Original researchThe development and validation of a questionnaire to assess relative energy deficiency in sport (RED-S) knowledge
Section snippets
Practical implications
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Healthcare professionals achieved significantly higher RED-S knowledge score than physically active individuals, indicating that the questionnaire may accurately assess knowledge across a wide variety of people.
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The study provides strong evidence that the questionnaire was adequately validated through expert review and pretesting, as well as good internal reliability and test–retest reliability for use in future studies.
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The validity and internal reliability suggest the questionnaire could be
Methods
Ethical approval for this study was obtained from the Department of Human Nutrition, University of Otago reference D18/068. A two-phase method based on that proposed by Boateng et al13 was used and broken down into eight steps (illustrated in Supplementary Fig. 1).
Step 1: Defining questionnaire scope: Knowledge of RED-S in females can be measured by assessing the theoretical or practical understanding of the known consequences including menstrual irregularities,11 poor bone health,12
Results
After identifying the 23 items, four sports nutritionists were interviewed using a predetermined template to evaluate each item. Details of the interview questions and evaluation criteria for each item with an average score of four experts are provided in Supplementary Table 1. They reported no problems with most of the items and their interpretation did not differ from what the items were designed to measure. There was very good agreement by the experts on the clarity (mean score = 3.95) and
Discussion
The comprehensive 18-item questionnaire assesses theoretical and practical understanding of the signs, symptoms, and consequences of RED-S. Previous studies assessing RED-S knowledge utilised questionnaires that lacked face, content, and construct validity (internal consistency and test–retest).9, 10, 11 Therefore, this new validated tool may be used for future research.
The questionnaire has high face and content validity according to our population of health professionals and the general
Conclusion
In this study we have validated a novel questionnaire designed to test knowledge of RED-S signs, symptoms, and consequences among HP and PAI. The questionnaire's good validity and reliability, paired with its short length, suggest that it might be used to screen for HP and PAI who need additional education. Future studies could also use the questionnaire to explore the association between risk of RED-S and knowledge of RED-S among PAI and athletes.
Funding information
This research did not receive any specific grant from funding agencies in public, commercial or not-for profit sectors.
Declaration of interest statement
None.
Confirmation of ethical compliance
Ethical approval for this study was obtained from the Department of Human Nutrition, University of Otago reference D18/068.
Acknowledgements
Authors would like to thank all the participants who were involved in the various stages of the study. A special thanks to the healthcare professionals who took part in the expert panel review, and to nutritionists and dietitians, who contributed to an internal review of an early version of the questionnaire.
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