Development of a Tool to Stage Households Readiness to Change Dietary Behaviours in Kerala, India
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Date
2016-12
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PLOS one
Abstract
Dietary interventions and existing health behaviour theories are centred on individuals;
therefore, none of the available tools are applicable to households for changing dietary
behaviour. The objective of this pilot study was to develop a practical tool that could be
administered by community volunteers to stage households in rural Kerala based on readiness
to change dietary behaviour. Such a staging tool, comprising a questionnaire and its
algorithm, focusing five dietary components (fruits, vegetables, salt, sugar and oil) and
households (rather than individuals), was finalised through three consecutive pilot validation
sessions, conducted over a four-month period. Each revised version was tested with a total
of 80 households (n = 30, 35 and 15 respectively in the three sessions). The tool and its
comparator, Motivational Interviewing (MI), assessed the stage-of-change for a household
pertaining to their: 1) fruit and vegetable consumption behaviour; 2) salt, sugar and oil consumption
behaviour; 3) overall readiness to change. The level of agreement between the
two was tested using Kappa statistics to assess concurrent validity. A value of 0.7 or above
was considered as good agreement. The final version was found to have good face and
content validity, and also a high level of agreement with MI (87%; weighted kappa statistic:
0.85). Internal consistency testing was performed using Cronbach’s Alpha, with a value
between 0.80 and 0.90 considered to be good. The instrument had good correlation
between the items in each section (Cronbach’s Alpha: 0.84 (fruit and vegetables), 0.85 (salt,
sugar and oil) and 0.83 (Overall)). Pre-contemplation was the most difficult stage to identify;
for which efficacy and perceived cooperation at the household level were important. To the
best of our knowledge, this is the first staging tool for households. This tool represents a
new concept in community-based dietary interventions. The tool can be easily administered
by lay community workers and can therefore be used in large population-based studies. A
more robust validation process with a larger sample is needed before it can be widely used.
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Citation
Daivadanam M, Ravindran TKS, Thankappan KR, Sarma PS, Wahlstrom, R. Development of a Tool to Stage Households Readiness to Change Dietary Behaviours in Kerala, India. PLOS one. 2016