Elsevier

Journal of Nutrition Education and Behavior

Research Brief

Development and Evaluation of the Infant Feeding Education Questionnaire for the Expanded Food and Nutrition Education Program

ABSTRACT

Objective

Develop and evaluate the Infant Feeding Education Questionnaire (IFEQ) to measure the impact of the Expanded Food and Nutrition Education Program (EFNEP) infant-feeding education on knowledge, attitudes, and behavioral intent.

Methods

Evaluation included content validity testing through expert reviews and cognitive interviews with low-income mothers (n = 37); construct validity using the known-groups technique (n = 679); convergent validity testing using the Infant Feeding Practices Study II questionnaire (n = 66); and test-retest reliability (n = 66).

Results

The IFEQ had strong construct validity for knowledge and attitudes; IFEQ scores were significantly higher for the high-knowledge/attitude group (29.6 ± 3.08) than the low-knowledge/attitude group (14.5 ± 5.81; P < .001). The IFEQ failed to show convergent validity. The percent agreement between baseline and retest questions was moderate to high, indicating reliability over time.

Conclusions and Implications

This study represents the first steps in the development of the IFEQ. There's a need to perform further testing to establish convergent validity and pilot-test the questions following EFNEP infant-feeding education.

Section snippets

INTRODUCTION

Infancy presents a critical time for establishing dietary patterns and food-related practices that persist through the life span.1 Rapid weight gain and excess weight during infancy can lead to an increased risk of overweight or obesity during childhood and subsequent life stages.2 , 3 Infants from low-income families are especially vulnerable to subsequent obesity, possibly owing to a higher prevalence of undesirable feeding practices.2 , 4 Overweight during infancy is associated with respiratory

METHODS

Following psychometric analysis guidelines,16 the IFEQ was developed using content validity and cognitive interviews and evaluated using construct and convergent validity and test-retest reliability. Mothers were targeted for this tool because women make up most of EFNEP participants and typically serve as primary caregivers during infancy.17

The University of Wisconsin-Madison Institutional Review Board approved this study.

Instrument Development

Demographic characteristics for participants from all tests are presented in Table 2. Expert review of topics resulted in modification to 2 topics and 4 subtopics, the addition of 3 subtopics, and added detail to 10 subtopics. Some suggestions to add new subtopics or add detail to existing subtopics were not adopted because they did not reflect the infant-feeding curricula reviewed previously. As previously stated, expert review of IFEQ questions only resulted in minor changes to the wording.

Of

DISCUSSION

This study describes the development and evaluation of the IFEQ to measure the postintervention impact of EFNEP infant-feeding education for use among low-income mothers with infants across the US. To the authors' knowledge, IFEQ is the first questionnaire to evaluate EFNEP infant-feeding education that has been tested for validity and reliability.

Using the known-groups technique, it can be reasoned that the high-knowledge group is more informed and has stronger attitudes toward desirable

IMPLICATIONS FOR RESEARCH AND PRACTICE

Researchers and EFNEP nutrition educators can use the IFEQ to evaluate infant-feeding education and improve or sustain effective programming targeting low-income mothers with infants. Using infant-feeding curricula delivered by EFNEP and similar programs allowed for the identification of topics and development of questions that closely match current education. Because the Supplemental Nutrition Assistance Program–Education curricula and the WIC Works Resource System also were used, the IFEQ

ACKNOWLEDGMENTS

This research was funded by the Wisconsin Alumni Research Foundation and the National Institute of Food and Agriculture US Department of Agriculture Hatch Grant Project 1012544. The authors thank Susan Baker, Kathryn McGirr, Karen Frank, Cheng Li, Debra Palmer-Keenan, Michael Puglisi, Pam Halbach, Jill Hicks, Lisa Messer, Amanda Moore, Meredith Quenzer, Teresa Ward, Laura Yergler, Jen Birstler, Samuel Engle, and Elizabeth Chitwood for their assistance. They also express gratitude to the WIC

REFERENCES (35)

  • et al.

    The healthy babies curriculum

    J Nutr Educ Behav

    (2014)

  • IR Contento et al.

    Review and analysis of evaluation measures used in nutrition education intervention research

    J Nutr Educ Behav

    (2002)

  • AL Thompson et al.

    Development and validation of the Infant Feeding Style Questionnaire

    Appetite

    (2009)

  • CM Rose et al.

    Dietary patterns in infancy are associated with child diet and weight outcomes at 6 years

    Int J Obes (Lond)

    (2017)

  • RS Gross et al.

    Maternal infant feeding behaviors and disparities in early child obesity

    Child Obes

    (2014)

  • I Öhlund et al.

    BMI at 4 years of age is associated with previous and current protein intake and with paternal BMI

    Eur J Clin Nutr

    (2010)

  • LS Goodell et al.

    Rapid weight gain during the first year of life predicts obesity in 2-3 year olds from a low-income, minority population

    J Community Health

    (2009)

  • KM Flegal et al.

    Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010

    JAMA

    (2012)

  • EA Finkelstein et al.

    Lifetime direct medical costs of childhood obesity

    Pediatrics

    (2014)

  • JS Savage et al.

    Effect of the INSIGHT responsive parenting intervention on rapid infant weight gain and overweight status at age 1 year: a randomized clinical trial

    JAMA Pediatr

    (2016)

  • LM Wen et al.

    Effectiveness of home based early intervention on children's BMI at age 2: randomised controlled trial

    BMJ

    (2012)

  • US Department of Agriculture, National Institute of Food and Agriculture. 2016 Impacts: the Expanded Food and Nutrition...
  • US Department of Agriculture, National Institute of Food and Agriculture. Expanded Food and Nutrition Education Program...
  • Eating Smart Being Active

    (2015)

  • University of Wyoming Extension. Cent$ible Nutrition Program: Lessons in Action. http://www.uwyo.edu/cnp/. Accessed...
  • B de Lauzon-Guillain et al.

    A review of methods to assess parental feeding practices and preschool children's eating behavior: the need for further development of tools

    J Acad Nutr Diet

    (2012)

  • LR. Price

    Psychometric Methods: Theory Into Practice

    (2016)

  • Cited by (1)

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