Development of a National Dietary Behaviors Questionnaire for EFNEP Adult Participants.

Abstract Objective Develop and establish the reliability and validity of dietary behavior evaluation questions for the Expanded Food and Nutrition Education Program (EFNEP). Design A mixed-methods study using cognitive interviews, expert panels, test/retest reliability, and pretests/posttests. Setting 14 states across the US. Participants A convenience sample of low-income EFNEP or EFNEP-eligible participants for cognitive interviews (n = 111), reliability testing (n = 181), and sensitivity to change testing (n = 382). Main Outcomes Measures Indicators of face and content validity, temporal reliability, and sensitivity to change. Analysis Questions interpreted as intended in cognitive interviews, intraclass correlation coefficient and Spearman rank-order correlation for reliability testing; paired t tests or Wilcoxon signed-rank tests for sensitivity to change; and exploratory factor analyses to identify possible scales. Results Cognitive interviews resulted in 3 rounds of question revisions; reliability value ranges were 0.48–0.77 for intraclass correlation coefficient and 0.43–0.77 for Spearman rank-order correlation. For sensitivity to change, 9 items had evidence of change (P Conclusions and Implications The EFNEP's new dietary behavior evaluation questions demonstrated face and content validity, moderate to strong reliability, and sensitivity to detect self-reported behavior changes among low-income, diverse populations (culturally, racially/ethnically, and level of education) across 14 states. Nutrition education programs targeting similar behaviors with English speaking clients could consider this dietary behavior questionnaire.