Development and Validation of a Fruit and Vegetable Consumption Measurement Tool for School‑Aged Children in Myanmar

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Background: Adequate fruit and vegetable (FV) consumption during childhood is essential for healthy growth, micronutrient adequacy, and long-term prevention of non-communicable diseases. In Myanmar, FV intake remains below World Health Organization (WHO) recommendations, and culturally appropriate, validated tools for assessing FV consumption among young children are limited. This study aimed to develop and validate a culturally appropriate questionnaire to assess fruit and vegetable consumption among elementary school–aged children in Myanmar. Methods: A multi-phase methodological study was conducted in Yangon Region. Item generation was informed by literature review, WHO dietary guidelines, and contextual input from parents, teachers, and nutrition experts. Content validity was assessed using item–objective congruence (IOC) by three experts. The questionnaire was pre-tested for clarity and comprehension, and pilot tested among 20 children aged 5–6 years. Internal consistency reliability was assessed using Cronbach’s alpha, test–retest reliability using intraclass correlation coefficients (ICC), and construct validity using exploratory factor analysis (EFA). Results: The final questionnaire comprised eight items across four domains: FV consumption frequency, portion size, variety, and consumption context. IOC values ranged from 0.67 to 1.00, indicating satisfactory content validity. The overall Cronbach’s alpha was 0.82, with subscale values ranging from 0.71 to 0.78. EFA supported a four-factor structure consistent with the conceptual framework, explaining 79% of the total variance, with factor loadings ranging from 0.70 to 0.84. Test–retest reliability demonstrated good temporal stability, with ICC values ranging from 0.72 to 0.80 across subscales and an overall ICC of 0.81. Conclusions: The FV consumption questionnaire demonstrated satisfactory validity and reliability and is suitable for assessing fruit and vegetable intake among elementary school–aged children in Myanmar. The tool can support dietary surveillance and evaluation of nutrition interventions in similar low- and middle-income settings.

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Related topics: Health Education and Validation · Nutritional Studies and Diet · Nutrition, Health and Food Behavior