Development and preliminary validation of the nutrition literacy scale for type 2 diabetes mellitus in China—a mixed methods study

BackgroundNutrition literacy is an important predictor of eating behavior in patients with type 2 diabetes. However, current methods lack rigorously validated tools to assess nutrient literacy in this group. Therefore, the aim of this study was to develop and validate the Nutrition Literacy Scale fo...

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Main Authors: Wenjuan Zhang, Yan Wu, Yibao Zhang, Ziyu Sun, Jiaqi Wang, Yuhong Wu
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-05-01
Series:Frontiers in Public Health
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Online Access:https://www.frontiersin.org/articles/10.3389/fpubh.2025.1569675/full
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author Wenjuan Zhang
Yan Wu
Yibao Zhang
Ziyu Sun
Jiaqi Wang
Yuhong Wu
author_facet Wenjuan Zhang
Yan Wu
Yibao Zhang
Ziyu Sun
Jiaqi Wang
Yuhong Wu
author_sort Wenjuan Zhang
collection DOAJ
description BackgroundNutrition literacy is an important predictor of eating behavior in patients with type 2 diabetes. However, current methods lack rigorously validated tools to assess nutrient literacy in this group. Therefore, the aim of this study was to develop and validate the Nutrition Literacy Scale for patients with type 2 diabetes mellitus.MethodsThis study was divided into two phases, including the generation of the items and the validation of the scales. The generation of the items was developed through a literature study, semi-structured interviews, a Delphi expert consultation, and a small-sample pre-survey. Convenience sampling method was used to select a large sample of 576 patients in Hangzhou for item analysis, reliability and validity tests.ResultsThe formal scale covered 4 dimensions with 31 items. The exploratory factor analysis extracted four common factors with a cumulative variance contribution of 62.725%; the results of the confirmatory factor analysis showed that the model fit was good, the content validity of the scale was 0.957. The calibration correlation validity of the newly developed scale with the Adult Nutrition Literacy Measurement Scale was 0.760. Cronbach’s α coefficient was 0.946, and re-test reliabilitiy was 0.884.ConclusionThe nutrition literacy scale for people with type 2 diabetes has good reliability and validity and is suitable for assessing the level of nutrition literacy in relevant populations.
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spelling doaj-art-60b094d3b19b41e39fd9bc6757fc52712025-08-20T02:57:29ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-05-011310.3389/fpubh.2025.15696751569675Development and preliminary validation of the nutrition literacy scale for type 2 diabetes mellitus in China—a mixed methods studyWenjuan Zhang0Yan Wu1Yibao Zhang2Ziyu Sun3Jiaqi Wang4Yuhong Wu5School of Public Health and Nursing, Hangzhou Normal University, Hangzhou, ChinaDepartment of Endocrinology, Zhejiang Greentown Cardiovascular Disease Hospital, Hangzhou, ChinaSchool of Public Health and Nursing, Hangzhou Normal University, Hangzhou, ChinaSchool of Public Health and Nursing, Hangzhou Normal University, Hangzhou, ChinaSchool of Public Health and Nursing, Hangzhou Normal University, Hangzhou, ChinaSchool of Public Health and Nursing, Hangzhou Normal University, Hangzhou, ChinaBackgroundNutrition literacy is an important predictor of eating behavior in patients with type 2 diabetes. However, current methods lack rigorously validated tools to assess nutrient literacy in this group. Therefore, the aim of this study was to develop and validate the Nutrition Literacy Scale for patients with type 2 diabetes mellitus.MethodsThis study was divided into two phases, including the generation of the items and the validation of the scales. The generation of the items was developed through a literature study, semi-structured interviews, a Delphi expert consultation, and a small-sample pre-survey. Convenience sampling method was used to select a large sample of 576 patients in Hangzhou for item analysis, reliability and validity tests.ResultsThe formal scale covered 4 dimensions with 31 items. The exploratory factor analysis extracted four common factors with a cumulative variance contribution of 62.725%; the results of the confirmatory factor analysis showed that the model fit was good, the content validity of the scale was 0.957. The calibration correlation validity of the newly developed scale with the Adult Nutrition Literacy Measurement Scale was 0.760. Cronbach’s α coefficient was 0.946, and re-test reliabilitiy was 0.884.ConclusionThe nutrition literacy scale for people with type 2 diabetes has good reliability and validity and is suitable for assessing the level of nutrition literacy in relevant populations.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1569675/fulldiabetes mellitusliteracynutrition statusscalevalidation
spellingShingle Wenjuan Zhang
Yan Wu
Yibao Zhang
Ziyu Sun
Jiaqi Wang
Yuhong Wu
Development and preliminary validation of the nutrition literacy scale for type 2 diabetes mellitus in China—a mixed methods study
Frontiers in Public Health
diabetes mellitus
literacy
nutrition status
scale
validation
title Development and preliminary validation of the nutrition literacy scale for type 2 diabetes mellitus in China—a mixed methods study
title_full Development and preliminary validation of the nutrition literacy scale for type 2 diabetes mellitus in China—a mixed methods study
title_fullStr Development and preliminary validation of the nutrition literacy scale for type 2 diabetes mellitus in China—a mixed methods study
title_full_unstemmed Development and preliminary validation of the nutrition literacy scale for type 2 diabetes mellitus in China—a mixed methods study
title_short Development and preliminary validation of the nutrition literacy scale for type 2 diabetes mellitus in China—a mixed methods study
title_sort development and preliminary validation of the nutrition literacy scale for type 2 diabetes mellitus in china a mixed methods study
topic diabetes mellitus
literacy
nutrition status
scale
validation
url https://www.frontiersin.org/articles/10.3389/fpubh.2025.1569675/full
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