Collection Methods for the 24-Hour Dietary Recall as Used in the Expanded Food and Nutrition Education Program

24-Hour Dietary Recall in the Expanded Food and Nutrition Education Program: Perspective of the Program Coordinator

The purpose of this study was to determine how the 24-hour dietary recall (24HDR) is administered and how the Expanded Food and Nutrition Education Program (EFNEP) peer educators and other staff are trained on the data collection and entry process, from the EFNEP coordinators' perspectives. This cross-sectional, quantitative study utilized an online survey to collect information from EFNEP coordinators representing 61 of 76 EFNEP programs. While 56% of the programs collected the 24HDR data starting with the first thing eaten the previous day, 49% of them started collecting data at the time of class, going backwards. Most programs, i.e., 72%, reported using a multiple-pass method; however, only one-third of them reported using the standard five-pass method. Almost all programs, i.e., 97%, reported one peer educator collecting data from a group of 2-12 clients. All programs reported collecting the 24HDR data in a group setting, with about one-third of the programs also collecting data one-on-one. Most programs, i.e., 57%, reported spending ≤4 h on the initial training of staff in how to collect 24HDR data, and 54% of them reported that the peer educators entered the data themselves. This study found that the methods used to collect answers, train the staff, and enter the 24HDR data varied across EFNEP programs and that there is a need to standardize or revise the collection of 24HDR data.

Opportunities and Challenges of Integrating Food Practice into Clinical Decision-Making

BACKGROUND

Food practice plays an important role in health. Food practice data collected in daily living settings can inform clinical decisions. However, integrating such data into clinical decision-making is burdensome for both clinicians and patients, resulting in poor adherence and limited utilization. Automation offers benefits in this regard, minimizing this burden resulting in a better fit with a patient's daily living routines, and creating opportunities for better integration into clinical workflow. Although the literature on patient-generated health data (PGHD) can serve as a starting point for the automation of food practice data, more diverse characteristics of food practice data provide additional challenges.

OBJECTIVES

We describe a series of steps for integrating food practices into clinical decision-making. These steps include the following: (1) sensing food practice; (2) capturing food practice data; (3) representing food practice; (4) reflecting the information to the patient; (5) incorporating data into the EHR; (6) presenting contextualized food practice information to clinicians; and (7) integrating food practice into clinical decision-making.

METHODS

We elaborate on automation opportunities and challenges in each step, providing a summary visualization of the flow of food practice-related data from daily living settings to clinical settings.

RESULTS

We propose four implications of automating food practice hereinafter. First, there are multiple ways of automating workflow related to food practice. Second, steps may occur in daily living and others in clinical settings. Food practice data and the necessary contextual information should be integrated into clinical decision-making to enable action. Third, as accuracy becomes important for food practice data, macrolevel data may have advantages over microlevel data in some situations. Fourth, relevant systems should be designed to eliminate disparities in leveraging food practice data.

CONCLUSION

Our work confirms previously developed recommendations in the context of PGHD work and provides additional specificity on how these recommendations apply to food practice.

Healthy Hearts for an Abundant Life: Feasibility of a Culturally Adapted Cardiovascular Disease Prevention Curriculum for African American Women

Background: This study tested the feasibility of implementing Healthy Hearts for an Abundant Life (HHAL), a cultural adaptation for African American (AA) women of the evidence-based cardiovascular disease prevention program Strong Women-Healthy Hearts (SWHH). Methods: Using a quasi-experimental pre-post study design, this 12-week program was implemented in four faith-based organizations between 2017 and 2018. Eligible participants were AA women between 40 and 65 years who had a body mass index of 25 or higher and were currently sedentary. HHAL program participants met weekly for 2-h sessions led by program leaders. The curriculum has four modules: total health; relationships, family, and networks; material security and the environment; and emotional wellness. Each class included walking for 30 min, goal-setting session, and a group dialog called "making it work" for building collective efficacy. Results: Of the 27 participants (mean age=54.2±5.9), 24 completed postassessments (93% retention rate). All outcome measures proved feasible and weekly program attendance was 73%. Findings from in-depth interviews show high satisfaction with the program and suggest extending the class time and adding cooking demonstrations. Conclusions: The culturally adapted HHAL proved feasible and was positively received by the participants. Future studies will evaluate the effectiveness of the program.

Positive Change in Healthy Eating Scores Among Adults With Low Income After Expanded Food and Nutrition Education Program Participation

OBJECTIVE

Using 24-hour dietary recalls, compare Healthy Eating Index (HEI)-2005 scores of Expanded Food and Nutrition Education Program participants before and after 8-12 weekly lessons.

DESIGN

Analysis of preexisting 24-hour dietary recalls information collected from October, 2012 through September, 2014.

PARTICIPANTS

Participants with complete pre-post dietary data (n = 122,961); subset of those with complete demographic data (n = 97,522).

MAIN OUTCOME MEASURES

Change in HEI-2005 scores (total and components).

STATISTICAL ANALYSIS

Linear regression model fit separately for total HEI and 12 components. The response variable was changed in the HEI-2005 score; predictor variables included age, education, sex, and race/ethnicity.

RESULTS

The mean total HEI scores were 51.1 (SD, 13.7) at entry and 56.5 (SD, 13.7) at exit, with a change of 5.4 (SD, 16.2). Nine of 12 component scores increased. Changes were greater as age increased, with increasing education, and in women. Hispanics had the greatest improvement (mean ± SE) in total HEI score (8.3 ± 0.1).

CONCLUSIONS AND IMPLICATIONS

Although diet quality remained poor, participation in the Expanded Food and Nutrition Education Program resulted in improvement in dietary quality. The degree of improvements varied among demographic groups, but all groups improved.

Documenting the Food Insecurity Experiences and Nutritional Status of Women in India: Study Protocol

BACKGROUND

Despite significant growth and change in India over the past two decades, some public health indicators have failed to keep pace. One such indicator is food insecurity. India is home to the largest number of people experiencing hunger and food insecurity. Food security is described as "a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life". While there has been considerable research investigating the role of crop yields, policy interventions, and food production in alleviating food insecurity in India, there is insufficient research investigating the social and cultural influences of food insecurity, including the role of women. The primary aim of this research is to investigate the experience of food insecurity among women in India. The objectives of this research are (1) to determine the role of women in food production and its contribution to household food security; (2) to examine the gender roles within households and the decision-making processes that influence food security, and (3) to investigate household nutritional status and food insecurity experience.

METHODS

Participants will include women who live in a village in Punjab, India. Interviews with 100 households, drawn from a convenience sample will be conducted. Interviews will be conducted in Punjabi with simultaneous English translation, and will include: food related experiences, anthropometric measurements (weight, height, waist, and hip) and dietary assessment (24-h diet recall, two non-consecutive days), dwelling facilities, agriculture related information, including household agriculture activities undertaken, food security status (via the United States Department of Agriculture Household Food Security Scale Measurement), and demographic information.

DISCUSSION

This study aims to investigate a range of determinants of food insecurity among a rural population. It will allow for the identification of some of the components of household food insecurity among women in India and will go part of the way to understanding how and why India continues to experience food and nutritional insecurity despite growth and progress in a range of other indicators.

Evaluation of the Proximity of Singaporean Children's Dietary Habits to Food-Based Dietary Guidelines

Dietary habits in children may not only impact current health status but could also shape future, lifelong dietary choices. Dietary intake data in Singaporean children are limited. The current study aimed to define the overall diet quality of Singaporean children using an existing cross-sectional dataset and to consider how demographic factors (i.e., body mass index (BMI) status, ethnicity, age, and sex) were associated with these scores. Existing, cross-sectional dietary data (n = 561 children aged 6–12 years, collected in 2014–2015) from duplicate 24-h recalls were assessed for diet quality using an index based on the Singaporean Health Promotion Board dietary guidelines. Total diet quality scores were calculated from ten different components (frequencies of rice and alternatives, whole grains, fruits, vegetables, meat and alternatives, dairy and alternatives, total fat, saturated fat, sodium intake, and added sugars). Association with demographic factors and BMI category was evaluated by one-way multivariate ANOVA (MANOVA) tests, with Bonferroni post hoc analyses. Median (interquartile range) total diet quality scores were 65.4 (57.1–73.0). Median scores for whole grains (0.0, 0.0–33.4), fruits (24.1, 0.0–65.3), vegetables (36.5, 10.4-89.8), and sodium (58.4, 0.0–100.0) intake were frequently sub-optimal. Children of Malay ethnic origin had statistically lower total diet quality scores ((55.3, 47.5–60.3) vs. other ethnic groups (combined median 65.4 (57.1, 73.0); p < 0.001). These findings highlight the need for continuing efforts to improve dietary intake in young Singaporeans and for longitudinal dietary monitoring in this group.

The Effectiveness of the Expanded Food and Nutrition Education Program (EFNEP) on Diet Quality as Measured by the Healthy Eating Index

The objective of the study was to assess the relationship between participation in the Expanded Food and Nutrition Education Program (EFNEP) and food-related behavior change, as measured by the Healthy Eating Index (HEI)-2005, using a single-state, case study approach. Pre-EFNEP and post-EFNEP participation HEI scores as well as demographic, geographic, socioeconomic, and program participation characteristics from fiscal years 2013-2016 were analyzed using summary statistics and Ordinary Least Squares regressions. HEI scores were adjusted for age, sex, race, rural/urban residence, county, highest grade achieved, income, number of children, public assistance programs, and number of hours in EFNEP in the analysis. The total HEI score and several HEI subscores improved from pre-EFNEP to post-EFNEP at the 5% significance level or better. Sodium and total grains scores decreased post-EFNEP: P = .003 and P = .05, respectively. Participation in Women, Infants, and Children or the Supplemental Nutrition Assistance Program had no effect on HEI scores or changes in scores post-EFNEP. Spending less than 7 hours in the program was associated with a smaller improvement in total HEI score (P = .05) and an increased intake of sodium (P = .03), compared with spending 7 to 16 hours in the program. Overall, EFNEP participation was associated with improvements in diet quality.

An Evaluation of Inter-coder and Intra-coder Reliability for 24-Hour Dietary Recall Data Entered in WebNEERS

OBJECTIVE

To evaluate inter-coder (between-coder) and intra-coder (within-coder) reliability among trained data coders who enter 24-hour dietary recall data collected through Expanded Food and Nutrition Education Program operations in the state of Georgia.

DESIGN

This study employed multiple cross-sectional evaluations of inter-coder reliability and a short-term longitudinal evaluation of intra-coder reliability.

PARTICIPANTS/SETTING

Study participants consisted of trained data coders (n = 9) who were employed during the 12-month period of evaluation.

MAIN OUTCOME MEASURES

Primary outcome measures were inter-coder and intra-coder reliability across data entered into the Web-based Nutrition Education Evaluation and Reporting System. Statistical analyses were conducted using IBM SPSS 24. Descriptive statistics were generated and inter-coder and intra-coder reliability were assessed using 2-way mixed intraclass correlation coefficients.

RESULTS

Results of this evaluation indicated good to excellent inter-coder reliability among all coders, and excellent intra-coder reliability among the majority of coders. However, some notable inconsistencies were identified within the intra-coder reliability analyses.

CONCLUSIONS

Future strategies to improve data quality within Expanded Food and Nutrition Education Program operations might include enhanced training for data coders, implementation of error detection protocols, expansion of the Web-based Nutrition Education Evaluation and Reporting System database, and exploration of automated, computer-assisted administration of 24-hour dietary recalls.

Similar 24-Hour Dietary Recall Results from Low-Income Women When Collected by a Paraprofessional Nutrition Educator or Registered Dietitian Nutritionist

BACKGROUND

The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded, community nutrition education program that assists the low-income population in acquiring knowledge and skills related to nutrition, food safety, food resource management, food security, and physical activity. Evaluation of EFNEP includes a 24-hour dietary recall (24HDR) administered by paraprofessional educators, yet protocols for most large-scale nutrition research studies employ registered dietitian nutritionists (RDNs) or individuals with educational backgrounds in nutrition or related fields to collect dietary recalls.

OBJECTIVE

To compare 24HDRs collected by trained paraprofessional educators with recalls collected by an RDN.

DESIGN

Exploratory cross-over study comparing same-day 24HDR in a one-on-one setting collected by paraprofessional educators and an RDN. Paired recalls were separated by at least 1 hour.

PARTICIPANTS AND SETTING

The participants (n=41) were volunteer women who were eligible for participation in EFNEP in two states.

MAIN OUTCOME MEASURES

The 24HDRs were compared for energy, macronutrients, micronutrients, and food groups.

STATISTICAL ANALYSIS PERFORMED

Mixed-model analysis to account for repeated measures. Intraclass correlation and Spearman correlation coefficients to determine interrater agreement.

RESULTS

No difference in 24HDR was seen when compared by interviewer (paraprofessional vs RDN) or by site (Colorado vs North Carolina). There were significant differences in four components (energy, total fat, saturated fat, and solid fats-added sugar) based on recall order, with a higher intake in the second recall compared with the first.

CONCLUSION

The results of this preliminary study suggest that a well-trained paraprofessional educator using a valid methodology can collect a 24HDR that is similar to a recall collected by an RDN. The paraprofessional educator can be employed for dietary data collection, allowing the RDN to focus on more advanced aspects of scope of practice, such as data evaluation and program development.