Assessing and monitoring healthy eating among preschool-aged children : a report card approach /

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Student Theses

2024

Wan, Wing Lam Alison

Hong Kong : The Education University of Hong Kong

Thesis

Childhood obesity has become a global epidemic. Healthy eating behaviours and favourable family home food environments (FHFEs) play pivotal roles in preventing obesity. This has sparked calls for assessing the prevalence of healthy eating among preschool-aged children. This thesis includes three inter-related studies presenting the comprehensive development and application of the Healthy Eating Report Card for Preschool-Aged Children at both the regional and international levels. It is considered an innovative tool for assessing, monitoring and promoting healthy eating behaviours and favourable FHFEs among preschool-aged children. Study 1 (Chapter 2) is a cross-sectional study that initially developed a Healthy Eating Report Card for Preschool-Aged Children in Hong Kong. Among the 538 parent-child dyad participants, the report card assessed children's eating behaviours and FHFEs using a traditional grading system (i.e., A (≥ 80%) = Excellent, B (60-79%) = Good, C (40%-59%) = Fair, D (20%-39%) = Poor, F (<20%) = Very Poor and including the plus (+) and minus (-) signs) to represent the proportion of participants who could meet the predefined benchmarks. The findings revealed that children's eating behaviours were classified as Fair ("C"), while FHFEs were Good ("B") and highlighted the need to examine the reliability and validity of the assessment tool and establish an international-level Healthy Eating Report Card for analysing cultural variations in the prevalence of healthy eating among preschool-aged children. Study 2 (Chapter 3) was built on Study 1 to validate the assessment tool of the International Healthy Eating Report Card Scale (IHERCS) across different cultural contexts. A total of 2059 parent-child dyads from Australia, Hong Kong, Singapore, and the US participated in this cross-cultural study. Exploratory structural equation modelling (ESEM) was employed to examine the psychometric properties of the assessment tool. The findings demonstrated robust support for the construct validity and measurement invariance of the IHERCS facilitating the international assessment of eating behaviours and FHFEs in young children.Study 3 (Chapter 4) extended the application of the International Healthy Eating Report Card for Preschool-Aged Children to provide an overview of the prevalence of healthy eating behaviours and FHFEs among preschool-aged children. Utilising data from nearly 2000 parent-child dyads in Study 2, this cross-cultural study compared report card grades across those cultural contexts. The overall report card grades ranged from "C+" to"B-". Statistically significant differences between the report card scores of the different cultural contexts were observed. Australia had a significantly greater overall report card score than Singapore and the US, with Hong Kong also achieving a significantly greater score than Singapore. These findings highlighted the value of the International Healthy Eating Report Card in providing cross-cultural comparisons, identifying areas for the improvement of healthy eating, and ultimately informing public health initiatives and policy changes. Overall, the Healthy Eating Report Card may offer a novel and systematic approach for assessing the prevalence of healthy eating behaviours and favourable FHFEs among preschool-aged children. By providing a reliable, valid and comprehensive assessment tool for assessing children's eating behaviours and FHFEs across different cultural contexts, this tool can support global efforts to promote healthier eating habits and favourable home food environments and ultimately combat childhood obesity

LG51.H43 Dr 2024eb Wanwla

https://educoll.lib.eduhk.hk/records/RQJR9XZA