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A Qualitative Analysis of the Remote Food Photography Method and the Automated Self-Administered 24-hour Dietary Assessment Tool for Assessing Children’s Food Intake Reported by Parent Proxy

Published:November 09, 2021DOI:



      Accuracy and participant burden are two key considerations in the selection of a dietary assessment tool for assessing children’s full-day dietary intake.


      The aim of this study was to identify barriers experienced by parents and burden when using two technology-based measures of dietary intake to report their child’s intake: the Remote Food Photography Method (RFPM) and the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24).


      Qualitative, semistructured, focus groups were conducted with parents who served as proxy reporters of their child’s dietary intake using the two different dietary assessment methods (ie, RFPM and ASA24) 1 week apart.


      This study was conducted in 2019 and included 32 parents of children aged 7 to 8 years in Colorado and Louisiana.

      Main outcome measures

      Barriers adhering to the protocol and burden with the RFPM and ASA24.

      Qualitative analyses

      Qualitative content analysis and Atlas.ti software were used to analyze and interpret focus group data.


      For the RFPM, parents described missing photos due to unobserved intake, forgetting to capture images, disruption of mealtimes, and child embarrassment when meals were photographed at school. For the ASA24, parents described the time commitment as the main source of burden and the need to expand the food database to include additional ethnic foods and restaurant items. The main strengths were ease of use for the RFPM and the consolidated workload for the ASA24.


      The barriers experienced by parents and burden differed by method, highlighting the importance of considering the unique characteristics of each assessment tool when designing a pediatric dietary assessment study and interpreting findings.


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      T. A. Bekelman is a research assistant professor, Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora.


      R. I. Steinberg is a senior professional research assistant, Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora.


      S. Luckett-Cole is a graduate student research assistant, Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora.


      K. A. Sauder is assistant director, Lifecourse Epidemiology of Adiposity and Diabetes Center, and an associate professor, Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora.


      SL. Johnson is a professor, Section of Nutrition, Department of Pediatrics, and director, The Children’s Eating Laboratory, University of Colorado Anschutz Medical Campus, Aurora.


      D. H. Glueck is a professor, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora.


      D. Dabelea is director, Lifecourse Epidemiology of Adiposity and Diabetes Center, and a professor of Epidemiology and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora.


      C. K. Martin is a professor and director, Ingestive Behavior, Weight Management & Health Promotion Laboratory, and director, Human Phenotyping Core, Nutrition Obesity Research Center, Louisiana State University, Baton Rouge.


      D. S. Hsia is an associate professor, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge.