Development and Validation of a Tool to Assess Responsive Complementary Feeding: Sri Lanka’s Responsive Feeding Practices Assessment Tool (RFPAT)

To develop and validate a scale to assess responsive feeding practices among mothers and infants between 6 and 12 months of age in Sri Lanka. The Responsive Feeding Practices Assessment Tool (RFPAT) was developed and validated using standard scale development techniques using a three step approach. A comprehensive review was conducted in PubMed and Scopus to identify possible items for assessing responsive feeding (RF) practices. Then, an in-depth qualitative study explored RF practices in the Sri Lankan context. Finally, RFPAT was validated through a cross-sectional study. The study was conducted in Anuradhapura district, Sri Lanka in a purposeful sample of 170 mother-infant pairs. The initial tool had 17 items. All items had responses in an adjectival scale; i.e., always, often, sometimes, rarely and not at all that were scored as 4, 3, 2, 1 and 0, respectively. Content validation was performed among experts using standard techniques, followed by cognitive interviews among mothers. The revised 15-items tool was pretested on 30 mothers. Principal Component Analysis (PCA) and Parallel Analysis were carried out for Structural validation. Test-retest reliability was done with a sample of 50 mothers. Ethical clearance was obtained from the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2014/060). Cognitive validation with mothers confirmed the applicability and comprehensiveness of a 15-item tool. The tool possessed good reliability with an intra-class correlation of 0.80 and internal consistency of 0.79. The PCA showed a clear 3-factor solution. The results of Parallel Analysis supported with the PCA results. The 3-factors were interpreted as responsive communication during feeding, appropriate feeding attentive to child's signals and pro-active preparation of the feeding environment. An additive composite score was generated with a range of 0 to 60 (quartiles scores ranges: Poor 0–34, Moderate 35–36, Good 37–40, and Very Good 41–60 RF practices). RFPAT is a valid tool to assess RF. The tool can help assess complementary feeding behaviors and design and program evaluation of Infant and Young Child Feeding in order to influence policies across low- and middle- income countries. No funding source