Feasibility of using technology-based dietary assessment with photography in New Zealand adolescents to measure food intake - a pilot study

Background: Traditional forms of dietary assessment, including the 24 hour recall, food frequency questionnaire and pen and paper food records tend to underestimate energy intakes in adolescents due to under-reporting and non-compliance. This is in part due to the high respondent burden required to complete them and the difficulty adolescents have in accurately estimating portion size. Preliminary research in the United States of America (USA) has shown that adolescents are more likely to engage in dietary assessment through technology that is relevant to them, and the use of photography can help to reduce the inaccuracy associated with portion size estimation. So far in New Zealand there has been no research using technology based dietary assessment (TBDA) with photography to measure the food intake of adolescents. Objective: The aim of this study is to investigate the feasibility of using an electronic food record with photography to measure food intake in New Zealand adolescents. Feedback from participants regarding the usability of the food record will then be used to improve the future design (interactive design). Design: Five males and five females between the ages of 16 and 19 years were asked to complete an eight day food record with photography on both an Apple iPad® (iPad®) and Apple iPod® (iPod®) touch over eight days (four days using each device). Participants were asked to take photos of the foods they were about to eat, and to fill in a food log underneath each picture. Participants then attended a group interview where they were asked questions in order to gain feedback on the usability of the food record. Feasibility was evaluated by how well participants filled in the food record, clarity/usability of images, a realistic energy intake recorded and feedback given at the group interview. Results: There was relatively high compliance to using the electronic food record with all participants recording at least two meals per day, on six out of the eight days. The majority of entries could be used (79%) as they contained photographs with excellent image clarity. Overall energy intake measured from both devices was similar to New Zealand Adult Nutrition Survey 2008/09 (NZANS) data (iPad® 8114kJ/day, iPod® 8546kJ/day, ANS 9480kJ/day) from a similar age group. Participant feedback from the focus group gave useful suggestions for improvements to the food record such as the request for a more simple application which required fewer steps to record food intake. Compliance to the devices and participant feedback tended towards preferring the use of the iPod® versus the iPad® to record food intake. Conclusion: The use of TBDA with photography appears to be a feasible way to measure food intake in the adolescent population, as evidenced by the relatively high compliance to using the device, energy intake comparable to the NZANS data and positive feedback from participants using the device