Elsevier

Appetite

Volume 42, Issue 3, June 2004, Pages 249-254
Appetite

Research Report
Mothers misunderstand questions on a feeding questionnaire

https://doi.org/10.1016/j.appet.2003.12.002Get rights and content

Abstract

Feeding questionnaires have not consistently identified mothers' beliefs or behaviors associated with preschool children becoming overweight. One reason may be that mothers do not understand the constructs in the questions in the way intended by the developers of the questionnaire. This study assessed items on the Preschooler Feeding Questionnaire (PFQ)—a maternal questionnaire about feeding practices and beliefs relating to the weight status of preschoolers. Seven audio-taped interviews were conducted with African American mothers of 24–59 month-old children in Chicago enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children. Questions in the PFQ were interpreted by respondents to mean something other than what was intended. In particular, the constructs difficulty in child feeding, pushing the child to eat more, and using food to calm the child were present among the mothers but not captured by items on the questionnaire. Thus, qualitative interviewing could help to match the intention in asking a question with its interpretation by respondents. A mismatch may contribute to our low level of understanding about the causes of early obesity.

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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