Adaptation and validation of the Perceived Nutrition Environment Measures Survey for the Chilean context (NEMS-P-Ch)

Abstract

There is an increasing interest in having validated instruments that can classify food environments due to their influence on eating behavior and nutritional status. In Chile, it is not known how people perceive food environments and only a few studies have adapted instruments to the Chilean context, all of which use objective measures. The aim of this study is to present the adaptation and validation of the Perceived Nutrition Environment Measures Survey (NEMS-P-Ch) for Chile using a cross-sectional, non-probability study. First, the NEMS-P was adapted in 3 stages: cultural translation and adaptation, expert judgment (focus groups), and cognitive interviews with a population similar to the target audience. Then, the adapted questionnaire (NEMS-P for Chile, NEMS-P-Ch) was tested on people responsible for buying food in their homes in the Metropolitan Region, Chile, for statistical validation. After 200 people completed the questionnaire a final version of the NEMS-P-Ch was generated with 48 questions and seven sections that measure food environments: home, food supply, restaurants and street. NEMS-P-Ch had acceptable reliability in more than half of the questions analyzed, with Cronbach's alpha values between 0.44 and 0.82. Acceptable values were also obtained for most of the questions when the consistency of the instrument was evaluated after applying it for the second time (n= 167). The NEMS-P-Ch adapted to the Chilean context showed acceptable validity and reliability. Having instruments adapted and validated to the national reality will promote their use and adaptation in other countries of the region and thus deepen the study of food environments in various territories and populations.

Validity and reliability of the Perceived Nutrition Environment Measures Survey (NEMS-P) for use in Brazil

“…Regarding intra-rater reliability, the instrument demonstrated acceptable reliability for most of the questions analysed, as was observed in the original scale ( 14 ) , in the adaptation for the Spanish population ( 15 ) and to the Chilean context ( 16 ) . Most items showed acceptable values between 0·563 and 0·878, demonstrating the stability of the instrument to provide the same results when repeated in the same individuals and obtained at different moments in time.…”

“…In order to assess the validity and reliability, questions with ordinal scales and those used in the original article were selected (14) , validated for Spanish (14) and validated to the Chilean context (16) . For this purpose, the questions below were selected: question 3, which assesses the accessibility of healthy and unhealthy foods at home through a four-point scale of 'never or rarely' (1) to 'almost always' (4); question 10 regarding the importance of the decision to go to the establishment where most food purchases are made with a four-point scale from 'not at all important' (1) to 'very important' (4); question 11 whether it is easy or not finding healthy and unhealthy foods where most purchases are made with a four-point scale 'very easy' (1) 'very difficult' (4); question 14 in relation to the establishment where one buys most of their food and shopping habits, with a five-point scale 'strongly disagree' (1) to 'strongly agree' (5) and question 19 in relation to the most frequented restaurant with a five-point scale 'strongly disagree' (1) to 'strongly agree' (5).…”

“…However, there were also low values for items related to accessibility to healthy options in restaurants (0·253) and for the last items on motivation of choice of place of purchase (0·263) ( 15 ) . And in the version for the Chilean context of the NEMS-P-Ch, reliability levels varied between 0·44 and 0·88, with low values referring to aspects of food at home ( 16 ) . These results demonstrate that the instrument has good internal reliability, that is, the questions measure what they are intended to do ( 29 ) .…”

“…The tool measures the perception of individuals based on its theoretical model, subdivided into three environments: home, consumer and community ( 14 ) . It was also validated for Spanish and the Chilean context, demonstrating its feasibility after cultural adaptations ( 15 , 16 ) .…”