Lessons learned from adolescents
On the first day of the study, 27 of the 31 participants (87%, 13 boys and 14 girls) turned in their completed 6 days of food records. Fifteen males and 14 females participated in focus groups regarding the six different dietary assessment methods. A summary of statements from the focus groups is in . Girls commented that the FR was a ‘hassle.’ The PDA methods were described as ‘better than the interview’ (referring to the 24HR), ‘high technology’ and ‘easier.’ Comments about using a camera included: ‘lot easier,’ ‘fun’ and ‘wasn’t anything I didn’t like about this.’ In the focus group sessions, especially among the boys, a high level of frustration about the 24HR was expressed, for example, ‘boring,’ ‘tedious.’
Quotes from focus groups among boys (n = 15) and girls (n = 14) between 11 and 15 years regarding likes and dislikes of dietary assessment methods.
During the focus groups, subjects expressed difficulty in finding foods using the hierarchical tree data entry method and suggested the addition of a search mechanism for the PDA food record tool. The subjects explained that they did not always know the food grouping for a food. The search method for finding a food was added as a feature during the washout period. Other issues that distracted from the data entry process were the unfamiliar food names used in the database (for example, gum drops for gummy bears, frankfurters for hot dogs) and programme bugs that surfaced during the programme’s first use by a variety of adolescents.
shows the cooperation of the 30 adolescents provided with a disposable camera and small notebook to take home during the 1-week washout period. Despite the lack of remuneration and reminders, 23 of 30 individuals (77%) took pictures beyond the requested 1 day. Just over half of the participants (17/30) recorded in the notebook, whereas 29 of 30 took pictures.
Frequency of participation of 30 boys and girls aged 11–15 years provided with a disposable camera and small notebook to take home, to photograph foods consumed and record descriptions of foods for at least 1 day during a 1-week period
During the focus groups, in response to the question, ‘Were there any situations where you felt embarrassed using the camera?,’ most individuals said ‘no.’ Those respondents who claimed potential for embarrassment, including one who stated ‘some embarrassment at a buffet,’ were comfortable with the process of saying things such as, ‘My friends would think it was weird. But I would take the pictures anyway.’ There was verbal consensus that audio recordings of their intakes would have been embarrassing, and they expressed dislike at the idea of talking out loud about their food intakes.
The results of the questionnaire asking for partiality toward the six diet assessment methods are shown in . When allowed to express their opinions on the questionnaire, which is confidential compared with the more public focus group approach, the 24HR was disliked no more than the PDA tree method. A surprising observation was that a larger proportion of respondents selected liking the 24HR compared with the PDA tree method. The paper and pencil food record was liked the least. There was 100% agreement for the disposable camera and PDA camera as well-liked methods.
Preferences for six dietary assessment methods among 29 boys and girls aged 11–15 years
When testing the pilot PDA food record tool with the subjects, almost every child indicated previous experience in using a PDA and readily adapted to using the tool. Of the 29 subjects completing the questionnaire, 59% (17/29) owned a mobile phone and 66% (19/29) reported owning a digital camera.
A unique aspect of this pilot study was that the subjects were exposed to six different dietary assessment methods, with some of these methods incorporating digital images and handheld PDA tools. Adolescents in this study showed a strong preference for using methods that incorporate technology such as capturing images of food. The use of properly designed handheld computing devices that work through the paradigm of how young people actually live and interact in the ‘digital’ age may address many of the issues outlined as barriers to recording intake among adolescents.
Adolescents’ unstructured eating patterns may be contributing to the underreporting often seen in this age group, along with a combination of forgetfulness, irritation and boredom caused by having to record intake frequently (Livingstone and Black, 2003
). Our focus group testing and quantitative data would support this. We had high adherence when subjects were asked to use a disposable camera to photograph all foods consumed. The young people even took pictures of single food items and small snacks, such as a single licorice rope and a single frankfurter along with one of the recommended fiducial markers (for example, coin, small notebook). With future technology-based applications, we envisage that adolescents will be more engaged in the activity of collecting food intake data, which may lead to more accurate information and representative data on their dietary intakes. This is consistent with the observation that dietary assessment methods perceived as less burdensome and time-consuming may improve compliance (Livingstone and Black, 2003
). To confirm these predictions, validation studies that compare dietary intakes based on technological methods with recovery biomarkers, such as doubly labelled water and urinary nitrogen, need to be undertaken.