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Obesity Perception Survey Among Youth in Turkey: Instrument Development and Test- Retest Reliability

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Obesity Perception Survey Among Youth in Turkey: Instrument Development and Test- Retest Reliability Turkish Journal of Medical Sciences Turk J Med Sci (2019) 49: http://journals.tubitak.gov.tr/medical/ © TÜBİTAK Research Article doi:10.3906/sag-1811-56 Obesity perception survey among youth in Turkey: instrument development and test- retest reliability 1, 2 1 1 3 Wasantha JAYAWARDENE *, Salih PINAR , Mohammad TORABI , Pengcheng XUN , Mustafa ÖZER 1 School of Public Health - Bloomington, Indiana University, Bloomington, Indiana, USA 2 Faculty of Sports Science, Marmara University, İstanbul, Turkey 3 Faculty of Sports Science, İstanbul Gedik University, İstanbul, Turkey Received: 07.11.2018 Accepted/Published Online: 17.02.2019 Final Version: 00.00.2019 Background/aim: We aimed to develop an instrument that can assess the perceptions and opinions of young people regarding the causes and consequences of obesity and the role of individuals, families, communities, and government in addressing obesity. Materials and methods: A 36-question (101-item) survey was developed by adopting, translating, and revising multiple-choice or Likert- scale questions from existing surveys to assure construct cross-cultural validity. A two-factor mixed-effects model estimated the intraclass correlation coefficient (ICC) to measure the test-retest reliability of questions administered 2 weeks apart to a convenient sample of İstanbul high school and university students, aged 15–25 years (n = 122). Results: The mean ICC for university and high school was 0.70 and 0.63, respectively. University students were more consistent in relating the problem to society and public policy preferences. High school students were more consistent in relating the problem and solution to themselves and their immediate environments. Using a 0.5 cutoff for the ICC’s lower 95% confidence limit, followed by reevaluation of the question flow, a 19-question (36-item) survey was retained for adolescents and a 26-question (52-item) survey for young adults. Conclusion: While the survey items have moderate to excellent reliability for high school and university students, it can be administered longitudinally to suggest changes to policies and interventions, and after cross-cultural validation, it can be utilized to compare obesity perceptions across different populations. Key words: Obesity, perception of problems and solutions, adolescents, young adults 1. Introduction and 21.7% among men, whereas overweight prevalence is Having doubled in more than 70 countries since 1980, 30.1% among women and 38.0% among men [8]. Straddling an estimated 5% of children (108 million) and 12% of Europe and Asia, Turkey has cultural connections to both adults (604 million) are currently obese [1]; the prevalence continents spanning centuries. Accordingly, a mixture is higher among women [2]. If not controlled, over one of problems from developing and developed countries billion adults worldwide will be obese by 2030 [3]. can presumably contribute to Turkey’s obesity burden, Obesity burden is generally higher in developed countries, which has been worsening steadily since the 1990s [9]. although the proportional contribution of each underlying Everyday consumption of calorie-dense, once-in-a-while cause varies by region, country, and community [2]. Some festive foods, increased processed food consumption, countries with a high obesity burden and/or an emerging and decreased physical activity are considered to be the obesity epidemic do not yet acknowledge this critical health emerging causes. In addition to the healthcare costs of problem with its numerous socioeconomic consequences obesity-related chronic diseases, Turkey currently spends [4]. Individuals are generally considered more responsible $5 billion annually in support of an emerging, lucrative than governments for creating solutions, although both industry of weight-loss products, online support groups, environmental and behavioral trends contribute to the and dietitians.1 Various studies have explored obesity emerging obesity pandemic [5–7]. prevalence in Turkish adults [9,10]. While 27.8% of adults in Turkey are obese, 34.1% are Numerous surveys have been conducted to evaluate overweight. Obesity prevalence is 34.0% among women the perceptions of childhood and adult obesity in both * Correspondence: [email protected] 1 http://www.hurriyetdailynews.com/ 1 This work is licensed under a Creative Commons Attribution 4.0 International License. JAYAWARDENE et al. / Turk J Med Sci developed and developing countries [11–22]. For example, participants and persons known to the participants). the Obesity Perception Survey of the U.S. (OPSUS), a Hereafter, ‘problem’ denotes obesity-related problems nationally representative survey of U.S. adults (n = 1011) either in the public or private sphere while ‘solution’ stands [23], assessed public perceptions and opinions regarding for existing or potential answers to such problems in either the causes and consequences of obesity, including links sphere. to other chronic conditions. OPSUS also explored the Problem Perception – Public Sphere (‘Problem-Public’), roles of individuals, families, communities, and respective 15 questions: How participants understand and perceive governments in addressing obesity. Similarly, the Obesity the magnitude of obesity problem compared to other Perception Survey of the European Union (OPSEU), health issues in Turkey, potential causes and consequences conducted in seven countries (n = 14,000), assessed of obesity, the relationship between overweight and overall obesity awareness, including its causes, implications, and health status, and obesity-related societal discrimination. treatments, plus self-reported weight status. Additionally, Solution Perception – Public Sphere (‘Solution- a multinational survey assessed obesity perceptions and Public’), 6 questions: Participants’ opinions regarding policy preferences among policymakers in Europe and potential treatments for obesity, including morbid the Americas [21]. However, no study has evaluated obesity, and the responsibility of individuals, families, perceptions and beliefs about obesity among youth (i.e. communities, healthcare providers, various institutions, adolescents and young adults) and adults in Turkey, and government for solving the obesity problem of the including their preferred solutions. country along with the participants’ support for existing or hypothetical policies targeting obesity. The variations of obesity-related social norms, Problem Perception – Private Sphere (‘Problem- perceptions, and preferred solutions across countries, and Private’), 6 questions: Participants’ overall health status, even across geographical regions, age groups, and social including height, weight, and perceived body image, plus classes within a country, make it challenging to utilize a knowing a person with obesity. standard survey for investigating these constructs. This Solution Perception – Private Sphere (‘Solution- study is part of a research collaboration to assess obesity- Private’), 5 questions: Instructions received from related perceptions and preferences in Turkey. This study participants’ healthcare providers about obesity prevention aimed to develop a survey for adolescents and young or treatment and participants’ behavioral strategies for adults by translating and revising questions from existing weight management plus awareness of physical and social surveys [22,23] to accommodate the Turkish cultural environments that promote or impede healthy behaviors. context and subsequently to evaluate the construct validity Sociodemographic, 4 questions: Basic information and test-retest reliability of survey questions administered about participants’ sex, age, income, and area of residence. to İstanbul youth. Some questions were presented in tabular format to reduce the target response time to 15 min. The questions 2. Materials and methods were listed continuously with no topical dividers or skip The Obesity Perception Survey among Youth in Turkey patterns. As this study evaluated perceptions, not attitudes, (OPSYT) was designed for self-administered, standardized a ‘don’t know’ option was included where relevant (27 data collection from adolescents and young adults in of 36 questions) to allow the respondents to indicate no the region. It was pilot-tested in İstanbul, considering its previous consideration of a particular issue. All response central location in the target region. In 2016, the high choices facilitated coding and data analysis. school (ages 14–17) net enrollment rate in Turkey was 79% 2.1. Assessment of construct validity for males and 78% for females [24]. In 2017, about 31% The survey was originally composed in English and of men and 32% of women in the 25–34 age group had translated into Turkish. To establish face validity, two completed some tertiary education [25]. Considering that U.S. experts individually reviewed each question, with the target age group is 15–25, the survey was intended to response options, to ensure the operationalization of each accommodate the expected average literacy level of high construct against a detailed description of the relevant school students. The survey structure and a majority of content domain [26,27]. Subsequently, two Turkish OPSYT questions were based on the OPSUS and OPSEU experts individually reviewed the questions, with response surveys [22,23], validated with permission, and were options, to ensure that each met the average literacy level subsequently revised as necessary. All the questions were of Turkish high school students and Turkish contextual
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