Development and Validation of a Filipino Eating Behavior Questionnaire among Adult Type 2 Diabetes Mellitus Patients

Abstract

Background. Management of type 2 diabetes mellitus requires the maintenance of self-care behaviors, which include proper nutrition.  However, diabetic patients often find that following a healthy diet is the most difficult component of self-care.  It is important to assess the eating behaviors of diabetic individuals in order to customize a dietary plan but locally clinicians are hampered by the lack of a culturally adapted or validated tool.

Objective. The goal of this study is to develop and validate a Filipino eating behavior questionnaire for adults with type 2 diabetes mellitus. 

Methodology. Literature review, expert interviews and focus group discussions among type 2 diabetic patients were done. All inputs, including pooled items from existing eating behavior questionnaires, were reviewed and categorized into corresponding eating behavior domains as determined by expert panel consensus. After translation into Filipino and pre-testing, the questionnaire was administered twice to 197 adults with type 2 diabetes.  Questionnaire reliability was determined using Cronbach’s α and Spearman’s rank correlation coefficient.

Results. A 29-item, self-administered, Filipino eating behavior questionnaire answerable by a 4-point Likert scale was initially developed. This questionnaire featured three known eating behaviors namely: uncontrolled, restrained, and emotional eating; and included two newly identified eating behaviors: social and pro-active eating. In both first and second tests, only the items in the uncontrolled (Cronbach’s α 0.739 & 0.816), social (Cronbach’s α 0.641 & 0.707), and pro-active (Cronbach’s α 0.622 & 0.665), eating domains were found to be internally consistent. One item under the restrained eating domain was deleted to improve the consistency of the items.  For the test-retest reliability, moderate to high positive correlation (coefficients ranging from 0.530 to 0.744) between scale scores in the two test runs was achieved. This indicated stable responses to the items.

Conclusion. An eating behavior questionnaire for type 2 diabetic individuals that was developed to be culturally appropriate is a generally reliable, reproducible and valid instrument to assess eating behaviors. This study identified social and pro-active eating as behaviors among Filipinos with type 2 diabetes mellitus that were not previously described in foreign literature.  The instrument may provide benefit in evaluating eating behaviors and formulating more individualized nutrition management plans.