Development And Application Of The Responsive Feeding Questionnaire Based On Self-determination Theory For Caregivers Of Toddlers Aged Between 12 Months And 24 Months

Objective1.To develop a responsive feeding questionnaire based on self-determination theory for caregivers of toddlers aged between 12 months and 24 months and examine its reliability and validity.2.To investigate the current status of responsive feeding in caregivers of toddlers aged between 12 months and 24 months and analyze the influencing factors.Methods1.Develop item pool:The literature retrieval strategy was used to search domestic and foreign literature,and the relevant literature related to the guidelines of responsive feeding,the feeding questionnaires involving responsive feeding and the application of self-determination theory in the field of feeding were reviewed to preliminarily formulate dimensions and items of the questionnaire.An expert meeting with the participation of 5local experts from Qingdao was conducted to supplement the item pool.2.Form the pre-test questionnaire:(1)Expert consultations:A total of 20 experts were invited to complete two rounds of expert consultations to initially screen items of the preliminary questionnaire.(2)Pre-investigation:Using the objective sampling method,toddler caregivers were selected from four maternal and child health hospitals for pre-investigation to test the comprehensibility of the items,and optimize the content and language expression of the items.3.Form the formal questionnaire and test its reliability and validity:(1)Item reduction:A convenient sampling method was used to select 350 caregivers of toddlers from four maternal and child health hospitals in Shandong Province between October 2021 and January 2022.The pre-test questionnaire was used to investigate.The items were further screened using item analysis to form the formal questionnaire.(2)Test reliability and validity of the questionnaire:A total of 420 caregivers were selected by a convenient sampling from four maternal and child health hospitals in Shandong Province between February 2022 and April 2022,and were asked to complete the formal questionnaire.The Cronbach’s alpha coefficient,split-half reliability,test-retest reliability,and composite reliability were used to examine its reliability.The content validity,construct validity,convergent validity,and discriminant validity were used to examine its validity.4.Investigation of the current status and influencing factors:A total of 350 toddler caregivers were selected by a convenient sampling from four maternal and child health hospitals in Shandong Province between June 2022 and August 2022.The responsive feeding questionnaire,children’s eating behavior questionnaire,and early childhood behavior questionnaire-very short form were used to investigate the current status of responsive feeding in toddler caregivers and its influencing factors.Results1.A total of 32 literature meeting the inclusion criteria were obtained.Autonomy support,positive involvement,and structure provision,which satisfy the three basic psychological needs in the self-determination theory,were determined as the theoretical framework,and the content of the dimensions was determined by combining the characteristics of responsive feeding.Combined with the results of literature research and expert meetings,an item pool,including 51 items,was formed.2.(1)Delphi expert consultations:A total of 18 experts participated in two rounds of expert consultations.The effective response rates to the questionnaire were 90%and 100%.In the first round,14 experts(77.78%)offered amendments,and in the second round,2experts(11.11%)proposed amendments.The expert authority coefficients were 0.906 and0.914,and the expert coordination coefficients were 0.233 and 0.248.A total of 9 items were deleted,10 items were rewritten and 2 items were merged.(2)Pre-investigation:According to the feedback of the caregivers,2 items were rewritten in the pre-investigation,resulting in the pre-test questionnaire with 3 dimensions and 40 items.3.(1)Item reduction:A total of 17 items did not reach the criteria for the reservation.Factor analysis showed that 1 item in the presupposed dimension“autonomy support”and5 items in the presupposed dimension“positive involvement”loaded onto the dimension“provision of structure”.The initial dimension name was renamed to“appropriate response”based on the item common characteristics of the dimension.The final formal questionnaire was formed including 3 dimensions and 23 items.(2)The examination for reliability and validity of the questionnaire:Cronbach’s alpha coefficient,split-half reliability,and test-retest reliability of the questionnaire were 0.867,0.810,and 0.920,and the composite reliability of the dimensions were 0.935,0.877,and 0.872,which indicated satisfactory reliability of this questionnaire.The scale-level content validity was 0.960,and the item-level content validity was 0.833～1.000,indicating good content validity.The cumulative variance contribution rate of the three factors extracted by exploratory factor analysis was55.872%.The results of confirmatory factor analysis showed that the fitting indicators of the 3-factor model reached the standard,indicating that the 3-factor model was rational(?~2/df=1.563,RMSEA=0.068,GFI=0.955,CFI=0.916,IFI=0.912,NFI=0.958,and TLI=0.942).Except that the average variance extracted of the dimension“appropriate response”was 0.411,the average variance extracted of others was greater than 0.50,and the differences between the original model and other models were significant,which indicated that the convergent validity and discriminant validity of the questionnaire were good.4.The results of the application of the questionnaire showed that the average score of responsive feeding in toddler caregivers was(78.19±7.22)points.The multi-factor results showed that the caregiver’s sex and education level,as well as toddler’s age,appetitive traits(food approach and food avoidance),and temperament(effortful control,surgency,and negative affect)were the main factors affecting responsive feeding of toddler caregivers(t=2.040;t=2.064;t=4.224;t=-2.903;t=-2.547;t=3.614;t=-2.439;t=-2.250;all P<0.05).Conclusions1.The responsive feeding questionnaire for caregivers of toddlers included 3dimensions(autonomy support,positive involvement,and appropriate response)and 23items,which had good reliability and validity.It could be employed to evaluate the level of responsive feeding of toddler caregivers.2.The responsive feeding level of toddler caregivers was at a medium level.Caregiver’s sex and education level,as well as the toddler’s age,appetitive traits,and temperament were the influencing factors of responsive feeding.It was suggested that responsive feeding interventions should consider the caregiver’s sex and education level,as well as the toddler’s age,appetitive traits,and temperament.