Anemia Prevention: Development of a Theory-Driven Nutrition Education Measurement Instrument

Date of Completion

January 2011


Psychology, Behavioral|Health Sciences, Nutrition|Education, Health




Iron deficiency anemia remains the most prevalent nutritional disorder worldwide and is a long standing public health concern. In the US, anemia has one of the highest prevalence rates in women of child-bearing age, specifically during the preconception period (e.g., 10.2%). Currently, the US government spends almost $6.5 billion dollars on the WIC program of which anemia prevention is a major component. In Connecticut, 35.5 million dollars is spent on food only. Iron deficiency anemia continues to afflict low-income, minority women of child-bearing age living in urban areas, including Hartford, CT. This research generated, tested and evaluated a robust, theory-driven nutrition education measurement instrument in three separate and sequential studies.^ The first study generated the instrument. Researchers developed the initial instrument, tested for content validity and piloted with the target audience. The instrument was assessed via exploratory factor analysis with 206 urban women of child-bearing age. A four factor, 35-item scale, relating to the constructs information, social sources, motivation and behavioral skills was generated at the end of the first study.^ The second study updated the instrument based on findings from the first study and tested the anticipated factor structure with a new sample of urban women of child-bearing age using confirmatory factor analysis. Applying the Information-Motivation-Behavioral Skills (IMB) behavior change model, the researchers developed a theoretical model of anemia prevention behaviors. Researchers interviewed 199 low-income, urban women of child-bearing age. A three factor, 17-item scale testing the information, motivation and behavioral skills constructs with good fit remained at the end of the second study. ^ The third study evaluated the proposed theoretical model of anemia prevention behaviors with the final instrument and an objective outcome measure. The final instrument measured information, motivation and behavioral skills relating to anemia prevention behaviors of heme iron food intake in 198 urban women. Structural equation modeling revealed the IMB model accounted for 8% of the variance of urban women's heme iron food intake. Motivation had a positive significant effect on heme iron food intake mediated through behavioral skills. ^ The overall goal of this research was to develop a theory-driven nutrition education measurement instrument, utilized by nutrition educators, that measures changes in behaviors relating to iron deficiency anemia. In order to achieve this goal, investigators followed the standard three-tiered process in instrument development. Three separate and sequential studies generated, tested and evaluated the instrument using the IMB model as the theoretical foundation for behavior change. ^