Development of a Tool to Stage Households’ Readiness to Change Dietary Behaviours in Kerala, India

Abstract

Dietary interventions and existing health behaviour theories are centred on individuals; therefore, none of the available tools are applicable to households for changing dietary behaviour. The objective of this pilot study was to develop a practical tool that could be administered by community volunteers to stage households in rural Kerala based on readiness to change dietary behaviour. Such a staging tool, comprising a questionnaire and its algorithm, focusing five dietary components (fruits, vegetables, salt, sugar and oil) and households (rather than individuals), was finalised through three consecutive pilot validation sessions, conducted over a four-month period. Each revised version was tested with a total of 80 households (n = 30, 35 and 15 respectively in the three sessions). The tool and its comparator, Motivational Interviewing (MI), assessed the stage-of-change for a household pertaining to their: 1) fruit and vegetable consumption behaviour; 2) salt, sugar and oil consumption behaviour; 3) overall readiness to change. The level of agreement between the two was tested using Kappa statistics to assess concurrent validity. A value of 0.7 or above was considered as good agreement. The final version was found to have good face and content validity, and also a high level of agreement with MI (87%; weighted kappa statistic: 0.85). Internal consistency testing was performed using Cronbach’s Alpha, with a value between 0.80 and 0.90 considered to be good. The instrument had good correlation between the items in each section (Cronbach’s Alpha: 0.84 (fruit and vegetables), 0.85 (salt, sugar and oil) and 0.83 (Overall)). Pre-contemplation was the most difficult stage to identify; for which efficacy and perceived cooperation at the household level were important. To the best of our knowledge, this is the first staging tool for households. This tool represents a new concept in community-based dietary interventions. The tool can be easily administered by lay community workers and can therefore be used in large population-based studies. A more robust validation process with a larger sample is needed before it can be widely used.

Changing household dietary behaviours through community-based networks: A pragmatic cluster randomized controlled trial in rural Kerala, India

“…As there was no tool till date to assess the stage of change at a household level as opposed to an individual level; key findings related to food decisions [ 36 ] and the conceptual model [ 26 ] were used to develop such a tool that could be administered by lay community volunteers. This staging tool used a simple algorithm to compute the household stage based on responses from the female heads of households [ 37 ] and, consequently, the tool was administered only to the female heads of the households in this pragmatic RCT. Efficacy and perceived cooperation at the household level were found to be crucial identifiers when assessing the household’s readiness to change dietary behaviour.…”

“…Efficacy and perceived cooperation at the household level were found to be crucial identifiers when assessing the household’s readiness to change dietary behaviour. A pilot validation of the tool was carried out before its use in the cRCT [ 37 ].…”

“…Tools were developed for: 1) screening; 2) staging of households’ readiness-to-change [ 37 ]; 3) general questionnaire for baseline and end-line data collection at the individual and household levels, which included two 24-hour recalls (one weekend + one weekday recall using multiple pass method to measure FV intake for the selected individual); a structured section to collect data on reported monthly SSO utlilisation at the household level and a 2-week FV procurement diary for the household; 4) process documentation to keep track of the various processes and strategies involved in the intervention; and 5) template counselling sheets specific to stage of change of the household to guide counsellors during face-to-face and telephonic counselling and briefly document the content of the session. All data collection tools were translated to the local language Malayalam, back translated and pre-tested before the baseline data collection.…”

Knowledge and lifestyle practices associated with non-communicable diseases risk factors among undergraduate students, Thiruvananthapuram, India: a mixed method study

“…5,6 A systematic review found high prevalence of NCD risk factors in Kerala mostly due to unhealthy dietary patterns and sedentary lifestyle. 7 A 10-year prospective study done in Kerala reports a high incidence of prediabetes showing an epidemic trend towards the development of type 2 diabetes mellitus and that it requires immediate public health action. 8 Bijumone S et al Int J Community Med Public Health.…”