Abstract overview:
Suboptimal dietary intake during pregnancy is associated with various adverse health outcomes. Many pregnant women lack sufficient knowledge of both nutrition and food safety, which can impact their food choices. Currently, no culturally relevant tool exists to assess these areas of knowledge specifically for Mediterranean populations, highlighting the need for such an instrument.

Aims and objectives:
This study aims to develop and validate the Pregnancy Nutrition and Food Safety Questionnaire (PREG-NFS-Q), designed to measure maternal nutrition and food safety knowledge in pregnant women in a Mediterranean setting.

Methods:
The study involved two phases: instrument design and judgemental evidence. The domain was determined through a comprehensive literature review, alignment with international dietary guidelines, expert consultation, and an evaluation of existing assessment tools, followed by sampling (item generation) and the formation of the initial 55-item instrument. For content validation, a panel of six experts evaluated the questionnaire to assess the relevance and clarity of the items. The content validity ratio (CVR) and content validity index (CVI) were calculated. Face validation was evaluated qualitatively based on feedback from nine participants, comprising six experts and three individuals from the target population.

Results:
Initial versions of the tool demonstrated strong content validity for individual items (I-CVI range: 0.83 to 1.00) and moderate to high overall content validity for the PREG-NFS-Q (S-CVI Average range: 0.96 to 0.99; S-CVI Relevance = 0.93; S-CVI Clarity range: 0.75 to 0.87). Items were removed due to low CVR, insufficient clarity, and conceptual overlap. Through qualitative methods, the items were refined until saturation was reached. The final tool comprises 4 domains and 45 questions.

Conclusion:
The PREG-NFS-Q is a tool demonstrating high item content validity for assessing maternal nutrition and food safety knowledge in a Mediterranean setting, with potential to inform targeted nutrition interventions to improve maternal and fetal health outcomes.