Background Web-based time-use diaries for schoolchildren are limited, and existing studies focus mostly on capturing physical activities and sedentary behaviors but less comprehensively on dietary behaviors. Objective This study aims to describe the development of My E-Diary for Activities and Lifestyle (MEDAL)—a self-administered, web-based time-use application to assess diet and movement behavior—and to evaluate its usability in schoolchildren in Singapore. Methods MEDAL was developed through formative research and an iterative user-centric design approach involving small groups of schoolchildren (ranging from n=5 to n=15, aged 7-13 years). To test the usability, children aged 10-11 years were recruited from 2 primary schools in Singapore to complete MEDAL for 2 weekdays and 2 weekend days and complete a 10-item usability questionnaire. Results The development process revealed that younger children (aged <9 years) were less able to complete MEDAL independently. Of the 204 participants (118/204, 57.8% boys, and 31/201, 15.4% overweight) in the usability study, 57.8% (118/204) completed 3 to 4 days of recording, whereas the rest recorded for 2 days or less. The median time taken to complete MEDAL was 14.2 minutes per day. The majority of participants agreed that instructions were clear (193/203, 95.1%), that MEDAL was easy to use (173/203, 85.2%), that they liked the application (172/202, 85.1%), and that they preferred recording their activities on the web than on paper (167/202, 82.7%). Among all the factors evaluated, recording for 4 days was the least satisfactory component reported. Compared with boys, girls reported better recall ability and agreed that the time spent on completing 1-day entry was appropriate. Conclusions MEDAL appears to be a feasible application to capture diet and movement behaviors in children aged 10-12 years, particularly in the Asian context. Some gender differences in usability performance were observed, but the majority of the participants had a positive experience using MEDAL. The validation of the data collected through the application is in progress.
BACKGROUND Web-based time-use diaries for schoolchildren are limited and exiting studies focus mostly on capturing physical activities and sedentary behaviours, but less comprehensively on dietary behaviours. OBJECTIVE In this study, we described the development of MEDAL—a self-administered, web-based time-use application to assess diet and movement behaviour, and evaluated its usability in schoolchildren in Singapore. METHODS MEDAL was developed through formative research and an iterative user-centric design approach involving small groups of schoolchildren (ranging from n=5 to 15, aged 7-13 years). To test the usability, children aged 10-11 years were recruited from two primary schools in Singapore to complete MEDAL for 2 weekdays and 2 weekend days, and a 10-item usability questionnaire. RESULTS The development process revealed that younger children (<9 years) were less able to complete MEDAL independently. Of 204 participants (58% boys and 15% overweight) in the usability study, 58% of them completed 3-4 days of recording while the rest recorded 2 days or less. The median time taken to complete MEDAL was 14.2 min/day. Majority agreed that instructions were clear (95%), that MEDAL was easy to use (85%), that they liked the application (85%), and preferred recording their activities online than on paper (83%). Recording for 4 days was the least satisfactory component reported. Compared to boys, girls reported better recall ability and agreed that the time spent on completing 1-day entry was appropriate. CONCLUSIONS MEDAL appears to be a feasible application to capture diet and movement behaviours for children aged 10 years and above, particularly in the Asian context. Some gender differences in usability performance were observed but the majority of the participants had a positive experience using MEDAL. Validation of data collected through the application is in progress.
My E-Diary for Activities and Lifestyle (MEDAL), a web-based application, was developed to assess the diets of children. This study examined the validity of school recess meals reported by children on MEDAL, using meal photography as the reference. Recess meals were photographed by trained researchers, and food items and portion sizes of recess meals reported on MEDAL were compared to recess meal photos. Validity was assessed by percentages of match, omission and intrusion for food items and percentages of the match, underestimation and overestimation for portion sizes. The Mann–Whitney test and the Wilcoxon matched-pairs signed-rank test examined if sex, school and day of recording influenced the validity of food item reporting. We found that participants (n = 33, aged 10–11 years) recalled 60.2% of food items consumed at recess accurately (matches); omissions (24.6%) were more common than intrusions (15.2%). Omissions tended to be side dishes, and intrusions tended to be high-calorie items. Sex, school and day of recording did not influence validity. For food portion sizes, 58.3% of items were accurately reported. Overestimations (33.3%) were more common than underestimations (8.3%). In conclusion, these children were able to report food items consumed during school recess meals using MEDAL, albeit with limitations on the degree of accuracy.
BACKGROUND Existing modes of collecting self-reported 24-hour movement information from children, including digital assessments, have not been demonstrated to be of acceptable validity when compared to objective measurements. My E-Diary for Activities and Lifestyle (MEDAL) is an interactive web-based diary developed to collect time-use information from children aged 10 years and older. OBJECTIVE This study compared self-reported and accelerometer-measured time spent in movement behaviour among children in Singapore aged 10–11 years. METHODS Participants recorded their daily activities using MEDAL over two specified weekdays and two weekend days, and wore an Actigraph accelerometer on their non-dominant wrist throughout the study to objectively assess movement behaviours. Spearman correlation coefficient and intraclass correlation coefficient were used to compare the accelerometer measurements and self-reports for each movement behaviour. Bland-Altman plots were generated to investigate trends of bias in the self-reports. RESULTS Among the participants aged 10-11 years (n=49, 59% boys), we observed that children reported lower light physical activity (LPA), and higher moderate-to-vigorous physical activity (MVPA), inactivity and night sleep than accelerometer-measured. There was moderate to strong correlation between self-reported and accelerometer-measured MVPA (r=0.37, 95% CI 0.20–0.54), inactivity (r=0.36, 95% CI 0.18–0.54) and night sleep (r=0.58, 95% CI 0.43–0.74); the correlation for LPA was poor (r=0.19, 95% CI 0.02–0.36). Agreement was poor for all behaviours (MVPA ICC 0.24, 95% CI 0.07–0.40; LPA ICC=0.19, 95% CI 0.01–0.36; inactivity ICC=0.29, 95% CI 0.11–0.44; night sleep ICC=0.45, 95% CI 0.29–0.58). There was stronger correlation and agreement on weekdays for inactivity and night sleep; conversely, there was stronger correlation and agreement for MVPA and LPA on weekend days. Finally, we observed that with increasing MVPA, children tended to report higher MVPA than accelerometer measurements. There were no clear trends for the other behaviours. CONCLUSIONS MEDAL may be used to assess movement behaviours of children. Based on self-reports, the children are able to estimate their time spent in MVPA, inactivity and night sleep, although actual time spent in these behaviours may differ from accelerometer-derived estimates; self-reported LPA warrant cautious interpretation. Observable differences in reporting accuracy exist between weekdays and weekend days.
Background Existing modes of collecting self-reported 24-hour movement information from children, including digital assessments, have not been demonstrated to be of acceptable validity when compared to objective measurements. My E-Diary for Activities and Lifestyle (MEDAL) is an interactive web-based diary developed to collect time-use information from children aged 10 years and older. Objective This study evaluated the validity of MEDAL for assessing children’s movement behaviors by comparing self-reported and accelerometer-measured time spent in movement behavior among children in Singapore aged 10-11 years. Methods Funding for this study was obtained in October 2017, and data were collected between April and August 2020. Participants recorded their daily activities using MEDAL over 2 specified weekdays and 2 weekend days and wore an Actigraph accelerometer on their nondominant wrist throughout the study to objectively assess movement behaviors. Spearman correlation coefficient and intraclass correlation coefficient (ICC) were used to compare the accelerometer measurements and self-reports for each movement behavior. Bland-Altman plots were generated to investigate trends of bias in the self-reports. Results Among the participants aged 10-11 years (29/49, 59% boys), we observed that children reported lower light physical activity (LPA) and higher moderate-to-vigorous physical activity (MVPA), inactivity, and night sleep than that measured by the accelerometer. There was a moderate-to-strong correlation between self-reported and accelerometer-measured MVPA (r=0.37; 95% CI 0.20-0.54), inactivity (r=0.36; 95% CI 0.18-0.54), and night sleep (r=0.58; 95% CI 0.43-0.74); the correlation for LPA was poor (r=0.19; 95% CI 0.02-0.36). Agreement was poor for all behaviors (MVPA: ICC=0.24, 95% CI 0.07-0.40; LPA: ICC=0.19, 95% CI 0.01-0.36; inactivity: ICC=0.29, 95% CI 0.11-0.44; night sleep: ICC=0.45, 95% CI 0.29-0.58). There was stronger correlation and agreement on weekdays for inactivity and night sleep; conversely, there was stronger correlation and agreement for MVPA and LPA on weekend days. Finally, based on Bland-Altman plots, we observed that with increasing MVPA, children tended to report higher MVPA than that measured by the accelerometer. There were no clear trends for the other behaviors. Conclusions MEDAL may be used to assess the movement behaviors of children. Based on self-reports, the children are able to estimate their time spent in MVPA, inactivity, and night sleep although actual time spent in these behaviors may differ from accelerometer-derived estimates; self-reported LPA warrant cautious interpretation. Observable differences in reporting accuracy exist between weekdays and weekend days.
The first-year ophthalmology residents were most dissatisfied with their proficiency in irrigation/aspiration, suturing and tin can capsulotomy. More training needs to be directed to these areas during teaching sessions in the operating room, wet laboratory or cataract simulation training sessions.
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