Questionnaire to assess adherence to diet and exercise advices for weight management in lifestyle-related diseases

Abstract

Background:

Lifestyle-related diseases have assumed significant public health problem across the globe including developing nations. high rate of nonadherence to discussion poses challenges to syndicate physicians in its treatment .

Objective:

To develop a valid and reliable questionnaire for assessment of adhesiveness to lifestyle modification advices .

Materials and Methods:

The questionnaire was developed following a systematic, scientifically accepted methodology which included literature review, focused group discussions, detailed interviews, and expert evaluation. Comprehensibility, replicability, face validity, content robustness, patient acceptance, and ease of usage of the questionnaire were analyzed. Five-point Likert scale was employed as answer options. Cronbach ‘s alpha was calculated to assess home consistency of overall questionnaire. A cross-section survey was then performed on 100 corpulent patients with nonalcoholic fatty liver disease to validate the questionnaire.

Results:

The originate questionnaire consists of 14 questions under two domains, 12 items under diet and 2 items under the physical bodily process domain. Each of these questions is on a 5-point Likert scale. The joyride has shown satisfactory cogency. It besides has adequate dependability and inner consistency with Cronbach ‘s alpha measure of 0.9 .

Conclusion:

It is a valid and dependable cock which can be used in clinical practice to assess adhesiveness to lifestyle modification advices by family physicians. Keywords:

Adherence, diet, exercise, lifestyle, questionnaire

Introduction

With rapid economic exploitation and increasing westernization of life style in past few decades, preponderance of fleshiness and early lifestyle-related diseases has increased at an alarming rate across earth including India. [ 1 ] Obesity is an important hazard divisor in many lifestyle-related diseases like diabetes, high blood pressure, coronary artery diseases, stroke, etc. [ 2, 3 ] life style change advices like calorie restricted balanced diets and regular physical exercises are the cornerstones in the management of all lifestyle-related diseases. A weight personnel casualty of 5–10 % of existing body weight results significant decrease in the metabolic risks among these patients and is recommended as standard discussion protocol. [ 4 ] Studies suggest that only 15 % of subjects achieve the goal of 10 % body weight reduction largely because of the miss of conformity and nonadherence to lifestyle modification advices. [ 5 ] Most of these cases seek avail from syndicate physicians. They have a major function to play not lone in giving remedy advices but besides in planning preventive strategies. Understanding the determinants of nonadherence to lifestyle modification advices can help family physicians to plan and execute concentrate interventions to assist these patients in achieving long-run and sustainable weight passing. Absence of exchangeable tools makes it difficult to assess the quantum of adhesiveness in patients with life style diseases. thus, we planned this study to develop and validate questionnaire that would be extremely utilitarian for kin physicians in treating this park and significant condition .

Materials and Methods

The questionnaire was developed in a taxonomic manner, using scientifically accepted methodology which included literature review, focused group discussions ( FGDs ), expert evaluation, pretesting, and establishment. [ 6 ] The discipline was approved by ethical committee of our institute, and all the participants gave informed written accept prior to their participation .

Development of questionnaire

questionnaire was developed in a systematic multistep method .

Development phase

Step 1: Review of literature

In depth literature recapitulation was done to look for preexisting information in the field of life style disease-related questionnaires and define the reconstruct of the questionnaire. Keywords such as “ attachment, ” “ questionnaires and surveys ”, “ disobedience, ” “ nonalcoholic fatty liver disease, ” “ life style diseases, ” lifestyle change advices, ” and “ behavior change ” were used in PubMed, Google scholar, Web Of Science, Medline, and other medical search engines to look for relevant studies done over the past 5 years .

Step 2: Focus group discussion and detailed interviews

FGDs and detailed interviews were conducted with corpulent patients with not alcoholic fatso liver disease ( NAFLD ) enrolled from medicine OPD and metabolic clinic to understand their position about life style modifications as a treatment for fleshiness and NAFLD. Active participation and interaction of the subjects was encouraged during two sessions with six corpulent NAFLD patients in each discussion. Sessions were continued until no new ideas were available from the groups. More focus questions were asked. The data were recorded, analyzed qualitatively, and new items were included in the manufacture .

Step 3: Item generation

A list of items was generated that adequately represented the construct of the questionnaire in a dim-witted and limpid linguistic process. Attention was given to proper sequence and frame of questions. Items were checked again and again, to ensure that questions are relevant .

Step 4: Expert evaluation

Questions were then reviewed and improved by experts in internal medicate, metabolic disease, dietetics, forcible and medical rehabilitation, statistics and gastroenterology, and human nutrition, to avoid any ambiguity and confusion. Questions which were leading, ambiguous or duplicate, in nature were removed at this stage .

Step 5: Pretesting

The final draft of questionnaire punctually endorsed by experts was pretested in 20 corpulent NAFLD patients. psychoanalysis for comprehensibility, replicability, patient acceptance, and facilitate of custom was done during the pretesting phase. Questions that were irrelevant, equivocal, and duplicate were eliminated. After necessitate updation, the questionnaire was used for face to face interviews. 5-point Likert scale was employed as reaction options assuming equal distance between answer objects. Questionnaire was administered by the investigator because of little ball education of the report population .

Validation phase

The explicate questionnaire was subjected to robustness testing through a cross-section sketch on 100 corpulent NAFLD patients between the historic period of 18–60 years, who attended Gastroenterology and Medicine OPD at our establish. After obtaining patient ‘s consent, the questionnaire was administered by the chief research worker in the lyric silent by the participants, either in Hindi or English. Patients were excluded if they had other causes of fatso liver, refused to give accept and or were unable to communicate. The cogency and dependability of the questionnaire was psychometrically tested using the collected data from patients .

Item scoring

seduce was assigned to each reaction based on association with healthy dietary habits and physical natural process. Higher points were given to responses with healthy dietary habits and physical activeness and lower points were given to responses with bad dietary habits and forcible activity. For each question, minimum reception was 1 and maximal response was 5. For each question, there was continuum of responses from 1 to 5. To determine the final score, each question score was summed up leading to data on Likert plate .

Statistical analysis

descriptive statistics was used for patients for analyzing demographic and clinical parameters. For the quantitative parameters mean, median, standard deviation quartile range was calculated. For reducing the questionnaire, principal component analysis and correlation coefficient matrix was used. In the token analysis, items which met any of the keep up conditions were removed : ( a ) one of any two items with correlation coefficient greater than 0.7 ; ( bel ) correlation coefficient coefficient with early items and full mark was very low i, less than 0.05 compared to that of other items. Cronbach ‘s alpha was used to assess dependability and homogeneity of overall questionnaire. Cronbach ‘s alpha 0.7 or higher was considered to have good inner consistency and is acceptable. Construct validity was established by factor psychoanalysis with varimax rotation to test the speculate domain structure. Exploratory factor analysis was performed to examine subdomain infrastructure .

Results

Development phase

A pool of 20 items was generated after literature review and two sessions of FGDs with 12 NAFLD patients, covering both the aspects of diet and physical activity. Responses were built using 5-point Likert plate assuming equal distance between answer objects. By the end of literature inspection and FGD ‘s, reconstruct was clear and survey items were written in a language understood by the participants, making sure it made character to a individual concept, expressed in inaugural person and avoiding double negatives. The concluding draft of questionnaire was subjected to check for content cogency by a group of experts in Internal music, metabolic disease, physical and checkup reclamation, statistics and gastroenterology, and homo nutrition. significant modifications that rose from this stage were phrasing the questions with childlike words, making questions well apprehensible for patients and elimination of the items which are duplicate and equivocal. A full of five ambiguous items were deleted at this stage. The concluding blueprint of questionnaire with 15 items was applied to 20 corpulent NAFLD patients who came to medicine OPD, to look for relevance ; clearness ; readability which would last establish reconstruct cogency. All the participants were able to interpret the questions easily and no modification was done .

Description of final questionnaire

The questionnaire developed composed of 15 questions under two domains, diet and physical activeness. A entire of 12 questions were under diet domain and 3 questions were under physical activity. Each of these questions is on Likert type items, from 1 to 5. As a result, summation of scores of 15 items provides data on Likert scale, with a minimum score as 15 and maximum score as 75 .

Validation phase

The draft of questionnaire with 15 items was applied to 100 corpulent NAFLD patients, who attended Medicine and Gastroenterology OPD in AIIMS .

Background of participants

Out of the 100 corpulent NAFLD patients, 56 were male participants. The average age was 38.43 years ( SD : 9 ) ; mean body weight unit, 75.14 kilogram ( SD : 12.26 ) ; entail altitude, 163.34 curium ( SD : 9.35 ) ; mean BMI, 28.29 kg/m2 ( SD : 4.18 ). Baseline liver affair quiz ( LFT ) was besides done, base serum glutamic oxaloacetic transaminase ( SGOT ) was 46.69 ( SD : 14.99 ), beggarly serum glutamic pyruvic transaminase ( SGPT ) was 60.74 ( SD : 20.28 ), mean bilirubin was 0.6 ( SD : 0.2 ). These service line characteristics are depicted in .

Table 1

VariablesMean±Standard DeviationAge (in years)38.43±9.0Weight (in kg)75.14±12.26BMI28.29±4.18SGOT (IU/L)46.69±14.99SGPT (IU/L)60.74±20.28Bilirubin (mg/dl)0.6±0.2Open in a separate window

Item reduction

Correlation matrix of variables was done to look for correlation between the questions and reducing the number of the questions. With regards to correlation between items, 1 couple of items exhibited correlation coefficient of 0.7 or higher. Those were wonder numbers 14 and 15 ( correlation coefficient matrix is available as ). One of the questions among both was removed because correlation coefficient between both of them was greater than 0.7, after discussing with experts regarding the lapp. The concluding enlist of questionnaire after seeing correlation coefficient is composed of 14 questions under two domains, diet and physical activity. And 12 questions were under diet sphere and 2 questions were under physical natural process. Final draft of questionnaire is available as box 1. Following this, component analysis was done .

Supplementary Table 1

CorrelationQ1Q2Q3Q4Q5Q6Q7Q8Q9Q10Q11Q12Q13Q14Q15Q11.0000.1940.2130.0690.1820.2110.2160.1620.1150.1720.1170.200-0.0900.1490.134Q20.1941.0000.2940.3480.1480.3460.1720.0830.2900.4130.0530.4040.0970.1570.167Q30.2130.2941.000-0.0750.1530.1720.119-0.0710.0740.5000.2410.4350.1720.1870.147Q40.0690.348-0.0751.0000.157-0.0380.0300.2220.1750.0950.0880.0970.039-0.0450.029Q50.1820.1480.1530.1571.0000.2400.211-0.063-0.0560.4020.2530.3470.0340.1740.202Q60.2110.3460.172-0.0380.2401.0000.1770.0460.3300.3920.0600.192-0.0880.0350.075Q70.2160.1720.1190.0300.2110.1771.0000.1010.1800.338-0.0150.282-0.2750.0940.056Q80.1620.083-0.0710.222-0.0630.0460.1011.0000.154-0.0080.1150.0540.1220.1890.202Q90.1150.2900.0740.175-0.0560.3300.1800.1541.0000.4110.0940.121-0.132-0.059-0.102Q100.1720.4130.5000.0950.4020.3920.338-0.0080.4111.0000.2510.5620.0100.1660.174Q110.1170.0530.2410.0880.2530.060-0.0150.1150.0940.2511.0000.1450.245-0.162-0.184Q120.2000.4040.4350.0970.3470.1920.2820.0540.1210.5620.1451.0000.1250.1030.155Q13-0.0900.0970.1720.0390.034-0.088-0.2750.122-0.1320.0100.2450.1251.0000.072-0.008Q140.1490.1570.187-0.0450.1740.0350.0940.189-0.0590.166-0.1620.1030.0721.0000.908Q150.1340.1670.1470.0290.2020.0750.0560.202-0.1020.174-0.1840.155-0.0080.9081.000Open in a separate window

Adherence to Lifestyle Modification Advices in Non-alcoholic Fatty Liver Disease Questionnaire

Q1 How frequently do you eat meals in a sidereal day ( including tea, coffee bean, fruits, salads, snacks ) ?

  • A ) > 6 times
  • B ) 6 times
  • C ) 5 times
  • D ) 4 times
  • vitamin e ) 3 times .

Q2 How frequently do you drink sweetened beverages like soft drinks, juices, etc. ?

  • A ) At least once daily
  • B ) 3 to 6 times a week
  • C ) 1 to 2 times a workweek
  • D ) 2 to 3 times a calendar month
  • vitamin e ) once a month or less .

Q3 How frequently do you eat sweets such as Laddu, Barfi, Jalebi, Kulfi, Chocolate, Halwa, Rice pudding, etc. ?

  • A ) At least once daily
  • B ) 3 to 6 times a workweek
  • C ) 1 to 2 times a week
  • D ) 2 to 3 times a calendar month
  • e ) once a month or less .

Q4 How much do you eat fried foods such as Puri, Parathas, Kachori, Tikki, Bhature, Pakoras, Samosas etc. ?

  • A ) At least once casual
  • B ) 3 to 6 times a workweek
  • C ) 1 to 2 times a week
  • D ) 2 to 3 times a month
  • e ) once a calendar month or less .

Q5 How often do you eat gamey salt snacks such as Namkeen, Bhujia, Pickles, Chutney, Papad etc. ?

  • A ) At least once casual
  • B ) 3 to 6 times a week
  • C ) 1 to 2 times a week
  • D ) 2 to 3 times a month
  • einsteinium ) once a calendar month or less .

Q6 How much do you consume carbohydrate and honey in tea, coffee, curd, lassi, etc ?

  • A ) At least once day by day
  • B ) 3 to 6 times a workweek
  • C ) 1 to 2 times a week
  • D ) 2 to 3 times a month
  • east ) once a calendar month or less .

Q7 How much do you eat fruit and salad ?

  • A ) Every time in the main diet
  • B ) At least once a day
  • C ) 3 to 4 times a week
  • D ) 1 clock a week
  • e ) Less than once a week .

Q8 How frequently do you eat sprouted pulses and park vegetables ?

  • A ) Every clock in the chief diet
  • B ) At least once a day
  • C ) 3 to 4 times a week
  • D ) 1 time a workweek
  • e ) Less than once a week .

Q9 How much do you eat saturated fat like mouton fat, testis yolks, etc. ?

  • A ) At least once casual
  • B ) 3 to 6 times a week
  • C ) 1 to 2 times a workweek
  • D ) 2 to 3 times a calendar month
  • east ) once a calendar month or less .

Q10 How often do you eat refined food items like burgers, pizza, etc. ?

  • A ) At least once daily
  • B ) 3 to 6 times a workweek
  • C ) 1 to 2 times a week
  • D ) 2 to 3 times a calendar month
  • einsteinium ) once a calendar month or less .

Q11 How often do you eat ghee, butter, skim, mayonnaise, etc. ?

  • A ) At least once daily
  • B ) 3 to 6 times a workweek
  • C ) 1 to 2 times a workweek
  • D ) 2 to 3 times a calendar month
  • einsteinium ) once a calendar month or less .

Q12 How frequently do you eat out of the house ( such as marriage, party, family function etc. ) ?

  • A ) More than 3 times a week
  • B ) More than once a workweek
  • C ) 2 times in a calendar month
  • D ) 1 time in a month
  • vitamin e ) Less than 1 time in a month .

Q13 How many days do you exercise in a workweek ?

  • A ) daily
  • B ) 5 to 6 times a workweek
  • C ) 3 to 4 times a week
  • D ) 1 to 2 times a week
  • east ) never .

Q14 How much meter do you exercise for each school term ?

  • A ) > 40 minutes
  • B ) 30–40 minutes
  • C ) 20–30 minutes
  • D ) 20–10 minutes
  • vitamin e ) < 10 minutes .

Factor analysis

The questionnaire was constructed keeping two domains in take care. Factor analysis was performed using the chief factor method acting and varimax rotations to examine the domain social organization. Kaiser ‘s standard was used to enter the 14 items into the analysis and 6 components were extracted. A varimax rotation was performed to distribute the full discrepancy explained by the 6 components more evenly. After exploratory factor analysis, we got around 6 domains which could explain approximately 69.07 % of the division as shown in. We segregated 14 questions under 6 domains with each domain containing those questions with utmost loadings .

Supplementary Table 2

ComponentInitial EigenvaluesRotation Sums of Squared LoadingsTotal% of VarianceCumulative %Total% of VarianceCumulative %13.33023.78923.7892.87820.55820.55821.55211.08334.8711.49110.64731.20631.41210.08744.9581.41710.12341.32941.2929.23254.1901.3169.39750.72651.0717.65061.8401.3079.33660.06261.0127.23169.0711.2619.01069.07170.8746.24375.31580.8085.77481.08990.6614.72285.810100.5243.74489.554110.4743.38692.940120.4172.97895.918130.3122.22898.147140.2591.853100.000Open in a separate window

Reliability

The questionnaire showed dependable internal consistency in this sample distribution with Cronbach ‘s alpha of 0.94 indicating satisfactory inner consistency .

Discussion

The looming epidemic of lifestyle-related diseases is chiefly attributed to the improper dietary habits and physical inactivity. [ 7 ] Adherence to healthy life style advices not only reduces the risk but besides plays an authoritative function in the management of lifestyle-related diseases. Motivating patients to remain adherent to these advices is a huge challenge for family physicians and populace health professionals. [ 8 ] We developed and validated a questionnaire that will help class physicians to assess affected role ‘s adhesiveness to lifestyle modification devices particularly those pertaining to diet and exercise. Besides, this will besides help them to identify domains of nonadherence and thus assistant in individualizing the management and improve the adhesiveness to lifestyle alteration advices. The develop questionnaire is a short and concise tool with 14 items. All domains which are crucial for achieving and maintaining healthy burden like quantity and timbre of diet, meal type and frequency, saturation and duration of physical bodily process have been included in this questionnaire. Under the diet sphere, questionnaire has items to check individual ‘s inhalation of calorie dense unhealthy foods, such as fried foods, sugar sweetened beverages, firm foods containing saturated fats and refined flour, processed foods with excess salt content, etc. Besides, there are questions to assess the inhalation of healthy food items, such as fruits, salads, sprouts, etc. Questions pertaining to physical activity focusing on the frequency and duration of exercise per week have besides been included. In the last 1 ten, researchers from different parts of the global have shown sake in studying behavioral view of patients in the management of lifestyle-related diseases. [ 9 ] Tools have been developed to assess cognition, attitude, and practices of patients suffering from diverse lifestyle-related diseases. [ 10, 11 ] There are studies chiefly from the western countries, which have emphasized on studying the attachment to diet and exercise advices in lifestyle-related diseases. [ 12, 13 ] Some of these questionnaires, individually focused on diet and physical natural process, while some of them have addressed multidimensional components of life style. [ 14 ] A 25-item questionnaire called UK Diabetes and Diet ( UKDDQ ) was developed in 2016, for a agile assessment of dietary consumption in diabetic patients. [ 15 ] In Brazil, the fantastic life style questionnaire has been translated and validated for use in 2008, which assesses the life style of young adults. [ 16 ] Similarly, another questionnaire called as the Lifestyle Appraisal Questionnaire was published in the class 2007, which was designed to assess multifactorial aspects of life style including accumulative risks along with perceive stress of liveliness. [ 17 ] No such undertake has been made from the amerind subcontinent to develop a questionnaire which can assess the attachment to lifestyle modification advices. Since there is a score sociocultural difference among people from different demographic regions, there is a necessitate to modify and adapt the questionnaires made in the western countries, before their use in indian population. The questionnaire is beginning of its kind in the indian frame-up that has used diet and exercise domains relevant to our nation. It can be used in about all lifestyle-related diseases, where attachment to diet and physical bodily process guidelines is important to maintain healthy system of weights. This questionnaire was built, modified, and validated by using standard methods. We found that questionnaire has good comprehensibility, face validity, message cogency, and patient adoption. One advantage of this tool is that it is less time-consuming and does not take more than 5 minutes to administer. It has simpleton phrases and is in easily apprehensible speech to the patients. As of now there are no such tools to assess attachment to lifestyle advices in lifestyle-related diseases, this tool can be instrumental in generation of data related to the charge and reasons of miss of conformity and/or nonadherence. This questionnaire was developed by interviewing patients, majority of who belonged to North India. Thus, slender changes would be required for its use in unlike parts of the country, according to the regional dietary habits/food items preferences. Generalizability of the questionnaire could be increased by increasing the sample size. In our cogitation, only 20 participants were used for cognitive debriefing. A large total of participants need to be assessed in ordering to draw a firm conclusion, but our questionnaire had dependable dependability and robustness which would have detected any changes. Another point to emphasize is that whether a self-administered questionnaire would have provided a more objective way of administering a questionnaire. Such an instrument would decidedly reduce reception diagonal and interobserver unevenness.

Conclusion

Based on our analysis, we conclude that this questionnaire is a dependable and valid instrument to assess attachment to lifestyle modification advice in lifestyle-related diseases, particularly in Northern Indian population. We think it can besides be useful in any population when few modifications are made in the questionnaire, according to the regional dietary habits. This questionnaire makes way for future research where early important domains, such as stress, alcohol, smoke, etc., can be incorporated in this questionnaire, to cover all aspects of healthy life sentence .

Financial support and sponsorship

Nil .

Conflicts of interest

There are no conflicts of interest .

informant : https://nutritionline.net
Category : WEIGHT LOSS