Evaluation of Internal Consistency and Test‐Retest Reliability of a Food Behavior Checklist for Low‐Income Filipinos

Objective Filipinos in the US suffer from high rates of overweight and obesity. Since the year 2000, the number of people in the US who speak Tagalog, the official national language of the Philippines, has increased significantly; moreover, of the total popu‐lation of Tagalog speakers in the US, 32.8% speak English less than “very well.” Nutrition education programs may be used to promote healthy weight; however, validated tools in Tagalog to evaluate such programs are lacking. The purpose of this study was to assess internal consistency and test‐retest reliability of a Tagalog‐language food behavior checklist (FBC) for low‐income Filipinos. Methods A researcher fluent in Tagalog recruited participants (n=160) in O'ahu, Hawai'i from the Filipino Center, churches, low‐income housing complexes and other community sites. Participants provided demographic information and completed the 22‐item Tagalog‐language FBC on two occasions three weeks apart. The Tagalog‐language FBC consists of eight sub‐scales evaluating diet‐related practices such as intake of fruit and vegetables, dairy, sweetened beverages, fried food, as well as food security and overall diet quality. Face validity was previously assessed. All responses are reported on a 4‐point scale, with higher scores indicating more desirable behavior. To assess internal consistency, Cronbach's alpha was calculated for each sub‐scale and total scale at the first time point ( Table 1). To assess test‐retest reliability, Spearman's correlation or intraclass correlation coefficient (ICC) was calculated between the scores at the two time points for each item, each sub‐scale, and total scale ( Table 1). Items that referred to “yesterday” or “the past week” were excluded from the test‐retest reliability analysis. Results The average age of participants was 57 years (SD=20), and 70% of participants were female. Most participants (98%) were born in the Philippines, and 41% had completed high school or less as the highest level of education. Cronbach's alphas for internal consistency of sub‐scales ranged from 0.39 (diet quality sub‐scale) to 0.76 (fruit and vegetable variety sub‐scale), and the coefficient for the total scale was 0.75. The Spearman's correlations for test‐retest reliability for individual items ranged from 0.48 to 0.78 (ICC: 0.50–0.78), while correlations for each sub‐scale ranged from 0.66 to 0.80 (ICC: 0.68–0.80). The correlation for test‐retest reliability for the total scale was 0.78 (ICC: 0.79). Conclusions The individual items and sub‐scales on the Tagalog‐language FBC showed acceptable test‐retest reliability. Internal consistency was low for some sub‐scales. Although this was expected given the low number of items they contained, it indicates that the items in the sub‐scales may reflect different behaviors within each construct, allowing for evaluation of key dietary practices. Additional research is needed to evaluate the convergent and criterion validity of the tool. Upon completion of testing, the FBC may be used to evaluate the United States Department of Agriculture's nutrition education programs for Tagalog speakers. Support or Funding Information National Institute of General Medical Sciences: 5 U54 GM104944, National Institute on Minority Health and Health Disparities: U54MD007584 1 Internal Consistency, Test‐retest Reliability for FBC Sub‐Scales, Each Item, and Total Scale for Low‐Income FilipinosFood Behavior Item Internal Consistency Test‐retest Reliabilityρ 95% CI ICCFactor 1: Fruit and Vegetable Quantity sub‐scale 0.70 0.67 0.58, 0.75 0.71 1. Cups of fruit each day 0.60 0.49, 0.69 0.62 2. Svgs of fruit each day 0.57 0.45, 0.67 0.55 3. Cups of veg each day 0.59 0.48, 0.68 0.56 4. Svgs of veg each day 0.58 0.46, 0.67 0.63Factor 2: Fruit and Vegetable Variety sub‐scale 0.76 0.69 0.60, 0.76 0.71 5. Fruit or veg as snacks 0.48 0.36, 0.59 0.50 6. More than one kind of fruit each day 0.61 0.50, 0.70 0.59 7. More than one kind of veg each day 0.64 0.54, 0.72 0.63 8. Two or more veg at main meal 0.64 0.53, 0.72 0.65Does not load on any factor at >0.50:9. Citrus fruits of citrus juice during past week N/A N/A N/AMilk/Dairy sub‐scale 0.4510. Drink milk 0.72 0.64, 0.79 0.72 11. Drink milk or use milk on cereal in past week N/A N/A N/AFood Security Item N/A12. Run out of food before end of month 0.78 0.71, 0.84 0.74Factor 3: Fast Food sub‐scale 0.5713. Fried snacks yesterday N/A N/A N/A 14. Fried food yesterday N/A N/A N/A 15. Fast food yesterday N/A N/A N/A 16. Red meat or pork yesterday N/A N/A N/AFactor 4: Sweetened Beverage sub‐scale 0.68 0.80 0.73, 0.85 0.80 17. Drink fruit drinks, sport drinks or punch 0.71 0.63, 0.78 0.74 18. Drink regular soda 0.78 0.71, 0.83 0.78Factor 5: Healthy Fat sub‐scale 0.41 0.69 0.60, 0.76 0.69 19. Fish during past week N/A N/A N/A 20. Take skin off chicken 0.69 0.60, 0.76 0.69Factor 6: Diet Quality sub‐scale 0.39 0.66 0.56, 0.74 0.68 21. Use label when food shopping 0.66 0.57, 0.74 0.65 22. Rate eating habits 0.59 0.48, 0.68 0.57Total scale 0.75 0.78 0.71, 0.83 0.79CI: Confidential Interval, ICC: Intraclass Correlation Coefficient All p‐values for Spearmans' correlation ( ρ ) are less than 0.0001 N/A: Not applicable. Internal Consistency was not assessed when there was only a single item; Items that referred to “yesterday” or “the past week” were excluded from the test‐retest reliability analysis Internal consistency was assessed by Cronbach's alpha at the first time point. Test‐retest reliability was measured by Spearman's correlation ( ρ ) and ICC.