A qualitative study of participants' experiences with dietary assessment

Objective This article reports on the use of focus groups and an experiment al participatory activity to investigate factors influencing participants' decisions about what to eat and what to report on food records and food fre quency questionnaires. Design Four focus groups examined participants' experience with diet record s and 3 focus groups explored the topic of food portions using a group cons ensus activity. Twenty-two women participated in the diet record focus grou ps, and 15 participated in portion estimation groups. Subjects Focus group participants were equally distributed by age and body mass index values. Each woman completed a 10-day doubly labeled water proto col to measure total energy expenditure, 7 days of diet records (before and during total energy expenditure), and a food frequency questionnaire after the total energy expenditure. Analysis Transcripts of the focus groups were coded to index categories of responses and to identify themes within and across those responses. Themes discussed in this article are those that were discussed most often and at g reatest length by all groups. Results The diet record focus groups revealed that 2 major factors influenc ed reporting on diet records: honesty vs social acceptability, and simplify ing food intake. The portion estimation focus groups revealed 5 factors tha t influenced perceptions of portion size: the role of food in the meal, the type of food, personal preferences, product serving sizes, and comparison of personal servings with those of others. Applications The validity and reliability of self-reported food consumption is greatly influenced by the ways people interpret and respond to dietary assessment instruments. These findings indicate that dietetics professional s need to take extra steps to address issues of accurately recording "bad" foods when training patients to complete diet records. Extra probing is nee ded when dietary records do not include snacks and include simple meals and a large amount of prepared and packaged food because this may indicate tha t changes in normal dietary patterns were made in order to more easily comp lete a dietary record.