RESUMO
Background: In order to improve national sport achievement in Indonesia, a new policy of nutritionist placement in every training center in Indonesia was proposed. The understanding of barriers and potential facilitators was needed to identify problems and arrange policy implementation strategies. Aim: This study aims to determine the barriers in nutrition intervention practices for athletes and opportunities in implementing the proposed policy of sport nutritionist placement in athlete training centers. Methods: The study was conducted using Consolidated Framework of Implementation Research (CFIR) as the guideline for data collection and analysis. In-Depth Interview (IDI) and Focus Group Discussion (FGD) were conducted on 9 participants from the Ministry of Youth and Sport, the Republic of Indonesia. Results: This study indicates that there are several potential barriers, which are influential on the implementation of nutrition support for athletes. These include the lack of facilitation of athletes' nutritional needs, lack of supervision for food catering service, lack of communication, and limited funding. In contrast, the potential facilitators are strong relationship with sport-related stakeholders, compatibility with the existing policy, relative advantages, and trialability of the proposed policy. Conclusions: The Indonesia Ministry of Youth and Sports should utilize these facilitators as opportunities to design, develop, and implement a policy that requires nutrition support available for all athletes at every PPLP in Indonesia.
RESUMO
BACKGROUND: Parental child feeding practices (PCFP) are a key factor influencing children's dietary intake, especially in the preschool years when eating behavior is being established. Instruments to measure PCFP have been developed and validated in high-income countries with a high prevalence of childhood obesity. The aim of this study was to test the appropriateness, content, and construct validity of selected measures of PCFP in a low and middle-income country (LMIC) in which there is both undernutrition and obesity in children. METHODS: An expert panel selected subscales and items from measures of PCFP that have been well-tested in high-income countries to measure both "coercive" and "structural" behaviors. Two sequential cross-sectional studies (Study 1, n = 154; Study 2, n = 238) were conducted in two provinces in Indonesia. Findings of the first study were used to refine subscales used in Study 2. An additional qualitative study tested content validity from the perspective of mothers (the intended respondents). Factorial validation and reliability were also tested. Convergent validity was tested with child nutritional status. RESULTS: In Study 1, a confirmatory factor analysis (CFA) model with 11 factors provided good fit (RMSEA = 0.045; CFI = 0.95 and TLI = 0.95) after two subscales were removed. Reliability was good among seven of the subscales. Following a decision to take out an additional subscale, the instrument was tested for factorial validity (Study 2). A CFA model with 10 subscales provided good fit (RMSEA = 0.03; CFI = 0.92 and TLI = 0.90). The reliability of subscales was lower than in Study 1. Convergent validity with nutrition status was found with two subscales. CONCLUSIONS: The two studies provide evidence of acceptable psychometric properties for 10 subscales from tested instruments to measure PCFP in Indonesia. This provides the first evidence of the validity of these measures in a LMIC setting. Some shortcomings, such in the reliability of some subscales and further tests of predictive validity, require further investigation.
