European Journal of Clinical Nutrition (2010) 64, 210–217

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ORIGINAL ARTICLE
Validity and reliability testing of a short
questionnaire developed to assess consumers’ use,
understanding and perception of food labels
D Mackison1, WL Wrieden2 and AS Anderson1

1
Centre for Public Health Nutrition Research, Division of Clinical and Population Sciences and Education (CPSE), University of
Dundee, Ninewells Hospital and Medical School, Dundee, UK and 2School of Pharmacy and Life Sciences, The Robert Gordon
University, Aberdeen, UK

Background: Food labels may have an important function in communicating nutrition information and have considerable
potential to influence food choice and dietary behaviour.
Objectives: To assess the validity and reliability of a short (self-complete) questionnaire designed to measure consumers’ use
and understanding of food labels.
Methods: Questionnaire content was determined by gaps highlighted in a literature review of food labelling. Nineteen
questions (49 items) assessing frequency of label reading perceived importance of food labels, regularity of dining out, desire to
have nutrition information at specific catering outlets and ability to perform nutrition information tasks were formulated and
presented on four pages of A4. With the exception of two open-ended questions, all items were presented as closed (field box)
structures. Content validity, face validity, item analysis, repeat and internal reliability were assessed.
Results: Nutrition experts (26) completed detailed content validity assessment, resulting in high scores for appropriateness,
importance and phrasing of questions, although grammar and terminology changes were required. Face validity indicated that
the questionnaire was quick to complete (o15 min), easy to follow and comprehensible. Cronbach’s alpha scores (internal
reliability) for questions with multiple sections ranged from 0.72 to 0.91, indicating good internal consistency. Repeat reliability
testing showed Spearman’s correlation coefficients ranging from 0.51 to 0.97 (all Po0.001) showing high temporal stability.
Item Difficulty analysis indicated that questions (Section C only) were at an appropriate level (with P between 20 and 80% for all
items). Item discrimination analysis ranged from r ¼ 0.43 to 0.70, highlighting that items were suitable for inclusion.
Conclusions: This questionnaire is a suitable tool for assessing consumers’ use, understanding and perception of food labels.
European Journal of Clinical Nutrition (2010) 64, 210–217; doi:10.1038/ejcn.2009.126; published online 11 November 2009

Keywords: food labelling; labels; validity; reliability; questionnaire development

Introduction Encouragingly, most consumers claim to read food labels

Food labels are recognized as having a pivotal function in
communicating nutrition information to consumers and are
considered to have the potential to influence food choice
and dietary behaviour. For the consumer to make healthy
food choices, they must be able to locate, read, interpret and
understand the information presented on food labels.
Correspondence: D Mackison, Division of Clinical and Population Sciences
and Education (CPSE), Centre for Public Health Nutrition Research, University
of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
E-mail: d.mackison@dundee.ac.uk
Received 21 January 2009; revised 16 July 2009; accepted 20 July 2009;
published online 11 November 2009
often or sometimes (Cowburn and Stockley, 2005; European
Heart Network, 2003). Available literature, however, suggests
that while consumers claim to understand the information
they are reading (National Institute of Nutrition, 1999;
Stuart et al., 2004; Food Standards Agency, 2007), their actual
understanding is selective (European Heart Network, 2003;
Cowburn and Stockley, 2005). Consumers display little
difficulty judging the nutrient levels of products (Food
Standards Agency, 2006), yet struggle when asked to perform
arithmetical calculations and comparisons of different sizes
and types of products (Levy and Fein, 1998; Rothman et al.,
2006). Creating food label information that is easily inter-
preted by consumers requires knowledge of the specific label

attributes that consumers read and use. Energy and fat
information are the most commonly read nutrient by the
consumer (Black and Rayner, 1992; Institute of Grocery
Distribution, 1998; Kessler and Wunderlich, 1999; Marietta
et al., 1999; Neuhouser et al., 1999; Higginson et al., 2002;
Krukowski et al., 2006; Mannell et al., 2006); however, we
know little about the consumer’s interpretation of this
information and how this influences their food purchase
decisions (Grunert and Wills, 2007).
In a bid to standardize and ease the delivery of nutri-
tion information to the consumer, many countries have
adopted mandatory nutrition information on food labels
(for example United States, Australia and Canada) (Hawkes,
2004). If successful, the European Union’s recent proposal for
a Regulation on the provision of food information to
consumers (the consolidation and update of the general
food-labelling legislation (Council Directive 2000/13/EC of
the European Parliament and of the Council of 20 March
2000, 2000) and the nutrition-labelling legislation (Council
Directive 90/496/EEC of 24 September on nutrition labelling
for foodstuffs, 1990)) would introduce mandatory nutrition
labelling on the ‘principal field of vision’ (front of pack) on
all products throughout Member States (EU, 2008). During
the consultation and implementation phases of this Regula-
tion, increased consumer awareness of nutrition information
on food labels is anticipated as a direct result of media
coverage and as labelling changes become prevalent
throughout stores. The introduction of a new standardized
nutrition-labelling format provides a valuable opportunity
for education interventions focused on food labelling to take
centre stage. However, before public health practitioners can
tackle educating consumers on the new food-labelling
formats, it is imperative that we gain a better understanding
of the consumer’s views on food labels. More information is
needed on what information consumers actually use, and
how consumers use specific information and form food
purchase decisions based on food-labelling information.
Answering these questions will provide useful guidance for
a tailored food-labelling education campaign that will focus
on the key elements pertinent to improving consumers’ label
reading comprehension.
Estimated to be worth d36.6 billion by 2012 (Mintel,
2007), the catering sector has a significant function in
everyday life in Britain. Twenty-seven per cent of British
household’s food and drink expenditure is spent on food and
drink (excluding alcohol) outside the home (Defra, 2006).
Traditionally, eating out was initiated by a social event or
celebratory occasion; however, in today’s fast paced society,
eating outside the home is often a necessity. As dining out
increases, it raises the question, should we be seeing the
same nutrition and ingredient information when eating out
as we do when purchasing products in a retail environment?
As calorie information becomes compulsory in New York
chain restaurants with 15 or more outlets nationally (New
York City Department of Health and Mental Hygiene, 2007),
it becomes evident that we know very little about the British
Short questionnaire assessing food label use and understanding
D Mackison et al
211
consumers’ desire to have nutrition information available in
catering establishments. To date, there has been limited
research conducted on the British consumers’ views on the
application of nutrition style information in catering outlets.
The aim of this study was to develop a valid and reliable
short questionnaire to assess consumers’ use, understanding
and perception of food labels in both the retail and catering
environment.
Methods
Questionnaire development
Key areas were identified after a literature review on food
labelling and a draft questionnaire was devised. Five sections
(A–E) were identified:
a. Frequency of reading specific attributes on food labels, in
which food labels are read, and importance of food labels
b. Frequency of using, views on quantity and perceived
importance of nutrition information on food labels
c. Objective assessment of nutrition label tasks
d. Frequency of using specific catering establishments and
desire to see nutrition and additional information avail-
able in specific catering establishments
e. Demographic information
The instrument was intended to be completed indepen-
dently by adults aged 18 years of age and older, and it was
essential that the questionnaire was short in length (four
sides of A4 paper), quick to complete (o20 min), easy to
follow, comprehensible and contained short questions (with
language suitable for the target group). Questionnaire read-
ability was assessed using the Flesch Reading Ease Score
available on computer software (Microsoft Word 2003)
(Microsoft, 2007). Before validity and reliability testing
commenced, nutritionists working in the department
checked the questionnaire for both content and clarity.
Content validity was assessed by experts with a nutrition
and dietetic background. Both nutrition and dietetic profes-
sionals were contacted through an internet listserv group,
the Community Nutrition Group. Using e-mail, a PDF
version of the draft questionnaire, brief outline of the project
and score sheet were distributed to the group. The score
sheet listed each question and asked the respondent to score
the item out of 10 in relation to appropriateness, importance
and phrasing. A column was also provided on the score sheet
for other/additional comments to be completed as necessary
by the respondent. Responses were collated and the ques-
tionnaire was amended as appropriate.
Face validity of the amended questionnaire was assessed by
short post-questionnaire interviews with 20 adults represen-
tative of the population being sampled. Care was taken to
ensure that the sample interviewed were of varying educa-
tion level and socio-economic position. Individuals were
asked about the questionnaire instructions, layout and
length. Ease of completion, time to complete and question
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212
difficulty were also assessed. Respondents were given the
opportunity to ask questions and raise queries with ques-
tionnaire items.
Reliability testing was assessed using a convenience sample
recruited from local business, with the mean time between
completing the questionnaire at time 1 and at time 2, 7 days
later. Respondents completing the reliability testing had not
been earlier involved with either the content or face validity
testing. Ninety-seven participants were asked to complete
the questionnaire at time 1 and were informed that they
would be required to complete a similar questionnaire 1
week later. Correlation analysis was performed on the
reliability testing. Each question correlation was required
to be 40.5 and statistically significant for inclusion in the
final questionnaire. Cronbach’s alpha coefficient was cal-
culated to assess the internal consistency of similar
questions. Cronbach’s alpha values beyond 0.70 were
considered satisfactory for inclusion (Bland and Altman,
1997). As a further measure of reliability Item Difficulty
Index and Item Discrimination Index were calculated for
Section C (nutrition label task questions). The Item Diffi-
culty Index is determined by calculating the percentage of
the population answering the question correctly (P-value).
For inclusion, Kline (1993) suggests that the P-value should
be between 20 and 80%. The Item Discrimination Index was
assessed quantitatively by correlating the score for each item
with the total score. Item Discrimination Index correlations
40.20 are considered suitable for inclusion (Kline, 1986).
Results
Content validity
Twenty-six nutritionists/dietitians responded to the e-mail
request for comments. Of the 26 nutrition professionals,
84.6% had experience of teaching or advising on food labels.
With the exception of question 2 (‘Where do you read food
labels?’), all questions scored highly for importance, appro-
priateness and phrasing with mean scores above 8.0 for each
question. Overall means for importance, appropriateness
and phrasing were 8.77 s.d.±1.41, 8.79 s.d.±1.34 and 8.84
s.d.±1.20, respectively.
Amendments to the questionnaire included grammatical
changes and the addition of explanatory notes in question 1
(with regards to allergen, nutrition and producer informa-
tion), emphasis on the terms ‘read’ and ‘use’ in questions 1, 2
and 4, and the addition of ‘workplace canteen’ to questions
15–17. Despite scoring poorly, question 2 (‘Where do you
read food labels?’) was not removed as it was felt that this
question provided a valuable insight into label reading
behaviour (pre- and post-purchase).
Face validity
Twenty adults from various socio-demographic and educa-
tional backgrounds completed a short interview after
European Journal of Clinical Nutrition
completion of the questionnaire. Questionnaire completion
time was between 10 and 15 min with the majority of
respondents (80%) completing the questionnaire in
o10 min. All participants found the questionnaire layout
to be clear and the majority found both the font size and
questionnaire length ‘just right’. The questionnaire instruc-
tions were considered easy to understand by 80% of
respondents (with the remaining 20% stating the instruc-
tions were ‘neither easy nor difficult to understand’). Despite
respondents claiming to find elements of the questionnaire
difficult (in particular Section C of the questionnaire), it
should be noted that no sections were omitted. Sixty per cent
of respondents skipped the frequency question for ‘Other,
please specify’ in question 1, and as a result, this question
was formatted (shading and font alterations) to maximize
future responses. Four respondents enquired about the
meaning of question 4 (‘How frequently do you use nutrition
information on food labels?’) and as a result the question was
amended to include ‘on food labels when buying food’.
Readability
The higher the Flesch Reading Ease Score, the easier the
document is to understand. The questionnaire scored a
Flesch Reading Ease Score of 64.7, indicating that the
questionnaire was of a standard readability level (Flesch,
1948).
Reliability
Ninety-seven participants, 61 females and 36 males, com-
pleted the questionnaire at time 1. Eighty-one participants,
50 females and 31 males, completed the questionnaire at
time 2. The mean time in days between questionnaire
completions was 7 days, with a minimum interval period
of 6 days and a maximum interval period of 9 days.
Internal consistency of frequency of using specific label
attributes (question 1), frequency of dining at specific
catering outlets (question 17) and desire to obtain nutri-
tional and additional information at catering outlets (ques-
tions 18 and 19) were assessed using Cronbach’s alpha
coefficient. Given that the largest response was obtained at
time 1 (n ¼ 97) and participants had no earlier exposure to
the questionnaire at this point, time 1 data was used to assess
Cronbach’s alpha values. Cronbach’s alpha coefficients were
0.85, 0.75 and 0.91 for frequency of using specific label
attributes, frequency of dining at specific catering outlets
and desire to obtain nutritional and additional information
at catering outlets, respectively, showing good internal
consistency.
Repeat reliability testing was carried out on the data
obtained from the time 2 sample (n ¼ 81). Good temporal
stability was shown with Spearman’s correlation coefficients
ranging from 0.51 to 0.97, all significant at Po0.001.
Item Difficulty Index analysis was carried out using
questionnaires completed at time 1 (n ¼ 97). Five out of the
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213
Table 1 Item difficulty analysis for (the first) Section C

Question Difficulty (% answering correctly)

Locating the calories per 100 g (Question 7) 91.8

Locating the quantity of fat in the package (Question 8) 76.3
Calculating the amount of fibre in half the pack (Question 9) 84.5
Calculating the amount of saturated fat in 200 g of the product (Question10) 79.4
Looking at the sugar content of this product (Question 11) 22.7
Comparing the fat content of two products (Question 12) 82.5
Comparing the saturated fat content of two products (Question 13) 96.9
Comparing the energy content of two products (Question 14) 96.9

eight questions in Section C were answered correctly by Table 2 Spearman’s correlation coefficient for the final version of
480% of the respondents, indicating that they were too easy Section C
for inclusion in the final questionnaire (Table 1). On the Question N Test–retest
basis of this analysis, this section was revised and indepen- reliabilitya
dently underwent reliability testing.
Nutrition colleagues working within the research centre C7. Sugar in two servings 51 0.728
C8. Grams of fat in half the pack 51 0.779
were consulted during the revision of Section C. Reliability
C9. Servings in the product 51 0.936
testing of the revised Section C was conducted. Participants C10. Fat content in Product 1 51 0.570
received only Section C of the questionnaire and submitted C11. Fat content in Product 2 51 0.772
their post-code for matching purposes; no other demo- C12. Sugar content in Product 3 51 0.891
C13. Comparison between Products 2 and 3 51 0.790
graphic data was collected. Seventy participants completed
C14. Lowest saturated fat content 51 0.795
Section C at time 1 and 51 participants completed the C15. Losing weight 51 0.814
questionnaire at time 2 (with the average completion time C16. Reducing salt intake 51 0.616
between questionnaires, 7 days). a
Significant at Po0.001.
Internal consistency was assessed using Cronbach’s alpha
on data obtained during time 1 (n ¼ 70). For ability to make
judgements on nutrition content from available nutrition
information (questions 10–16), the Cronbach’s alpha was altered (from 16–25 to 18–25) to remain consistent with the
0.72, indicating good internal consistency. sample group used.
Repeat reliability of Section C was carried out using data Two additional questions were added to the questionnaire.
obtained for the 51 participants who completed Section C at Both questions were included in Section E of the question-
both time 1 and 2. Spearman’s correlation coefficients naire and assessed the participant’s motivation to eat a
ranged from 0.57 to 0.94 and were statistically significant healthy diet (‘How motivated are you to eat a ‘healthy’ diet?)
at Po0.001, indicating good temporal stability (Table 2). and their own perceived knowledge of a healthy eating
The Item Difficulty Index was re-assessed for the revised (‘How would you rate your own knowledge of ‘healthy
Section C. The P-value’s highlighted moderate scores for the eating’ on a scale of 1–10? (1 ¼ no knowledge and 10 ¼ very
new questions indicating that they were not as easy as the knowledgeable)’). The final version of the questionnaire
initial draft and appropriate for inclusion in the final (excluding Section E—the demographic items) is shown in
questionnaire (Table 3). Appendix Table 1.
With regards to Item Discrimination Index analysis, all
items in Section C achieved correlations above 0.20 (Kline,
1986), with r ranging from 0.43 to 0.70 (Table 3), indicating
that these items were suitable for inclusion in the final Discussion
questionnaire.
The questionnaire development process involved a literature
search, reviewing the findings from existing literature and
Final adjustments highlighting any gaps in the current research. The review
After the reliability and validity assessment, four further highlighted the limited availability of studies reporting the
alterations were made to the questionnaire. One amendment development of validated tools used to measure consumers’
was made to question 1 in Section A, the tick box was food label reading habits. To our knowledge, this is the first
removed from ‘Other please specify’ (as the majority of study to report the validation and reliability testing of a
participants omitted this question, despite earlier font and short questionnaire to assess consumers’ use, understanding
formatting alterations). The age range (question 23) was and perception of food labels.

European Journal of Clinical Nutrition

 Short questionnaire assessing food label use and understanding
D Mackison et al
214
Table 3 Item analysis for the final version of Section C
Question
Sugar content in two servings (Question 7)
Grams of fat in half pack (Question 8)
Servings in pack (Question 9)
Fat content in Product 1 (Question 10)
Fat content in Product 2 (Question 11)
Sugar content in Product 3 (Question 12)
Comparing the saturated fat content of two products (Question 13)
Saturated fat content in product with lowest sat fat (Question 14)
Losing weight (Question 15)
Salt intake (Question 16)
In the development of this instrument, special considera-
tion was given to developing a questionnaire, which could
be completed independently, without assistance. It was,
therefore, important that the readability level of the
questionnaire was pitched appropriately. Care was taken to
avoid long sentences, complex terminology, acronyms or
abbreviations, double-barrelled and leading questions.
It is recommended that independently administered
(self-completion) questionnaires are short in length and are
composed mostly of closed structure questions (McColl et al.,
2001). Postal questionnaires short in length (Edwards et al.,
2002) and containing o1000 words (Jepson et al., 2005) are
more likely to yield a high response rate. Care was taken to
ensure that the questionnaire was short in length (only four
sides of A4), contained o1000 words and comprised mainly
closed end questions (47 out of 49 items). The response
categories in the close structure questions were considered
mutually exclusive and exhaustive after the literature review
of the topic area and the considerable effort used during the
face and content validity process.
Various other formatting characteristics were consciously
applied in the questionnaire construction. Using a booklet
format with double-sided printing, vertical formats for
closed structure responses, a font size of 10 points and a
high text/background contrast were all incorporated into the
instrument layout, in line with best practice recommenda-
tions for questionnaire design (McColl et al., 2001).
Demographic questions were purposively inserted at the
end of the questionnaire, as it has been suggested that these
questions can be considered threatening (Sudman and
Bradburn, 1982) or boring (Rattray and Jones, 2007). The
demographic questions included in this questionnaire were
adapted from existing tools, for example The 2001 Census,
The Food Standards Agency Consumer Attitudes Survey and
The Family and Children’s Study.
Although the questionnaire underwent vigorous reliability
testing, limitations may still remain in the reliability
methodology used. Repeat reliability testing (test–retest)
presumes that exposure to the questionnaire at time 1 does
not trigger direct investigation of the topic area by the
respondent. In this study, no intervention took place
European Journal of Clinical Nutrition
Difficulty Discrimination
(% answering correctly) (item-total r-value)
51.4 0.57
61.4 0.64
71.4 0.55
60.0 0.43
38.6 0.53
62.9 0.47
67.1 0.70
28.6 0.50
72.9 0.63
71.4 0.63
between survey contact; therefore, no changes would be
expected unless enquiry of the subject area was prompted
by the initial questionnaire exposure. The Spearman’s
correlation coefficients (0.51 to 0.97) were statistically
significant at Po0.001, indicating strong reliability of these
items assessed.
Although the optimum value for Cronbach’s alpha varies
throughout the literature (DeVon et al., 2007), a value 40.70
is the most commonly accepted figure (Bland and Altman,
1997). In this study, all values were 40.70 indicating high
levels of internal consistency in this instrument.
The majority of the participants used in the reliability and
validity testing of this questionnaire were both White and
Scottish. This is recognized as a limitation of this study, as we
cannot presume that all ethnic groups and nationalities
would use nutrition labels in the same manner, nor interpret
this questionnaire in the same way. Future feasibility testing
in different geographic areas or with alternative ethnic
groups should be conducted before using this tool as a guide
to inform changes in policy.
A further limitation of this study is the use of closed
questions when assessing consumers’ attitudes to nutrition
information in catering establishments. Closed questions are
not considered suitable when investigating topics we have
limited knowledge of (Rattray and Jones, 2007). Although
accepting the possibility that information yielded from this
instrument on nutrition information in catering establish-
ments may not be representative of the entire population, it
is notable that robust content and face validity were
performed in the development of this questionnaire, and
future qualitative studies in the topic area will expand on the
findings derived from this instrument.
The questionnaire developed in this study was intended to
be administered by post, nationwide throughout the UK.
Further research should involve examining other question-
naire administration methods in various settings. For
example, administering the questionnaire in a supermarket
or retail setting may provide valuable information when
comparing the choices and decisions consumers make
within their own home environment and in a busy retail
or catering setting.

Given the short length of the questionnaire, questions
included in the final draft were those considered funda-
mental to the topic area. Future research in this subject area
may result in the expansion of this questionnaire to include
more in-depth items, particularly on issues surrounding the
catering industry.
In conclusion, the final questionnaire is a standardized
(self-complete) instrument for assessing consumers’ use,
understanding and perception of food labels.
Conflict of interest
The authors declare no conflict of interest.
Acknowledgements
This research was funded by the Food Standards Agency
Postgraduate Scholarship Scheme. We thank Dawn Mackison,
Tommy Mackison and the staff at the Centre for Public
Health Nutrition Research for their help with the packaging
and dissemination of the questionnaire.
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Appendix Table 1 Food label questionnaire Please complete sections A, B, C, D ane E

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