Question 2
This study gathered data for the recruited child's intake based on information provided to the researchers by the child's caregiver. This is mentioned as a program limitation in that caregivers may forget or not be present at every meal the child is at. If this study was replicated, how might this limitation be improved?
Posted on behalf of Noel Konken.
Posted on behalf of Noel Konken.
posted by Julie @ 12:02 PM
12 comments
12 Comments:
This limitation may be lessened through the distribution of a food diary log. Though this method is less convenient the implementation of a written log for the child's intake as recorded by the parent would increase the accuracy of the data.
To help with accuracy of data collected, a question can be included as to how many meals out of the week are eaten without primary caregiver's presence, and where are they consuming those meals. Although its up to the child how much they eat, if they are consuming a majority of meals at a day care with state nutrient regulations, that may show a general idea of the nutrition they are receiving at a given meal.
Perhaps limiting the participants to children who are not in daycare and stay with their caregiver throughout the day would be one way to avoid this. Although, I believe it would be very difficult to find that participants that meet that criteria due to the type of population. Participants can also be given food logs in which primary caregivers could physically record their child’s meal each time, and childcare providers could also complete the log when the primary caregivers are not present.
Nikki and Rachel, I agree that a written food log would help with collecting more reliable data! It is very easy for a person to forget what they ate, let alone what their child ate. Electronically logging what the child ate on a food diary/log app on a smartphone might also be a good suggestion if the primary care giver has access to a smartphone.
For a different population, I think it would be very interesting to have participants strictly use a smartphone food diary application, in which the data could be directly sent to the researchers from the application for more accurate results.
Inaccurate reporting on FFQ and 24 hour recalls will occur in some degree every time it is used in any type of data collection. This is a known drawback of these types of assessment tools. The FFQ is based on usual intake, and thus could likely be estimated relatively accurately by parents even if children eat away from home at childcare centers. I believe that parents generally have a good idea of what their children eat typically, even if they do not know everything they eat on a specific day. Parent-reported 24 hour recalls for their children may be more prone to misreporting than FFQs, since parents may forget about some foods or are not always present when their children eat. While the first thought to overcome this would be to have parents keep a food log for an accurate recall, this may not be the best approach. If the parents know that their child’s food intake for a specific day if being used in the study, they may alter what their children eat that day or what they record. Parents may feel pressured to report what they think researchers would find desirable if they were keeping a food log for their child. Also, it is questionable how easy or difficult it would be to keep a food log for any of the children in the study. The children cannot obviously keep their own food log. In order to gather accurate intake data on a log when the children are eating away from home, the caregivers feeding the child would need to record what they ate. This is not very feasible if the child attends a day care or some other similar childcare program, where many children are under the care of few caregivers. I am not sure if there is a reasonable way to truly overcome this limitation in future studies.
Questionable accuracy is always a concern when collecting retrospective dietary data. A food log may be helpful, but I do not think this would eliminate the limitation the authors discussed. Recording diet intake daily would be more of a participant burden and thus may create less accurate results than a FFQ or a 24-hour diet recall.
Tessa, I like your idea of using a phone app to collect dietary information. I think that would be interesting and possibly more accurate than a typical food log as many of those apps prompt the user with questions such as portion size that the consumer does not typically think of. I think using a phone or camera to take pictures and send pictures of meals to the researchers may also be an effective method. It requires less time than recording and allows the researchers to interpret portion sizes which may be more accurate than consumer interpretation of portion sizes. This, however, also would require use of a phone or camera which would be another limitation to the study.
Nikki, you idea to further evaluate the degree to which the parents lack of knowledge or imprecise reporting may limit the validity of the results is important. The inclusion of these questions may identify if further intake logs are necessary to the study?
This is certainly a limitation that is inherent to the FFQ and 24-hour recall, but it can potentially be minimized. For older children (ie. adolescents and teenagers), it may be more accurate to bypass the caregiver and ask the adolescent/teen directly. However, since the children ranged in ages from 2 years to 4.5 years, this would not be appropriate. I feel that using a FFQ has a smaller chance for error due to the report of intake over time. I feel that the limitation could be minimized by the addition of a question or two regarding average amount of meals/snacks eaten per day as well as location of meals. It would be best to add as few questions as possible so to not increase the time and effort it takes to complete the questionnaire (the article reports a current completion time of 3 minutes).
Rachel and Nikki, I think it is a great point to bring up the caregiver knowledge level in regards to the accuracy of food logs. I feel that the authors of the study have also taken this into consideration, as they provided food models and food model booklets as references during the first interview.
One of the best ways to minimize recall error would be to have participants’ journal or create a food log specifically noting the foods presented and eaten at each meal. Or participants could be asked to photograph each meal and snack or even utilize a nutrition tracking app to minimize recall error. However, the study also noted that reliability depends on food consumption frequency, the more often a food or beverage is consumed the more likely it is to be recalled and counted. So, these strategies (journaling or photography) may insure all foods and beverages presented and eaten are recorded, but recall likely captures the majority of foods eaten and provides a sufficient estimation of food consumption.
The best way to improve this limitation is by asking the caregiver to keep a food journal or food log of the child’s intake on a daily basis. If access to a computer you might also ask the caregiver to log it into the computer to limit the chances of the food log being lost.
Kandice, your idea of taking pictures of the food is a great idea to help improve this limitation. I think caregivers would like this because it is a fast way to log the food. However, my only concern would be if the caregivers don’t have access to a camera or have a smartphone. Therefore, giving the option to either take pictures or log would be a great idea!
I appreciate everyone's ideas in reducing this limitation of the study where caregivers report their child's dietary habits. I am aware of a research study at the U of I in which researchers took pictures of student's plates at the dining halls to assess dietary habits. This is an accurate way to measure food intake; however, this method is more time consuming than a FFQ for data entry. I appreciate Kirsten's comment that the nature of FFQ's measuring usual intake indicates that there will be slight variations from actual intake. Thus, perhaps the smallest detail of intake may not be of utmost importance, but the regularity of food habits as a whole.
It is not possible to eliminate all limitations of a study, but I think that the caregiver should indicate how many meals recorded were with the child and how many meals recorded were not with the child. Or, there could be a question added that asks the caregivers confidence in the accuracy of the information and why? Maybe, the
0 to 10 confidence scale could be adjusted to be used for this purpose!
As Tessa and others mentioned, using a phone app could improve this studies limitations. As part of the study, the caregivers could also be required to take pictures of all meals. If they do not have access to a camera or smartphone, a disposable camera could be distributed as part of the study. This would add an extra cost, but could also greatly improve the validity of the study.
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