Question 2
- One of the broader goals of this study was to help develop a publicly available 24-hour recall that could be unscheduled, automated, and self-administered. Participants could be sent the application over the Internet or have it administered at a clinic at low cost. The implication is that the subject would complete and deliver his/her 24-hour recall unsupervised: no dietitian would be present to answer questions, help with interpretation or assist. Given that 24-hour recalls are notoriously inaccurate anyway, how useful or accurate do you feel this type of unsupervised recall data would be, and why? Is this a good application or a poor one?
posted by Alison Geyer @ 9:12 AM
30 comments
30 Comments:
As I was reading through this research article, this exact question/thought popped into my head. I think that images and/or photos would certainly be beneficial; however, not everyone is computer savvy. Yes, having clients fill out an electronic version of a 24-hr diet recall, could result in greater RD productivity but don't we as future dietitians want to be directly involved in patient care. Perhaps, clients could choose as to whether or not they would like to complete it electronically or in-person and maybe a dietitian would be available to assist those completing it electronically. Overall, I think more studies need to be conducted comparing the differences between the accuracy of an electronic 24-hr recall versus a one-on-one diet recall.
I think that this would be a terribly inaccurate way to do this. I cannot believe how many times I would do a 24 hour recall and not get information directly from the client or patient unless I gave them hints or clues. It has been my experience that when doing a recall people think about what their three meals were and forget about everything inbetween, especially fluids. I think we are getting too focused on the easy way out and need to go back to one on one with counseling.
In my opinion, I do not feel that this will be a very accurate way to collect participants’ 24-hour recall data. As stated, the 24-hour recall has been known to have less accuracy compared to other methods of dietary assessment. It is very impersonal and I think that having a face-to-face, dietitian-to-patient type of application is absolutely necessary because each participant needs and individualistic approach as well as assistance. It may work great for some individuals that prefer to do things on their own in the privacy of their home, but it is obvious that there is a lack of motivation and efficacy among many individuals. Not being able to ask questions, be given an explanation or clarity on a matter regarding food is exactly the reason why individuals need to do a dietary recall to begin with. If they lack nutrition knowledge on portion sizes to begin with, an electronic version is not going to suffice for the real thing.
I completely agree with Anna. Many individuals do not have access to computers or have very little knowledge about them. It is absolutely important that RDs have a face-to-face interaction with their patients/clients. There are a lot of non verbal as well as verbal cues that the dietitian as well as patient can benefit from. For example, if a patient is not being entirely accurate when answering a question, the RD may pick up on that non verbal cue and find another way to address the question. In general, I think most individuals would want a dietitian to be there to answer their questions and would have the moral support and motivation from the RD as well.
On page 60, it says that “Approximately 15% of the overall number of estimates were within 10% of the amount actually consumed. The mean percentage of accuracy ranged from approximately 9% for foods represented by images of household measures (cup or spoons) to 23% for foods in
the single-unit category (such as bagels).” Table 2 shows a more specific breakdown of how many estimates were within +/- 10% of measured weight. These are pretty horrible statistics, and demonstrate a significant lack of accuracy by this tool as a 24-hour food recall. I feel that this application could be used as a tool by a dietitian for a good visual aid when collecting information to compile a 24-hour recall, but, on its own, this application is severely lacking any kind of real accuracy.
I'm not sure exactly as to what the creators of this program were hoping to accomplish if they do not wish to have any outside nutritional intervention as a supplement to the dietary recall. The 24-hour recall is used to provide a snapshot of what a person eats, and is almost always followed by some kind of dietary intervention/discussion. I don't see how it would help an individual of the general public. Now if it were to be used as a means for a dietitian to determine dietary recommendations, than I think that it would be helpful. Using pictures and allowing the subjects to visualize portion sizes is most likely going to be more accurate than just using their memory alone.
I can honestly see two views regarding the unsupervised recall data. On one hand, having an unsupervised recall opens many doors of opportunity for people to manipulate and skew the data when they wouldn't have had such opportunity if the recall was supervised. But on the other hand, as previously mentioned, recall data is typically inaccurate anyway, allowing an unsupervised recall to collect data may not be any more inaccurate than a supervised recall to collect data. I don't really have an absolute opinion on weather this data would be more/less useful or accurate. It seems it would be optimal for someone to conduct a study, then have half of the subjects participate in a supervised recall while the other half of the subjects participated in an unsupervised recall to assess if having unsupervised recalls leads to less accurate/useful data.
This study is a step in the right direction, but further research that is needed in this area. This study was not completely successful seeing as approximately 15% of the overall number of estimates were within 10% of the amount actually consumed. In order for a system like this to be successful, the subjects would need to be able to accurately indicate the foods consumed almost all the time. At this point, I think that assistance from a dietitian would still be needed for these types of 24-hour recall to be considered accurate.
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This doesn’t seem like the right approach toward 24-hour recalls. This recall data would be more inaccurate, seeing as it is unsupervised. I feel a RD should be present to aid clients in completing the 24-hour recalls. I agree that using images would be advantageous for identifying serving sizes, etc. Although, some people aren’t educated on how to use computers and they may not have easy access to a computer, hindering this process altogether.
I agree with Rose that this study is a step in the right direction. It would be interesting to see more studies examining the differences in accuracy between 24-hour recalls and diet recalls with a RD present, like Anna mentioned. Either way, more research is imperative to assess the accuracy of these types of 24-hour recalls.
I'm not sure that this type of recall data would be very accurate at all. Even if you have a dietitian present to help the client decipher their portion, it often leads to an inaccurate 24 hour recall because items are forgotten or size amounts are skewed. I can't imagine how inaccurate it it can be without a dietitian to ask the appropriate questions and help them through it. Also, as a side note, I feel my job security being slightly threatened by all these new technological ways of doing self-nutrition diagnoses on the internet, so I'm kind of nervous about that as well...
I think that many people do like doing things at their own pace on the Internet without people looking over their shoulders. Therefore, I think that it would be fine to let people do this at home on their own time. However, I think it would be necessary for the RD to review this with the client in further detail to make sure that the client wasn't leaving anything out, such as condiments/fluids/snacks/ect, as well as let the client have a chance to ask questions if they needed to. Letting people start this and complete as much as they can on their own would save the RD a lot of time in the end, but the RD would be the one to finalize this recall, which would hopefully be a way to gain further accuracy.
In my opinion, the intention of this study was to try and assess the accurracy of the 24-hour recall, which proved to be low, and find ways to improve it, by providing the images of food portions. With this being said, providing accurate images of portion sizes is definitely a step towards improving the 24-hour recall but as everyone else mentioned, it still is highly inaccurate and falsified. Being on the path to becoming a dietitian I feel that having the RD involved with this recall is very important and can provide much more accurate data. However, I feel this is a good application because many people would rather do the form on their own so it's important to try and find ways to improve the flaws in this system which is what this study is trying to do.
I definitely agree with Anna when mentioned that more research needs to be done in order to determine the accuracy of the 24-hour recall compared to completion with a dietitian. Just like any other health care visit or questionaire, people tend to lie about certain aspects of their life choices so who's to say that they aren't lying to the RD when meeting face to face. I think a comparison of an electronic recall and meeting with an RD would be a very beneficial study to this area of dietetics and also something I would be highly interested in reading.
I believe that this type of application would only benefit those with prior nutrition knowledge. Without a nutrition professional to help explain the data, and the changes to make, the application is pretty useless. This could be a beneficial aid for RDs in the future, but not an application for personal, at-home use. If this type of electronic 24-hr recall is repeatedly proven accurate, it should most definitely be welcomed as a data collection method.
Melissa, I completely agree with you when you say you feel as if your job security is being slightly threatened. Certainly, I can not believe the progress we have made regarding technology; however, now-a-days everyone seems to have a computer in which they hide behind. We have become so dependent upon technology that we at times don't know what to do without it! After thinking about it more, I think that this type of computer programming would be detrimental to our profession. I did not choose a profession in dietetics to sit behind a computer, but I chose it knowing that I would be able to interact with people day-in and day-out.
I feel like the concept of this study is interesting and may be a step in the right direction as far as how to include technology into our profession. I feel like this may be more accurate for those patients that are embarassed to be honest when doing a 24-hour recall with the dietitian one-on-one. I do recognize that there are going to be many patients that are uncomfortable with this as well, so obviously this could not be the only way it is done in a real-world setting. I do think some tweaking could be done to help with accuracy by having a "help" option that could answer faq's for patients while they are completing the recall.
Melissa-
I don't think we should really be threatened by technology such as this. It seems like technology has it's place in the collection of information such as the diet recall, food journals, etc. and the place of intervention and evaluation still lies with the dietitian and our ability to specialize care to each individual.
I believe that this application could be positive, but not necessarily in the way they have laid it out. I think it could be a good tool for those who are tech-savvy, if they used an online representative (who is a RD or a nutrition professional) to answer possible questions or make clarifications. As previously stated, 24-hour recalls are inaccurate even if administered by a professional, so one that has no supervision or guidance seems somewhat worthless to accurately measure one’s diet. If this application was used during an actual consultation, I feel it could be much more useful and maybe even allow for more accuracy so long as the patient clearly understands what is being asked and how to appropriately respond.
This method of submitting a 24-hour recall without a dietitian present could be used as an initiating foundation for one-on-one assessment with an RD but not the sole source of information to plan an intervention. Building rapport with the client/pt. is very important and this method makes that impossible. From my experience, 24-hour recalls being submitted in this manner create more of a guessing game. This is caused by a client’s limited knowledge of food and beverage related details that contribute to factors affecting health as well as the interpreter’s ability to make assumptions as to what the client is intending to mean or if it's accurate at all.
I have two reactions to the option of sending automated 24-hour recalls over the internet. Number one, not all patients have access to the internet, especially those of low SES. Also, many elderly patients may not be familiar with using the internet, and this fact alone may decrease the accuracy of their 24hour recalls. Although this option may be more convenient for a majority of clients; it would be markedly less convenient and accurate for those individuals who do not have a computer or are not familiar with using one.
-Sarah Gervais
I agree with Melissa- although the 24-hour recall seems to be a simple enough task, it is a notoriously inaccurate tool. Without the face-to-face contact and the prompting of the RD, I believe that the electronic 24 hour recall would even more inaccurate.
-Sarah Gervais
I think its good in theory. People are more technologically mind now and food models aren't always accessible. So the idea of a program that helps with the food recall, I think is a good idea. The problem was just what you stated in the question, no supervision. I understand that its more cost effective to have people do this on their own, particularly if they have financial issues already, but there are so many questions that need to be asked to get more detail on food recalls for them to be as accurate as possible. I think this would be a great tool, IF it was done with a dietitian present. In fact, it might be really handy with children/teenagers. But it really does need to have a dietitian with it to increase its accuracy.
Jen -- I agree that being unsupervised also raises the issue of manipulating/lying about the food recall to make it look better. The same could be said for food logs that patients fill out at home, too. So I guess, in a way it wouldn't be any more inaccurate than those can be. It just depends on how honest the client is.
As Rachel and Sarah G brought up, there seem to be some financial realities to consider. As Rachel said, using a tool such as this one before meeting with a dietitian may be more cost effective, but the key word there is "effective." No matter how cheap it is, it can't be considered cost effective if it isn’t accurate. Rachel makes the excellent point that "there are so many questions that need to be asked to get more detail on food recalls for them to be as accurate as possible." If accuracy is so important, then using this tool alone and then taking the time to correct information with a dietitian would probably still be less accurate than if a food recall was done entirely in the presence of an RD. Also, Sarah G. mentions the lack of accessability of a tool such as this one to many of those with a SES that makes Internet access difficult (although public libraries can alleviate this problem, there is still the task of getting transportation TO the library). Both Sarah G. and Rachel bring up interesting points concerning cutting corners in the name of saving money, but these shortcuts entirely exclude those lacking certain resources. What if personal financial status and hospital budgets weren't such a huge barrier when it came to health care? What would be the ideal situation for obtaining an accurate food recall then? Whatever the answer to that question, wouldn’t it be great if that method could be used whenever possible? A decrease in quality and accuracy should only be allowed if all other options are exhausted, but budgeting on both sides can make this impossible. Think of the caliber of care we as RD's could provide if value was measured in its accuracy, not its price tag.
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I agree with the overall notion that an unsupervised, self-administered 24-hour recall would be inaccurate. However, I'm on the same page as Sarah U and Kara, I think that dietetics as a profession should embrace advances in technology in all areas. A properly formatted, reliable electronic 24-hour food recall could be a beneficial educational aid.
Melanie -
I completely agree with you, and especially because I have had some direct experience with counseling at the various sites of my internship. It is essential to have a face-to-face, dietitian-to-client type interaction because it is very easy for people to leave items out and/or remember things incorrectly when reporting their intake. It is important to have a professional guide them through tracing their intake.
I completely agree with Sarah U. that this might be a better tool for people that are too embarrassed to talk to a dietitian in the first place. I think we need to be accessible in our area to all types of people. Some may love this concept and it may help them quite a bit, while others are going to need to see a professional and receive more one-on-one attention.
I also agree with Rose and Liz that this a step in the right direction, but more research is needed. I think it could be a great tool if properly used and so long as the individuals using it comprehend what they are doing.
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