Development and validation of a structured questionnaire to assess screen exposure, influence of food advertisement and parental nutrition knowledge in early childhood

Abstract

Background: Early childhood is a critical period for the establishment of food preferences and eating behaviour. The growing penetration of digital media and targeted food advertising has increased children’s exposure to energy-dense, nutrient-poor products, while parental nutrition knowledge mediates the impact of these exposures on child dietary behaviour. Methods: This cross-sectional, questionnaire-based instrument development and validation study was conducted among parent-child dyads recruited from Anganwadi centres and private preschools in Mysuru and Hosur taluks between March 2024 and October 2025. A structured questionnaire covering four domains food advertising exposure, screen-time patterns, parental nutrition knowledge, and preschoolers’ eating habits- was developed through item generation, expert content/face validation (content validity ratio using Lawshe’s method), pilot testing (n=25), and reliability testing, before administration to the final study sample of 1200 parent-child dyads (600 each from Mysuru and Hosur). Results: The questionnaire demonstrated good overall internal consistency (Cronbach’s α=0.78), with domain-wise values of 0.83 (food advertising exposure), 0.76 (screen time patterns), 0.72 (parental nutrition knowledge), and 0.81 (preschoolers’ eating habits). Among the 1200 children (mean age distributed across 3-5 years; 54.3% boys in Mysuru and 50.8% girls in Hosur), average daily screen time was 1.39±0.74 hours, with 23.3% of children in the high (>2 hours/day) screen-time category. Socio-economic classification using the Modified Kuppuswamy Scale (2025) showed the largest proportion of families (40.0%) in the lower-middle class, and 37.3% of parents demonstrated low nutrition knowledge at baseline. Conclusions: The developed questionnaire is a valid and reliable instrument for the integrated assessment of food advertising exposure, screen-time behaviour, parental nutrition knowledge, and dietary habits among preschool-aged children, and offers a practical, replicable tool for researchers and public health practitioners.