Background: The rising prevalence of childhood obesity is a major health problem worldwide. Hence, there is a growing need for health professionals to become capable of assessing the factors that determine lifestyle in a culturally relevant manner.
Objectives: This study aimed to develop and assess a questionnaire for measuring determinants of obesity-related behaviors in Tehranian adolescents.
Patients and methods: Based on the results of a qualitative study and an extensive literature review, the 44-item "Inventory of determinants of obesity-related behaviors in adolescents (IDOBA)" with eight subscales was developed: 1) unhealthy nutrition and physical inactivity; 2) stress-related eating; 3) perceived inability; 4) perceived lack of threat; 5) perceived priority of educational achievement; 6) perceived acceptability; 7) motivation loss; and 8) lack of support. Validity of IDOBA was assessed, utilizing face, content, and construct validity methods. To confirm face validity, ten overweight/obese adolescents completed the questionnaire. To calculate content validity ratio (CVR) and content validity index (CVI), a different panel of ten experts commented independently on the necessity, relevance, clarity, and simplicity of each item. To assess construct validity using exploratory factor analysis (EFA), a total of 478 adolescents (57.7% male) aged 13 to 18 years, who were recruited from schools, participated in the study. Confirmatory factor analysis (CFA) was used to test whether the data fit the hypothesized measurement model that was derived from EFA. Test-retest and internal consistency methods were used to assess reliability of the IDOBA scale.
Results: All items were perceived as relevant and comprehendible by adolescents. Content validity was confirmed by the panel of experts. The internal consistency, as measured by Cronbach's alpha coefficients, exceeded the minimum reliability standard of 0.60 for eight subscales. No ceiling effects were observed. Detected floor effects ranged from 0.2% for perceived acceptability subscale score to 18.8% for lack of threat subscale score. The EFA suggested an eight-factor construct and the results of the CFA indicated acceptable fit indices for the proposed model. All subscales demonstrated satisfactory test-retest reliability (intra-class correlation coefficient, 0.42 - 0.91) over one month.
Conclusions: Results provided initial evidence that the IDOBA is a valid and reliable instrument for measuring determinants of obesity-related behaviors in Iranian adolescents, indicating that the questionnaire can be used in future weight management programs for Tehranian adolescents.
Keywords: Adolescent; Iran; Obesity; Reliability; Validity.