Main results
We translated and verified the face validity and the psychometric validity of the French version of the MAQ in a sample of general practice patients in the Rhône-Alpes region.
The modified French version contained 17 items, one more than the original version, divided into four dimensions (Hedonism, Affinity, Entitlement and Dependence).
Comparison with the literature
Our French version of the MAQ confirms the validity and internal consistency of the results obtained by the authors of the original version of the MAQ22. The 4 dimensions observed were similar to those from the original version (Hedonism, Affinity, Entitlement and Dependence)22,23.
The 2 items that we modified (item 15 and 5 of the original questionnaire) did not seem to cause any comprehension problems in the validation studies22,23, but the authors did not perform a face validation for these items. Furthermore, in our study, the coefficients assessing correlations and internal consistency were generally weaker and less precise. These differences may be explained by the selection of the study populations. Participants in Graça et al.‘s study22 were likely more informed about meat consumption, as they self-selected based on the survey title. Linguistic variations during translation might also contribute to these differences.
The total MAQ score in our study was lower than that reported by Graça et al. As women tend to have lower MAQ scores22,23,50,51, we hypothesize that this difference may be linked to the greater proportion of women in our study.
Our translation methodology, following the guidelines of Guillemin and Sousa28,30, involved literal translation followed by transcultural adaptation. The Delphi method52 was deemed unnecessary because it focuses on expert agreement, which was not essential for our questionnaire aimed at general practice patients.
We tested face validity through cognitive semistructured interviews29 using the “think aloud” and “probing” techniques34. It is also possible to use either directive or free interviews. In our study, the first was not suitable, as we needed to explore the response mechanisms to the items. The second tends to be used when the respondents are experts on the subject and was not suitable for our sample or for the target population of our questionnaire, as mentioned above.
The MAQ has been used in numerous studies22,23,51, alone or in combination with other questionnaires in the general population. However, our study is the first to translate and validate it in a general practice population in the French context.
Strengths and weaknesses
The main strength of our study is its robust methodology. We followed the COREQ criteria32 for the qualitative phase and the STROBE36 for the quantitative phase. Our translation process followed validated protocols28,30 through two stages of literal translation and transcultural validation, with the help of a committee of experts and professional translators. MAQ authors were included in the process and validated the proposed modifications.
We performed face validation on a diversified sample, enabling us to test the comprehension of the items across various patient profiles. We developed an interview guide and a coding grid based on the literature29,31. The number of cognitive interviews was adequate34, which enabled us to recruit participants until data saturation.
We performed the third phase of psychometric validation on a large sample of patients with various sociodemographic characteristics, meeting the required number of participants28,40. Using a reliable database38, we randomized the practices and days of the week by a third party to avoid selection bias. We performed on-site visits, improving the quality of MAQ completion and resulting in high patient participation rates and a low proportion of missing data. We performed descriptive, factorial and internal consistency analyses similar to those of the validation source studies22,23.
Another strength of our study is the quality of the MAQ. Its English and Portuguese versions have interesting intrinsic qualities that we were able to preserve in our French version, thanks to our prior translation and face validation phases. The MAQ is concise, with clear items and a precise likert scale, making it easy to complete and analyse, as our results show. Its feasibility could be further improved with a shorter version, potentially using a multi-stage strategy.
Our study also has limitations
First, our sample included more women (65%), more managers and higher intellectual professions (34%) and fewer intermediate professions (8.4%) than did other general practice studies (58%, 13.5% and 16%, respectively, in a previous study53). These differences appear to have had a limited influence on the validation of the French version of the MAQ. Previous studies validating the MAQ22,23 had diverse samples (proportion of women ranging from 42 to 58%, mostly with a high level of education), with no effect on the calculated validity.
Similar to the original authors22, we excluded underaged patients from our population, which would probably have affected the validation. Further research is needed to validate the MAQ in this population, as there is no consensus on reducing meat consumption in this age group54.
Like in the first validations studies, we did not perform reproducibility and stability over time of the MAQ. These data should be evaluated in future studies.
We did not ask about meat consumption, because it has been correlated with the MAQ score already22. However, there is no definitive evidence that it replaces the intake measure. It would also have been beneficial to ascertain how the MAQ correlates with the intakes of different types of meat in our specific population. Further studies are needed to adress this purpose.
In the cognitive interview phase, healthcare professionals were over-represented (7 out of 11). Health professionals may have a higher level of comprehension than other participants, due to better health literacy. However, we did not observe any difference in the level of understanding between participants who were healthcare professionals and those who were not, probably due to the simplicity of the questions of the MAQ.
Finally, as the original authors, we did not make any difference between red and white meat in the questionnaire. This could result in an oversimplification that considers meat as a whole, whereas meat sub-categories are likely to have varying impacts on individual and environmental health.
Perspectives
From a planetary health perspective, the validation of the French version of the MAQ makes it possible to consider and encourage its use to explore adult patients’ attachment to meat in general practice.
The MAQ discriminates between patient groups effectively22,23,51,55. The MAQ is also effective in measuring and predicting people’s motivations and intentions to change meat consumption22,23,51. It is therefore an effective research tool, alone or in combination with other scores, for identifying groups with common characteristics with regard to reducing meat consumption (in terms of motivations, barriers and intentionality).
Further studies could be carried out to verify its validity in other French-speaking populations, its reproducibility and its stability over time. Research is also needed to validate its application in underaged patients, whose specificities will probably require the MAQ to be adapted or completed by their parents56.
Among the various tools designed to describe attitudes toward food, the Food Neophobia Scale (FNS) is a validated and widely used tool which measures the personal reluctance to accept and/or enjoy new or unfamiliar foods57,58. A higher food neophobia (FN) is associated with a lower intake of fruit and vegetables in children and adults58. A higher FN represents also a significant barrier to a balanced and healthy diet, such as the Mediterranean diet. On the other hand, a lower FN is associated with a higher acceptance of plant-based meats58,59. The combination of FNS and MAQ could prove an effective method of predicting the acceptability of vegetarian alternatives, thus aiding the design of appropriate interventions59 and providing valuable insight into meat attachment profiles. For instance, a person with a moderate attachment to meat and a low FN would likely benefit more from an intervention focused on replacing meat with plant-based alternatives than someone with a high FN.
In addition, given that the MAQ questionnaire was developed by studying people’s obstacles and incentives60, it aligns closely with the concerns they might have. Its simplicity makes it a useful tool for GPs and health professionals to explore representations of meat-based diets and planetary health. Completing the MAQ in waiting rooms could initiate discussions during consultations. As nutrition becomes a public health concern3,61, the MAQ could also be an interesting gateway to a broader nutritional approach.
Finally, from a public health perspective, the MAQ would make it possible to better target the profiles of hedonism, affinity, entitlement and dependence on meat products in the general population. This could be a first step towards developing appropriate population-based strategies to reduce meat proportions in the French diet.