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Development and validation of a nutrition literacy assessment tool for young adults

젊은 성인의 영양정보이해력 평가도구 개발 및 타당성 검증

  • Ahn, Seokyoung (Graduate School of Education, Gachon University) ;
  • Kim, Bogyeong (Graduate School of Education, Gachon University) ;
  • Um, Mihyang (Graduate School of Education, Gachon University) ;
  • Park, Yookyung (Department of Medical Nutrition, Graduate School of East-West Medicine, Kyung Hee University) ;
  • Kye, Seunghee (Graduate School of Education, Gachon University)
  • Received : 2019.10.01
  • Accepted : 2019.12.31
  • Published : 2020.04.30

Abstract

Purpose: This study was conducted to develop, validate, and assess the reliability of a questionnaire for nutritional literacy among young Korean adults. Methods: The draft questionnaire contained 65 items in 7 domains (i.e., dietary guideline, nutrition and health, nutrients, 5 food groups [food bicycle], nutrition labeling, portion size, and nutrition management for disease prevention). The authors developed a draft questionnaire based on a literature review. After multiple drafts, 52 items were retained and 13 were eliminated in the 7 domains according to professional advice from 5 nutrition experts. A panel of experts (n = 20) comprised of clinical dietitians and nutrition professors completed the content validity assessment, including quantitative and qualitative feedback. As the results, all items of the portion size were eliminated from the questionnaire. A sample of 211 young adults completed the test-retest reliability assessment. Test-retest reliability was evaluated using intra-class correlation coefficient (ICC) and inter-item reliability by Cronbach α coefficient. Results: The final questionnaire contained 30 items with 5 questions each on the dietary guideline, nutrition and health, nutrients, 5 food groups (food bicycle), nutrition labeling, and nutrition management for disease prevention. The Lawshe content validity ratio for domains ranged from 0.60 to 1.00. The ICC scores for questions ranged from 0.64 to 0.86. Cronbach's α for domains ranged from 0.83 to 0.90 and for the overall questionnaire was 0.87. Conclusion: The questionnaire showed strong content validity, test-retest reliability, and high inter-item reliability, indicating that it is a useful tool for assessing nutritional literacy of young adults.

본 연구는 젊은 성인을 대상으로 영양정보이해력을 평가할 수 있는 측정도구를 개발하기 위해 수행되었다. 영양정보이해력 평가를 위한 예비문항으로서 우선 7개 영역 65문항이 개발되었다. 작성된 예비문항을 영양전문가 5인에게 자문을 받아 불필요한 문항을 삭제하여 7개 영역 52문항으로 압축시켰다. 영양전문가 패널 20인을 대상으로 내용타당도 검증을 하였으며, Lawshe가 제안한 CVR값을 구하여 내용타당도 검증에 활용하였다. 평가도구 최종 항목으로서 총 6개 영역, 즉 식생활지침, 영양과 건강, 영양소, 다섯가지 식품군 (식품구성자전거), 영양표시, 질병 예방을 위한 영양관리를 포괄하는 30문항이 완성되었다. 이 평가도구를 이용하여 서울과 경인지역에 거주하는 성인 211명을 대상으로 신뢰도를 검증하기 위해 2주 간격으로 검사-재검사 (test-retest)를 실시하였으며, ICC값 (0.64-0.86)과 Cronbach's α 계수(0.83-0.90)를 산출한 결과 모두 높은 수준으로 나타났다. 따라서 본 연구를 통해 개발된 도구는 영양정보이해력을 평가할 수 있는 적합한 내용을 담고 있으며, 신뢰도 또한 매우 높은 것으로 검증되어, 젊은 성인의 다양한 수준의 영양정보이해력을 판별할 수 있을 것으로 본다. 또한 본 연구를 통해 개발된 평가도구는 지역사회 영양중재 프로그램 계획 시 그리고 만성질환의 예방관리를 위한 영양교육을 위해 대상자의 영양정보이해력을 파악하는 진단도구로 활용될 수 있을 것이다.

Keywords

References

  1. Korean Statistical Information Service. GNI [Internet]. Daejeon: Korean Statistical Information Service; [cited 2019 Aug 31]. Available from: http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_2KAA901&vw_cd=MT_RTITLE&list_id=ZTIT_I&seqNo=&lang_mode=ko&language=kor&obj_var_id=&itm_id=&conn_path=A4.
  2. Han KS, Seo KM, Park HN, Hong SY. Issues of Korean restaurant industry by content analysis of food yearly statistics. Korean J Food Cult 2004; 19(3): 313-325.
  3. Lee S. The effect of household demographic trend on food expenditure pattern. J Consum Cult 2014; 17(3): 85-104. https://doi.org/10.17053/JCC.2014.17.3.005
  4. Gibbs HD, Ellerbeck EF, Gajewski B, Zhang C, Sullivan DK. The nutrition literacy assessment instrument is a valid and reliable measure of nutrition literacy in adults with chronic disease. J Nutr Educ Behav 2018; 50(3): 247-257.e1. https://doi.org/10.1016/j.jneb.2017.10.008
  5. Silk KJ, Sherry J, Winn B, Keesecker N, Horodynski MA, Sayir A. Increasing nutrition literacy: testing the effectiveness of print, web site, and game modalities. J Nutr Educ Behav 2008; 40(1): 3-10. https://doi.org/10.1016/j.jneb.2007.08.012
  6. Majchrzak M, Shannon K, Pleasant A, Cabe J, Rella E, Giboyeaux K, et al. Using the power of culinary nutrition, health literacy, and partnerships to prevent and reverse chronic disease in low-income communities. J Acad Nutr Diet 2016; 116(9): A66.
  7. Gibbs HD, Kennett AR, Kerling EH, Yu Q, Gajewski B, Ptomey LT, et al. Assessing the nutrition literacy of parents and its relationship with child diet quality. J Nutr Educ Behav 2016; 48(7): 505-509.e1. https://doi.org/10.1016/j.jneb.2016.04.006
  8. Rothman RL, Housam R, Weiss H, Davis D, Gregory R, Gebretsadik T, et al. Patient understanding of food labels: the role of literacy and numeracy. Am J Prev Med 2006; 31(5): 391-398. https://doi.org/10.1016/j.amepre.2006.07.025
  9. Huizinga MM, Carlisle AJ, Cavanaugh KL, Davis DL, Gregory RP, Schlundt DG, et al. Literacy, numeracy, and portion-size estimation skills. Am J Prev Med 2009; 36(4): 324-328. https://doi.org/10.1016/j.amepre.2008.11.012
  10. Zoellner J, You W, Connell C, Smith-Ray RL, Allen K, Tucker KL, et al. Health literacy is associated with healthy eating index scores and sugar-sweetened beverage intake: findings from the rural Lower Mississippi Delta. J Am Diet Assoc 2011; 111(7): 1012-1020. https://doi.org/10.1016/j.jada.2011.04.010
  11. Rochman C, Nasrudin D, Helsy I, Hermita N, Darmalaksana W, Nasrullah N. Nutrition literacy program for improving public wellness. J Phys Conf Ser 2018; 1028(1): 012031. https://doi.org/10.1088/1742-6596/1028/1/012031
  12. Lino M, Basiotis PP, Anan RS, Variyman JN. Nutrition Insights. The diet quality of Americans: strong link with nutritional knowledge [Internet]. Alexandria (VA): USDA Center for Nutrition Policy and Promotion; [cited 2019 Jan 30]. Available from: https://fns-prod.azureedge.net/sites/default/files/SNOPSYear1.pdf.
  13. Guttersrud O, Petterson KS. Young adolescents' engagement in dietary behaviour - the impact of gender, socio-economic status, self-efficacy and scientific literacy. Methodological aspects of constructing measures in nutrition literacy research using the Rasch model. Public Health Nutr 2015; 18(14): 2565-2574. https://doi.org/10.1017/S1368980014003152
  14. Gibbs H, Chapman-Novakofski K. Exploring nutrition literacy: attention to assessment and the skills clients need. Health 2012; 4(3): 120-124. https://doi.org/10.4236/health.2012.43019
  15. Kim SS, Kim SH, Lee SY. Health literacy: development of a Korean health literacy assessment tool. J Korean Soc Health Educ Promot 2005; 22(4): 215-227.
  16. Lee TW. Research Report. Development and Evaluation of Health Literacy Improvement Program for the Low-income Elderly with Hypertension. Seoul: Yonsei University & Korea Foundation for the Advancement of Science & Technology; 2010 March. Report No.: 2007-0053325.
  17. Kim SH, Lee E. The influence of functional literacy on perceived health status in Korean older adults. J Korean Acad Nurs 2008; 38(2): 195-203. https://doi.org/10.4040/jkan.2008.38.2.195
  18. Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med 2005; 3(6): 514-522. https://doi.org/10.1370/afm.405
  19. Diamond JJ. Development of a reliable and construct valid measure of nutritional literacy in adults. Nutr J 2007; 6(5): 5. https://doi.org/10.1186/1475-2891-6-5
  20. Gibbs H, Chapman-Novakofski K. Establishing content validity for the nutrition literacy assessment instrument. Prev Chronic Dis 2013; 10: E109.
  21. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Source [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; [cited 2019 Feb 9]. Available from: http://www.mohw.go.kr/react/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=032901&CONT_SEQ=337296.
  22. Ministry of Food and Drug Safety. Sodium reduction data book [Internet]. Cheongju: Ministry of Food and Drug Safety; [cited 2019 Feb 9]. Available from: https://www.mfds.go.kr/brd/m_228/list.do?multi_itm_seq=0&board_id=data0019&seq=&srchTp=0&srchWord=%EB%82%98%ED%8A%B8%EB%A5%A8&data_stts_gubun=C9999.
  23. The Korean Dietetic Association. Correct eating manual [Internet]. Seoul: The Korean Dietetic Association; [cited 2019 Feb 9]. https://www.dietitian.or.kr/work/business/kb_c_habits.do.
  24. Choi HM. Carbohydrate metabolism. In: 21st Century Essentials of Nutrition. 3rd ed. Paju: Kyomoonsa; 2011. p.49-55.
  25. Seoul National University Hospital Gangnam Center. A Story about a Meal Waiting for a Medical Checkup. Seoul: Seoul National University Publishing Cultural Center; 2010. p.101-102.
  26. Hwang IK, Kim JW, Byun JW, Han JS, Kim SH. Essential Food Science. Seoul: Soohaksa; 2010. p.41-139.
  27. Kim SJ, Shin SW, Kim HJ. Obesity from the viewpoint of metabolic rate. J Korean Orient Assoc Stud Obes 2003; 3(1): 95-105.
  28. Kim DY, Lee H, Chio EY, Lim HJ. Analysis and evaluation of glycemic indices and glycemic loads of frequently consumed carbohydrate-rich snacks according to variety and cooking method. J Korean Soc Food Sci Nutr 2015; 44(1): 14-23. https://doi.org/10.3746/JKFN.2015.44.1.014
  29. Kim YA. Soybean protein: high-quality vegetable protein. Food Sci Ind 2018; 51(4): 270-7.
  30. Yoon T, Lee S, Shin HJ, Lee SY, Hong J, No KM, et al. Study of trans fatty acids and saturated fatty acids in child-favored foods. J Korean Soc Food Sci Nutr 2011; 40(11): 1562-1568. https://doi.org/10.3746/JKFN.2011.40.11.1562
  31. Ahn Y, Yeo I, Lee S, Nam K. Development of a food exchange table and food pattern for nutritionally balanced menu planning. Korean J Community Nutr 2018; 23(5): 411-423. https://doi.org/10.5720/kjcn.2018.23.5.411
  32. Son SM, Huh GY. Dietary risk factors associated with hypertension in patients. Korean J Community Nutr 2006; 11(5): 661-672.
  33. Song HR, Cho YG, Kim KA, Kim OH, Kang JH. Glycemic index and chronic diseases. J Korean Acad Fam Med 2008; 29(10): 725-735.
  34. Cho YW. Nutrition management of obesity. Korean J Stress Res 1995; 3(2): 181-189.
  35. Kennedy LG, Kichler EJ, Seabrook JA, Matthews JI, Dworatzek PDN. Validity and reliability of a food skills questionnaire. J Nutr Educ Behav 2019; 51(7): 857-864. https://doi.org/10.1016/j.jneb.2019.02.003
  36. Szklo M, Nieto FJ. Epidemiology: Beyond the Basics. 2nd ed. Sudbury (MA): Jones and Bartlett Publishers; 2007.
  37. Hong SY, Lee KH, Lee HS, Lee MS, Jee SH, Joung H. Association between compliance with dietary guidelines and dyslipidemia among Koreans. Korean J Nutr 2007; 40(8): 745-752.
  38. Korea Centers for Disease Control & Prevention. National health and nutrition survey [Internet]. Cheongju: Korea Centers for Disease Control & Prevention; [cited 2019 Sep 15]. Available from: https://knhanes.cdc.go.kr/knhanes/sub01/sub01_05.jsp#s5_03.
  39. The Korean Nutrition Society. Dietary Reference Intakes for Koreans 2010 [Internet]. Seoul: The Korean Nutrition Society; [cited 2019 Aug 31]. Available from: http://www.kns.or.kr/Data/FileRoom/2010KDRIs_open_final.pdf.
  40. Yoo H, Kim Y. A study on the characteristics of nutrient intake in metabolic syndrome subjects. Korean J Nutr 2008; 41(6): 510-517.
  41. Yoon JS. Evaluation of nutritional status of adults by food guide and food composition group score. J Living Sci Res 2002; 28: 1-10.
  42. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2013: Korea National Health and Nutrition Examination Survey (KNHANES VI-1). Cheongwon; Korea Centers for Disease Control and Prevention; 2014. p.429, 437, 555.
  43. Kim SY, Lee JH. Effect of nutrition labeling use on consumers' food choices. J Consum Stud 2010; 21(3): 107-128.
  44. Lee SE, Han K, Kang YM, Kim SO, Cho YK, Ko KS, et al. Trends in the prevalence of metabolic syndrome and its components in South Korea: findings from the Korean National Health Insurance Service Database (2009-2013). PLoS One 2018; 13(3): e0194490. https://doi.org/10.1371/journal.pone.0194490
  45. Lim S, Shin H, Song JH, Kwak SH, Kang SM, Won Yoon J, et al. Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998-2007. Diabetes Care 2011; 34(6): 1323-1328. https://doi.org/10.2337/dc10-2109
  46. Ahn BC, Hong E, Joung H. Regional convergence in the prevalence of metabolic syndrome in Korea. Korean Public Health Res 2013; 39(1): 1-11. https://doi.org/10.22900/KPHR.2013.39.1.001

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