Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
Department of Biosciences and Nutrition, Karolinska Institutet, 141 83, Huddinge, Sweden.
Nutr J. 2020 May 27;19(1):50. doi: 10.1186/s12937-020-00558-4.
Dietary 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.
We 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.
Nineteen 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.
The 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.
对于研究人员和参与者来说，简单易用、简单但有效的饮食评估方法很有吸引力，特别是在存在语言障碍和教育水平低的劣势环境中。我们测试了父母是否可以使用手机拍摄孩子所吃的食物，这是否是一种可行且可接受的方法，这种方法仍然可以提供足够的相对有效性信息。
我们采用混合方法设计，在瑞典贫困地区招募了 21 名 5-7 岁儿童的父母。父母在三天（两个工作日）内，在非上学时间使用照片法（PM）报告所有饮食摄入情况。PM 包含简单的说明和信托卡，但没有培训、设备或软件。如有必要，可以发送短信。作为参考方法，父母在第二天与采访员一起完成三次 24 小时回忆（24HR）。接下来的一周，父母完成了一份关于前一周的 9 项半定量食物频率问卷（FFQ）。结果是 9 种食物组的摄入量（以 dl 为单位），分为水果和蔬菜、高能量甜食/咸食和甜饮料。使用相关性、中位数差异和 Bland-Altman 图评估与参考 24HR 的一致性。父母完成了一份关于障碍和促进因素的开放式问卷。数据收集员提供了补充信息。定性数据使用定性显式分析进行分析。
19 位父母（90%）提供了完整的数据。大多数父母（n=13）将瑞典语作为第二语言，很少有父母（n=4）精通。与 24HR 相比，PM 测量的摄入量相关性良好，所有类别均如此（Spearman's rho=0.609-0.845）。然而，摄入量被低估了，水果和蔬菜的摄入量明显被低估；Bland-Altman 图表明，这种低估在整个摄入量水平上相当稳定。当 FFQ 与 24HR 相比时，一致性参数通常不如 PM 好。父母认为 PM 是一种积极的体验，主要是因为它简单且熟悉。障碍主要与时间和物流有关，可以为进一步的方法改进提供信息。
在来自贫困地区的父母中，PM 是一种在非上学时间测量儿童饮食的可接受且可行的方法。虽然还需要进一步评估绝对有效性，但这种相对简单的方法具有在群体水平上评估明确食物摄入量的潜力。
