Assessing attitudes towards dietary fats in five countries: development and validation of Fat-related Attitude Scale (FATTS)

Article type
Authors
Alonso-Coello P1, Bała M2, Castro Reyes B3, Cruz Lopes L4, de Souza Serio dos Santos D5, Franka Žuljević M6, Gajdzica M2, Ge L7, Johnston B8, Maraj M2, Poklepovic T6, Prokop-Dorner A2, Wang Q7, Warzecha S2, Zawisza K2
1Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
2Jagiellonian Univeristy Medical College, Krakow, Krakow, Poland
3Hospital Clìnic del Maresmena, Barcelona, Spain
4University of Sorocaba, São Paulo, Brazil
5Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
6University of Split School of Medicine, Split, Croatia
7Lanzhou University, Lanzhou, China
8Texas A&M University, College Station, Texas, USA
Abstract
Background: The multitude of contemporary discourses on dietary fat could take precedence over medical advice and instead promote uninformed health choices and adherence to established dietary patterns. Understanding patient’s beliefs and practices in regard to consumption of fats could support clinicians in diagnosing and advising their patients and enhancing the nutritional guideline implementation process.
Objectives: We aimed to develop and validate a measurement instrument assessing individual attitudes toward dietary fats consumption.
Methods: In preparation of the study on values and preferences regarding fats consumption we generated the item pool based on explorative interviews and tested it on purposeful samples in Brazil, China, Croatia, Poland, and Spain. We performed an expert assessment of the content validity. We carried out a survey on academic communities (N=3633) from 5 countries using the CAWI technique. We developed the scale based on the Polish data split into subsamples. We conducted Exploratory Factor Analysis on a developmental subsample (70%) and Confirmatory Factor Analysis on a validation subsample (30%). We tested known-group differences linked to sociodemographics and health behaviors. We assessed internal consistency with the ordinal alpha coefficient. We applied the Item Response Theory with Graded Response Model to handle polytomous ordinal manifest items. 
Results: We initially formulated 25 common and 33 country-specific items. Nine experts from five countries scored them in terms of relevance to the given definitions. We found three-dimensional structure of the instrument and established its psychometric properties as sufficient. The Fat Elimination Subscale addresses the practices of avoiding visible fat when purchasing meat products or consuming meat dishes. The Fat Awareness Subscale measures the general attitude towards the content of fats and the practices of verifying it on the product information. The Trans-Fat Avoidance Scale regards practices and preferences linked to trans fats consumptions dictated by individual taste or convenience.
Conclusions: Because of its brief format, the Fat-related Attitude Scale can be used in clinical and research settings to explore individual attitudes related to fats and facilitate implementation of nutritional guidelines.
The relevance to patients: We built a tool for the assessment of individual attitudes toward products high in fats.