Abstract
BackgroundDietary assessment methods that are user-friendly, simple, yet valid are of interest to both researchers and participants, particularly for use in disadvantaged settings, where language barriers and low levels of education are often present. We tested if parents taking photos of what children ate, using mobile phones, would be a feasible, acceptable method that could still provide information with adequate relative validity.MethodsWe used a mixed-methods design, with parents of 21 5- to 7-year-olds from disadvantaged areas in Sweden. Parents reported all dietary intake, during non-school hours, on three days (two weekdays) using a photo method (PM). The PM consisted of simple instructions and a fiduciary card, but no training, equipment or software. Text messages could be sent if necessary. As a reference method, parents completed three 24-h recalls (24HRs) with an interviewer each following day. The next week, parents completed a 9-item semi-FFQ regarding the preceding week. The outcomes were intakes (in dl) of 9 food groups, categorised as fruits and vegetables, energy-dense sweet/salty foods, and sweet drinks. Agreement with the reference 24HRs was assessed using correlations, median differences and Bland-Altman plots. Parents completed an open-ended questionnaire on barriers and facilitators. Data collectors provided complementary information. Qualitative data was analysed using qualitative manifest analysis.ResultsNineteen parents (90%) provided complete data. The majority (n = 13) spoke Swedish as a second language, few (n = 4) were proficient. Compared to 24HRs, intakes measured by PM correlated well for all categories (Spearman’s rho = 0.609–0.845). However, intakes were underreported, significantly so for fruits and vegetables; Bland-Altman plots indicated that the underestimation was fairly constant across intake levels. When the FFQ was compared to the 24HRs, parameters of agreement were generally inferior than for the PM. Parents found the PM a positive experience, primarily facilitated by its simplicity and familiarity. Barriers, mainly related to time and logistics, can inform further methodological refinements.ConclusionsThe PM was an acceptable and feasible way to measure children’s diet outside of school hours in this population of parents from disadvantaged areas. While the absolute validity should be evaluated further, this relatively simple method has potential for assessing intakes of well-defined foods at group level.
Highlights
Dietary assessment methods that are user-friendly, simple, yet valid are of interest to both researchers and participants, for use in disadvantaged settings, where language barriers and low levels of education are often present
We recruited parents who were participants of a previous intervention conducted several years previously [17]. They were eligible if they had a child aged between five and seven years. As this dietary assessment method was developed for use in families with low socioeconomic position (SEP), a further criterium was that families lived in specific areas in Stockholm County with low levels of employment and education, that have been identified by the government as being in need of socioeconomic development
The parent that provided the Differences according to whether review question was posed Of the 57 measurement days in total (19 × 3), this question was not asked on days, it was asked but not answered on 20, and it was answered on days
Summary
Dietary assessment methods that are user-friendly, simple, yet valid are of interest to both researchers and participants, for use in disadvantaged settings, where language barriers and low levels of education are often present. The traditional and still dominant methods are questionnaires, written records and recalls, each with their advantages and disadvantages [1]. Issues and costs related to software development, data protection/storage, and equipment can be prohibitive for both researchers with limited resources and/or their intended participants. This is the case for image-based methods where data volumes can be substantial [5,6,7,8,9]
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