# An Evaluation of Healthy Eating Scale for Patients with Pre-Diabetes Using Rasch Analysis
###### Abstract  
Consumption of a healthy diet is required to manage blood glucose level in people with diabetes or pre-diabetes. The aim of this study was to test the internal validity of healthy eating habits assessed using a self-reported scale, the Rapid Eating Assessment for Participants (REAP) scale, in participants with pre-diabetes. The scale had 15 items with 4 categories: \"Never\", \"Rarely\", \"Some days\" and \"Usually/most days\". Those items were administered to 119 participants from 2006 to 2008 in Victoria, Australia. Rasch analysis was applied using RUMM2030 software. Overall fit was adequate in the unaltered model (\(\chi^{2}\) = 29.29, \(p\) = 0.500, person separation index (PSI) = 0.500), however, seven items had disordered thresholds which were remedied by collapsing \"Rarely\" with \"Some days\" (\(\chi^{2}\) = 37.36, \(p\) = 0.166, psi = 0.550). Item 1 (\"Ent 3 main meals\") remained disordered after collapsing. Two persons were removed due to their fit residuals being outside \(\pm\)2.5, however, these deletions did not improve the fit, so it was decided to retain these persons in the scale. Overall, there was no significant differential item functioning (DIF) or local dependency. However, there was evidence of multidimensionality and a ceiling effect toward healthy eating in the person item threshold. The results from Rasch analysis showed that the current scale needs some improvement, such as addressing disordered thresholds, for measuring eating habits for people with pre-diabetes. A modified version with middle categories collapsed would provide a psychometrically more robust measure. Further study is needed to validate the scale as a screening tool for measuring healthy eating among people with pre-diabetes. pre-diabetes; healthy eating scale; [PERSON] analysis; Australia +
Footnote †: journal:  
Americans had lower T2 DM prevalence than white Americans [8]. Gender differences have been found to affect the prevalence of diabetes and pre-diabetes [11; 12]. Type 2 diabetes is characterized by gradual onset, with most people first experiencing pre-diabetes, a condition of impaired glucose control [13]. Since the pre-diabetic state is often asymptomatic it often takes a considerable amount of time before the condition is diagnosed [14]. Many studies have shown a worrisome situation where people with diagnosed T2 DM or pre-diabetes represent a small proportion of the true prevalence of these conditions [14; 15; 16]. Of further concern, patients often have already experienced health complications such as retinopathy or cardiovascular disease before they were diagnosed with T2 DM or pre-diabetes [17]. These findings support the concept that early detection and intervention are crucial. There are a number of risk factors, including obesity, which contribute to the development of T2 DM [18; 19; 20]. Early detection and management of diabetes through lifestyle changes and healthier eating are recommended [21; 22]. Nutrition plays a critical role in the prevention and treatment of T2 DM, avoiding or delaying the appearance of related complications [20]. Dietary counseling should be employed in the prevention and management of T2 DM [22] to improve the healthy eating habits of patients, because among patients, diabetes awareness and management represent a major challenge [23]. Assessing the quality of eating patterns in people with diabetes and pre-diabetes is needed. Various scales have been developed to assess the quality of eating patterns. [PERSON] et al. [22] developed the \"Healthy Diet Index\" (HDI) as a tool to evaluate dietary compliance. The index was derived from the 16-item Food Intake Questionnaire (D2D-FIQ), which was a part of a Finnish type 2 diabetes prevention implementation program. The criterion validity of the HDI was tested using the Pearson's correlation between the index and the nutrient intakes calculated from 7-day food records. In the United Kingdom, [PERSON] et al.