Development and validation of the Eating Maturity Questionnaire: Preliminary findings

Introduction

The ongoing progress of civilization has been significantly altering human eating behaviors and habits for decades. In the past, these behaviors were determined primarily by physiological cues from the body, but psychological and social factors are currently playing an increasing role in shaping such behaviors (Ogden, 2010; Story et al., 2002; Verstraeten et al., 2014). As a consequence, the contemporary diet, which is frequently a source of excessive energy intake, is a departure from primordial eating patterns that were largely physiologically driven and therefore simpler in terms of satisfying the needs of organisms. Such changes largely apply to highly developed Western societies, but they are also increasingly becoming an issue in Asian countries.

The extant research clearly indicates that inappropriate nutrition leads to health problems (World Health Organization (WHO), 2009). Strong evidence indicates that rational eating is the most significant factor in decreasing the risk of obesity and chronic non-infectious diseases, such as cardiovascular system diseases, diabetes, cancers, osteoporosis, caries, and many other diet-related diseases (WHO, 2008). Hence, the modification of eating habits is an important element of preventive programs and campaigns for health. Given the multifactorial determinants of health behaviors, encouraging people to change their lifestyles—including dieting—is not a simple or easily applicable process (e.g. Robles et al., 2014; Sharkey et al., 2010; Sobal and Bisogni, 2009). Therefore, eating behavior-oriented interventions should focus on modifiable and controllable factors that involve social and psychophysiological aspects (in the immediate environment of an individual), such as cognitive and emotional attributes that are the main personality regulatory mechanisms of human behavior.

To explain the personality mechanisms involved in eating behaviors, the extant research has studied (1) eating choices (e.g. favorite tastes, types of diets), (2) personality traits/dimensions in the context of eating and eating disorders (primarily anorexia, bulimia, and obesity), and (3) other psychological attributes that are associated with personality and related to healthy and disordered eating behaviors (e.g. self-efficiency, body image, sense of control, self-efficacy).

To the best of our knowledge, no existing theory of personality regulatory mechanisms of eating behaviors simultaneously (1) considers a set of consistent personality traits relating precisely to eating behaviors, (2) characterizes both healthy and disordered eating behaviors, and (3) serves as a basis for practitioners to design consistent interventions aiming to improve personal and public health. We assumed that explaining human eating behaviors requires the establishment of a specified profile of psychological traits. Such traits would be involved in the performance of eating behaviors, would be treated as personal resources, and would be dynamic in nature. Equally important, such a profile will enable the design and development of effective interventions targeting eating behaviors.

The above conclusions inspired us to develop eating maturity theory (EMaT), with eating maturity (EM) constituting the central concept. The key assumptions of EMaT derive from two well-established psychological theories: the theory of personality by G. Allport (1961) and the regulatory theory of personality by T. Reykowski (Kochanska, 1984).

The aim of this article is to present the key components of EMaT, especially the tool designed to measure EM. We identified a strong need to develop appropriate tools for diagnosing the reasons that individuals eat. Only an adequate knowledge of the motives behind a person’s eating habits can provide proper solutions for his or her eating problems or disorders.

The process of designing the questionnaire is also the process of operationalizing this newly created concept.

Definition and operationalization of EM

Based on G. Allport’s definition of personality, we assumed that EM is a dynamic organization of psychophysical systems (traits and abilities) within an individual that initiates and directs his characteristic eating behaviors and thoughts. In his theory, Allport (1961) distinguished six attributes of a mature personality. These attributes and their extension as EM features are presented in Table 1.

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Table 1.

The traits of mature personality by G. Allport and the dimensions of eating maturity.

No.	Allport’s traits of mature personality	Expression of eating maturity	Traits of eating maturity	Regulation
1.	Extension of the sense of self	Culinary curiosity, openness to new flavors, trying new dishes, experimenting in the kitchen	Eating openness	Psychosocial motive
2.	Warm relating of self to others	Eating meals together, molding other people’s behaviors by means of one’s own eating behaviors, tolerating/understanding the eating preferences of other people, avoiding subordination, manipulation or blackmailing others by means of eating, not using food as punishment, etc.	Relationship building by means of eating
3.	Emotional security and self-acceptance	Joy of eating and feasting, self-awareness and control over the strategies used for stress reduction by means of eating	Eating-related emotional strain: • Mental comfort • Strain reduction
4.	Self-objectification	Self-criticism regarding one’s own diet (eating style), consciousness of one’s own eating motivations, ability to joke about eating and circumstances related to it	Self-objectification: • Eating insight • Eating outer/inner containment Distance from eating
5.	Unifying philosophy of life	Unifying philosophy of life in dieting (e.g. types of products chosen) reflecting the attitude toward health, physical activity, ecology, religion, etc.	A lifestyle expressed by eating
6.	Realistic perception of oneself and the environment	Rational attitude toward eating: knowing and obeying healthy eating rules (in terms of quality and quantity), moderation in eating, etc.	Rational eating attitude	Biological motive

Therefore, EM is characterized by a set of traits that are derived from Allport’s theory. In terms of mature personality and in view of the current knowledge, we recognized particular characteristics of eating behaviors and matched them with the dimensions that were established by Allport and that can be expected to correspond to the construct of EM. Table 1 presents a collation of Allport’s traits of mature personality and the traits of EM and provides examples of behaviors, attitudes, and beliefs.

Food can be used to satisfy various human needs, including biological (hunger and thirst), psychological (food as a method of compensation for discomfort, strain or lack of satisfaction), and social needs (food as a facilitator of integration within social groups and as a tool to influence other people’s behavior) (Ogden, 2010). Because food may satisfy diverse needs, the characteristics of EM may also shape human eating behaviors that aim to satisfy biological, psychological, and social needs (i.e. regulating biological and psychosocial motives).

Initially the EM construct had six-factor structure (Table 1). Yet, we assumed this may be reduced to two general dimensions that refer to two motives that can be controlled through eating behavior - biological and psychosocial. thus, we simplified the initial six-factor structure to a two-factor structure. The personality traits and the beliefs connected with them, as numbered 1–5 in Table 1, constitute one of the theoretical dimensions that we called “the Control of Psychosocial Motives” (CPM). The traits and beliefs numbered as 6 were included in the second theoretical dimension—“the Control of Biological Motives” (CBM)

We assumed that EM may manifest on two possible levels: the level of cognitive regulatory mechanisms (beliefs) and the level of eating behaviors. These two levels determine the methods of measuring EM—the assessment of eating beliefs (with a questionnaire) or the assessment of dieting and nutrition using an eating interview. We chose the first of the above-mentioned options and assumed that EM is manifested in six traits that play a regulatory role in satisfying various human needs (the regulation of biological and psychosocial motives) based on an individual’s system of beliefs.

The CPM refers to the system of beliefs concerning the use of food for aims other than satisfying physiological hunger; this dimension implies maturity in the psychosocial context. The CBM is understood as a set of beliefs concerning dieting, nutrition, and eating knowledge; it reflects maturity in the context of acceptance and compliance with the rules of rational energy intake with food. Thus, our first hypothesis is as follows:

Questionnaire development

Concurrent with EM theory development, we designed a psychometric measurement instrument. The study sample included Polish-speaking participants.

The afore-mentioned dimensions were operationalized in the form of a measurement tool. The development of a self-administered questionnaire consisted of several stages.

In the first stage of development, a team of experts consisting of psychologists and researchers developed a list of beliefs referring to the traits and dimensions of EM. This list was used to establish potential items for the dimensions of psychosocial and biological motives. Next, referring to such beliefs, the experts devised items that matched these motives. The initial pool of items was checked for overlap. Any disagreements between experts were resolved by discussion. The final pool of 100 statements was accepted by all the experts. More than half of the statements (68) concerned CPM, whereas 32 concerned CBM. We then developed the instructions for respondents. A 4-point Likert-type response scale was used for the questionnaire.

Table 2 presents the items used in the pilot study. The brackets next to the item content indicate the order of the questionnaire items used during the pilot study.

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Table 2.

The initial pool of 100 items and index of discrimination (item-total) correlation coefficients (r_it) for each item after the pilot study.

1. The Control of Psychosocial Motives—the pool of 68 statements divided into five traits of eating maturity	rit
Eating openness
I like cooking using new recipes (6)	0.26
I like exploring new flavors (94)	0.34
I like ordering new meals that I do not know (28)	0.14
When traveling, it is good to try local cuisines/delicacies (39)	0.27
In new places, you should order only traditional, well-known dishes (50)	0.30
I like reading about the latest culinary trends and dishes from around the world (1)	0.34
I prefer casual, traditional dishes (56)	0.31
I like programs such as “culinary travels” (61)	0.25
I have my favorite foods, but I am not closed to new experiences (70)	0.29
I like exchanging culinary ideas with my family and friends (77)	0.36
Getting to know a different cuisine is an interesting experience for me (83)	0.38
I like mixing traditional cuisine with new tastes (89)	0.40*
Relationship building by means of eating
Eating meals together brings people closer (43)	0.19
A good table atmosphere makes food taste better (12)	0.12
Food is a good way to express caring feelings toward relatives (18)	0.03
Food is a good way to enforce obedience (22)	0.50*
Limiting food may be an effective punishment (29)	0.31
Delicious food is the best reward for good behavior (78)	0.50*
It is unacceptable for anyone to refuse to eat the dish I prepared (84)	0.48*
I expect people for whom I prepared a meal to eat everything on the plate (57)	0.44*
You cannot have a good party or meeting with relatives without eating (58)	0.33
The topic of eating is a cause of argument in my family (45)	0.22
Forcing somebody to eat may be an effective punishment (71)	0.38
Cooking with family and/or friends is a great way of spending time together (74)	0.30
It is not right to refuse to eat when we are being given a treat (75)	0.35
Refusing to taste something during family meetings reflects a lack of respect for the hosts (9)	0.33
Love is best expressed with food (10)	0.29
Giving a child something to eat calms him or her down best (16)	0.49*
It is best to reconcile an argument with good food (34)	0.36
I often feel a strain while preparing and/or eating family meals (53)	0.31
I find it easy to accept that other people like flavors that differ from those I like (62)	0.28
I easily accept that other people eat more or less than I do (73)	0.40*
Eating-related emotional strain
(a) Mental comfort
The subject of eating makes me anxious (42)	0.40*
Issues concerning eating influence my mood (48)	0.15
Any issues connected with eating make my everyday functioning difficult (26)	0.48*
Eating is usually a pleasure (24)	0.17
If I did not have to, I would not eat (19)	0.26
Issues connected with eating are problematic for me (80)	0.53*
(b) Strain reduction
Eating is a good way to relieve stress (95)	0.48*
Eating is an effective “escape” from worries and problems (52)	0.52*
Eating something delicious is the best way to improve your mood (63)	0.39
Eating is good for boredom (36)	0.48*
Focusing on eating gives me a sense of control over things that are happening around me (32)	0.18
Getting up at night to have a bite to eat is natural (41)	0.48*
I feel better when I carry a snack with me (44)	0.23
Self-objectification
(a) Eating insight
By eating, I satisfy various needs—not only hunger (66)	−0.28
I notice which food products benefit me and which harm me (54)	0.39
I sometimes do not know whether I eat because of hunger, boredom, or habit (35)	0.41*
I can distinguish hunger from a whim (47)	0.47*
(b) Eating locus of control
I prefer somebody else to make eating decisions for me (21)	0.46*
The eating preferences of a group to which you belong (e.g. family, creed community) are more important than the personal culinary preferences of an individual (67)	0.47*
It is hard to accept a diet that differs from the diet of people whom you often spend time with (e.g. at work, at school, at home) (4)	0.21
In making eating choices, I mainly follow trends and/or what others choose (98)	0.47*
I easily succumb to others’ persuasions to eat something (85)	0.38
When shopping, you should keep to a previously made list (87)	0.18
It is easy to persuade me to buy food with an advertisement or a discount (33)	0.37
I succumb to trends in buying advertised food (23)	0.20
It does not usually matter to me what others think about my diet (88)	0.06
(c) Distance from eating
I can joke about my diet (91)	0.17
I am easily annoyed when somebody comments on my approach to eating (97)	0.35
In my life, even eating has to be perfect (99)	0.06
It is unacceptable to make eating mistakes (93)	0.12
Breaking rules in my diet is unacceptable (14)	0.01
A lifestyle expressed by eating
My diet (e.g. the type of products chosen) reflects my approach to various issues (e.g. health, physical activity, religion, philosophy of life) (31)	0.29
Eating a certain way is part of my image (92)	−0.01
I agree with the opinion that “we are what we eat” (7)	0.25
The way I eat might say a lot about me to people who do not know me (79)	0.15
My diet is part of my lifestyle (68)	0.29
2. Control of Biological Motives—the pool of 32 statements and one eating maturity trait
Rational eating attitude
If a nutritionist were to regularly assess the products I have in my fridge (in terms of being healthy)—I would get a good grade (2)	0.24
It is easier to find sweets than fruit or vegetables in my house (5)	0.31
I would be able to explain how a diet influences our health to a child (20)	0.38
I usually know the nutritional values of particular products and dishes (25)	0.35
I know what rules to follow in buying healthy food (30)	0.44*
Reading labels on the packaging of products is a waste of time (37)	0.49*
It is enough that my nearest and dearest (e.g. children) eat healthily; I do not have to (40)	0.50*
I can recall the last time I wondered whether my and/or my relatives’ diet is appropriate (46)	0.40*
I think that I try too hard to make myself or/and my family eat healthfully (51)	0.05
My diet may be an example for others to follow (55)	0.36
In my current situation, reflecting on my diet is needless—the time for this will come someday (59)	0.59*
Applying healthy eating rules is usually impossible (60)	0.51*
Healthy eating means almost nothing but elimination/deprivation (64)	0.59*
So-called “healthy food” is only another marketing trick (96)	0.45*
It is more important for food to be tasty than healthy (72)	0.53*
Only illness would force me to change my eating habits (81)	0.50*
I do not have the time or inclination to focus on eating issues (86)	0.40*
It is hard to say when I last planned meals in advance (11)	0.31
You should not leave food on a plate (15)	0.35
A child’s diet should differ from an adult’s diet (2)	−0.02
I do not find healthy food tasty (17)	0.49*
I think that cooking healthy meals is difficult (90)	0.40*
I usually wonder whether my family and I eat healthily (100)	0.38
I know recipes for healthy meals (82)	0.45*
I usually do not care what I eat; I just eat anything (38)	0.58*
Parents should control what their children eat in kindergarten/at school (27)	0.32
A growing and developing child ought to eat without limits (49)	0.36
If someone is going to be ill, he or she will fall ill—no diet can help him or her (13)	0.25
When I am alone, I let myself eat more/different food than in the meals I eat with other people (65)	0.35
Children may eat anything they feel like eating (69)	0.44*
It is hard to say what healthy eating is (76)	0.57*
I believe that an appropriate diet may protect us from various ailments (8)	0.23

*

p<0.05.

Pilot study

We set two goals for the pilot study: (1) testing H₁ and (2) assessing the psychometric properties of the questionnaire to establish the final version of the questionnaire items.

In total, 300 adults participated in the pilot study: students from the University of Lodz and Technical University of Lodz and workers at enterprises located in Lodz (Poland). Study participation was voluntary and anonymous. The respondents gave their opinions by circling one of four possible answers ranging from I totally agree to I totally disagree. The participants completed the questionnaires by themselves.

A qualitative assessment of the questionnaires was then performed to exclude incomplete surveys. In further analysis, we used data from 215 respondents: 93 men and 132 women between the ages of 18 and 72 years (average age = 27 years).

In the second stage, an assessment of the psychometric properties of the questionnaire was performed. On the basis of the data derived from the pilot study, we calculated the index of discrimination of the items to assess how a singular item relates to the overall score of the questionnaire and whether it differentiates respondents based on the trait being measured (see Table 2). The index of discrimination was estimated on the basis of the correlations between particular items and the overall results of the questionnaire (the item-total correlation without the particular item considered as part of the sample). Items with an index of discrimination greater than 0.40 were used in further statistical analysis. Thus, we included 36 items in the factor analysis.

To verify H₁ regarding the factor structure of the Eating Maturity Questionnaire (EMQ), we conducted an exploratory factor analysis using the VARIMAX method of orthogonal rotation. VARIMAX rotation was used to improve the suitability of the data for factor analysis. This method is the most common rotational technique used in factor analysis and produces factor structures that are uncorrelated. The rotation method was used to ease interpretation of the results.

Table 3 presents the results of the analysis, which confirmed our theoretical assumptions (with final item numeration in brackets). Thus, a structure of two second-order factors was established, and two subscales were developed: the CBM consisting of 12 items (statements corresponding to the trait Rational Eating Attitude) and the CPM consisting of 9 items (statements corresponding to the following traits: Eating openness, Relationship building by means of eating, Eating-related emotional strain, Self-objectification, A lifestyle expressed by eating). The final version of the questionnaire included items with factor loadings greater than 0.5. Therefore, the EMQ consisted of 21 items.

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Table 3.

Factor analysis results and final item numeration (N = 215)(p<0,05).

Item content and number	Control of Biological Motives	Control of Psychosocial Motives
I do not find healthy food tasty (1)	0.50*	0.20
I know what rules to follow to buy healthy food (3)	0.51*	0.08
Reading labels on the packaging of products is a waste of time (5)	0.54*	0.20
I usually do not care what I eat; I just eat anything (6)	0.60*	0.25
It is enough that my nearest and dearest (e.g. children) eat healthily; I do not have to (7)	0.63*	0.14
In my current situation, reflecting on my diet is needless—the time for this will come someday (9)	0.60*	0.28
Healthy eating means almost nothing but elimination/deprivation (11)	0.60*	0.26
It is more important for food to be tasty than healthy (18)	0.64*	0.17
It is hard to say what healthy eating is (16)	0.55*	0.26
Only illness would force me to change my eating habits (13)	0.56*	0.21
I know recipes for healthy meals (19)	0.62*	0.02
I do not have the time or inclination to focus on eating issues (20)	0.56*	0.02
Food is a good way to enforce obedience (2)	0.20	0.50*
I sometimes do not know whether I eat because of hunger, boredom, or habit (4)	0.03	0.64*
Eating is good for boredom (8)	0.06	0.73*
Eating is an effective “escape” from worries and problems (10)	0.18	0.64*
I expect people for whom I prepared a meal to eat everything on the plate (12)	0.06	0.53*
The eating preferences of a group to which you belong (e.g. family, creed community) are more important than the personal culinary preferences of an individual (15)	0.15	0.58*
Delicious food is the best reward for good behavior (17)	0.08	0.67*
It is unacceptable for anyone to refuse to eat the dish I prepared (14)	0.09	0.62*
Eating is a good way to relieve stress (21)	0.07	0.67*
Cronbach’s α for the subscales	0.86	0.83
Cronbach’s α for the overall scale	0.83

*

p<0.05.

The next step of the questionnaire validation process is the confirmatory factor analysis. This procedure will be conducted following the collection of a considerable amount of data.

The reliability of the EMQ was then estimated through an internal consistency assessment. Thus, we calculated Cronbach’s α coefficients for the questionnaire as a whole and for the individual subscales. The values of these coefficients fluctuated between 0.83 and 0.88 (α_CBM = 0.86, α_CPM = 0.83, α_EMQ = 0.88). These results indicate that the EMQ is a reliable tool.

The final element of the EMQ design was the renaming of the subscales. The previously named Control of Biological Motives subscale became Rational Eating (RE), which better captured the essence of what it measured. Similarly, the Control of Psychosocial Motives scale was changed to the Psychosocial Maturity (PM) subscale. Appendix 1 contains the final version of the questionnaire.

In the final stage of EMQ development, we assessed the questionnaire’s convergent validity. We assumed that EM would be positively correlated with other characteristics that facilitate the maintenance of good health. Previous research has found that a sense of coherence (e.g. Binkowska-Bury et al., 2010; Miettola and Viljanen, 2014; Sarenmalm et al., 2013; Wainwright et al., 2007) and general indicators of health behaviors (e.g. Boguszewski et al., 2014; Lipowski, 2012; Ziarko et al., 2012) are significantly associated with health.

We expected that the correlation between EM and the mentioned variables would be moderate at best. Because a moderate correlation indicates that variables are independent, EM would then be considered a separate construct. Hence, we expected the following:

H₂. EM is positively and moderately correlated with health behaviors.

H₃. EM is positively and moderately correlated with the sense of coherence.

To test H₂ and H₃, a second study was designed. The validation study was conducted with 150 subjects (students and professionals). The participants completed sets of questionnaires that consisted of the following measures:

The final version of the EMQ consisting of 21 items is divided into two subscales: Rational Eating, including 12 items (1, 3, 5, 6, 7, 9, 11, 13, 16, 18, 19, and 20), and Psychosocial Maturity, including 9 items (2, 4, 8, 10, 12, 14, 15, 17, and 21). A respondent provides his or her opinion on each statement by choosing answers A, B, C, or D (A indicates that the respondent totally agrees with the item content, B = Somewhat Agrees, C = Somewhat Disagrees, and D = Totally Disagrees. A answers are counted as 1, B as 2, C as 3, and D as 4. Inversion must be applied only for items 3 and 19. The sum of all 21 items is an indicator of EM, but the results for the two subscales may be counted separately, providing a wider range of information. A higher total score (both overall and within the subscales) indicates greater EM or greater levels of specific dimensions of EM. The mean score for RE is 40.00 (standard deviation (SD) = 5.60), the mean score for PM is 28.11 (SD = 4.55), and the mean score for the full scale is 67.89 (SD = 8.34).

The Health Behaviors Inventory (in Polish: Inwentarz Zachowań Zdrowotnych —IZZ) developed by Juczyński (2012) is a self-administered measure that consists of 24 statements concerning various health behaviors. Respondents indicate the frequency of engaging in certain activities using a 5-point answer scale. The inventory includes four categories of health behaviors: the type of consumed food, preventive behaviors aimed at following medical recommendations, health practices (e.g. sleep, relaxation, and physical activity), and positive mental attitude (avoiding intensive emotions and depressing situations). The Cronbach’s α coefficient of the IZZ is 0.85, and the coefficients of the particular subscales range from 0.60 to 0.65 (Juczyński, 2012). For the current sample, the Cronbach’s α coefficient is 0.82.

The Sense of Coherence Questionnaire (SOC-29) developed by Antonovsky (1993) and adapted to Polish by Koniarek et al. (1993) consists of 29 items and assesses the sense of coherence and its three components: comprehensibility, manageability, and meaningfulness. Respondents respond using a 7-point answer scale. The Cronbach’s α coefficient of the SOC-29 is 0.78 (Koniarek et al., 1993), and the coefficient for the current sample is 0.91.

Following the quantitative assessment of the collected data, the data obtained from 104 respondents (84 women and 19 men) between 22 and 45 years of age (mean age = 32 years) were included in further analysis.

The correlation of the results of the EMQ, SOC-29 and IZZ constituted the convergent validity of the questionnaire. The analysis confirmed our expectations concerning H₂ and H₃. We found a positive correlation of the overall EMQ score with the IZZ (r = 0.38, p < 0.05). The validity of the EMQ was also confirmed by the results of the correlation analysis between the overall score of the EMQ and the SOC-29 (r = 0.29, p < 0.05). Furthermore, each subscale of the SOC-29 influenced the overall EMQ score. Thus, the results indicate that EM is positively correlated with the following components of the sense of coherence: comprehensibility (r = 0.20, p < 0.05), manageability (r = 0.23, p < 0.05), and meaningfulness (r = 0.33, p < 0.05).

Conclusion

The core construct of the EMQ was based on Allport’s theory of mature personality. According to this theory, we assumed that EM initiates and gives direction to human eating behaviors and may be described as an individual’s system of beliefs that plays a regulatory role in satisfying various personal needs (biological, psychological, and social needs). The EMQ was designed to assess EM as manifested in beliefs concerning dieting and “using” food for aims other than satisfying physiological hunger.

The EMQ was developed as a result of an exploratory factor analysis complemented by the reliability assessment of two dimensions established on the basis of theory and analysis. The questionnaire consists of 21 items that are divided into two subscales: Rational Eating and Psychosocial Maturity.

The internal consistency coefficients indicate that the EMQ is a trustworthy method and fulfills the commonly used methodological criteria.

On the basis of the EMQ results, for example, interventions directed at body mass reduction may be designed to assess whether a given individual requires modification of his or her eating habits and consultation with a dietician or requires corrections in their psychosocial motives and psychological consultation.