Validating and Investigating Reliability of Comprehensive Feeding Practices Questionnaire

Abstract

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.

Full text

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
Internal consistency
p-Value
Factors
Internal consistency
p-Value
1
0.455
0.01
7
0.366
0.01
2
0.378
0.01
8
0.296
0.01
3
0.334
0.01
9
0.671
0.01
4
0.419
0.01
10
0.722
0.01
5
0.390
0.01
11
0.580
0.01
6
0.351
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 Validity” in 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.
References
1. Lindsay AC, Sussner KM, Kim J and Gortmaker S. The
role of parents in preventing childhood obesity. Future
Child 2006; 16(1): 169-80.
2. Wilson G, Wood K. The influence of children on parental
purchases during supermarket shopping. Int J Consumer
Stud 2004; 28(4): 329-36.
3. Wardle J, Carnell S, Cooke L. Parental control over
feeding and children’s fruit and vegetable intake: How are
they related? J Am Diet Assoc 2005; 105(2): 227-32.
4. McCaffree J. Childhood eating patterns: The roles parents
play. J Am Diet Assoc 2003; 103(12): 1587.
5. Patrick H, Nicklas TA, Hughes SO and Morales M. The
benefits of authoritative feeding style: Caregiver feeding
styles and children’s food consumption patterns. Appetite
2005; (44): 243-249.
6. Birch LL. Psychological influences on the childhood diet.
J Nutr 1998; 128(2suppl): 407S-410S.
7. Birch LL, Fisher JO. Mothers’ child-feeding practices
influence daughters’ eating and weight. Am J Clin Nutr
2000; 71(5): 1054-61.
8. Brown K, Ogden J, Vogele C and Gibson L. The role of
parental control practices in explaining children’s diet and
BMI. Appetite 2008; 50(2-3): 252-259.
9. Moore S, Tapper K, Murphy S. Feeding strategies used by
others of 3-5-year-old children. Appetite 2007; 49(3): 704-
707.
10. Faith MS, Heshka S, Keller KL, et al. Maternal-Child
feeding patterns and child body weight: Findings from a
population-based sample. Arch Pediatr Adolesc Med
2003; 157(9): 926-932.
11. Crouch P, O’dea J, Battisti R. Child feeding practices and
perceptions of childhood overweight and childhood
obesity risk among mothers of preschool children. Nutr
Diet 2007; 64(3): 151-158.
12. Musher-Eizenman D, Holub S. Comprehensive feeding
practices questionnaire: Validation of a new measure of
parental feeding practices. J Pediatr Psychol 2007; 32(8):
960-972.
13. Kroller k, Warschburger P. Associations between maternal
feeding style and food intake of children with a higher risk
for overweight. Appetite 2008; 51(1): 166-172.
14. Bahrami M. [Malnutition and its effects on development
in Iranian children] Persian. J Pediatr 2004; 2(14): 149-
156.
15. Kelishadi R, Ardalan G, Gheiratmand R, et al. Thinness,
overweight and obesity in a national sample of Iranian
children and adolescents. Child Care Health Dev 2008;
34(1): 44-54.
16. Stephen N, Haynes D. Content validity in psychological
assessment: A functional approach to concepts and
methods. Am Psychol Assoc 1995; 7(3): 238-247.
17. Cronbach LJ, Meehl PE. Construct validity in
psychological tests. Psychol Bull 1955; 52(4): 281-302.
18. Plyphina DV. The reliability and validity of two
psychiatric screening questionnaires in the Russian
Federation. Int J Method Psych Res 1996; 6(1): 237-242.
19. Babaee S. [Validating and investigating reliability of the
weight efficacy life style questionnaire] Persian. J Behav
Sci 2008; 2(1): 81-87.
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.