Dr.C.Thatchinamoorthy

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Formulation and Validation of a Nutritional Knowledge Test Items for Street
Food Vendors and Consumers
Article · September 2021
DOI: 10.37896/jxu14.5/632
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2. Formulation and Validation of a Nutritional Knowledge
Test Items for Street Food Vendors and Consumers
Thatchinamoorthy.1
and J.Meenambigai2
Ph.D. Research Scholar and Associate Professor
Department of Agricultural Extension, Faculty of Agriculture
Annamalai University, Tamil Nadu, India
Abstract - This paper describes the formulation and validation of a nutritional knowledge test items to street food vendors and
consumers. Review of current literature and expert consultancy, some questions were included from the knowledge test. It was
decided to divide the questionnaire into four main dimensions such as dietary recommendations, food source and nutrients, food
priorities and diet – disease relationships. Using these categories, item pool of each section consists of 20 items and totally 80 were
generated. It is believed that this process served to maximize the content validity of the nutritional knowledge test; the items selected
were representative of the whole area of knowledge being measured. The nutritional knowledge test items was constructed and based
on past relevant literature and its content validity was scrutinized by a researcher. An item difficulty and internal consistency was
performed to reduce the number of items included. Pilot survey for further development of questionnaire, participants comprised of
60 randomly selected 30 street food vendors and 30 consumers in a non sampling area. Data analysis was performed on the responses
to measure the internal reliability, test-retest reliability and construct validity. The questionnaire should provide a useful tool in
research on nutritional knowledge to street food vendors and consumers.
Key words - Nutritional knowledge, Test Items, Formulation and validation
I. INTRODUCTION
Street food (SF) plays a vital important role in urban food security. SF sector operate by poor urban
vendors has improved access to nutritious food for the urban poor. It is also important for contributing to
the nutritional state of the population. One of the aim of this present study was to assess the nutritional
knowledge of the street food vendors and consumers. Currently there are no validated tools to measure
nutritional knowledge of the street food vendors and consumers in Tamil Nadu. In this context, develop a
nutritional knowledge questionnaire with reliability and validity for use among street food vendors and
consumers.
II. METHODS AND RESULTS
Nutrition knowledge (NK) is a modifiable determinant of dietary behaviour [1]. Nutrition knowledge
may play a pivotal role in the adoption of healthier food habits but it must be noted that knowledge on its
own cannot bring about the desired changes due to the complex nature of food behaviour [11]. There are
limitations with some of the NK questionnaires that have previously been employed, including testing
outdated recommendations, lack of comprehensiveness, lack of cultural appropriateness, and insufficient
validation [10]. The issue of inadequate validation is common in evaluation measures used in nutrition
education research [2]. Researchers may overlook comprehensive methodologies because the time taken to
develop and validate questionnaires can be prohibitive [8].
Literature on questionnaire development in a range of nutrition fields was reviewed and a set of
evidence-based guidelines specific to the creation of a nutritional knowledge test items have been
developed [4]. The systematic construction of questionnaire steps was clearly described in given below.
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3. Fig. 1 Nutritional knowledge questionnaire development process (Source: Design by researcher)
A. Item generation
In the first step, collecting literature on the nutritional knowledge aspects by referring research and
review articles, books and internet sources. Item pool generation, informal discussion with the research
committee members, teaching faculties, scientists, extension workers, NGOs person and progressive street
food vendors and street food consumers, These related source of information helps in the process of item
generation for the knowledge test to measure nutritional knowledge.
B. Development of questionnaire items
Based on the review of current literature and expert consultancy, some questions were excluded from
the knowledge test. It was decided to divide the questionnaire into four main dimensions such as dietary
recommendations, food source and nutrients, food priorities and diet – disease relationships. Using these
categories, item pool of each section consists of 20 items and totally 80 were generated. Some items were
included from existing nutrition knowledge test items while others were generated from the literature with
nutrition extension expert advice from scientists where necessary. It is assumed that this process served to
maximize the content validity of the knowledge questionnaire, that is, that the items selected were
representative of the whole area of nutritional knowledge being measured.
C. Pilot survey for further development of questionnaire
The questionnaire was self-administered among the respondents and supervised by the researcher.
Participants comprised of 60 randomly selected 30 street food vendors and 30 consumers in a non
sampling area. The survey instrument was based on a structured questionnaire comprising two categories,
One category with multiple choices another category with ‘yes’ or ‘no’ questions. Nutritional knowledge
test items responses were either “correct” or “incorrect”. Where there was a possibility of more than one
was counted as “correct”. The answers from each respondent’s responses were coded numerically. The
responses were also converted to 2 and 0 for correct and incorrect answers, respectively. Test schedule
were administered in quasi – interview method to street food vendors and consumers. This was necessary
as many of the vendors and consumers could not answer the questions without proper assistance and
guidance.
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4. D. Item difficulty
Item difficulty refers to the proportion of respondents answering items correctly. Individual items
should not be so easy that almost everyone completes them, nor so difficult that very few complete them.
According to Kline (1993) items are not useful if they are answered correctly by more than 80% or
fewer than 20% of respondents [7]. These indices were adjusted upwards slightly as the pilot sample was
skewed towards characteristics which have previously been associated with higher than average nutrition
knowledge [3]. Items were therefore rejected over 90% or fewer than 30% of the respondents answered
them correctly. Of the items which did not meet these criteria, about a quarter were retained on the
grounds of content validity that is they were considered to be testing an essential aspect of nutritional
knowledge not covered elsewhere in the test schedule. Considering the above facts, based on the pilot
study, 9 items were answered correctly by more than 90% and 27 items by less than 30% of the
respondents, 36 out of 80 items that did not meet the item difficulty criteria.
E. Internal consistency
Internal consistency refers to the homogeneity of the questionnaire. Individual items within each section
or subsections should be well correlated to the total score of all sections.
Internal consistency was measured using Cronbach’s a. Cronbach’s a values range from 0 to 1, and a
score of 0.7 or higher is generally acceptable. All variables were recorded into 1 or 0, where 1 correct, 0
wrong [5].
TABLE I
INTERNAL CONSISTENCY IN PILOT STUDY OF VENDORS AND CONSUMERS (N=60)
SI.
No
Knowledge section (number of items) Selected Items Internal consistency
------------------------------
(Cronbach’s α)
1 Dietary recommendations (20) 7 0.64
2 Food source and nutrients (20) 16 0.71
3 Food priorities (20) 12 0.74
4 Diet – disease relationships (20) 9 0.52
It was calculated for four sections as follows (using Cronbach's alpha): dietary recommendations (0.64),
Food source and nutrients (0.71), food choices (0.74), diet – disease relationships (0.52). Internal
consistency analysis of items in sections for dietary recommendations and diet – disease relationships was
conducted because these sections did not reach the score of 0.7. Totally, there were 39 items that produced
a higher value for the total section, only five items were removed. The results from the measures of item
difficulty and internal consistency from the pilot study and comments from the evaluation of the
questionnaire were all considered before further changes were done. After consultations with the expert
panel, draft of the 35 items were finalized. Some changes to wording were made in response to comments
written on the questionnaires, in order to reduce ambiguity and maximize the clarity of the questions.
F. Evaluation of validity and reliability of the final scale
Test–retest reliability involves administering the same measure to the same group of test-takers under
the same conditions on two different occasions and correlating the scores [9]. The reliability coefficient is
simply the correlation (usually a Pearson correlation) between the scores on the first and the second testing
[6]. The value for a Pearson’s correlation coefficient can fall between 0.00 (no correlation) and 1.00
(perfect correlation). A test retest study was conducted with two groups of respondents; one group
consisted of street food vendors (n=30) and the other group consisted of street food consumers (n=30).
Pearson’s correlation coefficients were calculated on the scores of the 60 participants who completed the
questionnaire twice. The correlation coefficients varied across the sections (ranging from 0.57 to 0.82).
The overall reliability was high (r =0.84, P<0.01; as shown in Table 2).
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5. TABLE III
TEST–RETEST RELIABILITY SCORES OF THE NUTRITIONAL KNOWLEDGE QUESTIONNAIRE ADMINISTERED TO STREET FOOD VENDORS
AND CONSUMERS (N =60).
SI.
No
Knowledge section (number of items) Selected Items Test–retest reliability
---------------------------
(Pearson’s r)
1 Dietary recommendations (7) 5 0.57*
2 Food source and nutrients (16) 15 0.82**
3 Food priorities (12) 10 0.71**
4 Diet – disease relationships (9) 5 0.64*
Total (1-4) 35 0.84**
*p < 0.05, **p< 0.01
In the present section, the validity of the scale was examined with the help of content validity. Content
validity is also designated by other terms such as intrinsic validity, relevance, circular validity and
representativeness. The contents of nutritional knowledge questionnaire were derived from previous
questionnaire, expert opinions and discussions with extension workers, scientists, department officials and
progressive street food vendors and consumers. The suggestions and remarks of the judges were given due
consideration and incorporated in the questionnaire. Care was taken to include all the questions which
represented the universe of content of assess to nutritional knowledge level of street food vendors and
consumers and also thus content validity was ensured.
III. CONCLUSION
The questionnaire should provide a useful tool in research on nutritional knowledge. The purpose of
development of these items was to measure the validity and reliability of a knowledge questionnaire for
use in the street food vendors and consumers. It can be used as a tool to examine the nutritional knowledge
among the street food vendors and consumers. However, further modifications are necessary to adapt the
questionnaire to the eating habits and patterns of street food consumers. Implementing the questionnaire
will probably not increase nutritional knowledge but it will provide information on the levels of nutritional
knowledge of the vendors and consumers, which can then be used to develop or street food vendors and
consumers health nutrition efforts to improve dietary habits and in turn influence nutrition-related disease
risk.
REFERENCES
[1] Axelson ML, Brinberg D. The measurement and conceptualization of nutrition knowledge. J Nutr Educ. 1992; 5:239–46.
[2] Contento IR, Randell JS, Basch CE. Review and analysis of evaluation measures used in nutrition education intervention research. J Nutr Educ Behav.
2002; 1:2–25.
[3] Crawford, D.A. and Baghurst, K.I. (1990) Diet and health: a national survey of beliefs, behaviours and barriers to change in the community. Australian
Journal of Nutrition and Dietetics, 47, 97-104.
[4] Gina Louise Trakman , Adrienne Forsyth , Russell Hoye and Regina Belski (2017), Developing and validating a nutrition knowledge questionnaire: key
methods and considerations. Public health nutrition, Volume 20, Issue 15, October, pp. 2670-267. Published online by Cambridge University Press: 24
July 2017.
[5] Hendrie GA, Coveney J, Cox D. Exploring nutrition knowledge and the demographic variation in knowledge levels in an Australian community sample.
Public Health Nutr 2008; 11(12):1365-1371.
[6] Hogan, T. P. (2007). Psychological testing: A practical introduction (2nd ed.). Hoboken, NJ: Wiley.
[7] Kline P. The Handbook of Psychological Testing. London: Routledge, 1993.
[8] Parmenter K, Wardle J. Development of a general nutrition knowledge questionnaire for adults. Eur J Clin Nutr. 1999; 3:298–08.
[9] McIntire, S. A. & Miller, L. A. (2000). Foundations of psychological testing. New York: McGrawHill.
[10] Trakman GL, Forsyth A, Hoye R, Belski R. Developing and validating a nutrition knowledge questionnaire: key methods and considerations. Public
Health Nutr. 2017; 15:2670–9.
[11] Worsley A (2002), Nutrition knowledge and food consumption: can nutritional knowledge change food behaviour? Asia Pac J Clin Nutr 11, Suppl. 3,
S579-S585.
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6. Appendix
Nutritional Knowledge among the Street Food Consumers
Instructions: The following questionnaire contains two types of questions, multiple choice and true/ false.
 Multiple choices: Choose one that you think is the correct answer and tick on the number that is next to your answer.
 True/ False: Choose the true or the false and tick one of them which you think is the correct answer.
A. DIETARY RECOMMENDATIONS
1. We eat food
a) To get energy and grow b) To prevent from illness
c) To fill stomach d) we have to eat for survival
2. How many servings of fruits are suggested to eat each day?
a) 0-1 b) 2-4
c) 5 or more d) None
3. How many servings of vegetables are suggested to eat each day?
a) 0-2 b) 3-5
c) 6 or more d) None
4. Regularity in meal time
a) Four times per day b) Three times per day
c) Five times per day d) intake of food at any time in a day
5. Carbohydrates provide the major source of our energy intake
a) True
b) False
6. Skipping meals is an appropriate way to lose weight
a) True
b) False
7. Healthy snacking can help control hunger
a) True
b) False
8. Adults should drink whole milk on regular basis
a) True
b) False
B. FOOD SOURCE AND NUTRIENTS
9. Food are classified based on
a) Nutrient content b) Availability
c) Productivity d) None
10. Which of the following are rich in carbohydrates
a) Bread and rice b) Meat
c) Egg and cheese d) Chicken
11. Which of the following has the more calories per gram?
a) Fat b) Protein
c) Carbohydrates d) Water
12. Which of the following foods are high in calcium?
a) Milk b) Water
c) Rice d) Meat
13. Which is more nutritious?
a) Rice b) Wheat
c) Ragi d) Don’t know
14. Protein is essential for
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7. a) Bone formation b) Body building
c) Good eye right d) None of the above.
15. Vitamin D is naturally got from
a) Sunlight b) water
c) Air d) fruits
16. A unit of fat is a calorie?
a) True
b) False
17. Low fat ice cream has fewer calories than regular ice cream
a) True
b) False
C. FOOD PRIORITIES
18. Rice is rich in
a) Carbohydrate b) Protein
c) Fat d) Vitamins
19. Spices are used in cooking
a) To increase taste b) To increase flavour
c) To enhance the digestion of foods d) All the above
20. Amla is rich in
a) Beta carotene b) Vitamin B
c) Vitamin C d) Vitamin D
21. Which one of the following does not come under the roots and tubers?
a) Beat root b) Potato
c) Carrot d) Cabbage
22. Fruits and vegetables are high in cholesterol
a) True
b) False
23. It’s difficult to find tasty vegetarian substitutes for “meatless meals”.
a) True
b) False
24. Eating large amounts of cheese would be recommended for someone with high blood pressure
a) True
b) False
25. Meats, like chicken, are naturally low in fat and provide much essential nutrition that is important for good health
a) True
b) False
26. Boiling water helps in killing germs
a) True
b) False
D. DIET – DISEASE RELATIONSHIPS
27. Carrot is good to overcome eye defects
a) True
b) False
28. Calcium is needed for
a) Bone development b) check manage ortho diseases
c) Nail growth d) All of these
29. Anemia is due to Iron deficiency
a) True
b) False
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8. 30. Fruits and vegetables are naturally low in fat
a) True
b) False
31. Vitamin E is important in building healthy bones
a) True
b) False
32. Iodine deficiency leads to
a) Thyroid b) diarrhoea
c) Fever d) Skin disease
33. How many glasses water do you need each day?
a) 4 b) 6
c) 8 d) 10
34. The reasons for deficiency disorders
a) Eating improper foods b) Eating more sweets
c) Eating imbalanced diet d) Eating fatty foods
35. During diarrhoea the following should be followed
a) Giving enough water b) Giving not enough water
c) Giving no water d) Giving (oral rehydration therapy) ORT
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