Background

An unprecedented rise in overweight and obesity cases around the world has prompted the WHO (1) to set a number of different strategic incentives to reduce the burden of disease. One such strategy is the launch of nutrition-related education and public awareness programs aiming to increase knowledge of healthy eating habits among children who are at-risk for obesity and obesity-related complications in later life (1). However, while the association between children’s nutrition knowledge and dietary behavior has been previously assessed, there is an evident lack in consistent results due to a shortage of properly-validated child nutrition knowledge assessment tools (2-3). This is especially true in the State of Kuwait, a country facing an alarming growth in both child-and-adult-onset obesity rates (4). Childhood obesity prevalence figures in Kuwait are as high as 19.9% in children between 5 to 13 years of age (5), and have now exceeded 30% in adolescents (6). Despite this, there are currently no valid and reliable instruments available to assess the food knowledge of children living in the country (7). 

Aims

The goal of this study was to assess the validity and reliability of the Kuwait Child Nutrition Knowledge Questionnaire (KCNKQ), a novel 5-item survey designed to evaluate nutrition knowledge in school-aged children and adolescents throughout the State of Kuwait. We aimed to use the KCNKQ as a standardized means by which to test food knowledge among children and youth living in Kuwait, and in so-doing raising awareness for healthy eating and preventing obesity-related disease onset in this population.

Methodology

A total of 705 school-aged students between the ages of 8 and 12 were recruited from 11 schools (n = 3 “Intervention Schools”, n = 4 “Control Schools”, and n = 4 “Reliability Schools”) across the 6 governorates of Kuwait. All participating students were asked to complete the KCNKQ at T0 and T1, with only students assigned to an Intervention School receiving a nutrition presentation prior to second administration. Schools allocated for reliability analysis received the second administration 2 weeks post T0, while all other schools completed the questionnaire 1-week after the first administration. Paired sample t-tests were used to assess content validity by analyzing the difference in rates between baseline (T0) scores and scores after questionnaire re-distribution (T1). Test-retest reliability was measured using Pearson’s correlation coefficients for knowledge score comparison at T0 and T1. 

Results

The KCNKQ demonstrated appropriate content validity, with students in intervention schools showing a significant increase in food nutrition knowledge between T0 and T1 (3.65 ± 1.03 to 4.20 ± 1.02; p <0.05). Control group scores were largely the same at T1 (3.80 ± 0.99 to 3.93 ± 0.96; p <0.05). Additionally, 50.34% of students receiving the intervention scored higher on the second distribution relative to the first, while 48.82% of control students did not experience a change in score at the end of T1. Correlations for the overall survey were also significant (r = 0.44, p <0.001), thereby representing appropriate test-retest reliability for the KCNKQ. Only 26.24% of reliability students demonstrated an increase in survey scores at T1, while the majority of scores (53.85%) remained unchanged.

Discussion

Findings from this study indicate that the KCNKQ demonstrated good content validity and test-retest reliability for 8 to 12 year-old school-aged children residing in Kuwait. In addition, when paired with a nutrition-knowledge intervention program, the KCNKQ can be a highly effective tool by which to determine, implement, and promote children’s nutrition knowledge throughout the country. We postulate that KCNKQ will be of great value in future interventions designed to assess the correlation between food knowledge and dietary behaviours in high-risk populations.

Assessing the validity and reliability of the Kuwait Child Food Knowledge Questionnaire (KCFKQ)