Healthy Menu Scoring Tool (HMST) : Content validity, face validity and internal consistency approaches in development and validation

Abstract

Introduction: Food service retailers, policy advisors and researchers need a simple easy to use tool that can measure the healthiness of meals to audit food environment and/or assess meal choices. The primary research objective of this study is to develop a validated meal scoring tool using content validity, face validity and internal consistency methods. Each of these steps have guided the researchers in making appropriate modifications to the meal scoring tool, as deemed relevant by the expert opinion of the participants. Methods: This study took place in two parts 1) Semi structured interviews and 2) focus group discussions. The comments were thematically analysed to identify broad main themes. The participants independently assessed the clarity, relevance, and essentiality of the scoring tool in its initial and revised stages to provide an item level content validity index (I-CVI). The final step asked a wider sample of nutrition experts to rate four randomly selected meals using the finalised version of the Healthy Menu Scoring Tool (HMST). Results: Nine nutrition experts took part in the semi-structured interviews and eight nutrition experts attended the focus group discussions. The semi structured interviews and focus group discussions found that a healthy meal is characterised by a variety of the four main food groups consumed within the recommended proportions. The ease of use of the tool and appropriate categorisation of food items and rating headings were identified as key themes to consider in the design of the tool. The intra-class coefficient showed excellent agreement between nine registered or student dietitians with 0.99 and a 95% confidence Interval of 0.96 – 0.99. This significant value in the final stage, revealed there was strong consistency in the scoring process of the finalised tool. Conclusion: The present study has validated a scoring tool for measuring the healthiness of a meal in line with the Healthy Eating Guidelines and nutrition expert feedback, designed to support healthier food choices. Suggestions are offered for improving the HMST, such as its use for specific clinical conditions or healthy eating across different life stages.