Use of an Observational Comparative Strategy Demonstrated Construct Validity of a Measure to Assess Adherence to the Satter Division of Responsibility in Feeding.

BACKGROUND: Currently developed parent feeding measures do not exclusively measure behaviors compatible with theoretical underpinnings of the Satter Division of Responsibility in Feeding for Children Aged 2 to 6 Years (sDOR.2-6y). A measure of adherence to sDOR.2-6y has been constructed and shown to have translational validity. OBJECTIVE: To examine the construct validity of the 15 sDOR.2-6y items. DESIGN: Observations from in-home mealtime video-capture in a household with a child aged 2 to 6 years were compared with parent sDOR.2-6y responses. One sDOR.2-6y item about mealtime regularity was compared with mealtime data provided in the Automated Self-Administered 24-Hour Dietary Assessment Tool that had been completed by a larger sample of parents that included the smaller sample of video-capture participants. PARTICIPANTS/SETTING: Parents of preschool children aged 2 to 6 years in central Pennsylvania participated in Automated Self-Administered 24-Hour Dietary Assessment Tool online dietary assessment (n = 61) from May to November 2013 or in-home mealtime video-capture (n = 20) during October 2013 or both (n = 16). MAIN OUTCOME MEASURES: Consensus of three trained sDOR coders of plausible parent sDOR.2-6y item responses after video viewing, parent responses to sDOR.2-6y items, and mealtime regularity from three Automated Self-Administered 24-Hour Dietary Assessment Tool recalls. STATISTICAL ANALYSIS: Data analysis included identification of codeable 5-minute segments, coding by three sDOR experts, intraclass correlation coefficient, and determination of coder congruence to establish plausible sDOR.2-6y responses and comparison between coder-observed and parent sDOR.2-6y responses. RESULTS: Video-capture participants were mostly women, White, and overweight with a mean ± standard deviation age of 35.3 ± 6.4 years. Postvideo debriefing supported the observed meal as typical in location, timing, and composition. Of 273 coding decisions, coder congruence was inadequate or dissonant for 3.7% and intraclass correlation coefficient was 0.81 (0.77 to 0.84; P < 0.001). Parent and congruent coder responses were in agreement for nearly 70% of the possible comparisons. Of the original 15 items, three were deemed not valid, nine of the remaining 12 were considered valid, and three could not be invalidated. CONCLUSIONS: Congruence between observed and self-reported behaviors supported additional validation and scoring studies with the 12-item sDOR.2-6y to assess adherence of parents to sDOR.

Development of a tool to assess adherence to a model of the division of responsibility in feeding young children: using response mapping to capacitate validation measures.

BACKGROUND: Accurate early assessment and targeted intervention with problematic parent/child feeding dynamics is critical for the prevention and treatment of child obesity. The division of responsibility in feeding (sDOR), articulated by the Satter Feeding Dynamics Model (fdSatter), has been demonstrated clinically as an effective approach to reduce child feeding problems, including those leading to obesity. Lack of a tested instrument to examine adherence to fdSatter stimulated initial construction of the Satter Feeding Dynamics Inventory (fdSI). The aim of this project was to refine the item pool to establish translational validity, making the fdSI suitable for advanced psychometric analysis. METHODS: Cognitive interviews (n = 80) with caregivers of varied socioeconomic strata informed revisions that demonstrated face and content validity. fdSI responses were mapped to interviews using an iterative, multi-phase thematic approach to provide an instrument ready for construct validation. RESULTS: fdSI development required five interview phases over 32 months: Foundational; Refinement; Transitional; Assurance; and Launching. Each phase was associated with item reduction and revision. Thirteen items were removed from the 38-item Foundational phase and seven were revised in the Refinement phase. Revisions, deletions, and additions prompted by Transitional and Assurance phase interviews resulted in the 15-item Launching phase fdSI. Only one Foundational phase item was carried through all development phases, emphasizing the need to test for item comprehension and interpretation before psychometric analyses. CONCLUSIONS: Psychometric studies of item pools without encrypted meanings will facilitate progress toward a tool that accurately detects adherence to sDOR. Ability to measure sDOR will facilitate focus on feeding behaviors associated with reduced risk of childhood obesity.

Eating competence: definition and evidence for the Satter Eating Competence model.

The evidence- and practice-based Satter Eating Competence Model (ecSatter) outlines an inclusive definition of the interrelated spectrum of eating attitudes and behaviors. The model is predicated on the utility and effectiveness of biopsychosocial processes: hunger and the drive to survive, appetite and the need for subjective reward and the biological propensity to maintain preferred and stable body weight. According to ecSatter, competent eaters have 1) positive attitudes about eating and about food, 2) food acceptance skills that support eating an ever-increasing variety of the available food, 3) internal regulation skills that allow intuitively consuming enough food to give energy and stamina and to support stable body weight, and 4) skills and resources for managing the food context and orchestrating family meals. Identifying these four constructs allows nutrition professionals to target interventions as well as trust and support the individual's own capabilities and tendency to learn and grow.

Measuring eating competence: psychometric properties and validity of the ecSatter Inventory.

OBJECTIVE: Assess validity of the ecSatter Inventory (ecSI) to measure eating competence (EC). DESIGN: Concurrent administration of ecSI with validated measures of eating behaviors using on-line and paper-pencil formats. SETTING: The on-line survey was completed by 370 participants; 462 completed the paper version. PARTICIPANTS: Participants included 863 adults with 832 usable surveys from respondents (mean age 36.2 +/- 13.4 years) without eating disorders, mostly female, white, educated, overweight, physically active, and food secure. Of those indicating intent to complete the on-line survey, 80.3% did so; 54% of mailed surveys were returned. VARIABLES MEASURED: Eating and food behaviors compared among EC tertiles and between dichotomous EC categories; internal consistency of ecSI. ANALYSIS: Analysis of variance, independent t tests, chi-square, factor analysis, logistic regression. Significance level was P < .05. RESULTS: Mean ecSI score was 31.1 +/- 7.5. ecSI included 4 subscales with internal reliability and content validity. Construct validity was supported by specific behavioral profiles for ecSI tertiles and ecSI dichotomized categories. Persons unsatisfied with weight were 54% less likely to be EC; unit increase in the food like index was associated with nearly 3 times greater likelihood of being EC. CONCLUSIONS AND IMPLICATIONS: The ecSatter Inventory is a valid measure of EC and can be used for descriptive and outcome measurements.

Reconceptualizing feeding and feeding disorders in interpersonal context: the case for a relational disorder.

The feeding of young children is fundamentally a relational and multisystemic process. Successful treatment of clinically significant feeding problems involves careful assessment of the full range of influences on the feeding relationship and integrated treatment approaches. However, current diagnostic approaches to feeding disorders tend to be reductionistic, exclusively focused on the child as an individual, and overly concerned with exclusionary criteria. Criteria are proposed for "Feeding Disorder Between Parent and Child" that address these limitations and embrace the complexity of feeding problems. A multiaxial diagnosis that describes the child (including medical, developmental, and behavioral characteristics); the parent; the parent-child relationship; and the social and nutritional context of feeding will more accurately speak to treatment planning in this population. The proposed diagnostic criteria were developed and refined on the basis of the available literature and many years of treatment experience across the authors of this article. The proposed diagnosis will support the development and evaluation of treatment packages with components specifically targeted to issues of the child, parent, parent-child interaction, and the broader environment.