The development of the Platform to Evaluate Athlete Knowledge of Nutrition Questionnaire (PEAKS-NQ): a valid and reliable measure of nutrition knowledge in athletes
Written by Dr Ryan Tam (Accredited Sports Dietitian; Lecturer, Australian Catholic University; Research Associate, The University of Sydney)
Nutrition knowledge assessment tools aim to help sports nutrition practitioners identify knowledge gaps and assist researchers with benchmark knowledge of different athlete groups.
This can then inform practitioners on how best to tailor their education sessions to maximize their effectiveness, given that education with athletes is often conducted in a group setting (2). Understanding an athlete’s nutrition knowledge may also be beneficial in individual settings, providing practitioners with information to guide what the key goals of the individual consult should be.
Historically, nutrition assessment tools have been limited by the lack of appropriate, valid and reliable instruments which makes it difficult to compare findings across studies, athlete groups, calibres and education methods (2-4). Moreover, the need to score, then analyse the results of these assessments can often stretch the capacities of already time-poor practitioners who are often looking after large groups of athletes (5).
To respond to the needs of practitioners and athletes, the Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaire (PEAKS-NQ) was developed.
The PEAKS-NQ was developed in 3 main stages. The first stage was a qualitative study which involved focus groups with sports nutritionists across state and national sporting institutes in Australia and New Zealand (5). The purpose of this study was to identify the barriers to using sports nutrition knowledge questionnaires and to identify what content, topics, and features should be included in the development of a new tool to best serve practitioners working in these environments. As a result of these focus groups, key areas such as food groups knowledge, macro and micronutrient knowledge and the ability to adapt nutritional intake for different scenarios such as training, competition, recovery, and hydration were identified for inclusion. After the development of a draft questionnaire, the same focus group participants were invited to participate in a modified Delphi process to get feedback on the draft questionnaire and to achieve consensus on questions that should be included. This resulted in a 94-item questionnaire (with 11 demographic and 83 scored items) that assessed knowledge across Food Groups, Nutrients, Applied Sports Nutrition, Competition Nutrition, and Supplements and Special Concerns.
In the second stage of development, 149 developmental pathway athletes from the High Performance Sport New Zealand’s Pathway To Podium program were invited to complete the PEAKS-NQ (6). Athletes were invited to complete a re-test (with at least 2 weeks apart) to assess reliability. Accredited dietitians registered with Sports Dietitians Australia (n=255), were invited to complete the PEAKS-NQ while also rating the relevance of each section on a four-point scale ranging from not relevant to highly relevant. The PEAKS-NQ showed good test-retest reliability, demonstrated by similar scores between attempts using data from 50 athletes (68.5±10.5% vs 73.6%±9.3%, p=0.14), with a strong positive relationship found between scores (Pearson’s r = 0.77). Accredited dietitians (n=45) scored better than the developmental athletes (n=88) across all sections and overall (p<0.001), supporting good construct validity. Overall content validity was high when assessed using Scale-Content Validity Index (7), with an average score of 0.88 (out of 1) across all sections. The mean Cronbach’s α was 0.86, indicating good internal consistency, with scores >0.7 deemed acceptable (8). Using Rasch Analysis, an Item Response Theory technique that can identify questions that do not fit the construct being assessed or were answered differently between the dietitian and athlete groups, the PEAKS-NQ was further refined (9). This resulted in the removal of 33 questions, primarily because the level of difficulty did not discriminate between respondents. Modifications such as wording changes or changes to images were made to 7 items to reduce any chance of ambiguity. This resulted in a 50-item questionnaire (not including demographics) across two main sections (general nutrition and sports nutrition), with an item reliability index of 0.91 and a person reliability index of 0.92, indicating strong reliability.
In the final stage of PEAKS-NQ development, a feedback sheet that displayed the overall and section scores was implemented (10). The feedback sheet also identified where respondents performed well and where they should aim to improve. The 50-item PEAKS-NQ was completed by a convenience sample of 240 high-level athletes across the National Institute Network across Australia, of which 63.3% had competed internationally. Sports dietitians of athletes who had completed the PEAKS-NQ were invited to provide feedback on the usefulness, acceptability and feasibility of the questionnaire and feedback sheet. The PEAKS-NQ found athletes had a greater understanding of general nutrition compared to sports nutrition concepts, that female athletes appeared to have a higher nutrition knowledge and that athletes had knowledge gaps in fats, recovery nutrition and managing body composition. Sports dietitians evaluated the PEAKS-NQ as highly acceptable, feasible and useful.
The PEAKS-NQ offers a rapid, low-cost method to assess nutrition knowledge in athletes. It is visually appealing, can be completed online using a variety of devices in approximately 15 minutes and is the first questionnaire to offer automated feedback that is sent to respondents upon completion. For sports nutritionists, this offers a way to identify and prioritise athletes that may be at the greatest need for nutrition support, allows them to tailor their education to target specific weaknesses and to track improvements in knowledge over time. From a research perspective, the availability of a valid and reliable tool allows researchers to investigate the nutrition knowledge of athletes and associated research questions.
Where is it now and can I use it with my athletes?
The PEAKS-NQ is currently free to use at www.sportsnutritionassessment.com/peaks-nq (Figure 1). Upon completion, respondents (by providing an email address) will receive their results (Figure 2) and can choose to also send these results to a nominated sports dietitian of their choosing. The feedback reports sent to dietitians are designed in a way that allow for easy collation of results into a spreadsheet, which is useful for practitioners using the questionnaire with groups of athletes. Currently, the PEAKS-NQ has only been validated in Australia and New Zealand.
Figure 1. The PEAKS-NQ on www.sportsnutritionassessment.com/peaks-nq
Figure 2. Example athlete feedback sheet
Can I use it for research?
The PEAKS-NQ is licensed by the University of Sydney. If you would like to use the PEAKS-NQ without modification as it appears on the www.sportsnutritionassessment.com for a research study, where you need access to collated group data, a data transfer agreement with the University of Sydney is needed.
If you would like to host your own version or modify and/or adapt the PEAKS-NQ for research, you will need to organise a licensing agreement with the University of Sydney for these purposes. The University of Sydney will continue to retain the ownership of the PEAKS-NQ.
References
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2. Tam R, Beck KL, Manore MM, Gifford J, Flood VM, O’Connor H. Effectiveness of education interventions designed to improve nutrition knowledge in athletes: a systematic review. Sports Med. 2019;49(11):1769-86.
3. Trakman GL, Forsyth A, Devlin BL, Belski R. A systematic review of athletes’ and coaches’ nutrition knowledge and reflections on the quality of current nutrition knowledge measures. Nutrients. 2016;8(9):570.
4. Heaney S, O’Connor H, Michael S, Gifford J, Naughton G. Nutrition knowledge in athletes: a systematic review. Int J Sport Nutr Exerc Metab. 2011;21(3):248-61.
5. Tam R, Beck KL, Gifford JA, Flood VM, O’Connor HT. Development of an electronic questionnaire to assess sports nutrition knowledge in athletes. J Am Coll Nutr. 2020;39(7):636-44.
6. Tam R, Beck K, Scanlan JN, Hamilton T, Prvan T, Flood V, et al. The Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaire: a reliable and valid electronic sports nutrition knowledge questionnaire for athletes. British Journal of Nutrition. 2020:1-11.
7. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459-67.
8. Tavakol M, Dennick R. Making sense of Cronbach’s alpha. Int J Med Educ. 2011;2:53-5.
9. Boone WJ. Rasch analysis for instrument development: why, when, and how? CBE—Life Sciences Education. 2016;15(4):rm4.
10. Tam R, Flood VM, Beck KL, O’Connor HT, Gifford JA. Measuring the sports nutrition knowledge of elite Australian athletes using the Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaire. Nutr Diet. 2021:1-9.
