Development and Validation of a Tool to Assess Determinants of Nutritional Behavior in Patients with Heart Failure Based on the Theory of Planned Behavior
Abstract
Background: Adopting healthy nutritional behavior among patients with heart failure (HF) plays a crucial role in controlling disease symptoms. Developing effective interventions requires identifying significant determinants of nutritional behavior using theoretical frameworks from behavioral sciences and validated instruments. This study aimed to develop and validate tools to assess the determinants of nutritional behavior in patients with HF based on the Theory of Planned Behavior (TPB).
Methods: A preliminary instrument with four subscales was developed based on the TPB. An instrument for measuring the nutritional behavior of patients with HF was also created. Face and content validity were assessed using qualitative and quantitative methods. The factor structure of the TPB instrument was examined using exploratory factor analysis (EFA) in a sample of 330 patients with HF. Instrument reliability was also evaluated.
Results: During face and content validity assessment, 13 items were removed from the TPB instrument, and 14 items were modified across both instruments. The EFA revealed that the 12 items measuring TPB variables loaded onto four distinct subscales: behavioral intention, attitude, perceived behavioral control, and subjective norms. The Kaiser-Meyer-Olkin measure and Bartlett test of sphericity were acceptable. These factors accounted for 87.03% of the total variance. All TPB subscales demonstrated acceptable internal consistency, as measured by Cronbach’s α. Both instruments showed satisfactory intraclass correlation coefficients.
Conclusion: The developed instruments are valid and reliable tools for assessing the determinants of nutritional behavior in patients with HF based on the TPB. They can be used for needs assessment and to develop educational interventions for this population.
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5. Sytkowski PA, D'Agostino RB, Belanger A, Kannel WB. Sex and time trends in cardiovascular disease incidence and mortality: the Framingham Heart Study, 1950-1989. Am J Epidemiol. 1996;143(4):338-50.
6. Barzin M, Mirmiran P, Afghan M, Azizi F. Distribution of 10-year risk for coronary heart disease and eligibility for therapeutic approaches among Tehranian adults. Public Health. 2011;125(6):338-44.
7. Abdollahy A, Bazrafshan H, Salehi A, Behnampour N, Hosayni S, Rahmany H, et al. Epidemiology of hypertension among urban population in Golestan province in north of Iran. J Gorgan Univ Med Sci. 2007;8(4):37-41.
8. Evangelista LS, Shinnick MA. What do we know about adherence and self-care? J Cardiovasc Nurs. 2008;23(3):250-7.
9. Riegel B, Jaarsma T, Stromberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204.
10. Sedlar N, Lainscak M, Mårtensson J, Strömberg A, Jaarsma T, Farkas J. Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies. Eur J Cardiovasc Nurs. 2017;16(4):272-82.
11. Mansouri K, Hasavari F, Sedghi Sabet M, Kazemnejad-Leili E, Gholipour M. Self-care status and its related factors in patients with heart failure. J Health Care. 2018;19(4):232-41.
12. Bagheri–Saweh MI, Lotfi A, Salawati Ghasemi S. Self-care behaviors and related factors in chronic heart failure patients. Int J Biomed Public Health. 2018;1(1):42-47.
13. Jaarsma T, Cameron J, Riegel B, Stromberg A. Factors related to self-care in heart failure patients according to the middle-range theory of self-care of chronic illness: a literature update. Curr Heart Fail Rep. 2017;14(2):71-7.
14. Riegel B, Moser DK, Anker SD, Appel LJ, Dunbar SB, Grady KL, et al. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. Circulation. 2009;120(12):1141-63.
15. Huyen NN, Jullamate P, Kangchai W. Factors related to self-care behaviors among older adults with heart failure in Thai Nguyen General Hospital, Vietnam. In: Proceedings of the First International Conference on Interdisciplinary Research and Development; 2011.
16. Billingsley HE, Hummel SL, Carbone S. The role of diet and nutrition in heart failure: A state-of-the-art narrative review. Prog Cardiovasc Dis. 2020;63(5):538-51.
17. Liou H-L, Chen H-I, Hsu S-C, Lee S-C, Chang C-J, Wu M-J. The effects of a self-care program on patients with heart failure. J Chin Med Assoc. 2015;78(11):648-56.
18. Antonogeorgos G, Panagiotakos DB, Pitsavos C, Papageorgiou C, Chrysohoou C, Papadimitriou GN, et al. Understanding the role of depression and anxiety on cardiovascular disease risk, using structural equation modeling; the mediating effect of the Mediterranean diet and physical activity: the ATTICA study. Ann Epidemiol. 2012;22(9):630-7.
19. Hou N, Chui MA, Eckert GJ, Oldridge NB, Murray MD, Bennett SJ. Relationship of age and sex to health-related quality of life in patients with heart failure. Am J Crit Care. 2004;13(2):153-161.
20. Ahmadi Tabatabaei S, Taghdisi M, Nakheei N, Balali F. Effect of educational intervention based on the theory of planned behaviour on the physical activities of Kerman health center's staff. J Babol Univ Med Sci. 2010;12(2):62-9.
21. Pakpour Hajiagha A, Mohammadi Zeidi I, Mohammadi Zeidi B. The impact of health education based on theory of planned behavior on the prevention of AIDS among adolescents. Iran J Nurs. 2012;25(78):1-13.
22. Jadgal KM, Zareban I, Rakhshani F, Shahrakipour M, Sepehrvand B, Alizadeh Sivaki H. The effect of health education according to the theory of planned behavior on malaria preventive behavior in rural men of Chabahar. J Res Health. 2012;2(2):237-46.
23. Hajizadeh E, Heidarnia A, Niknami S, Karimy M. Psychometric properties of a theory of planned behavior questionnaire for tobacco use in male adolescents. JSUMS. 1970;19(2):190-7.
24. Nohtani V, Zareban I, Ansari H. Educational program based on the theory of planned behavior and its effect on self-care behaviors in patients with pre-hypertension. Iran J Health Educ Health Promot. 2021;9(1):5-19.
25. Hatefnia E, Niknami S, Mahmudi M, Lamyian M. The effects of “Theory of Planned Behavior” based education on the promotion of mammography performance in employed women. J Birjand Univ Med Sci. 2010;17(1):50-8.
26. Mirzaei N, Dehdari T, Taghdisi MH, Zare N. Development of an instrument based on the theory of planned behavior variables to measure factors influencing Iranian adults’ intention to quit waterpipe tobacco smoking. Psychol Res Behav Manag. 2019;12:901-12.
27. Riegel B, Carlson B, Moser DK, Sebern M, Hicks FD, Roland V. Psychometric testing of the self-care of heart failure index. J Card Fail. 2004;10(4):350–360. PubMed PMID: 15309704.
28. Vellone E, Riegel B, Cocchieri A, Barbaranelli C, D'Agostino F, Antonetti G, et al. Psychometric testing of the self-care of heart failure index version 6.2. Res Nurs Health. 2013;36(5):500-511.
29. Andreae C, Strömberg A, Sawatzky R, Årestedt K. Psychometric evaluation of two appetite questionnaires in patients with heart failure. J Card Fail. 2015;21(12):954-8.
30. Reilly CM, Higgins M, Smith A, Gary RA, Robinson J, Clark PC, et al. Development, psychometric testing, and revision of the Atlanta Heart Failure Knowledge Test. J Cardiovasc Nurs. 2009;24(6):500-509.
31. Bentley B, Lennie TA, Biddle M, Chung ML, Moser DK. Demonstration of psychometric soundness of the Dietary Sodium Restriction Questionnaire in patients with heart failure. Heart Lung. 2009;38(2):121-8.
32. Bennett SJ, Milgrom LB, Champion V, Huster GA. Beliefs about medication and dietary compliance in people with heart failure: an instrument development study. Heart Lung. 1997;26(4):273-9.
33. Wu J-R, Lennie TA, Dunbar SB, Pressler SJ, Moser DK. Does the theory of planned behavior predict dietary sodium intake in patients with heart failure? West J Nurs Res. 2017;39(4):568-81.
34. Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best practices for developing and validating scales for health, social, and behavioral research: a primer. Front Public Health. 2018;6:149.
35. Francis JJ, Eccles MP, Johnston M, Walker A, Grimshaw JM, Foy R, et al. Constructing questionnaires based on the theory of planned behaviour: A manual for health services researchers. Newcastle upon Tyne: Centre for Health Services Research, University of Newcastle upon Tyne; 2004.
36. Abbasi A, Araban M, Heidari Z, Alidosti M, Zamani-Alavijeh F. Development and psychometric evaluation of waste separation beliefs and behaviors scale among female students of medical sciences university based on the extended parallel process model. Environ Health Prev Med. 2020;25(1):12.
37. Lawshe CH. A quantitative approach to content validity. Pers Psychol. 1975; 28: 563-575.
38. Polit DF, Beck CT. Nursing research: Principles and methods. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2004.
39. Guadagnoli E, Velicer WF. Relation of sample size to the stability of component patterns. Psychol Bull. 1988;103(2):265–275.
40. Hsu LL, Hsieh SI. Development and psychometric evaluation of the competency inventory for nursing students: a learning outcome perspective. Nurse Educ Today. 2013;33(5):492-7.
41. Tran TD, Tran T, Fisher J. Validation of the depression anxiety stress scales (DASS) 21 as a screening instrument for depression` and anxiety in a rural community-based cohort of northern Vietnamese women. BMC Psychiatry. 2013;13:24.
42. Cronbach LJ. Coefficient alpha and the internal structure of tests.Psychometrika. 1951;16:297‑334.
43. Hajizadeh E, Asghari M. Statistical methods and analysis with a view to research methods in biological and health sciences. Tehran: Jahad Daneshgahi Publications; 2011.
44. Caro-Bautista J, Espinar-Toledo M, Villa-Estrada F, Lupiáñez-Pérez I, Kaknani-Uttumchandani S, García-Mayor S, et al. Development and psychometric validation of an instrument to identify barriers to self-care among Spanish patients with type 2 diabetes on the basis of theory of planned behavior. Value Health. 2019;22(9):1033-41.
45. Jackson C. Behavioral science theory and principles for practice in health education. Health Educ Res. 1997;12(1):143-50.
46. Glanz K, Rimer BK. Theory at a glance: a guide for health promotion practice. 2nd ed. Bethesda, MD: U.S. Dept. of Health and Human Services, National Institutes of Health, National Cancer Institute; 2005.
47. Gilbert GE, Prion S. Making sense of methods and measurement: Lawshe's content validity index. Clin Simul Nurs. 2016;12(12):530-531.
48. Wicaksana AL, Wang ST. Psychometric testing of the Indonesian version of dietary sodium restriction questionnaire among patients with hypertension. Asian Nurs Res. 2018;12(4):279‑85.
49. d'Almeida KS, Souza GC, Rabelo-Silva ER. Validez y fiabilidad del Dietary Sodium Restriction Questionnaire (DSRQ). Nutr Hosp. 2013;28(5):1702-1709.
50. Mohammadi M, Akhondzadeh S, Keshavarz SA, Mostafavi SA. The characteristics, reliability and validity of the Persian version of Simplified Nutritional Appetite Questionnaire (SNAQ). J Nutr Health Aging. 2019;23(9):837-842.
51. Heikkilä M, Valve R, Lehtovirta M, Fogelholm M. Development of a nutrition knowledge questionnaire for young endurance athletes and their coaches. Scand J Med Sci Sports. 2018;28(3):873-880.
52. Vázquez-Espino K, Fernández-Tena C, Lizarraga-Dallo MA, Farran-Codina A. Development and validation of a short sport nutrition knowledge questionnaire for athletes. Nutrients. 2020;12(11):3561.
53. El‑Osta A, Riboli‑Sasco E, Barbanti E, Webber I, Alaa A, Karki M, et al. Tools for measuring individual self-care capability: a scoping review. BMC Public Health. 2023;23(1):1312.
54. McNamara J, Kunicki ZJ, Olfert MD, Byrd‑Bredbenner C, Greene G. Revision and psychometric validation of a survey tool to measure critical nutrition literacy in young adults. J Nutr Educ Behav. 2020;52(7):726‑731.
55. Jaarsma T, Strömberg A, Mårtensson J, Dracup K. Development and testing of the European heart failure self‐care behaviour scale. Eur J Heart Fail. 2003;5(3):363-370.
56. Koirala B, Budhathoki C, Dennison-Himmelfarb CR, Bhattarai P, Davidson PM. The Self-Care of Heart Failure Index: A psychometric study. J Clin Nurs. 2020;29(3-4):645-652.
57. Fromm SP, Horstmann A. Psychometric evaluation of the German version of the dietary fat and free sugar-short questionnaire. Obes Facts. 2019;12(5):518-528.
2. Hasanpour-Dehkordi A, Khaledi-Far A, Khaledi-Far B, Salehi-Tali S. The effect of family training and support on the quality of life and cost of hospital readmissions in congestive heart failure patients in Iran. Appl Nurs Res. 2016;31:165-9.
3. Moradi Y, Rahmani A, Aghakarimi K, Sheikhy N. Effect of applying follow-up care model on self-care management in heart failure patients: a randomized clinical trial. Nurs Midwifery J. 2017;15(3):208-17.
4. Shahbaz A, Hemmati-Maslakpak M. Relationship of self-care behaviors with hospital readmission in people with heart failure. Iran J Cardiovasc Nurs. 2017;6(2):24-33.
5. Sytkowski PA, D'Agostino RB, Belanger A, Kannel WB. Sex and time trends in cardiovascular disease incidence and mortality: the Framingham Heart Study, 1950-1989. Am J Epidemiol. 1996;143(4):338-50.
6. Barzin M, Mirmiran P, Afghan M, Azizi F. Distribution of 10-year risk for coronary heart disease and eligibility for therapeutic approaches among Tehranian adults. Public Health. 2011;125(6):338-44.
7. Abdollahy A, Bazrafshan H, Salehi A, Behnampour N, Hosayni S, Rahmany H, et al. Epidemiology of hypertension among urban population in Golestan province in north of Iran. J Gorgan Univ Med Sci. 2007;8(4):37-41.
8. Evangelista LS, Shinnick MA. What do we know about adherence and self-care? J Cardiovasc Nurs. 2008;23(3):250-7.
9. Riegel B, Jaarsma T, Stromberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204.
10. Sedlar N, Lainscak M, Mårtensson J, Strömberg A, Jaarsma T, Farkas J. Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies. Eur J Cardiovasc Nurs. 2017;16(4):272-82.
11. Mansouri K, Hasavari F, Sedghi Sabet M, Kazemnejad-Leili E, Gholipour M. Self-care status and its related factors in patients with heart failure. J Health Care. 2018;19(4):232-41.
12. Bagheri–Saweh MI, Lotfi A, Salawati Ghasemi S. Self-care behaviors and related factors in chronic heart failure patients. Int J Biomed Public Health. 2018;1(1):42-47.
13. Jaarsma T, Cameron J, Riegel B, Stromberg A. Factors related to self-care in heart failure patients according to the middle-range theory of self-care of chronic illness: a literature update. Curr Heart Fail Rep. 2017;14(2):71-7.
14. Riegel B, Moser DK, Anker SD, Appel LJ, Dunbar SB, Grady KL, et al. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. Circulation. 2009;120(12):1141-63.
15. Huyen NN, Jullamate P, Kangchai W. Factors related to self-care behaviors among older adults with heart failure in Thai Nguyen General Hospital, Vietnam. In: Proceedings of the First International Conference on Interdisciplinary Research and Development; 2011.
16. Billingsley HE, Hummel SL, Carbone S. The role of diet and nutrition in heart failure: A state-of-the-art narrative review. Prog Cardiovasc Dis. 2020;63(5):538-51.
17. Liou H-L, Chen H-I, Hsu S-C, Lee S-C, Chang C-J, Wu M-J. The effects of a self-care program on patients with heart failure. J Chin Med Assoc. 2015;78(11):648-56.
18. Antonogeorgos G, Panagiotakos DB, Pitsavos C, Papageorgiou C, Chrysohoou C, Papadimitriou GN, et al. Understanding the role of depression and anxiety on cardiovascular disease risk, using structural equation modeling; the mediating effect of the Mediterranean diet and physical activity: the ATTICA study. Ann Epidemiol. 2012;22(9):630-7.
19. Hou N, Chui MA, Eckert GJ, Oldridge NB, Murray MD, Bennett SJ. Relationship of age and sex to health-related quality of life in patients with heart failure. Am J Crit Care. 2004;13(2):153-161.
20. Ahmadi Tabatabaei S, Taghdisi M, Nakheei N, Balali F. Effect of educational intervention based on the theory of planned behaviour on the physical activities of Kerman health center's staff. J Babol Univ Med Sci. 2010;12(2):62-9.
21. Pakpour Hajiagha A, Mohammadi Zeidi I, Mohammadi Zeidi B. The impact of health education based on theory of planned behavior on the prevention of AIDS among adolescents. Iran J Nurs. 2012;25(78):1-13.
22. Jadgal KM, Zareban I, Rakhshani F, Shahrakipour M, Sepehrvand B, Alizadeh Sivaki H. The effect of health education according to the theory of planned behavior on malaria preventive behavior in rural men of Chabahar. J Res Health. 2012;2(2):237-46.
23. Hajizadeh E, Heidarnia A, Niknami S, Karimy M. Psychometric properties of a theory of planned behavior questionnaire for tobacco use in male adolescents. JSUMS. 1970;19(2):190-7.
24. Nohtani V, Zareban I, Ansari H. Educational program based on the theory of planned behavior and its effect on self-care behaviors in patients with pre-hypertension. Iran J Health Educ Health Promot. 2021;9(1):5-19.
25. Hatefnia E, Niknami S, Mahmudi M, Lamyian M. The effects of “Theory of Planned Behavior” based education on the promotion of mammography performance in employed women. J Birjand Univ Med Sci. 2010;17(1):50-8.
26. Mirzaei N, Dehdari T, Taghdisi MH, Zare N. Development of an instrument based on the theory of planned behavior variables to measure factors influencing Iranian adults’ intention to quit waterpipe tobacco smoking. Psychol Res Behav Manag. 2019;12:901-12.
27. Riegel B, Carlson B, Moser DK, Sebern M, Hicks FD, Roland V. Psychometric testing of the self-care of heart failure index. J Card Fail. 2004;10(4):350–360. PubMed PMID: 15309704.
28. Vellone E, Riegel B, Cocchieri A, Barbaranelli C, D'Agostino F, Antonetti G, et al. Psychometric testing of the self-care of heart failure index version 6.2. Res Nurs Health. 2013;36(5):500-511.
29. Andreae C, Strömberg A, Sawatzky R, Årestedt K. Psychometric evaluation of two appetite questionnaires in patients with heart failure. J Card Fail. 2015;21(12):954-8.
30. Reilly CM, Higgins M, Smith A, Gary RA, Robinson J, Clark PC, et al. Development, psychometric testing, and revision of the Atlanta Heart Failure Knowledge Test. J Cardiovasc Nurs. 2009;24(6):500-509.
31. Bentley B, Lennie TA, Biddle M, Chung ML, Moser DK. Demonstration of psychometric soundness of the Dietary Sodium Restriction Questionnaire in patients with heart failure. Heart Lung. 2009;38(2):121-8.
32. Bennett SJ, Milgrom LB, Champion V, Huster GA. Beliefs about medication and dietary compliance in people with heart failure: an instrument development study. Heart Lung. 1997;26(4):273-9.
33. Wu J-R, Lennie TA, Dunbar SB, Pressler SJ, Moser DK. Does the theory of planned behavior predict dietary sodium intake in patients with heart failure? West J Nurs Res. 2017;39(4):568-81.
34. Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best practices for developing and validating scales for health, social, and behavioral research: a primer. Front Public Health. 2018;6:149.
35. Francis JJ, Eccles MP, Johnston M, Walker A, Grimshaw JM, Foy R, et al. Constructing questionnaires based on the theory of planned behaviour: A manual for health services researchers. Newcastle upon Tyne: Centre for Health Services Research, University of Newcastle upon Tyne; 2004.
36. Abbasi A, Araban M, Heidari Z, Alidosti M, Zamani-Alavijeh F. Development and psychometric evaluation of waste separation beliefs and behaviors scale among female students of medical sciences university based on the extended parallel process model. Environ Health Prev Med. 2020;25(1):12.
37. Lawshe CH. A quantitative approach to content validity. Pers Psychol. 1975; 28: 563-575.
38. Polit DF, Beck CT. Nursing research: Principles and methods. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2004.
39. Guadagnoli E, Velicer WF. Relation of sample size to the stability of component patterns. Psychol Bull. 1988;103(2):265–275.
40. Hsu LL, Hsieh SI. Development and psychometric evaluation of the competency inventory for nursing students: a learning outcome perspective. Nurse Educ Today. 2013;33(5):492-7.
41. Tran TD, Tran T, Fisher J. Validation of the depression anxiety stress scales (DASS) 21 as a screening instrument for depression` and anxiety in a rural community-based cohort of northern Vietnamese women. BMC Psychiatry. 2013;13:24.
42. Cronbach LJ. Coefficient alpha and the internal structure of tests.Psychometrika. 1951;16:297‑334.
43. Hajizadeh E, Asghari M. Statistical methods and analysis with a view to research methods in biological and health sciences. Tehran: Jahad Daneshgahi Publications; 2011.
44. Caro-Bautista J, Espinar-Toledo M, Villa-Estrada F, Lupiáñez-Pérez I, Kaknani-Uttumchandani S, García-Mayor S, et al. Development and psychometric validation of an instrument to identify barriers to self-care among Spanish patients with type 2 diabetes on the basis of theory of planned behavior. Value Health. 2019;22(9):1033-41.
45. Jackson C. Behavioral science theory and principles for practice in health education. Health Educ Res. 1997;12(1):143-50.
46. Glanz K, Rimer BK. Theory at a glance: a guide for health promotion practice. 2nd ed. Bethesda, MD: U.S. Dept. of Health and Human Services, National Institutes of Health, National Cancer Institute; 2005.
47. Gilbert GE, Prion S. Making sense of methods and measurement: Lawshe's content validity index. Clin Simul Nurs. 2016;12(12):530-531.
48. Wicaksana AL, Wang ST. Psychometric testing of the Indonesian version of dietary sodium restriction questionnaire among patients with hypertension. Asian Nurs Res. 2018;12(4):279‑85.
49. d'Almeida KS, Souza GC, Rabelo-Silva ER. Validez y fiabilidad del Dietary Sodium Restriction Questionnaire (DSRQ). Nutr Hosp. 2013;28(5):1702-1709.
50. Mohammadi M, Akhondzadeh S, Keshavarz SA, Mostafavi SA. The characteristics, reliability and validity of the Persian version of Simplified Nutritional Appetite Questionnaire (SNAQ). J Nutr Health Aging. 2019;23(9):837-842.
51. Heikkilä M, Valve R, Lehtovirta M, Fogelholm M. Development of a nutrition knowledge questionnaire for young endurance athletes and their coaches. Scand J Med Sci Sports. 2018;28(3):873-880.
52. Vázquez-Espino K, Fernández-Tena C, Lizarraga-Dallo MA, Farran-Codina A. Development and validation of a short sport nutrition knowledge questionnaire for athletes. Nutrients. 2020;12(11):3561.
53. El‑Osta A, Riboli‑Sasco E, Barbanti E, Webber I, Alaa A, Karki M, et al. Tools for measuring individual self-care capability: a scoping review. BMC Public Health. 2023;23(1):1312.
54. McNamara J, Kunicki ZJ, Olfert MD, Byrd‑Bredbenner C, Greene G. Revision and psychometric validation of a survey tool to measure critical nutrition literacy in young adults. J Nutr Educ Behav. 2020;52(7):726‑731.
55. Jaarsma T, Strömberg A, Mårtensson J, Dracup K. Development and testing of the European heart failure self‐care behaviour scale. Eur J Heart Fail. 2003;5(3):363-370.
56. Koirala B, Budhathoki C, Dennison-Himmelfarb CR, Bhattarai P, Davidson PM. The Self-Care of Heart Failure Index: A psychometric study. J Clin Nurs. 2020;29(3-4):645-652.
57. Fromm SP, Horstmann A. Psychometric evaluation of the German version of the dietary fat and free sugar-short questionnaire. Obes Facts. 2019;12(5):518-528.
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| Issue | Vol 20 No 3 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v20i3.20108 | |
| Keywords | ||
| Heart Failure Nutritional Behavior Theory of Planned Behavior Psychometrics Instrument | ||
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How to Cite
1.
Alavi F-S, Farahbakhsh P, Dehdari T. Development and Validation of a Tool to Assess Determinants of Nutritional Behavior in Patients with Heart Failure Based on the Theory of Planned Behavior. Res Heart Yield Transl Med. 2024;20(3):173-184.
