Chapter IV

METHODOLOGY
 CHAPTER IV

DESIGN AND METHODOLOGY

The major aim of this chapter is to describe about how the study was
conducted to fulfill the criterion of good quality empirical research. This
chapter describes about the design employed, sample, tools/material used and
the procedure. The present chapter also talks about the s tatistical techniques
applied for the data analyses.”

The present empirical investigation entitled ―Executive functions in relation to

eating behaviour of school students‖ was designed in order to explore the role of
eating behaviour and BMI in executive functions. The following design and
methodology were used to fulfil the objectives of the study.

Research Design:

The study was conducted in two phases:

Phase I: In the first phase correlational design was used to study the
relationship between Eating Behaviour (subjective measure) and Executive functions
(self-reported measure) of school students across three BMI groups i.e. normal, under-
weight and over-weight.

Phase – II: In the second phase, a multi-group design (3 x 2 factorial design)

would be used. On the basis of two measures of eating behaviour i.e. BMI (objective
measure) and eating behaviour (subjective measure- questionnaire) respondents were
divided into 6 groups (3 (BMI) x 2 (eating behaviour questionnaire) factorial design)
and their executive functions were assessed with Delis Kaplan executive function
system (D-KEFS).

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Sample

The phase wise sample was as follows:

Phase I: For the present study, a sample of 300 school students (boys and
girls) was selected from the different private schools of Sonipat and Rohtak within the
age range of 14-16 years (mean age= 15.4), who were studying in 8th – 1oth grade.
The participants were able to read, write and understand the english language. These
respondents were divided in three BMI categories i.e. normal BMI (n = 147),
overweight (n = 73) and underweight (n = 80)

Phase II: A sample of 102 school students were drawn from Phase I, on the
basis of their BMI and their scores on eating behavior questionnaire (3 X 2 factorial
design) i.e Group I comprises 17 adolescent participants which were selected from
130 adolesents having normal BMI and healthy eating behavior (N(BMI)+HE), Group
II consisted of 17 adolescents participants who had normal BMI but unhealthy eating
behavior (N(BMI)+UE), Group III includes 17 adolescents participants which were
selected from 47 adolescents who were overweight and had healthy eating behavior
(Ow+HE) , Group IV consisted of 17 adolescents (selected from 26 respondents) who
were overweight and had unhealthy eating behavior (Ow+UE), Group V comprises 17
adolescent participants selected from 53 adolesents who were underweight but had
healthy eating behavior (U+HE). Group VI includes 17 participants who were
selected from 27 underweight adolescents with unhealthy eating behavior (U+UE).
Thus, 17 participants were selected in each cell. Further, only those school students,
who voluntarily agreed to participate in the study and were granted permission by the
concerned class teacher, could be included in the sample.

Tools

The description and psychometric properties of each tool have been given in
detail as follows:

A: Demographic Information Form

After explaining the purpose and benefits of the current research, each
participant was supposed to provide the demographic information. They were

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informed that the demographic information which included name, age, gender,
education, rural/urban would be used for research purposes only and not to be used
for any other purpose hence they should provide accurate information. Further, to
calculate the BMI, height and weight were included in the demographic information.
The scale has been shown in Appendix- A.

B. Eating Behaviour Measures

To assess eating behaviour two measures were taken into consideration

including BMI and dietary questionnaire on eating behaviour, food habits and
nutritional knowledge of adolescents. These tools were used for a comprehensive
understanding of the eating behavior of school students.

(a) Eating Behaviour- Objective Measure

Body Mass Index (BMI) was used as an objective measure of Eating behaviour. For
the purpose weight in kilogram and high in meters were recorded systematically. To
compute the BMI scores, the formula kg/m2 has been selected where weight is
divided by height. Weight is measured in kilograms whereas height is taken in meter
square. The BMI for children and teenagers aged 2 to 19 years varies depending on
their age and gender. So, to classify the BMI score into the different categories, the
categorization suggested by Centers for Disease Control and Prevention (CDC) was
employed.

Table 4.1
Categories of BMI for adolescents
Percentile range Category

< 5th Under Weight

5th to < 85th Normal Weight

85th to < 95th Over Weight

Equal to or > 95th Obese

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Figure 4.1

BMI for age percentile of boys

Note: Boys body mass index for age percentile was developed by the national center
for chronic disease prevention and health promotion in 2000, retrieved from
https://www.cdc.gov/growthcharts

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Figure 4.2

BMI for age percentile of girls

Note: Girls body mass index for age-percentile was developed by the national center
for chronic disease prevention and health promotion in 2000, retrieved from
https://www.cdc.gov/growthcharts

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(b) Eating Behaviour- Subjective Measure

To assess the eating behaviour of the participants, a multidimensional

dietary questionnaire was used to assess eating behaviour, food habits and nutritional
knowledge of adolescents. The dietary questionnaire on eating behaviour ,food
habits and nutritional knowledge of adolescents was developed by Turconi, Celsa,
Rezzani, Sartirana & Roggi (2003) and consists of 99 questions. This questionnaire
is further divided into nine parts concerning the physical activity and lifestyle, food
habits, frequency of food consumption, self-efficacy, unhealthy and healthy diet,
nutrition knowledge, barriers to change, food safety knowledge, food safety and
behaviour in hygiene. This questionnaire is a comprehensive tool for evaluating
eating behaviour. The questionnaire has satisfactory reliability with Cronbach's
alpha ranging from a minimum of 0.55 in section G to the maximum of 0.75 in
section C. Whereas, Cronbach's alpha for Section E is 0.59, suggesting a nearly
sufficient score. To assess test-retest reliability, Pearson‘s correlation method was
used. Pearson correlation coefficients vary from 0.78 to 0.88, suggesting that the
questionnaire has excellent test-retest reliability. The first section (Section A)
included personal data acquired through seven questions. In the present study,
section C to J were scored sperately and a total score was computed for this
questionnaire. The detailed description of each section of the questionnaire is given
in Appendix-B (I) .

C. Executive Function Measures:

To examine executive functions two measures were used. In phase I executive

functions were assessed using executive function index (EFI Spinella, 2005) and in
phase II, D- KEFS (Delis, Kaplan & Kramer, 2001) was used for comprehensive
assessment of executive functions.

(a) Executive Function Index

This is a self-rating measure of executive functioning. It was

developed by spinella in 2005. This measure provides a convenient and quick
measure of an individual‘s perception of his or her executive functions. It is
similar in content and structure with other self-rating executive function

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measures. The EFI measures executive function rather than dysfunction. EFI
was developed with five sub-scales i.e. motivational drive (MD), impulse
control (IC), organization (ORG), strategic planning (SP) and empathy (EM).
Higher scores indicate better executive functioning and lower scores indicate
poor executive functioning. Some items (i.e. 2, 4, 5, 6, 11, 12, 13, 15, 17, 20,
22, 23, 24) indicate poor executive functioning, so their scores must be
inverted before being totalled (i.e. 1=5, 2=4, 3=3, 4=2, 5=1), while other items
are scored as is. The Cronbach‘ alpha was .82 for the total scores which was
acceptable, whereas .76, .70, .75, .69 and .70 acceptable for the five sub-scales
respectively.

(b) Delis- Kaplan Executive Function System (D- KEFS)

Delis, Kaplan, and Kramer developed this battery of tests in 2001,

which is considered as a ―standardized neuropsychological assessment
protocol with excellent psychometric properties.‖ This is a battery that is
comprised of 9 tests. This battery examines the executive functions in terms of
planning, thinking flexibility, fluency, problem-solving and deductive
reasoning in both verbal and spatial modalities. This was the first standardised
battery for assessing higher-cognitive functions (executive functions) in
children and adults (ages 8–89 years). Each test is designed to be a stand-
alone instrument that can be administered individually or along with other D-
KEFS tests. The seven tests from the above-discussed battery have been
selected for the current investigation. The reflection of performance has been
tested based on these tests. The first test is ‗Trail Making‘ which assesses
cognitive flexibility. The second test is of ‗Verbal Fluency‘ which takes into
consideration the processing speed and lexical organization. The third test is
named ‗Design Fluency‘ which emphasizes non-verbal processing speed.
‗Colour-Word Interference‘ is the fourth test that measures response
inhibition. The fifth one is ‗Sorting Test‘ which assesses sproblem-solving.
The sixth one is Tower test and it measures planning ability of school students
and the seventh is Word Context Test, which measures expressive language
skills. All the sub-tests possess sound psychometric properties. Detailed
discription of each sub-test is given in Appendix-B (II). In the current

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investigation primary measures of each sub-test were included. The obtained
raw scores were turned into gender-based and age scaled scores as per the
manual. The lower score here signifies poorer performance. The Table 4.4
depicts the seven executive functions included in the present study and the
different conditions of D-KEFS sub-tests through which they were assessed.

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Table 4.2
Executive functions and their respective sub- tests of D-KEFS with scoring criteria

Executive functions Test of D-KEFS (Condition) Scoring criteria

Cognitive Flexibility Verbal Fluency Test (Category Switching) Number of response in 60 sec
Design Fluency Test (Switching) Number of designs in 60 sec
Trail making Test (Number-letter Switching) Time to completion
Problem-solving Sorting Test (Free sorting) confirmed correct sorts
Inhibitory Control Color-Word Interference Test (Inhibition) Time to completion
Planning ability Tower Test Total achievement score
(Correct moves within the time limit)
Fluency ability Verbal Fluency Test (Letter Fluency) Number of correct response in 60 sec
Verbal Fluency Test (Category Fluency) Number of correct response in 60 sec
Design Fluency Test (Filled dots) Number of correct filled dots designs in 60 sec
Design Fluency Test (Empty dots) Number of correct empty dots designs in 60 sec
Linguistic ability Word Context Test Total Consecutively Correct
Color-Word Interference Test (Colour naming) Time to completion
Color Word InterferenceTest: (Word reading) Time to completion
Psychomotor ability Trail making Test (Motor Speed) Time to completion

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Procedure

The present research work aimed to explore the relationship between eating
behaviour and executive functions of adolescents. For this purpose, permission from
the principals of schools was sought and school students who were willing to
participate were selected for the present study.

Phase I:

Before starting the testing procedure, general instructions were given as

follows:-

―I am a research scholar in Department of Psychology, M. D. University

Rohtak. I am going to give you a set of some questionnaire one by one, in which there
are some questions regarding your personal data, eating behaviour and executive
functions. Firstly you fill your personal data sheet then, answer each item without
leaving any statement in between with no response. Please read them carefully
because they are concern to you. The detailed instructions regarding each of the
questionnaires are on the top of the first page of the questionnaire. You are requested
to answer frankly and honestly as the information provided by you will be kept
confidential and would only to be used for research purposes.‖

All the tests were paper-pencil tests and instructions for each test were
provided separately. At the time of filling the questionnaire, first of all the subjects
were asked to fill in the demographic information which included name, age, gender
and education. Further, to calculate the BMI, height and weight were also included in
demographic information. When the participants were comfortable and ready for
testing, the eating behavior questionnaire and Executive functions Index (EFI) was
administered on them along with the demographic and consent form. Instructions
relevant to each test were given to them and they filled the questionnaire according to
the instructions mentioned.

After completion of Phase I, all the measures were collected and checked
carefully that subject had answered all the items of the test. The subject was thanked
for his/her cooperation. The same procedure was used to collect data from all the
subjects. Scoring was done as per the manuals of the respective tests. Then these 300

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school students were divided into 3 groups based on their BMI i.e Normal BMI,
overweight and underweight.

Phase II:

In the second phase, the participants were distributed in 6 groups on the basis
of their BMI and their scores on eating behavior questionnaire (3X 2 factorial design).
Out of these 6 groups two belong to the normal BMI category, two to the overweight
BMI category, and the other two to the underweight category, with students who eat
healthy and unhealthy in respective categories. Thus six groups are as follows; Group
I (N(BMI)+HE) i.e normal BMI with healthy eating behavior, Group II (N(BMI)+UE)
i.e normal BMI with unhealthy eating behavior, Group III (Ow+HE) i.e overweight
with healthy eating behavior, Group IV (Ow+UE) i.e overweight with unhealthy
eating behavior, Group V (U+HE) i.e underweight with healthy eating behavior,
Group VI (U+UE) i.e underweight with unhealthy eating behaviour. Therefore, total
number of participants in each group are as follows; Group I comprises 17 adolescent
participants which were slected from 130 adolescents having normal BMI and healthy
eating behavior (N(BMI)+HE), Group II consisted of 17 adolescents participants who
had normal BMI but unhealthy eating behavior (N(BMI)+UE), Group III includes 17
participants which were selected from 47 adolescents who were overweight and had
healthy eating behavior (Ow+HE) , Group IV consisted of 17 adolescents (selected
from 26 respondents) who were overweight and had unhealthy eating behavior
(Ow+UE), Group V comprises 17 adolescent participants selected from 53
adolescents who were underweight but had healthy eating behavior (U+HE). Group
VI includes 17 participants who were selected from 27 underweight adolescents with
unhealthy eating behavior (U+UE). Thus, 17 participants were selected in each cell. It
is improtent to mention that only those school students, who volunteered to participate
in the study with the permission of the concerned class teacher,were included in the
sample. Therefore, in second phase 102 respondents were selected and divided into 6
groups with an equal number of participants in each cell.

These 102 respondents were contacted again and seven tests from the D-KEFS
battery of executive functions were administered on them individually. The
participants took an average of 120 minutes to complete all seven D-KEFS tests.

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Further, it was ensured that each participant would complete the given set of measures
in a single sitting with 10 mins break after 60 mins to avoid fatigue. At the end of the
administration, it was ensured that every participant has responded properly to each
condition and the session was terminated with the vote of thanks for their cooperation.
The subjects were assured of the confidentiality of the information. Each D-KEFS test
provides a number of achievement and process measures. But the battery suggests that
researcher may choose to compute mostly the primary measures if the scoring is done
manually. Primary measures provide global achievement score for characterizing an
examinee‘s overall performance on a particular task. The comparison of groups was
made by applying analysis of variances. The analyses have been presented in the next
chapter. We may now proceed to the next chapter dealing with results and discussion.

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