Scientists at the Education University of Hong Kong, China, have developed a 43-item International Healthy Eating Report Card Scale (IHERCS) to assess the eating behaviors and family home food environment of preschool children from different cultural backgrounds.

The study is published in the journal Frontiers in Nutrition.

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Study: An assessment tool for the international healthy eating report card for preschool-aged children: a cross-cultural validation across Australia, Hong Kong, Singapore, and the United States. Image Credit: Sharomka / Shutterstock

Background

The development of a regional or national Report Card with a traditional grading system is vital for assessing the prevalence of a particular health-related behavior within a specific region or country. It is considered an effective and valuable approach to increasing public awareness about the significance of targeted health behaviors.

A Healthy Eating Report Card for preschool children was recently developed in Hong Kong, adopting the conceptual framework of a well-established Physical Activity Report Card. This Report Card has been used successfully to assess the prevalence of healthy eating behaviors among preschool children in Hong Kong.

However, widespread implementation of such region-specific Report Cards may face potential challenges because of dietary guidelines and recommendations vary across different geographical and cultural environments.

To overcome this shortcoming, scientists have developed a new International Healthy Eating Report Card for preschool children and its globally applicable assessment tool of the IHERCS based on the global health authority guidelines and recommendations.

Report Card development

The study population included 2,059 parent-child dyads from Australia, Hong Kong, Singapore, and the United States. The parent participants were asked to complete a questionnaire comprising the IHERCS and other validated scales related to children’s mealtime behaviors and family mealtime environments.

Demographic questions were included in the questionnaire to collect participants’ personal information. The IHERCS included 43 items to assess mealtime behaviors of children and family mealtime environments.

The well-established and widely-used Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was used for an alternative assessment of the frequency of particular mealtime behaviors of children. Similarly, the Household Questionnaire (MOH) was used for an alternative assessment of the frequency of children involved in certain structured family mealtime environments.

Important observations

The findings indicated robust factor structures of the scales of children’s eating behaviors and family home food environments in the IHERCS. Internal consistency was also acceptable.

Regarding measurement invariance between cultural contexts, the findings indicated the establishment of full configural invariance and metric invariance across the four cultural contexts. However, full scaler invariance could not be achieved. Partial scalar invariance was found only in the scale of family home food environments.

Significance

The study finds that the IHERCS is effective for a reliable, valid, and comprehensive assessment of eating behaviors and family home food environments among children from different cultural settings.

The tested scales’ lack of full scaler invariance could be due to cultural differences in the interpretation and scoring of items related to children’s eating behaviors.

The scale of children’s eating behavior in the IHERCS is relatively shorter and easier than other validated assessment tools. This can potentially reduce participants’ response burden and facilitate the implementation of IHERCS in large-scale studies.

As the scientists mentioned, the study could not establish the temporal stability of eating behaviors and family home food environments over time because of its cross-sectional design. Moreover, the study could not establish the scales’ predictive efficacy toward other behavioral or health outcomes over time.

The influence of social desirability and self-serving biases on study findings could not be ignored because the study only relied on parent-reported measures of children’s eating behaviors and family home food environments.

Future studies should include independent assessors, observational methods, and dietician-mediated verification for more accurate responses.