A cultural adaptation and validation of a child eating behaviour measure in a low- and middle-income country.

Abstract

The Child Eating Behaviour Questionnaire (CEBQ), a widely used instrument that has been validated mostly in high-income countries, has limitations in its factorial validity when used among different cultures. This study examines whether the CEBQ instrument is culturally appropriate and valid to be used in a low- and middle-income country (LMIC) in a setting where child undernutrition remains prevalent. The study employed a qualitative process to validate the content of items relative to the culture and setting, which was followed by a survey to test the psychometric properties of the instrument. Tests of factorial validity, convergent validity and reliability were performed. Three different socio-economic settings of Yogyakarta, Indonesia. The participants of this study were mothers of children aged 25-60 months. In-depth interviews were conducted with twenty-four mothers and the questionnaire validation process involved 238 mothers in the survey. A Confirmatory Factor Analysis model with eight subscales provided the best fit (root-mean-square error of approximation = 0·048 (90 % CI 0·040, 0·057); Comparative Fit Index = 0·95 and Tucker Lewis Index = 0·95) after three new items and eight items from the original CEBQ were removed. Convergent validity with child's weight was found for two subscales, slowness in eating and satiety responsiveness. Reliability measured using Cronbach's alpha provided values between 0·62 and 0·78. The original eight-factor structure of the CEBQ showed adequate content validity and provided factorial, discriminant and convergent validity with mothers of preschool children living in a LMIC where child nutrition remains a significant public health issue.