Reliability and validity of the hidden hunger assessment scale in China-revised for high school students

Objective

Hidden hunger remains a severe public health problem that affects millions of people worldwide. In China, challenges related to dietary imbalance and hidden hunger persist. Micronutrient inadequacy deserves more attention among adolescents, given its vital role in their growth and development; however, this problem appears to have been largely ignored. High school students, in particular, are often at a high risk of hidden hunger but have limited assessment tools available. Therefore, this study aims to revise the hidden hunger assessment scale for high school students (HHAS-HSS) in China and assess its reliability and validity.

Methods

Based on a literature review, expert consultation, pre-experiment, and formal survey, a hidden hunger assessment scale was revised for high school students. The formal survey involved 9 336 high school students in 11 of the 16 cities in Anhui Province, China, and 9 038 valid questionnaires were collected and included in the analysis. The item analysis, internal consistency reliability, test–retest reliability, content validity, exploratory factor analysis, and confirmatory factor analysis of the HHAS-HSS were examined.

Results

The HHAS-HSS included a total of 4 dimensions and 12 items: “vegetables and food diversity” (three items), “fruits and dairy products” (three items), “micronutrient-dense foods” (four items), and “health condition and eating habits” (two items). The results showed a Cronbach's alpha of 0.758, a split-half reliability of 0.829, and a test-retest reliability of 0.793, indicating good internal consistency. Using the Bartlett's test and Kaiser–Meyer–Olkin test (KMO) to test the exploratory factor analysis presented a four-factor model of the HHAS-HSS, the KMO value was 0.820 (P < 0.001), which indicated the possibility for factor confirmatory factor analysis. Using the maximum variance rotation method, four factors were obtained, and the cumulative variance explained rate was 57.974%. Confirmatory factor analysis also supported the division of the scale into four dimensions, and the fitting indices were χ² = 1417.656, χ²/df = 29.534, goodness-of-fit index = 0.974, adjusted goodness-of-fit index = 0.958, parsimonious goodness-of-fit index = 0.600, normed fit index = 0.938, incremental fit index = 0.940, Tucker–Lewis index = 0.917, comparative fit index = 0.939, and root mean square error of approximation = 0.056. Except for χ²/df, all the indices reached the fitting standard, and the above results showed that the construct validity of the scale reached an acceptable level.

Conclusions

The HHAS-HSS has good validity and reliability for Chinese high school students. It is a convenient self-report measure of hidden hunger risk.