School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales, Level 3 Samuels Building, Sydney, 2052, Australia.
The Centre for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Farmako Sekip Utara, Daerah Istimewa Yogyakarta, DIY, 55281, Indonesia.
Int J Behav Nutr Phys Act. 2018 Nov 20;15(1):113. doi: 10.1186/s12966-018-0736-7.
Parental child feeding practices (PCFP) are a key factor influencing children's dietary intake, especially in the preschool years when eating behavior is being established. Instruments to measure PCFP have been developed and validated in high-income countries with a high prevalence of childhood obesity. The aim of this study was to test the appropriateness, content, and construct validity of selected measures of PCFP in a low and middle-income country (LMIC) in which there is both undernutrition and obesity in children.
An expert panel selected subscales and items from measures of PCFP that have been well-tested in high-income countries to measure both "coercive" and "structural" behaviors. Two sequential cross-sectional studies (Study 1, n = 154; Study 2, n = 238) were conducted in two provinces in Indonesia. Findings of the first study were used to refine subscales used in Study 2. An additional qualitative study tested content validity from the perspective of mothers (the intended respondents). Factorial validation and reliability were also tested. Convergent validity was tested with child nutritional status.
In Study 1, a confirmatory factor analysis (CFA) model with 11 factors provided good fit (RMSEA = 0.045; CFI = 0.95 and TLI = 0.95) after two subscales were removed. Reliability was good among seven of the subscales. Following a decision to take out an additional subscale, the instrument was tested for factorial validity (Study 2). A CFA model with 10 subscales provided good fit (RMSEA = 0.03; CFI = 0.92 and TLI = 0.90). The reliability of subscales was lower than in Study 1. Convergent validity with nutrition status was found with two subscales.
The two studies provide evidence of acceptable psychometric properties for 10 subscales from tested instruments to measure PCFP in Indonesia. This provides the first evidence of the validity of these measures in a LMIC setting. Some shortcomings, such in the reliability of some subscales and further tests of predictive validity, require further investigation.
父母的育儿喂养方式（PCFP）是影响儿童饮食摄入的关键因素，尤其是在儿童建立饮食习惯的学龄前时期。在儿童肥胖症高发的高收入国家，已经开发并验证了用于测量 PCFP 的工具。本研究的目的是测试在一个儿童存在营养不良和肥胖的低收入和中等收入国家（LMIC）中，这些经过充分测试的 PCFP 测量工具的适宜性、内容和结构有效性。
一个专家小组从经过高收入国家充分测试的 PCFP 测量工具中选择了子量表和项目，以衡量“强制性”和“结构性”行为。在印度尼西亚的两个省进行了两项顺序的横断面研究（研究 1，n=154；研究 2，n=238）。第一项研究的结果用于改进第二项研究中使用的子量表。一项额外的定性研究从母亲（预期的受访者）的角度测试了内容有效性。还测试了因子验证和可靠性。采用儿童营养状况测试了聚合效度。
在研究 1 中，在删除两个子量表后，具有 11 个因素的验证性因子分析（CFA）模型提供了良好的拟合度（RMSEA=0.045；CFI=0.95 和 TLI=0.95）。七个子量表中的可靠性良好。在决定删除另一个子量表后，在研究 2 中测试了该工具的因子有效性。具有 10 个子量表的 CFA 模型提供了良好的拟合度（RMSEA=0.03；CFI=0.92 和 TLI=0.90）。子量表的可靠性低于研究 1。与营养状况的聚合效度在两个子量表中得到了验证。
这两项研究为在印度尼西亚使用经过测试的工具测量 PCFP 的 10 个子量表提供了可接受的心理测量学特性的证据。这首次证明了这些措施在 LMIC 环境下的有效性。一些缺点，如一些子量表的可靠性和进一步的预测有效性测试，需要进一步研究。
