Question 1
One example of an assessment tool used in nutrition-related research is the 24-hour recall. Do you find this to be a reliable tool? Why or why not? Are there measures that researchers can take to increase its reliability?
posted by Rachel Johanek @ 10:47 AM
20 comments
20 Comments:
First off, I'm going to have to say that I don't think that dietitians would be using this tool unless it was proven to be a reliable source to gain information about what people are eating. Secondly, I do not think there is a better way to assess what somebody ate the night before unless you were physically with them, jotting down everything they ate or didn't eat. So, I am going to have to say that for the purpose of measuring what someone ate the day before, then yes the 24-hour recall is a reliable source. However, there are many faults with it such as, the person may leave out information intentionally or forgetfully or it may not be a "typical day" diet. With this I think that this tool should be included with a food frequency questionnaire and a diet recall of a "typical day." I also think that nutrition-related researcher should have the subjects keeping a food diary that way you can physically look back on what the person ate. This combination of tools provides a broader understanding of the person's diet and it makes the tool more accurate, therefore more reliable.
In my opinion, I definitely think that the 24-hour recall is a reliable tool to use when assessing nutritional intake because it allows the client to go through the previous day or a typical days food intake. Clients are likely to remember what they had to eat for the past 24 hours or what they normally eat on a typical day. Using something like just a food frequency questionnaire doesn't cover as much as the 24-hour recall does. I think that doing a 24-hour recall is a great way for a client to actively participate and interact with the dietitian, while allowing the dietitian to go into further detail with questions (e.g. how do you prepare your foods, how much, what time etc.). I think the best way in increase the reliability of this assessment tool is pairing it with other tools of nutrition assessment such as having the client keep a food journal or diary to track their foods/beverages each day, doing a diet history, and using the food frequency questionnaire (possibly using all three)to get the most accurate and inclusive information as possible.
I definitely agree with you Bethany on how clients tend to forget or intentionally leave of important information when going through a 24-hour recall. No tool is going to be 100% accurate or reliable and there is always going to be some type of disadvantage, but I agree with the fact that dietitians would not still be using this tool of assessment if it were not at least somewhat reliable.
I believe that a 24-hour recall can be reliable for some people and not for others. I’m not sure if researchers can increase its reliability. Like in anything, there are going to be some who truly remember what they ate the day before and typically follow that pattern day-to-day. On the other hand, there are going to be some people who don’t pay attention to what they consume and/or how much of it they eat. Also, if the person administering the 24-hour recall uses inappropriate questions, leading questions or vague questions, the information found through the 24-hour recall will not be a true representation of someone’s diet.
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I agree with Bethany that the 24-hour recall would not be used it if was not a reliable measure and that it is the best way to have a participant remember what they ate the previous day. I also agree with Liz, though, that there are some people who have more difficultly remembering what they ate. In this scenario, it may be necessary to have that person keep a food diary versus completing a 24-hour recall or any other type of dietary recall.
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I believe that if administered correctly the 24-hour recall is a valid measurement tool. It works well to get a general idea of a person’s dietary patterns over the past 24 hours; otherwise it would not be utilized. On the other hand, if the individual conducting the 24-hour recall is inexperienced, it may not accurately measure the food intake of the participant. I believe having an experienced facilitator and making sure they are not leading the participant to provide answers are good ways to increase the reliability of the 24-hour recall. It may also be necessary to include other diet recall methods such as a food frequency questionnaire or food diary, to accurately capture a person’s diet patterns.
I feel like this is hard to answer and I think it really depends on the individual who is recalling his or her diet. I think it as reliable of a tool as we can get at the moment, short of following a person around and recording everything he or she eats. If people are honest about how much they eat, if they accurate about the portion sizes they consume and they have decent memories, then this tool can be very reliable and useful. However, if people being assessed do not do those things then the recall will not be accurate. I really believe the only things researchers can do to increase reliability is to go over the recall with the patient slowly and to get as many details as possible. It may help to go over the recall another time or two afterward, to see if the individual says the same things again.
I find the 24-hour recall to be somewhat reliable. I think this is based on the researcher’s implementation of the assessment tool. If the researcher asks any type of leading questions, the reliability of the tool decreases. Also, a variable that researchers cannot control is the truthfulness of the participant's responses. People may not be comfortable telling what they ate in the past 24 hours, and may change their answers accordingly.
I think we all agree that the participant's level of honesty plays a large part in the reliability of the 24-hour recall. This is one of the most reliable tools we have at the moment, so we as nutrition professionals must do everything we can to ensure it's reliability.
Years ago the JADA had an article that tested the reliability and validity of the 24-hour recall method. The researchers found that the observed intake was significantly different from the recalled data. However, this study used children ages 10-12 with diseases such as asthma, cystic fibrosis, and diabetes. This is not a fair representation of the general population that is asked to recall their recent 24 hour intake. Kids may not be as interested in paying attention or remembering what they eat as adults. I thought I would note that they used the paired test and regression analysis to compare the two sets of data. This just proves the reliability of this tool may work better for some than others.
Reliability and validity of the 24-hour recall.
Carter RL, Sharbaugh CO, Stapell CA. – November 1981
(Volume 79, Issue 5, Pages 542-547)
In concurrence with many previous comments, I feel as though the 24-hour recall is a reliable assessment tool used under proper circumstances. Ensuring that the individual collecting the recall is experienced and able to analyze the information properly is important. Honesty from the patient/client is indeed important, but we only have so much control over honesty with such nutrition assessment tools. Directly observing these patients/clients is timely and most often impossible.
I agree with Bethany’s comment referencing the fact that dietitians would not be using this tool unless it was proven to reliable. Meredith made a great conclusion that we as nutrition professionals should ensure the reliability of the 24-hour recall method as best we can as it is widely used and of the most reliable we have. Rose makes a great point by including methods such as a food frequency questionnaire or food diary, to make a more accurate foundation for a patient/client’s intake.
I find difficult to determine whether a 24-hour recall is reliable or not. I think that the 24-hour usual intake is a better tool than the 24-recall from, say, the previous day. I believe that this tool is better than other diet recall tools such as a food frequency questionnaire, but depending on the client and the RD, there is a lot of room for variability in reliability. Researchers should take care to properly train the individual conducting the recall.
Bethany, I agree with what you have to say. However, it is often found that food diaries are highly unreliable and run the risk of noncompliance. Unless you have a very highly motivated client, you will have a very hard time getting them to keep a food diary- and the quality may be poor.
The main issue here is what every survey tool is going to have an issue with and that is the honesty of the participants. Like everyone mentioned, this is not something that can be easily fixed because how do you force someone to tell the truth? I think it's great, Liz, that you mentioned leading questions because if we can't make our clients/patients tell the truth then the next step is to make sure that we are thorough and accurate with our questioning and data gathering.
I think that 24 hour recalls are reliable in ideal situations when the pt is being honest with the RD. There is really no way to know if the pt is being honest so we just have to believe them. There really isn't a more reliable way unless we go home with them and monitor everything they eat which is definitely not practical. 24-hour recalls are most likely the most reliable tool we have to date that is practical for clinical use.
Sarah G:
I agree with your comment about usual intake recalls being more reliable than 24-hour recalls since they are based on a typical day. I have found from my observations so far in my community rotation that most, if not all RDs say "what do you eat on a typical day" to correct for that problem. Great point though!
I agree with Liz in that I believe that the 24-hr recall can be a reliable tool for some people and not one for others, depending on their honesty, how typical that day was, their understanding of portion sizes consumed, and their overall memory. I think there are ways for researchers to increase its reliability--providing food models; probing for additional information concerning condiments, snacks, beverages, etc; using open questions to avoid suggesting or affecting answers, etc.
~Anna Taylor
I don't know that I agree that the tool must be valid simply because it's been used by RDs for a long time. Perhaps it does suggest that it is one of the easiest or most valid tools currently known to dietitians and researchers, however. I think it's important to acknowledge that, just because this is the way we do something, it doesn't mean it is a good way to do it.
~Anna Taylor
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