1 Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; 2 Universidade de São Paulo (USP), São Paulo, Brazil; 3 Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Introduction: Child feeding behaviors are highly influenced by parents, who are the child’s first nutritional educators, and shape the child’s food environment. The Comprehensive Feeding Practices Questionnaire (CFPQ) was developed in the US to measure feeding practices among parents of 2-to-8-year-olds. Although school-aged when compared to younger aged children are more independent and more exposed to external influences such as school, friends, and advertising, parents’ attitudes and practices regarding eating behavior and food choice still play a vital role. Objectives: To test the validity of the CFPQ among Brazilian parents of 5-to-9-year-olds enrolled in private schools and propose a new version of the instrument, if necessary. Methods: Transcultural adaptation included translation into Portuguese, back-translation, content validity performed by an expert panel, testing for semantic equivalence, and pilot studies, resulting in a small number of cultural and grammatical modifications. Confirmatory and exploratory factor analysis was then conducted, as well as psychometric analyses including tests for internal consistency and factor correlations, item-discriminant and convergent validity, and test-retest reliability. Results and conclusions: Confirmatory factor analysis demonstrated a poor fit of the data to the original 12-factor model in this sample of Brazilian school-aged children (n=659). Exploratory factor analysis generated a 6-factor model composed of 42 items: Healthy Eating Guidance, Monitoring, Restriction for Weight Control, Restriction for Health, Emotion Regulation/ Food as Reward, and Pressure. This factor solution was supported by psychometric analyses including tests for internal consistency (Cronbach’s alpha 0.71-0.91) and factor correlations (low, indicating little overlap). Item-discriminant and convergent validity testing showed that parents who used coercive practices were more concerned about child’s weight and had more overweight children. Test-retest reliability was acceptable. Since parental practices are highly culturally-sensitive, it is essential to conduct careful evaluations of questionnaires when introduced into new cultural settings.