How well do preschoolers identify healthy foods? Development and preliminary validation of the Dietary Interview Assessing Nutritional Awareness (DIANA)

Abstract

The current study aimed to develop and initially validate a brief Dietary Interview Assessing Nutritional Awareness (DIANA) that mapped onto the Stop-Light Diet System. Participants for this study included 69 preschool children (83% boys; mean age = 5.13 years; 86% Latino) recruited from two summer programs. Children were presented with 24 pictures and were asked to name the food and indicate how healthy they felt each food was by pointing to a smiley face (very healthy = Green/Go food), neutral face (somewhat healthy = Yellow/Slow food), or a sad face (not healthy at all = Red/Whoa foods). Psychometric properties of the DIANA were assessed via a baseline assessment while children were re-administered the DIANA within 4-6 weeks to ascertain the test-retest reliability. Discriminant validity was also assessed in an exploratory fashion with a small subsample (n = 11) of children who participated in a healthy-lifestyle intervention program (HIP). Results indicated that the internal consistency of the DIANA for both the expressive knowledge and the health classification scales was acceptable (α = .83 and .82, respectively) along with the test-retest reliability (ICC = .86 and .81, respectively). Lastly, children who participated in HIP experienced greater gains in their ability to classify food based on the Stop-Light System and greater expressive knowledge of Green/Go foods compared to children who did not participate in the intervention suggesting adequate construct validity. These findings highlight the feasibility and utility of the DIANA in assessing young children's knowledge of foods and their relative healthiness as well as its potential sensitivity to intervention effects.

Keywords: Health; Nutrition assessment; Pediatric obesity intervention; Preschool; Stop-light diet; Test development.