Using qualitative methods to improve questionnaires for Spanish speakers: assessing face validity of a food behavior checklist

Abstract

Development of outcome measures relevant to health nutrition behaviors requires a rigorous process of testing and revision. Whereas researchers often report performance of quantitative data collection to assess questionnaire validity and reliability, qualitative testing procedures are often overlooked. This report outlines a procedure for assessing face validity of a Spanish-language dietary assessment tool. Reviewing the literature produced no rigorously validated Spanish-language food behavior assessment tools for the US Department of Agriculture's food assistance and education programs. In response to this need, this study evaluated the face validity of a Spanish-language food behavior checklist adapted from a 16-item English version of a food behavior checklist shown to be valid and reliable for limited-resource English speakers. The English version was translated using rigorous methods involving initial translation by one party and creation of five possible versions. Photos were modified based on client input and new photos were taken as necessary. A sample of low-income, Spanish-speaking women completed cognitive interviews (n=20). Spanish translation experts (n=7) fluent in both languages and familiar with both cultures made minor modifications but essentially approved client preferences. The resulting checklist generated a readability score of 93, indicating low reading difficulty. The Spanish-language checklist has adequate face validity in the target population and is ready for further validation using convergent measures. At the conclusion of testing, this instrument may be used to evaluate nutrition education interventions in California. These qualitative procedures provide a framework for designing evaluation tools for low-literate audiences participating in the US Department of Agriculture food assistance and education programs.

Figure 1

Four issues identified with the Spanish-language food behavior checklist by respondents during cognitive testing sessions at community sites during a study to test validity of a low-literacy Spanish-language dietary assessment tool.

Figure 1

Four issues identified with the Spanish-language food behavior checklist by respondents during cognitive testing sessions at community sites during a study to test validity of a low-literacy Spanish-language dietary assessment tool.

Figure 2

Three versions of one evaluation item demonstrate changes made to photographs through cognitive testing interviews with low-income Spanish-speaking clients: original photograph of American fruit drinks (panel a), new photograph of mainly Mexican fruit drinks (panel b), and split photograph with both American and Mexican fruit drinks as final version of text and photograph per clients’ recommendations (panel c). (Figure was created by Jinan Banna, Marilyn Townsend, and Kathryn Sylva, and is used with their permission.)

Figure 3

Food behavior checklist (Lista de hábitos alimenticios) resulting from assessment of face validity in sample of low-income Spanish-speaking women in California. (Figure was created by Jinan Banna, Marilyn Townsend, and Kathryn Sylva, and is used with their permission.)

Figure 3

Food behavior checklist (Lista de hábitos alimenticios) resulting from assessment of face validity in sample of low-income Spanish-speaking women in California. (Figure was created by Jinan Banna, Marilyn Townsend, and Kathryn Sylva, and is used with their permission.)

Figure 3

Food behavior checklist (Lista de hábitos alimenticios) resulting from assessment of face validity in sample of low-income Spanish-speaking women in California. (Figure was created by Jinan Banna, Marilyn Townsend, and Kathryn Sylva, and is used with their permission.)

Figure 3

Food behavior checklist (Lista de hábitos alimenticios) resulting from assessment of face validity in sample of low-income Spanish-speaking women in California. (Figure was created by Jinan Banna, Marilyn Townsend, and Kathryn Sylva, and is used with their permission.)