Original Article

Designing and Validating a Questionnaire on Healthy Lifestyle to Reduce Depressive Symptoms among Adolescents

Abstract

Objective: Most adolescents do not meet national recommendations for healthy lifestyle and reducing depressive symptom. A comprehensive educational program with its specified questionnaire is needed to improve healthy lifestyle to assess the lifestyle components. This study aimed to confirm the validity of a healthy lifestyle questionnaire to assess depressive symptoms among adolescents.
Method: A descriptive predictive study using simple random sampling was performed in a secondary school in Kuala Lumpur, Malaysia, among 235 school-going adolescents (13-15 years old) with Malaysian nationality. The instrument consisted of a set of dual language (English and Malay) for both researcher-administered questionnaires (knowledge, attitude, eating behavior, and relaxation activities) and standard-validated questionnaires (Physical Activity questionnaire for Adolescents, Depression, Anxiety, and Stress Scale- 21, and Brief Copping). Data were analyzed using the kappa statistics (k) and the intraclass correlation coefficient test for reliability and Partial Least Squares (PLS) for validity.
Results: The reliability of all variables was over the substantial level (ICC and/or k > 0.61). The model and construct variables were predictive of depressive symptoms by 49.4%. To analyze the validity of the questions, 11 questions were removed from the initial model for factorial loading less than 0.5. In convergent validity of theory of information-motivation-behavioral skills, AVE (average variance construct), the outer loading, was higher than 0.5.
Conclusion: PLS confirmed the existence of sufficient correlations between different items of the construct. Thus, the weights of indicators appeared to be appropriate indicators for the model. The results proved that the information, motivation, and behavioral skills model was efficient for healthy lifestyle and can be a good base for further research.

1. Sarris J, O’Neil A, Coulson CE, Schweitzer I, Berk M. Lifestyle medicine for depression. BMC psychiatry. 2014;14(1):107.
2. Banterle F, Artusi A, Debattista K, Chalmers A. Advanced high dynamic range imaging: theory and practice.2011. AK Peters. CRC Press.
3. Saxe JS. Promoting Healthy Lifestyles and Decreasing Childhood Obesity: Increasing Physician Effectiveness Through Advocacy. Ann Fam Med, 2011;9: 546–48.
4. Pillai A, Patel V, Cardozo P, Goodman R, Weiss R, Andrew G. Non-traditional lifestyles and prevalence of mental disorders in adolescents in Goa, India. Br J Psychiatry. 2008;192(1):45-51.
5. Bukman AJ, Teuscher D, Feskens EJ, van Baak MA, Meershoek A, Renes RJ. Perceptions on healthy eating, physical activity and lifestyle advice: opportunities for adapting lifestyle interventions to individuals with low socioeconomic status. BMC public health. 2014;14(1):1036.
6. Derman EW, Patel D, Nossel CJ, Schwellnus, M.P. Healthy lifestyle interventions in general practice, S Afr Fam Pract. 2008;50(4):6-12.
7. Rönkkö M, Ylitalo J, editors. Construct Validity in Partial Least Squares Path Modeling. ICIS; 2010.
8. Rönkkö M, Ylitalo J, editors. Construct Validity in Partial Least Squares Path Modeling. ICIS; 2010.
9. Carek PJ, Laibstain SE, Carek SM. Exercise for the treatment of depression and anxiety. Int J Psychiatry Med. 2011;41(1):15-28.
10. Jacka FN, Kremer PJ, Leslie ER, Berk M, Patton GC, Toumbourou JW, et al. Associations between diet quality and depressed mood in adolescents: results from the Australian Healthy Neighbourhoods Study. Aust N Z J Psychiatry. 2010;44(5):435-42.
11. Tajik E, Abd Latiff L, Adznam SN, Awang H, Yit Siew C, Abu Bakar AS. A study on level of physical activity, depression, anxiety and stress symptoms among adolescents. J Sports Med Phys Fitness. 2017;57(10):1382-7.
12. Tajik E, Latiffah AL, Awang H, Nur’Asyura AS, Chin YS, Shah ABA, et al. Unhealthy diet practice and symptoms of stress and depression among adolescents in Pasir Gudang, Malaysia. Obes Res Clin Pract. 2016;10(2):114-23.
13. Kelly S, Melnyk BM, Belyea M. Predicting physical activity and fruit and vegetable intake in adolescents: a test of the information, motivation, behavioral skills model. Res Nurs Health. 2012;35(2):146-63.
14. Khazaeian S, Kariman N, Ebadi A, Nasiri M. Factors Associated with Mental Health and Its Relation with Health-Promoting Lifestyle in Female Heads of Households: A Cross-Sectional Study. Iran Red Crescent Med J. 2018;20(11):e64479.
15. Roohafza H, Sadeghi M, Shirani S, Bahonar A, Mackie M, Sarafzadegan N. Association of socioeconomic status and life-style factors with coping strategies in Isfahan Healthy Heart Program, Iran. Croat Med J. 2009;50(4):380-6.
16. Baranowski T, Cullen KW, Baranowski J. Psychosocial correlates of dietary intake: advancing dietary intervention. Annu Rev Nutr. 1999;19:17-40.
17. Gao J, Wang J, Zhu Y, Yu J. Validation of an information-motivation-behavioral skills model of self-care among Chinese adults with type 2 diabetes. BMC Public Health. 2013;13:100.
18. Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25(4):462-73.
19. Fisher JD, Fisher WA, Bryan AD, Misovich SJ. Information-motivation-behavioral skills model-based HIV risk behavior change intervention for inner-city high school youth. Health Psychol. 2002;21(2):177-86.
20. Osborn CY, Rivet Amico K, Fisher WA, Egede LE, Fisher JD. An information-motivation-behavioral skills analysis of diet and exercise behavior in Puerto Ricans with diabetes. J Health Psychol. 2010;15(8):1201-13.
21. Pelletier LG, Dion SC, Slovinec-D'Angelo M, Reid R. Why do you regulate what you eat? Relationships between forms of regulation, eating behaviors, sustained dietary behavior change, and psychological adjustment. Motiv Emot. 2004;28(3):245-77.
22. Morrow JR, Jr., Krzewinski-Malone JA, Jackson AW, Bungum TJ, FitzGerald SJ. American adults' knowledge of exercise recommendations. Res Q Exerc Sport. 2004;75(3):231-7.
23. Turconi G, Celsa M, Rezzani C, Biino G, Sartirana MA, Roggi C. Reliability of a dietary questionnaire on food habits, eating behaviour and nutritional knowledge of adolescents. Eur J Clin Nutr. 2003;57(6):753-63.
Stevens J, Cornell CE, Story M, French SA, Levin S, Becenti A, et al. Development of a questionnaire to assess knowledge, attitudes, and behaviors in American Indian children. Am J Clin Nutr. 1999;69(4 Suppl):773S-81S.
24. Fuqua JL, Gallaher PE, Unger JB, Trinidad DR, Sussman S, Ortega E, et al. Multiple peer group self-identification and adolescent tobacco use. Subst Use Misuse. 2012;47(6):757-66.
25. Meyer TJ, Miller ML, Metzger RL, Borkovec TD. Development and validation of the penn state worry questionnaire. Behav Res Ther. 1990;28(6):487-95.
26. Pearlin LI, Schooler C. The structure of coping.National institute of mental health. J health soc behave. 1978;19(1):2-21.
27. Kato Y, Iwanaga M, Roth R, Hamasaki T, Greimel E. Psychometric validation of the motivation for healthy eating scale (MHES). Psychology. 2013;4(2):136-41.
28. Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. 1982;12(4):871-8.
29. Fam KS, Waller DS, Erdogan BZ. The influence of religion on attitudes towards the advertising of controversial products. Eur J Mark. 2004;38:537-55.
30. Boulton MJ. Teachers' views on bullying: definitions, attitudes and ability to cope. Br J Educ Psychol. 1997;67(2):223–33.
31. Nåden D, Eriksson K. Understanding the Importance of Values and Moral Attitudes in Nursing Carein Preserving Human Dignity. Nurs Sci Q. 2004;17:86-91.
32. Tarry H, Emler N. Attitudes, values and moral reasoning as predictors of delinquency. Br J Dev Psychol. 2007; 25(2):69–83.
33. Kentsch M, Rodemerk U, Müller-Esch G, Schnoor U, Münzel T, Ittel TH, Mitusch R. Emotional attitudes toward symptoms and inadequate coping strategies are major determinants of patient delay in acute myocardial infarction. Z Kardiol. 2002;91(2):147-55.
34. Koenig HG, George LK, Siegler IC. The use of religion and other emotion-regulating coping strategies among older adults. GSA. 1988;28(3): 303-10.
35. Chin YS, Mohd Nasir MT. Eating Behaviors among Female Adolescents in Kuantan District, Pahang, Malaysia. Pakistan J Nutr. 2009;8:425–32.
36. Liu C, Xie B, Chou CP, Koprowski C, Zhou D, Palmer P, et al. Perceived stress, depression and food consumption frequency in the college students of China seven cities. Physiol Behav. 2007; 92(4):748-54.
37. Savige G, Macfarlane A, Ball K, Worsley A, Crawford D. Snacking behaviours of adolescents and their association with skipping meals. Int J Behav Nutr Phys Act. 2007, 9, 1–9.
38. Lien N, Jacobs DR, Klepp K. Exploring predictors of eating behaviour among adolescents by gender and socio-economic status. Public Health Nutr. 2002;5(5):671–81.
39. Feldman G, Greeson J, Senville J. Differential effects of mindful breathing, progressive muscle relaxation, and loving kindness meditation on decentering and negative reactions to repetitive thoughts. Behav Res Ther. 2010;48(10): 1002–11.
40. Lehrer PL, Woolfolk RL, Sime WE. Principles and Practice of Stress Management. 3rd ed., United States America: The Guilford Press, 2007.
41. Kowalski KC, Crocker PR, Donen RM. The physical activity questionnaire for older children (PAQ-C) and adolescents (PAQ-A) manual. College of Kinesiology, University of Saskatchewan. 2004;87(1):1-38.
42. Ernst MP, Pangrazi RP. Effects of a physical activity program on children’s activity levels and attraction to physical activity. Pediatric Exercise Science. 1999;11(4):393-405
43. Richardson D, Cavill N, Ells L, Roberts K. Measuring Diet and Physical Activity in Weight Management Interventions: A Briefing Paper. Oxford, National Obesity Observatory. 2011.
44. Dan SP, Mohd Nasir MT, Zalilah MS. Sex and Ethnic Differentials in Physical Activity Levelsof Adolescents in Kuantan. Mal J Nutr. 2007;13(2): 109-20.
45. Carver CS. You want to measure coping but your protocol’s too long: Consider the brief COPE. Int J Behav Med. 1997;4(1): 92–100.
46. Yusoff N, Low WY, Yip CH. Reliability and validity of the Malay version of brief cope scale: a study on Malaysian women treated with adjuvant chemotherapy for breast cancer. Med J Malaysia. 2010;65:41-4.
47. Yusoff MSB. The validity of the Malay Brief COPE in identifying coping strategies among adolescents in secondary school. Int Med J. 2011;18(1):29-33.
48. Hashim HA, Golok F, Ali R. Factorial validity and internal consistency of Malaysian adapted Depression Anxiety Stress Scale-21 in an adolescent sample. International Journal of Collaborative Research on Internal Medicine & Public Health. 2011;3(1):29-39.
49. Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. Psychology Foundation of Australia; 1996.
50. Lawshe CH. A quantitative approach to content validity 1. Pers Psychol. 1975 Dec;28(4):563-75.
51. Maciel ED, Vasconcelos JS, Silva LK, Sonati JG, Galvão J, Silva DD, Oetterer M. Designing and validating the methodology for the Internet assessment of fish consumption at a university setting. Food Science and Technology. 2014;34(2):315-23.
52. Buhi ER, Goodson P, Neilands TB. Structural equation modeling: A primer for health behavior researchers. Am J Health Behav. 2007;31(1):74–85.
53. Gefen D, Straub D, Boudreau MC. Structural equation modeling and regression: Guidelines for research practice. Communications of the association for information systems. 2000;4(1):7.
54. Hershberger SL, Marcoulides GA, Parramore MM. Structural equation modeling: an introduction. In B. H. Pugesek, A. Tomer & A. V. Eye (Eds.), Structural equation modeling: applications in ecological and evolutionary biology. UK, Cambridge: Cambridge University Press, 2003.
55. Maruayama GM. Basic of structural equation modeling, 1st ed., USA, Thousand Oaks: Sage Publications,1998.
56. Kline RB. Principales and practice of Strutural equation modeling. 3rd ed.; THE GUILFORD PRESS, London; 2013. pp. 1689-1699.
57. Myr RK, Bere E, Øverby NC. Test-retest reliability of a new questionnaire on the diet and eating behavior of one year old children. BMC Res Notes. 2015;8(1):16.
58. van der Ploeg HP, Tudor-Locke C, Marshall AL, Craig C, Hagströmer M, Sjöström M, et al. Reliability and validity of the international physical activity questionnaire for assessing walking. Res Q Exerc Sport. 2010;81(1):97-101.
59. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.
60. Wong KK-K. Partial least squares structural equation modeling (PLS-SEM) techniques using SmartPLS. Marketing Bulletin. 2013;24(1):1-32.
61. Hair JF, Black WC, Babin BJ, Anderson RE, Tatham RL. Análise multivariada de dados. 6th ed., Porto Alegre, Bookman, 2009.
62. Zwicker R, Souza CA, Bido DS. Uma revisão do modelo do grau de informatização de empresas: novas propostas de estimação e modelagem usando PLS (Partial Least Squares). Brazil, Rio de Janeiro, 2008.
63. Falk RF, Miller NB. A primer for soft modeling. University of Akron Press; 1992.
64. Mueller RO. Structural equation modeling: Back to basics. Struct Equ Modeling. 1997;4(4):353-69.
65. Hassan SH, Ramayah T, Mohamed O, Maghsoudi A. E-Lifestyle conceptualization: Measurement model validation using variance based structural equation modeling (SEM-PLS). Modern Applied Science. 2015;9(2):307-19.
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IssueVol 15 No 1 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v15i1.2437
Keywords
Depressive Symptom Lifestyle Partial Least Squares Reliability Validity

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1.
Tajik E, Abd Latiff L, Yit Siew C, Awang H, Adznam SNA. Designing and Validating a Questionnaire on Healthy Lifestyle to Reduce Depressive Symptoms among Adolescents. Iran J Psychiatry. 2020;15(1):27-40.