Research ReportMothers misunderstand questions on a feeding questionnaire
Introduction
Investigations that seek feasible obesity prevention interventions for young children are often based on questionnaires that link maternal feeding practices and beliefs to successful energy balance. To date, however, such instruments have not clearly identified aspects of mothers' feeding patterns that consistently relate to obesity in their children (Baughcum et al., 2001, Birch et al., 2001, Wardle et al., 2001, Wardle et al., 2002).
Our research group has developed and employed an instrument called the Preschooler Feeding Questionnaire (PFQ) (Baughcum et al., 2001). Using this questionnaire, we hypothesized that specific maternal beliefs and practices about child feeding would be associated with the development of obesity in their children—and that these same beliefs and practices could be targeted in developing interventions to prevent obesity in children.
As part of the PFQ, we explored three constructs, difficulty in child feeding, pushing the child to eat more, and using food to calm the child. Although these behaviors seemed intuitively related to obesity, our results did not reveal consistent associations between the practices assessed and the weight status of preschool children (Baughcum et al., 2001). We wondered whether the practices were truly unimportant or if misunderstanding of the questions contributed to the lack of a relationship between the questionnaire constructs and anthropometric data. In addition, from clinical experience and qualitative research conducted on the same population (Jain et al., 2001), we suspected that our previously formulated constructs may not be meaningful or important to respondents. To assess question interpretation and the presence and relevance of particular feeding constructs, we conducted semi-structured interviews. We also wished to shape our questionnaire items for research among urban, low-income, African American mothers of preschool-aged children, a group at high risk for obesity (Pamuk, Makuc, Heck, Reuben, & Lochner, 1998), who constituted only a sub-sample of our original study population for the PFQ.
Section snippets
Development of the PFQ
The PFQ contains 29 closed-ended items whose responses yielded scores for eight factors: (1) difficulty in child feeding, (2) concern about child overeating or being overweight, (3) pushing the child to eat more, (4) using food to calm the child, (5) concern about the child being underweight, (6) child's control of feeding interactions, (7) structure during feeding interactions, and (8) age-inappropriate feeding. Each factor describes a construct about child feeding that we hypothesized was
Results
Three of the eight PFQ constructs, difficulty in child feeding, pushing the child to eat more, and using food to calm the child, were consistently misunderstood across the seven research subjects. For these three constructs, six PFQ items (two items per construct) and the sample probing questions illustrate how the respondents interpreted the questionnaire items and constructs.
Discussion
The interviews found instances where urban, low-income African American mothers of preschool children understood a construct and a question item differently from the investigators' original intention. This was particularly evident for three constructs: difficulty in child feeding, pushing the child to eat more, and using food to calm the child.
Acknowledgments
We give special thanks to Diana O'Rourke with whom we consulted for this work for her expertise on cognitive interviewing methods and assessing question interpretation. This work was supported by federal funds from the US Department of Agriculture, Economic Research Service, Cooperative Agreement no. 43-3AEM-0-80078. The contents of this publication do not necessarily reflect the views or policies of the US Department of Agriculture, nor does the mention of trade names, commercial products, or
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