title: Development of a Tool to Stage Households' Readiness to Change Dietary Behaviours in Kerala, India.
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.
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India.|Dept. of Public Health Sciences (Global Health), Tomtebodavagen 18A, Karolinska Institutet, 171 77, Stockholm, Sweden.|Dept. of Food, Nutrition and Dietetics, Uppsala University, Box 560, SE-751 22, Uppsala, Sweden.
authors.forename: Meena
authors.initials: M
authors.lastname: Daivadanam
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India.
authors.forename: T K Sundari
authors.initials: TK
authors.lastname: Ravindran
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India.
authors.forename: K R
authors.initials: KR
authors.lastname: Thankappan
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India.
authors.forename: P S
authors.initials: PS
authors.lastname: Sarma
authors.affiliation: Dept. of Public Health Sciences (Global Health), Tomtebodavagen 18A, Karolinska Institutet, 171 77, Stockholm, Sweden.|Family Medicine and Preventive Medicine, Dept. of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Rolf
authors.initials: R
authors.lastname: Wahlström
mesh_terms: D004032:Diet; D005191:Family Characteristics; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011795:Surveys and Questionnaires