A Web-Based Time-Use Application to Assess Diet and Movement Behavior in Asian Schoolchildren: Development and Usability Study of My E-Diary for Activities and Lifestyle (MEDAL)

Abstract

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.

A Web-Based, Time-Use App To Assess Children’s Movement Behaviors: Validation Study of My E-Diary for Activities and Lifestyle (MEDAL)

“…We also acknowledge that the sample size of this study was modest, largely due to the exclusion of participants that did not have any day of recording on MEDAL that corresponded with the days the accelerometers were worn. Notwithstanding, MEDAL was reported previously to be feasible and acceptable among children of this age group [ 18 ]. Some differences in characteristics exist between participants included in our study and those recruited but not included (ie, those excluded from movement behavior validation analyses and those involved in the other validation studies; Multimedia Appendix 2 ).…”

“…The details and features of MEDAL have been reported elsewhere [ 18 ]. In brief, participants were instructed to enter the time they slept the previous day, the time they woke up, and all the activities in which they participated in chronological order until the time they went to bed.…”

“…However, not all self-reported behaviors reported on these assessments have been validated against objective measurements; therefore, the utility of these assessments for collecting 24-hour movement behavior information in comparison to objective measures remains unclear. These applications were also developed for Western populations (ie, Australia, the United Kingdom, and the Netherlands, respectively), and the behavioral patterns of children in Western versus Asian populations may differ (eg, the prevalence of children attending tuition or shadow education) [ 18 ], limiting the relevance of existing applications to the Asian setting.…”

“…To bridge this gap, My E-Diary for Activities and Lifestyle (MEDAL), an interactive web-based diary, was developed to collect time-use information from children of at least 10 years of age in Singapore [ 18 ]. Usability testing suggests that MEDAL is a feasible application for capturing the movement behaviors of children aged 10 to 12 years [ 18 ].…”

“…To bridge this gap, My E-Diary for Activities and Lifestyle (MEDAL), an interactive web-based diary, was developed to collect time-use information from children of at least 10 years of age in Singapore [ 18 ]. Usability testing suggests that MEDAL is a feasible application for capturing the movement behaviors of children aged 10 to 12 years [ 18 ]. We aimed to validate the use of MEDAL for assessing children’s movement behaviors by comparing self-reported and accelerometer-measured time spent in MVPA, LPA, inactivity, and sleep among children aged 10 to 11 years in Singapore.…”