Formative evaluation of the usability and acceptability of myfood24 among adolescents: a UK online dietary assessments tool

BackgroundMyfood24 is a new online 24 h dietary assessment tool developed for use among the UK population. Limited information is available on the usability and acceptability of such tools. Hence this study aims to determine the usability and acceptability of myfood24 among British adolescents (11-18y) before and after making the improvements.MethodsA total of 84 adolescents were involved in two stages. In stage-I (beta-version of myfood24), 14 adolescents were recruited, 7 of whom (group-1) were asked to enter standardized tasks in a testing room with screen capture software. The remaining 7-adolescents (group-2) were asked to report their previous food intake using myfood24 at home. All participants then completed a usability and acceptability questionnaire. Stage-II was carried out after making amendments to the live-version of myfood24 in which 70 adolescents were asked to enter their food intake for two days and then complete the same questionnaire. Thematic analysis was conducted of observer comments and open-ended questions.ResultsNavigation, presentation errors and failure to find functions were the main usability issues identified in the beta-version. Significant improvements were found in the usability and acceptability of most functions after implementing certain features like a spell checker, auto-fill option, and adding ‘mouse hover’ to help with the use of some functions. Adolescents’ perceptions of searching food items, selecting food portion sizes and making a list function were significantly improved in the live-version. The mean completion time of myfood24 reduced from 31 (SD?=?6) minutes in the beta-version to 16 (SD?=?5) minutes in the live-version. The mean system usability score (SUS) of myfood24 improved from 66/100 (95 % CI 60, 73) in the beta-version to 74/100 (95 % CI 71, 77) in the live-version, which is considered as ‘good’. Of the adolescents in stage-II, 41 % preferred using myfood24 to the interviewer-administered 24 h recall because myfood24 was quicker, easier to use and provided the adolescents with privacy when reporting dietary intake.ConclusionConsidering adolescents’ feedback has helped in improving the usability and acceptability of the final-version of myfood24. myfood24 appears to support adolescents’ need in reporting their dietary intake, which may potentially improve the overall quality of adolescents’ self-reported dietary information

Development of a new branded UK food composition database for an online dietary assessment tool

The current UK food composition tables are limited, containing ~3300 mostly generic food and drink items. To reflect the wide range of food products available to British consumers and to potentially improve accuracy of dietary assessment, a large UK specific electronic food composition database (FCDB) has been developed. A mapping exercise has been conducted that matched micronutrient data from generic food codes to “Back of Pack” data from branded food products using a semi-automated process. After cleaning and processing, version 1.0 of the new FCDB contains 40,274 generic and branded items with associated 120 macronutrient and micronutrient data and 5669 items with portion images. Over 50% of food and drink items were individually mapped to within 10% agreement with the generic food item for energy. Several quality checking procedures were applied after mapping including; identifying foods above and below the expected range for a particular nutrient within that food group and cross-checking the mapping of items such as concentrated and raw/dried products. The new electronic FCDB has substantially increased the size of the current, publically available, UK food tables. The FCDB has been incorporated into myfood24, a new fully automated online dietary assessment tool and, a smartphone application for weight loss

Development of a UK online 24-h dietary assessment tool:Myfood24

Abstract: Assessment of diet in large epidemiological studies can be costly and time consuming. An automated dietary assessment system could potentially reduce researcher burden by automatically coding food records. myfood24 (Measure Your Food on One Day) an online 24-hour dietary assessment tool (with the flexibility to be used for multiple 24hour-dietary recalls or as a food diary), has been developed for use in the UK population. Development of myfood24 was a multi-stage process. Focus groups conducted with three age groups, adolescents (11-18 yrs) (n = 28), adults (19-64 yrs) (n= 24) and older adults (≥65 years) (n= 5) informed the development of the tool, and usability testing was conducted with beta (adolescents n= 14, adults n= 8, older adults n= 1) and live (adolescents n= 70, adults n= 20, older adults n= 4) versions. Median system usability scale (SUS) scores (measured on a scale of 0-100) in adolescents and adults were marginal for the beta version (adolescents median SUS =66, interquartile range (IQR) =20; adults median SUS=68, IQR=40) and good for the live version (adolescents median SUS= 73, IQR =22; adults median SUS= 80, IQR=25). myfood24 is the first online 24 hour dietary recall tool for use with different age groups in the UK. Usability testing indicates that myfood24 is suitable for use in UK adolescents and adults

Exploring the Feasibility of Use of An Online Dietary Assessment Tool (myfood24) in Women with Gestational Diabetes

myfood24 is an online 24 hr dietary recall tool developed for nutritional epidemiological research. Its clinical application has been unexplored. This mixed methods study explores the feasibility and usability of myfood24 as a food record in a clinical population, women with gestational diabetes (GDM). Women were asked to complete five myfood24 food records, followed by a user questionnaire (including the System Usability Scale (SUS), a measure of usability), and were invited to participate in a semi-structured interview. Of the 199 participants, the mean age was 33 years, mean booking body mass index (BMI) 29.7 kg/m², 36% primiparous, 57% White, 33% Asian. Of these, 121 (61%) completed myfood24 at least once and 73 (37%) completed the user questionnaire; 15 were interviewed. The SUS was found to be good (mean 70.9, 95% CI 67.1, 74.6). Interviews identified areas for improvement, including optimisation for mobile devices, and as a clinical management tool. This study demonstrates that myfood24 can be used as an online food record in a clinical population, and has the potential to support self-management in women with GDM. However, results should be interpreted cautiously given the responders' demographic characteristics. Further research to explore the barriers and facilitators of uptake in people from ethnic minority and lower socioeconomic backgrounds is recommended

Improvement of Dietary Assessment among Adolescents

Background: Collecting information on food and dietary intake provides valuable insights into the associations between diet and health and helps to evaluate the impact of intervention programmes. Measuring dietary intake is challenging, particular when adolescents are the target group. Errors associated with the quantification of food portion size (FPS) are the most common errors to arise when assessing dietary intake. Aims: To improve the measurement of adolescents’ dietary intake by investigating certain variables related to adolescents’ FPSs, and developing and validating an online 24-hour dietary assessment tool (myfood24) based on adolescents’ (11-18 years old) needs and preferences. Methodology: In the first part of the thesis, the UK National Diet and Nutritional Survey (NDNS 2008-2011) was used to investigate adolescents’ FPSs, to identify differences in FPS between adolescents and adults (19-65y), and to investigate the relationship between adolescents’ FPS and BMI. The second part was a collaborative project to develop myfood24, a new web-based dietary assessment tool. I was responsible for ensuring fit for purpose for adolescents. A multi-stage process was used to facilitate this. It comprised of focus groups, usability and acceptability studies, and evaluation of the relative-validity of myfood24 among adolescents. Results: FPS differed by age group more than it did by gender, and older adolescents (15-18y) had slightly larger FPSs than younger adolescents (11-14y). Differences were more noticeable for beverages than for food items. Some significant differences were found in FPS between adolescents and adults, although the differences were small in terms of weight. The top ten contributing foods towards adolescents’ daily EI can be defined as high-energy-dense foods. Portion sizes of a number of high-energy-dense foods were found to be positively associated with BMI, when eliminating the effect of underreporting EI. Involving adolescents in the development process of myfood24 enhanced the overall acceptability and usability of myfood24. Following improvements, the average system usability score (SUS) of myfood24 was 74/100 and the mean completion time was 16 minutes. There was no significant bias identified when comparing myfood24 with an interviewer-administered multiple-pass recall for EI and most reported nutrients. The mean difference between myfood24 and the interviewer (MPR) was small, -55 kcal (-230kJ) (95% CI: -117, 7 kcal, (-490 to 30 kJ); P=0.4) for EI. There were strong intraclass correlation coefficients (ICCs) for EI and most reported nutrients. Conclusion: FPS increased by age and there was some disparity between adolescents and adults in FPSs. However, the magnitude of the differences was small. The portion sizes of a limited number of high-energy-dense foods were found to be associated with a higher BMI in all adolescents. However, when eliminating the effect of under-reporting, portion sizes of a number of high-energy-dense foods were associated with a higher BMI. myfood24 is an appropriate, reliable and easy to use dietary assessment tool for adolescents (11-18y). It has the potential to collect dietary data of comparable quality to that of an interviewer-administered multiple-pass recall. From a public health perspective, multiple approaches directed at adolescents to enhance their food choices and portion sizes of high-energy-dense foods are needed to prevent and control obesity and its related diseases

Does food portion size differ by level of household income? A cross-sectional study using the UK National Diet and Nutrition Survey 2008–11

Background: in developed countries, disadvantaged groups have higher prevalence of obesity and its associated chronic diseases than do high income groups. This study aimed to investigate the association between the level of household income and food portion size for the top 20 most frequently consumed foods by adolescents and adults.Methods: data for this study came from the UK National Diet and Nutritional Survey (2008–11). Using a 4 day estimated food record, we calculated food portion size for 567 adolescents (11–18 years) and 992 adults (19–65 years). For each participant, average portion size for each food was calculated by dividing the total weight of the food by the frequency of consumption; then the average food portion size was calculated for each food for the whole sample. This method avoided portion sizes being skewed because of individuals who frequently consumed small or large portions. Levels of income were classified by household income per year: low (?£24?999), middle (£25?000–49?999), and high (?£50?000). Associations with food portion size were tested with multivariable regression models adjusting for sex and age (significance at p?0·01).Findings: 205, 226, and 136 adolescents and 395, 379, and 218 adults were classified as having low, middle, and high household incomes, respectively. Adolescents from low income households consumed smaller portions of “tap water” than did those in high income households (by 52 mL, 99% CI 7–97; p<0·0001). Adolescents from middle income households consumed larger food portion sizes of “carbonated soft drinks” than did those from high income households (40 mL, 2–81; p=0·01). Adults in low income households consumed larger food portion sizes of “cheese”, “mashed potato”, and “savoury sauces, pickles” (by 9 g [2–15], 25 g [2–15], and 12 g [7–43], respectively; p<0·0001), and drank smaller portions of “tap water” (34 mL [3–71], p=0·01) than did those from high income households. No significant differences were seen in food portion sizes between adults in middle and high income households.Interpretation: portion sizes of only a few foods differed by household income; nonetheless, these foods might contribute to inequalities in healthy dietary intake in both adults and adolescents. More attention should be given to both food and drink portion sizes when planning public health nutrition interventions and policy programmes aimed at closing the socioeconomic gap in obesity and chronic disease morbidity and mortalit

Agreement between an online dietary assessment tool (myfood24) and an interviewer-administered 24-h dietary recall in British adolescents aged 11-18 years on behalf of the myfood24 Consortium Group

Abstract myfood24 Is an online 24-h dietary assessment tool developed for use among British adolescents and adults. Limited information is available regarding the validity of using new technology in assessing nutritional intake among adolescents. Thus, a relative validation of myfood24 against a face-to-face interviewer-administered 24-h multiple-pass recall (MPR) was conducted among seventy-five British adolescents aged 11-18 years. Participants were asked to complete myfood24 and an interviewer-administered MPR on the same day for 2 non-consecutive days at school. Total energy intake (EI) and nutrients recorded by the two methods were compared using intraclass correlation coefficients (ICC), Bland-Altman plots (using between and within-individual information) and weighted κ to assess the agreement. Energy, macronutrients and other reported nutrients from myfood24 demonstrated strong agreement with the interview MPR data, and ICC ranged from 0·46 for Na to 0·88 for EI. There was no significant bias between the two methods for EI, macronutrients and most reported nutrients. The mean difference between myfood24 and the interviewer-administered MPR for EI was −230 kJ (−55 kcal) (95 % CI −490, 30 kJ (−117, 7 kcal); P = 0·4) with limits of agreement ranging between 39 % (3336 kJ (−797 kcal)) lower and 34 % (2874 kJ (687 kcal)) higher than the interviewer-administered MPR. There was good agreement in terms of classifying adolescents into tertiles of EI (κ w = 0·64). The agreement between day 1 and day 2 was as good for myfood24 as for the interviewer-administered MPR, reflecting the reliability of myfood24. myfood24 Has the potential to collect dietary data of comparable quality with that of an interviewer-administered MPR

Additional file 1: Table S1. of Formative evaluation of the usability and acceptability of myfood24 among adolescents: a UK online dietary assessments tool

Tasks completed by users in stage-I (group-1). Table S2. Task analysis criteria for each user (Note taker’s guide). Table S3. System Usability Scale (SUS)*. (PDF 276 kb

Is there an association between food portion size and BMI among British adolescents?

The prevalence of obesity has increased simultaneously with the increase in the consumption of large food portion sizes (FPS). Studies investigating this association among adolescents are limited; fewer have addressed energy-dense foods as a potential risk factor. In the present study, the association between the portion size of the most energy-dense foods and BMI was investigated. A representative sample of 636 British adolescents (11-18 years) was used from the 2008-2011 UK National Diet and Nutrition Survey. FPS were estimated for the most energy-dense foods (those containing above 10·5 kJ/g (2·5 kcal/g)). Regression models with BMI as the outcome variable were adjusted for age, sex and misreporting energy intake (EI). A positive association was observed between total EI and BMI. For each 418 kJ (100 kcal) increase in EI, BMI increased by 0·19 kg/m2 (95 % CI 0·10, 0·28; P< 0·001) for the whole sample. This association remained significant after stratifying the sample by misreporting. The portion sizes of a limited number of high-energy-dense foods (high-fibre breakfast cereals, cream and high-energy soft drinks (carbonated)) were found to be positively associated with a higher BMI among all adolescents after adjusting for misreporting. When eliminating the effect of under-reporting, larger portion sizes of a number of high-energy-dense foods (biscuits, cheese, cream and cakes) were found to be positively associated with BMI among normal reporters. The portion sizes of only high-fibre breakfast cereals and high-energy soft drinks (carbonated) were found to be positively associated with BMI among under-reporters. These findings emphasise the importance of considering under-reporting when analysing adolescents' dietary intake data. Also, there is a need to address adolescents' awareness of portion sizes of energy-dense foods to improve their food choice and future health outcomes

A period-doubling bifurcation for the Duffing equation(Study of Partial Differential Equations by means of Functional Analysis)

Background: Dietary assessment is complex and strategies to select the most appropriate dietary assessment tool (DAT) in epidemiological research are needed. The Dietary Assessment Tools Network (DIET@NET) aimed to establish expert consensus on Best Practice Guidelines (BPG) for dietary assessment using self-report. Methods: The BPG were developed using the Delphi technique. Two Delphi rounds were conducted. 131 experts were invited, of these 65 accepted, with 48 completing Delphi round I and 51 completing Delphi round II. In all, a total of 57 experts from North America, Europe, Asia, and Australia commented on the 47 suggested guidelines. Results: 43 guidelines were generated, grouped into 4 stages: Stage I. Define what is to be measured in terms of dietary intake (what? who? and when?); Stage II. Investigate different types of DAT; Stage III. Evaluate existing tools to select the most appropriate DAT by evaluating published validation studies; Stage IV. Think through the implementation of the chosen DAT and consider sources of potential biases. Conclusions: The Delphi technique consolidated expert views on best practice in assessing dietary intake. The BPG provide a valuable guide for health researchers to choose the most appropriate dietary assessment method for their studies, these guidelines will be accessible through the Nutritools website, www.nutritools.org