(P07-022-23) Is The Teen Moms Child Feeding Readiness to Change Questionnaire for Sub-Saharan Africa a Psychometrically Valid Instrument for Evaluating Stages of Behavioral Change?

Objectives: In Sub-Saharan Africa, 3.5 million children (0 – 5 years) die annually from child undernutrition linked with inadequate dietary intake. Among teenage mothers, theory-based behavior change interventions can improve infant and young child feeding (IYCF). This study created and validated the Teen Moms Readiness to Change Questionnaire for Sub-Saharan Africa, to measure three of six transtheoretical stages of behavior change in IYCF interventions.

Methods: Nineteen Likert-type items were generated with 5-point responses from “strongly agree” to “strongly disagree.” Content validation by ten experts, and assessment of comprehensibility by six teenage mothers led to deletion of two items. Construct validation was conducted in 150 low-income, teenage mothers in Abuja, Nigeria. Item discrimination and difficulty indices, and item characteristic and scale information curves were obtained using polytomous item response theory. Molenaar Sijtsma rho coefficients and standardized chi-square determined internal consistency reliability and model fit, respectively.

Results: The final instrument contained three questions in the precontemplation subscale, and four questions each in the contemplation and action subscales. All items had factor loadings > 0.4, and exhibited good discriminating properties (≥ 1). Items Q4 (2.957) and Q7 (0.939) were the most and least discriminating items, respectively. Item difficulty estimates (-4.272 to 3.022) covered a wide range of ability to perform the latent construct (readiness to change). Item characteristic curves showed that the answer choice “neither agree nor disagree” was not frequently chosen across all items, resulting it its removal. The precontemplation subscale was more precise in estimating scores of particpants with low levels (-2 to 0) of readiness to change; the contemplation and action subscales precisely estimated scores of participants with average ability related to the underlying construct (-1 to +1). All rho coefficients, Root Mean Square Errors of Approximation and p-values met the cut-off criteria.

Conclusions: The Teen Moms Child Feeding Readiness to Change Questionnaire for Sub-Saharan Africa is a valid tool for documenting the progress of teenage mothers along the continuum of change in IYCF interventions.

Funding Sources: Funded by the Schlumberger Foundation Faculty for the Future Program