Abstract
Self-reported dietary assessment methods can be challenging to validate, and reporting errors for those with lower health literacy (HL) may be augmented. Interactive multimedia (IMM) based questionnaires could help overcome these limitations. The objectives of this investigation are to assess the comparative validity and sensitivity to change of an IMM beverage intake questionnaire (IMM-BEVQ) as compared to dietary recalls and determine the impact of HL. Adults completed three 24-h dietary recalls and the IMM-BEVQ at baseline and after a six-month intervention targeting either sugar-sweetened beverages (SSB) or physical activity. Correlations and paired-samples t-tests are presented. For validity (n = 273), intake of SSB (mean difference = 10.6 fl oz) and total beverage consumption (mean difference = 16.0 fl oz) were significantly different (p ≤ 0.001) at baseline between the IMM-BEVQ and dietary recalls for all participants. However, the differences in intake were generally greater in low HL participants than in adequate HL participants. For sensitivity (n = 162), change in SSB intake (mean difference = 7.2 fl oz) was significantly different (p ≤ 0.01) between pre-/post-IMM-BEVQ and pre-/post-dietary recalls, but not total beverage intake (mean difference = 7.6 fl oz) for all participants. Changes in SSB and total beverage intake were not significantly different for those with adequate HL. The IMM-BEVQ is a valid dietary assessment tool that is as responsive to detecting changes in beverage intake as dietary recalls. However, adults with lower HL may need additional guidance when completing the IMM-BEVQ.
Highlights
The various types of self-reported dietary assessment tools have prompted controversy regarding their ability to accurately and consistently capture an individual’s dietary intake [1]
One-third of participants were identified as low health literacy (HL) (Figure 3), and the majority of participants were Caucasian, female, and had a mean BMI in the obese category (Table 1)
This may be especially prevalent when examining consumption of socially undesirable items such as sugar-sweetened beverages (SSB) [41]. In this sample, reported consumption of individual and total SSB was significantly greater on the Interactive multimedia (IMM)-BEVQ versus the dietary recalls; there were no significant differences in healthier beverages, such as water
Summary
The various types of self-reported dietary assessment tools have prompted controversy regarding their ability to accurately and consistently capture an individual’s dietary intake [1]. Food intake records and dietary recalls have been recognized as the “gold standards” for valid, reliable, and non-invasive dietary assessment tools for community-based populations [1]. These methods are resource-intensive, highly burdensome to researchers and subjects, and are only able to provide recent dietary intake [1]. Food frequency questionnaires (FFQ), which have less associated researcher and participant burden than food records/recalls, may be used as an alternative method for briefly and cost-effectively capturing an individual’s habitual dietary intake [1]. In regards to food records/recalls, participants may alter their normal intake patterns, unintentionally forget items, or misinterpret portion sizes [1,3,4]. FFQ can be cognitively complex for lower literate audiences, often leading to unintentionally skipped questions
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