPQ). Therefore, nutrition
experts and other related sub-disciplines can use this
questionnaire to identify the parents-children nutritional
interactions. As the validity measurement of the
questionnaire is not limited to the methods used in the
research, it is recommended to consider other validity
measurement methods including “Concurrent Validity”
and “Predicative Validityin complementary studies.
Acknowledgements
The present research is part of a research project titled
“Study of the Relationship between Social Factors and
Children Feeding Methods with Dietary and BMI of 3-6
year Old Children in Rasht in 2010” (No.040398) for
which the National Nutrition and Food Technology
Research Institute has allocated its budget. We thank the
Welfare Organization of Gilan Province for the necessary
cooperation with us on implementing this project.
Authors’ Contributions
Doaee S. participated in the project carried out most of
the experimental work. Dr. S. Jafari Shoorijeh and Dr.
Tabatabai-Naini as project leaders, designed the study,
and coordinated all manuscript preparation. Dr. A
CVR
Questions
CVR
Questions
CVR
Questions
CVR
Questions
CVR
Questions
0.6
41
0.6
31
0.6
21
0.6
11
0.6
1
0.6
42
1
32
0.6
22
1
12
-0.2
2
0.6
43
1
33
1
23
0.6
13
1
3
0.6
44
0.6
34
0.6
24
0.6
14
1
4
1
45
0.6
35
0.6
25
0.6
15
0.6
5
-0.2
46
0.6
36
0.6
26
-0.2
16
1
6
0.6
47
0.6
37
0.6
27
1
17
1
7
0.6
48
1
38
0.6
28
0.6
18
0.6
8
0.6
49
1
39
1
29
1
19
1
9
0.6
40
1
30
0.6
20
0.6
10
Validating of child feeding questionnaire Doaei S et al.
45
Tamadon drafted the first version of the manuscript and
performed the statistical analysis.
Conflict of Interest
The authors declare no conflict of interest.
Funding/Support
National Nutrition and Food Technology Research
Institute, Shahid Beheshti University of Medical
Sciences,Tehran,Iran.
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Please cite this article as: Doaei S, Naser Kalantari N, Gholamalizadeh M, Rashidkhani B. Validating and investigating reliability of
comprehensive feeding practices questionnaire. Zahedan J Res Med Sci (ZJRMS) 2013; 15(3): 42-45.
... Consistent with our hypothesis, a modified version of the CFPQ with five factors and 34 items was found to better assess maternal feeding practices in this sample than the original 12-factor, 49-item CFPQ (Musher-Eizenman & Holub, 2007). The lack of fit to the original model is consistent with other studies examining the appropriateness of using the CFPQ among other ethnicities outside the United States (Al-Qerem et al., 2017;Doaei, Kalantari, Gholamalizadeh, & Rashidkhani, 2013;Haszard et al., 2013;Mais et al., 2015;Melbye, Ogaard, & Overby, 2011;Shohaimi et al., 2014;Warkentin et al., 2016). As with the present study, many of these studies also required an EFA with substantial modification to achieve an acceptable fit. ...
... Monitoring was the only factor in the present study that was identical to that of the original CFPQ. This is consistent with studies examining the psychometric properties of the CFPQ in countries besides the United States, which have consistently included all monitoring items from the original CFPQ (Al-Qerem et al., 2017;Doaei et al., 2013;Haszard et al., 2013;Mais et al., 2015;Melbye et al., 2011;Shohaimi et al., 2014). This indicates that these items are well understood and that monitoring is likely a relevant construct across varying cultures and ethnicities. ...
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The Comprehensive Feeding Practices Questionnaire (CFPQ)is an important measure to assess parent feeding practices as it encompasses a broad range of feeding behaviors, not just behaviors negatively associated with child weight outcomes. However, parent feeding practices have been shown to differ across ethnicities and the CFPQ has not been tested among low-income, Hispanic-American parents with preschool-aged children, a group at elevated risk for developing obesity. A confirmatory factor analysis was performed with the present Hispanic-American sample of Head Start mothers with preschoolers to confirm the original 12-factor, 49-item structure of the CFPQ. Because the original factor structure was not confirmed in the present Hispanic-American sample, an exploratory factor analysis was conducted to examine the psychometric properties of the CFPQ in this sample (n = 187). Among this sample, a five-factor model with 34 items was found to more appropriately assess parent feeding practices than the original 12-factor, 49-item CFPQ. This study provides preliminary validation of the CFPQ for use among low income, Hispanic-American families. Although future research is needed to replicate findings among a larger sample, this study takes an important first step toward more accurately assessing parent feeding practices among this high-risk population to inform tailored interventions that aim to reduce economic and ethnic disparities in child obesity.
... Subsequently to its publication, the instrument has been validate and widely used in different countries such as the United States [27,37], France [37], Iran [46], New Zealand [42], Brazil [45], Norway [43], Jordan [41] and Malaysia [44]. ...
... Our findings do not confirm the structure of the original CPFQ in the Greek version of the questionnaire. This was also the case of previous studies aimed the validation of the tool, in other languages and countries, such as the United States [27,37], France [27], Iran [46], New Zealand [42], Brazil [45], Norway [43], Jordan [41] and Malaysia [44]. ...
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... For this reason, the CFPQ with its scope and specificity meets many aspects of food education for adolescents. The reliability and validity analyses done here showed compatible results with those of the original [22] and related studies [5,9,16]. However, regarding stability, the factors "teaching about nutrition" and "food as reward" presented rates slightly lower than expected. ...
... As for internal consistency, generally speaking, an instrument is classified as having adequate reliability when α is at least 0.70 [16]. However, in some scenarios of research in the social sciences an α of 0.60 is considered acceptable provided that the results obtained with this instrument are interpreted with caution [36]. ...
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... Questions number 16, 37, and 42 were reversely coded [15]. The intra-class correlation coefficient (ICC) was in the range of 0.80 to 0.91 and the Cronbach α was obtained in the range of 0.80 to 0.90 [16]. ...
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Background: Overweight, obesity, and underweight are common child health problems in Iran. Child-feeding practices are one of the major factors affecting children's weight through eating behavior and dietary intake. The Comprehensive Feeding Practices Questionnaire (CFPQ), a 49-item measure comprising 12 subscales, assesses parental child-feeding practices. It is used to determine factors that may affect the development of overweight, obesity, and underweight and therefore, helps us plan appropriate preventive action. The aim of this study was to revise and adapt CFPQ to be used for 2-5-year-old children. Methods: This study including, 300 mothers selected by simple systematic random sampling, was conducted in the rural and urban areas of Birjand city, Iran. Health workers interviewed the mothers and completed questionnaire according to the standard protocol. Exploratory factor analysis (EFA), tests for internal consistency, and test-retest reliability were conducted. Results: EFA resulted in a final questionnaire with 39 items distributed over seven factors, including Healthy Eating Guidance, Modeling, Parent Pressure, Monitoring, Emotion Regulation, Child Control, and Restriction. The internal consistency reliability for the proposal scales was acceptable for five out of the seven factors and all of the seven factors demonstrated excellent test-retest reliability. Conclusions: The revised CFPQ is a valid tool for determining the various aspects of parental feeding practices aiming to prevent overweight, obesity, and underweight among 2-5-year-old children.
... The validity value of the CFPQ (Comprehensive Feeding Practice Questionnaire) questionnaire was 0.80-0.91 and the reliability value of the CFPQ questionnaire was 0.80-0.90 (Doaei, Kalantari, Gholamalizadeh, & Rashidkhanip, 2013). The feeding practice instrument used in this study was analyzed using a 75 percent value of the total score of the questionnaire. ...
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... Mothers responded to each item on a five-point scale from 1 ("strongly disagree") to 5 ("strongly agree"). The PAQ has adequate discriminant and criterionrelated validity [33]. A sample item from the permissive subscale is "I feel that in a well-run household, children should be free to behave as they see fit to the same extent as parents"; a sample item from the authoritarian subscale is "When I tell my child what to do, I expect immediate and unquestioning obedience"; a sample item from the authoritative subscale is "Whenever we establish a family policy, we discuss its rationale with the children". ...
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