RESUMEN
Objective: This study aimed to initially adopt an International Healthy Eating Report Card for Preschool-Aged Children to assess the prevalence of healthy eating behaviours and favourable family home food environments (FHFEs) among preschool-aged children in Australia, Hong Kong, Singapore, and the US. We also examined which cultural contexts would exhibit significant differences in the report card scores among the four cultural contexts. Methods: In this cross-cultural study, 2059 parent-child dyads, with approximately 500 dyads in each cultural context, were recruited. The parents were asked to complete the validated International Healthy Eating Report Card Scale to assess the dimensions of the Report Card [i.e., Indicator of Children's Eating Behaviours: (1) Children's Dietary Patterns and (2) Children's Mealtime Behaviours, and Indicator of FHFEs: (3) Parental Food Choices and Preparation, (4) Home Healthier Food Availability and Accessibility and (5) Family Mealtime Environments]. Each indicator received a letter grade [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. We also employed ANCOVA and Bonferroni's post-hoc test to examine the differences in the report card scores between the four cultural contexts. A significance level was set at p < 0.05. Results: The average overall report card grade across the four cultural contexts was "B-" (Good), ranging from "C+" (Singapore and the US) to "B-" (Australia and Hong Kong). The average grade for Children's Eating Behaviours was classified as Fair ("C-"), while the average grade for FHFEs was classified as Good ("B+") for all cultural contexts. A comparison of the overall report card scores revealed that Australia exhibited a significantly higher report card score than Singapore and the US, while Hong Kong achieved a significantly higher score than Singapore. Conclusion: The International Healthy Eating Report Card provided an overview of the prevalence of healthy eating in different cultural contexts. We believe that the International Healthy Eating Report Card may offer new perspectives on interventions for fostering healthy eating in young children.
RESUMEN
Objective: This study aimed to develop and validate a globally applicable assessment tool of the 43-item International Healthy Eating Report Card Scale (IHERCS) which was designed to assess preschool-aged children's eating behaviours and family home food environments (FHFEs) across different cultural settings. In particular, we examined the factor structure, internal consistency and measurement invariance of the IHERCS across four cultural samples, including Australia, Hong Kong, Singapore, and the US. Convergent and discriminant validity were then conducted. Methods: In this cross-cultural study, a total of 2059 parent-child dyads from these four regions were recruited, and the parents were asked to complete the IHERCS. An exploratory structural equational modelling approach was employed to examine two higher-order factor models of children's eating behaviours and FHFEs in the IHERCS and its cross-cultural measurement invariance. Results: The findings demonstrated robust factor structures of the scales of children's eating behaviours and FHFEs in the IHERCS (i.e., CFI and TLI > 0.90; RMSEA and SRMR < 0.08) and an acceptable level of internal consistency (i.e., Cronbach's α = 0.55-0.84). Full configural invariance and metric invariance were established across the four cultural contexts, but full scalar invariance was not achieved. Partial scalar invariance was found only in the scale of FHFEs. The convergent validity and discriminant validity were supported. Conclusion: Overall, the current findings provided preliminary support for the construct validity and measurement invariance of the IHERCS. It provides a reliable, valid and comprehensive assessment of eating behaviours and FHFEs among children in different cultural settings.