Development and Validation of Food and Nutrition Literacy Assessment Tool for Iranian High‑school Graduates and Youth

Marziyeh Ashoori, Nasrin Omidvar, Hassan Eini‑Zinab, Elham Shakibazadeh, Azam Doustmohamadian

Abstract


Background: Food and nutrition literacy (FNL) is an emerging concept that emphasizes not only on personal knowledge, but food and nutrition skills about. This study aimed to develop and validate a food and nutrition literacy assessment tool (FNLAT) for youth and high‑school graduates in Iran. Methods: The study protocol included the following steps: First, FNL components for Iranian high‑school graduates and youth were identified through literature review and interviews with experts. Delphi method was used in order to achieve consensus about FNL components. Then, the questionnaire items were generated, and its content and face validity were assessed. Construct validity of the questionnaire was evaluated through applying principal component analysis (PCA) and confirmatory factor analyses (CFA) in the next step. Finally, reliability of the FNLAT was assessed by calculating Cronbach’s Alpha and evaluating test‑retest reliability. Results: A 104‑item questionnaire was developed. S‑CVI was ≥90 which confirmed content validity of the questionnaire. PCA suggested that it was constructed of 6 factors, one in knowledge domain (food and nutrition knowledge) and five in skill domain (functional skills, interactive skills, advocacy, critical analysis of information, and food label reading skills). On the basis of CFA, the fit indices of the model had acceptable fit and confirmed construct validity of the FNLAT (X2 /df = 1.58, RMSEA = 0.041; P = 1.00, RMR = 0.034, GFI = 0.79). The values of Cronbach’s Alpha and intraclass correlation coefficient (ICC) confirmed internal consistency and time stability of the FNLAT and its subscales. Conclusions: The developed FNLAT is a valid and reliable tool to assess FNL in Iranian late adolescents and youth.

Keywords


Literac; nutrition; validation study; young adults

Full Text:

PDF

References


Willett WC, Koplan JP, Nugent R, Dusenbury C, Puska P,

Gaziano TA. Prevention of Chronic Disease by Means of Diet and

Lifestyle Changes. In: Disease Control Priorities in Developing

Countries, Jamison DT, Breman JG, Measham AR, Alleyne G,

Claeson M, Evans DB, et al., editors.Washington (DC): The

International Bank for Reconstruction and Development/The

World Bank; 2006.

Fuster V, Kelly BB. Promoting Cardiovascular Health in the

Developing World: A Critical Challenge to Achieve Global

Health. Washington (DC): National Academies Press (US); 2010.

Haghighian Roudsari A, Vedadhir A, Amiri P, Kalantari N,

Omidvar N, Eini‑Zinab H, et al. Psycho‑socio‑cultural

determinants of food choice: A qualitative study on adults

in social and cultural context of Iran. Iran J Psychiatry

;12:241‑50.

Wardle J, Parmenter K, Waller J. Nutrition knowledge and food

intake. Appetite 2000;34:269‑75.

Worsley A. Nutrition knowledge and food consumption: Can

nutrition knowledge change food behaviour? Asia Pac J Clin

Nutr 2002;11:S579‑85.

Vaitkeviciute R, Ball LE, Harris N. The relationship between

food literacy and dietary intake in adolescents: Asystematic

review. Public Health Nutr 2015;18:649‑58.

Vidgen HA, Gallegos D. Defining food literacy and its

components. Appetite 2014;76:50‑9.

Zoellner J, Connell C, Bounds W, Crook L, Yadrick K. Nutrition

literacy status and preferred nutrition communication channels

among adults in the Lower Mississippi Delta. Prev Chronic Dis

;6:A128.

Kolasa KM, Peery A, Harris NG, Shovelin K. Food literacy

partners program: Astrategy to increase community food literacy.

Top Clin Nutr 2001;16:1‑10.

Thomas HM, Irwin JD. Cook It Up! A community‑based

cooking program for at‑risk youth: Overview of a food literacy intervention. BMC Res Notes 2011;4:495.

Cullerton K, Vidgen HA, Gallegos D. A review of food literacy

interventions targeting disadvantaged young people. Queensland

University of Technology Brisbane, Queensland, Australia, 2012.

McClintic E. Planting Seeds of Mindfulness in Northwest

Atlanta: A Food Literacy and Empowerment Program for African

American Youth. PhD Thesis. Emory University, 2016.

Fordyce‑Voorham S. Identification of essential food skills for

skill‑based healthful eating programs in secondary schools.

J Nutr Educ Behav 2011;43:116‑22.

Truman E, Lane D, Elliott C. Defining food literacy: A scoping

review. Appetite 2017;116:365‑71.

Ronto R, Ball L, Pendergast D, Harris ND. Food literacy at

secondary schools in Australia. J Sch Health 2016;86:823‑31.

Sumner J. Food literacy and adult education: Learning to read

the world by eating. Can JStudy Adult Educ2013;25:79.

Howard A, Brichta J. What’s to eat. In improving food literacy

in Canada. Ottawa: Conference Board of Canada; 2013.

Sadegholvad S, Yeatman H, Omidvar N, Parrish AM, Worsley A.

Essential nutrition and food systems components for school

curricula: Views from experts in Iran. Iran. J Public Health

;46:938‑47.

Poelman MP, Dijkstra SC, Sponselee H, Kamphuis CBM,

Battjes‑Fries MCE, Gillebaart M, et al.Towards the measurement of

food literacy with respect to healthy eating: The development and

validation of the self perceived food literacy scale among an adult

sample in the Netherlands. Int J Behav Nutr Phys Act 2018;15:54.

Grea Krause C, Beer‑Borst S, Sommerhalder K, Hayoz S,

Abel T. A short food literacy questionnaire (SFLQ) for

adults: Findings from a Swiss validation study. Appetite

;120:275‑80.

Liao LL, Lai IJ. Construction of nutrition literacy indicators for

college students in Taiwan: A Delphi consensus study. J Nutr

Educ Behav 2017;49:734‑42 e1.

Ndahura NB. Nutrition literacy status of adolescent students in

Kampala district, Uganda. M.Sc. Thesis, Høgskolen i Oslo og

Akershus. 2012.

Gibbs H, Chapman‑Novakofski K. Establishing content validity

for the nutrition literacy assessment instrument. Prev Chronic

Dis 2013;10:E109.

Parrish AM, Worsley A, Yeatman H, Sadegholvad S. What food

knowledge ensures school leavers are capable of healthy food

practice? Br J Sch Nurs 2016;11:384‑90.

Sadegholvad S, Yeatman H, Omidvar N, Parrish AM, Worsley A.

Best strategies to improve school‑leavers’ knowledge of nutrition and

food systems: Views from experts in Iran. Int J Prev Med 2016;7:119.

Doustmohammadian A, Omidvar N, Keshavarz‑Mohammadi N,

Abdollahi M, Amini M, Eini‑Zinab H. Developing and validating

a scale to measure Food and Nutrition Literacy (FNLIT) in

elementary school children in Iran. PLoS One 2017;12:e0179196.

Nutbeam D. Health literacy as a public health goal: Achallenge

for contemporary health education and communication strategies

into the 21st century. Health Promot Int 2000;15:259‑67.

Krause C, Sommerhalder K, Beer‑Borst S, Abel T. Just a subtle

difference? Findings from a systematic review on definitions

of nutrition literacy and food literacy. Health Promot Int

;33:378‑89.

Sorensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J,

Slonska Z, et al. Health literacy and public health: Asystematic

review and integration of definitions and models. BMC Public

Health 2012;12:80.

Lynn MR. Determination and quantification of content validity.

NursRes 1986;35:382‑6.

Polit DF, Beck CT. The content validity index: Are you sure you

know what’s being reported? Critique and recommendations. Res

Nurs Health 2006;29:489‑97.

Osborne JW, Costello AB. Sample size and subject to item

ratio in principal components analysis. Pract Assess Res Eval

;9:8.

Hooper D, J. Coughlan, Mullen M. Structural equation

modelling: Guidelines for determining model fit. Electron J Bus

Res Methods 2008;6:53‑60.

Gliem JA, Gliem RR. Calculating, interpreting, and reporting

Cronbach’s alpha reliability coefficient for Likert‑type scales.

Midwest Research‑to‑Practice Conference in Adult, Continuing,

and Community Education; 2003.

Karras DJ. Statistical methodology: II. Reliability and

variability assessment in study design, Part A. Acad Emerg Med

;4:64‑71.

Velardo S. The nuances of health literacy, nutrition literacy, and

food literacy. J Nutr Educ Behav 2015;47:385‑9 e1.

Marsh HW, Balla JR, McDonald RP. Goodness‑of‑fit indexes in

confirmatory factor analysis: The effect of sample size. Psychol

Bull 1988;103:391.

Sharma S, Mukherjee S, Kumar A, Dillon WR. A simulation

study to investigate the use of cutoff values for assessing model

fit in covariance structure models. J Bus Res 2005;58:935‑43.

Hilton K, Fricke J, Unsworth C. A comparison of self‑report

versus observation of performance using the Assessment of

Living Skills and Resources (ALSAR) with an older population.

Br J Occup Ther 2001;64:135‑43.




ijpm_12_448