Development and validation of an illustrated questionnaire on healthy eating practices among Korean preschool children.

BACKGROUND/OBJECTIVES: An illustrated questionnaire, the Healthy Eating Practice Questionnaire (HEPQ), was developed and validated to assess healthy eating practices among Korean preschool children. SUBJECTS/METHODS: The development process consisted of 4 phases: (1) item generation based on a literature review and focus group interviews, (2) item refinement through expert consultation, (3) illustration design, and (4) validation. One hundred and eighty-seven child-parent pairs and 24 teachers participated in the validation study. The reliability was examined using test-retest analysis, and the validity was assessed by comparing the children's self-reports with those of their parents and teachers. The level of agreement was determined using the percentage agreement, kappa statistics, and intraclass correlation coefficient (ICC). RESULTS: The final 30-item questionnaire consisted of 4 domains: food preferences, eating behaviors, hand/oral hygiene practices, and nutrition knowledge. Most items showed a percentage agreement above 60% and kappa coefficients exceeding 0.5 in test-retest analysis, indicating acceptable consistency. The child-caregiver agreement was moderate to substantial, with kappa values generally above 0.4. The domain-level ICCs indicated good reliability (ICC = 0.49-0.83) and validity (ICC = 0.33-0.77) across all domains and subgroups. The comparisons by age showed that 4-yr-olds provided valid and reliable responses comparable to 5-yr-olds. The parents and teachers confirmed that the illustrated format was easy for the children to understand and complete independently. CONCLUSION: The HEPQ showed satisfactory reliability and validity for assessing healthy eating practices among preschool children. The illustrated format enhances comprehension and engagement, supporting its applicability for research and nutrition education in daycare settings.