The thesis of Kristen N. Arnold was reviewed and approved* by the following

114 Pages·2012·1.68 MB·English

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The Pennsylvania State University
The Graduate School
College of Health and Human Development

FORMATIVE DEVELOPMENT OF THE
SATTER FEEDING DYNAMICS INVENTORY:
A TOOL TO ASSESS THE FEEDING RELATIONSHIP
BETWEEN CAREGIVER AND PRESCHOOLER

A Thesis in
Nutrition
by
Kristen Nicole Arnold

© 2012 Kristen Nicole Arnold

Submitted in Partial Fulfillment
of the Requirements
for the Degree of

Master of Science

May 2012
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The thesis of Kristen N. Arnold was reviewed and approved* by the following:

Barbara Lohse
Associate Professor of Nutritional Sciences
Thesis Advisor

Lori Francis
Assistant Professor of Biobehavioral Health

Jill Patterson
Assistant Professor of Nutritional Sciences

Gordon Jensen
Professor of Nutrition
Head of Department of Nutritional Sciences

*signatures are on file in the Graduate School
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ABSTRACT
Concerns about feeding are among the most common behavioral problems reported to
health care professionals, with approximately 24-45% of parents reporting this issue.
Disruptions in feeding are associated with a number of negative behavioral and developmental
outcomes in children, and may to lead to disruptive mealtime behavior, picky eating, less-than-
optimal growth, and obesity. The Satter Feeding Dynamics Model (fdSatter) has been proposed
to guide parents and professionals in optimizing the feeding relationship between parent and
child. fdSatter is an authoritative model that proposes that parents guide the feeding process
based on cues coming from the child, and as a result, the child will be competent with eating
attitudes, food regulation and growth, food acceptance, and mealtime behavior. Maintaining a
division of responsibility in feeding and trusting a child to grow and eat as intended is suggested
to be an effective means of reducing child feeding problems. To evaluate and develop effective
interventions, a tool that can capture the division of responsibility and can identify positive and
negative feeding behaviors is needed. Among existing tools assessing child feeding, few are
validated, and few assess the dynamics between the parent and child in the feeding relationship.
To address this need, a prototype instrument was offered by Satter that addressed parent’s
leadership and autonomy roles incumbent in adhering to the division of feeding responsibility as
defined by fdSatter; this measure is the Satter Feeding Dynamics Inventory (fdSI).
This project summarizes the iterative process of developing and testing the fdSI.
Included in this summary are details and findings from 4 early phases and a fifth phase resulting
in a version ready for construct validation and intensive psychometric analyses. The fifth phase
was accomplished with cognitive interviews of 9 low-income and 5 middle-income parents of
preschool aged children to assess comprehension of survey items using response mapping and
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thematic analysis. Findings revealed low respondent burden of the fdSI and led to revisions of 2
items and the elimination of one item. Eating competence (EC) was examined as a moderator of
adherence to fdSatter by comparing fdSI scores to those on the Satter Eating Competence
Inventory for Low-Income. Despite the small sample size of the fifth phase of testing, trends
were apparent that supported EC as a moderating influence. Eating competent parents were
more likely to perceive their child’s eating positively, compared to non-eating competent parents.
Outcomes from the iterative fdSI testing plan supported cognitive testing as an essential
step in readying an instrument for the validation and psychometric studies necessary to support
its use in intervention assessment. Multi-phase and constant comparative testing have resulted in
an instrument ready for validation as a measure of adherence to the division of feeding
responsibilities as defined by fdSatter. Subsequent availability of this valid measure is essential
for study of interventions that seek to improve the parent-child feeding relationship, especially
those with the goal of understanding the role of parenting in child obesity prevention.
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TABLE OF CONTENTS

LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

LIST OF FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Chapter 1. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Child Feeding Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
The Feeding Relationship and Child Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
The Satter Feeding Dynamics Model (fdSatter) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
The Division of Responsibility in Feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Available Tools to Assess Child Feeding Practices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Need for the Satter Feeding Dynamics Inventory (fdSI) . . . . . . . . . . . . . . . . . . . . . . . . . 12
Overview of the Satter Feeding Dynamics Inventory (fdSI) Development . . . . . . . . . . 13

Chapter 2. JOURNAL MANUSCRIPT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Study Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Recruitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Data Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Description of Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Data Collection Process Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Comparison of Earlier Phase Responses to Current Responses . . . . . . . . . . . . . 24
Item Response Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Eating Competence as a Moderator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Implications for Research and Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Chapter 3. IMPLICATIONS FOR RESEARCH AND PRACTICE . . . . . . . . . . . . . . . . . . . . . . 38
Implications for Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
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Implications for Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

APPENDIX A: Literature Review of Currently Available Feeding Tools . . . . . . . . . . . . . . . . 55

APPENDIX B: Stages of Item Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

APPENDIX C: Discussion and Rationale for Item Modifications . . . . . . . . . . . . . . . . . . . . . . . 75

APPENDIX D: Participant Interview Responses and Response Mapping . . . . . . . . . . . . . . . . . 81

APPENDIX E: Data Collection Forms (Cognitive Interview Script, Survey) . . . . . . . . . . . . . . 99
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LIST OF TABLES

Table 1.1: Baumrind’s Model of Parenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Table 1.2: Satter Feeding Dynamics Inventory Leadership and Autonomy Questions. . . . . . . . 13
Table 2.1: Participant Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Table 2.2: Comparison of Responses for Items Appearing on Both Versions 4 and 5 . . . . . . . 34
Table 2.2: Participant Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Table 2.3: Item Modification: Rationale for Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
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LIST OF FIGURES

Figure 1.1: The Satter Feeding Dynamics Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Figure 1.2: Timeline of fdSI Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
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ACKNOWLEDGEMENTS

I would like to acknowledge Ellyn Satter, Barbara Lohse, and Christine Least for their
contribution and involvement in all stages of survey development. I am thankful for the
opportunity to work on this project, and for their guidance and wisdom throughout this process.
I would also like to acknowledge the following organizations for their involvement in data
collection and recruitment:
- Lewistown WIC clinic
- State College Preschools
- Schlow Library
Finally, I would like to thank the members of my thesis committee, Dr. Jill Patterson and
Dr. Lori Francis for their insight, and also my research mentor, Dr. Barbara Lohse, for her
guidance and support over my two years as a graduate student.
This project was funded by the PA Department of Public Welfare (DPW) through the
PENNSYLVANIA NUTRITION EDUCATION TRACKS, as part of USDA’s Supplemental
Nutrition Assistance Program (SNAP) and also by Ellyn Satter Associates. This research was
also supported by the Penn State Department of Nutritional Sciences, and in part by Agriculture
and Food Research Initiative Grant no. 2011-67001-30117 from the USDA National Institute of
Food and Agriculture Childhood Obesity Prevention Challenge Area.
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CHAPTER 1

Background
Child Feeding Problems
Concerns about feeding are among the most common behavioral problems reported to
health care professionals by parents of young children, with approximately 24-45% of parents
reporting this issue (Lincheid, Budd, & Rasnake, 2003). Feeding problems are associated with a
number of negative behavioral and developmental outcomes in children, including disruptive
mealtime behavior, picky eating, less-than-optimal growth, and obesity (Lincheid, Budd, &
Rasnake, 2003). In addition, early childhood eating problems can contribute to the development
of anxiety disorder (Ong et al., 2006) and eating disorders (Marchi & Cohen, 1990). Feeding
problems are multidimensional, and can be influenced by parent attitudes and behaviors, child
eating behaviors, and the feeding relationship between the care provider and child (Satter, 1990).
Satter (1986) defined the term feeding relationship to be “. . . the complex of
interactions that takes place between parent (or other primary caregiver) and child as they engage
in food selection, ingestion, and regulation.” Problems in the feeding relationship can negatively
affect the parent-child relationship and can lead to growth problems (Marchi & Cohen, 1990),
inadequate nutrition (Galloway, et al., 2005), and child behavioral problems. Maternal reports of
child feeding problems are associated with perceptions of difficult temperament, unstable
mother-child interactions outside of the feeding context, and reports of sleeping problems
(Lindberg, et al; Raynor & Rudolf, 1996; Farrow & Blisset, 2006). Mothers who reported a
struggle for control over their child’s eating were more likely to report externalizing behavior