A Mobile Phone Food Record App to Digitally Capture Dietary Intake for Adolescents in a Free-Living Environment: Usability Study

Abstract

BackgroundMobile technologies are emerging as valuable tools to collect and assess dietary intake. Adolescents readily accept and adopt new technologies; thus, a food record app (FRapp) may be a useful tool to better understand adolescents’ dietary intake and eating patterns.ObjectiveWe sought to determine the amenability of adolescents, in a free-living environment with minimal parental input, to use the FRapp to record their dietary intake.MethodsEighteen community-dwelling adolescents (11-14 years) received detailed instructions to record their dietary intake for 3-7 days using the FRapp. Participants were instructed to capture before and after images of all foods and beverages consumed and to include a fiducial marker in the image. Participants were also asked to provide text descriptors including amount and type of all foods and beverages consumed.ResultsEight of 18 participants were able to follow all instructions: included pre- and post-meal images, a fiducial marker, and a text descriptor and collected diet records on 2 weekdays and 1 weekend day. Dietary intake was recorded on average for 3.2 (SD 1.3 days; 68% weekdays and 32% weekend days) with an average of 2.2 (SD 1.1) eating events per day per participant. A total of 143 eating events were recorded, of which 109 had at least one associated image and 34 were recorded with text only. Of the 109 eating events with images, 66 included all foods, beverages and a fiducial marker and 44 included both a pre- and post-meal image. Text was included with 78 of the captured images. Of the meals recorded, 36, 33, 35, and 39 were breakfasts, lunches, dinners, and snacks, respectively.ConclusionsThese data suggest that mobile devices equipped with an app to record dietary intake will be used by adolescents in a free-living environment; however, a minority of participants followed all directions. User-friendly mobile food record apps may increase participant amenability, increasing our understanding of adolescent dietary intake and eating patterns. To improve data collection, the FRapp should deliver prompts for tasks, such as capturing images before and after each eating event, including the fiducial marker in the image, providing complete and accurate text information, and ensuring all eating events are recorded and should be customizable to individuals and to different situations.Trial RegistrationClinicaltrials.gov NCT01803997. http://clinicaltrials.gov/ct2/show/NCT01803997 (Archived at: http://www.webcitation.org/6WiV1vxoR).

Is there any alternative to traditional food frequency questionnaire for evaluating habitual dietary intake?

“…Among university students (study sample), dietary intake is variable from day-to-day, with sporadic changes in food intake (skipping meals, snacking, school events that interfere with meal time), as well as frequent dining out. These aspects interfere with the precise determination of habitual dietary intake (17), especially in the case of FFQs, where data is collected only once at the end of an extended time period.…”

“…Any tool that provides a simple method facilitating the collection of data about dietary intake without changing behavior is an important advancement in nutritional epidemiology (17). Despite repeated use, the modification of habitual intake seems unlikely through the use of e-EPIDEMIOLOGY, due to the reduced workload that using this application presents (one minute/day) (19).…”

“…In these studies, the participants completed electronic food records or 24-hour recalls based on applications for mobile phones, which allowed digital recording of all foods/drinks consumed for 1-7 days. The objective of these short-term instruments was to assess the whole diet (14)(15)(16)(17)(18). However, until now, no electronic long-term tools had been developed for evaluating habitual dietary intake of selected food/drink groups, benefitting from mobile technologies and serving as an alternative to traditional short FFQs (19).…”

Electronic 12-Hour Dietary Recall (e-12HR): Comparison of a Mobile Phone App for Dietary Intake Assessment With a Food Frequency Questionnaire and Four Dietary Records (Preprint)

“…For each food group, the participant would choose the most appropriate image (or images) from a series of color photographs with 2-4 possible options, shown simultaneously [14,27], that illustrated the different serving sizes to assist with selecting the number of standard servings consumed [10,12,14,20,27]. To further assist with estimating serving sizes, each photograph was accompanied by an explanatory text and three objects of known/predictable size for the students [30,31] (fiducial markers): a commonly used pencil, pen and a marker. For example, on the first screen of the app, the following would appear: How many pieces of fruit have you eaten today?, with the Rations button and Next button and a box with the value set to 0 by default.…”

“…To assist with estimating serving sizes, each photograph was accompanied by an explanatory text and three reference objects of known/predictable size for the students [30,31] (fiducial markers): a commonly used pencil, pen and a marker.…”