Children's Dietary Knowledge, Skills, and Attitudes: Measurement Issues
Contento, Isobel R., Journal of School Health
Reflecting different approaches to studying dietary behavior and conducting nutrition education, dietary knowledge and attitude measurement instruments for children can be divided into two categories. The more general approach studies many factors influencing children's dietary practices. It also examines the effects of nutrition education programs on the knowledge, skills, and attitudes needed by children to understand broad, contemporary food and nutrition issues and to select a diet that is good for general health.
The nutrition education literature is replete with instruments to assess the effects of these general interventions, but the instruments often are used only once and psychometric data are lacking or inadequate. [1-3] A more specific and recent approach studies dietary behavior that predispose to diet-related chronic diseases, particularly heart disease, and examines effects of interventions on the knowledge, skills, and attitudes needed to adopt behaviors that will reduce risk of these specific conditions. [4,5]
The Centers for Disease Control published a compendium of instruments that covers a variety of contemporary topics reflecting both approaches.  The instruments appear interesting and useful, but psychometric data are not available. In this article, selected instruments used during the past decade tat exemplify both approaches are reviewed. The instruments are used in conjunction with comprehensive programs, and psychometric data on them have been published.
ATTITUDES, AND SKILLS
Psychometric data for the general nutrition scales are presented in Table 1. Instruments for evaluating the "Food . . . Your Choice" curriculum for grades K-6 assess knowledge in seven areas: physiological facts, nutrients, food handling, life cycle nutrition, social/psychological aspects of food, food technology, and nutrition, and society.  Prototypes were field-tested with 3,393 students natiowide. The instruments, one for each grade in a multiple-choice format, were subject to thorough item analysis and to validity and reliability assessments. Scores are the sum of correct answers. Pictures are employed as response options for K-2. The same seven conceptual areas from the basis of the knowledge instrument for grades 7-10. 
Another set of general knowledge instruments was developed for "Nutrition in a Changing World," a K-12 sequential curriculum. [9-11] Eating a variety of foods provides a theme for all grades with consumer issues added in the upper grades. Questions in the elemantary grades ask about vitamin content of foods, the four food groups, ethnic foods, and foods in the grocery store. Questions for junior and senior high levels also are directed at general nutrition concerns such as the role of vitamins, minerals, calories, and fat in the diet. A multiple-choice format is used with picture responses in the early grades Questions are read aloud to students in the elementary grades.
Attitude scales also were developed for "Nutrition in a Changing World." [9-11] For the lower grades, three a priori scales assess the constructs, "I feel good about 1) eating new/different foods, 2) eating vegetables, and 3) foods that make me healthy." For the upper elementary grades an additional construct was included, 4) learning about what to eat. There are approximately five items per scale. In lower grades, children circle one of three faces (smiling, neutral, or frowning). In the upper grades, children respond on a three-point scale from least positive to most positive. Examples of items are: mark the option or picture which "tells how you feel about foods that give you energy," or "tells how you feel about learning about the four food groups." Scores range from one-three for each scale. Construct validity was confirmed with factor analysis. Attitude scales for this curriculum for junior high and senior high school students involve four similar a priori constructs. …