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Randomized Controlled Trial
. 2016 Dec 23;9(1):5.
doi: 10.3390/nu9010005.

The Impact of Health Literacy Status on the Comparative Validity and Sensitivity of an Interactive Multimedia Beverage Intake Questionnaire

Lucy P Hooper  1 , Emily A Myers  2 , Jamie M Zoellner  3 , Brenda M Davy  4 , Valisa E Hedrick  5
Affiliations
Randomized Controlled Trial

The Impact of Health Literacy Status on the Comparative Validity and Sensitivity of an Interactive Multimedia Beverage Intake Questionnaire

Lucy P Hooper et al. Nutrients. .

Abstract

Self-reported dietary assessment methods can be challenging to validate, and reporting errors for those with lower health literacy (HL) may be augmented. Interactive multimedia (IMM) based questionnaires could help overcome these limitations. The objectives of this investigation are to assess the comparative validity and sensitivity to change of an IMM beverage intake questionnaire (IMM-BEVQ) as compared to dietary recalls and determine the impact of HL. Adults completed three 24-h dietary recalls and the IMM-BEVQ at baseline and after a six-month intervention targeting either sugar-sweetened beverages (SSB) or physical activity. Correlations and paired-samples t-tests are presented. For validity (n = 273), intake of SSB (mean difference = 10.6 fl oz) and total beverage consumption (mean difference = 16.0 fl oz) were significantly different (p ≤ 0.001) at baseline between the IMM-BEVQ and dietary recalls for all participants. However, the differences in intake were generally greater in low HL participants than in adequate HL participants. For sensitivity (n = 162), change in SSB intake (mean difference = 7.2 fl oz) was significantly different (p ≤ 0.01) between pre-/post-IMM-BEVQ and pre-/post-dietary recalls, but not total beverage intake (mean difference = 7.6 fl oz) for all participants. Changes in SSB and total beverage intake were not significantly different for those with adequate HL. The IMM-BEVQ is a valid dietary assessment tool that is as responsive to detecting changes in beverage intake as dietary recalls. However, adults with lower HL may need additional guidance when completing the IMM-BEVQ.

Keywords: beverage consumption; dietary assessment methodology; health literacy; responsiveness; sensitivity; sugar-sweetened beverages; technology; validity.

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Conflict of interest statement

None of the authors have conflicts of interest to disclose. The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
Screenshot example of the sweetened juice drink beverage category from the interactive multimedia beverage intake questionnaire (IMM-BEVQ-15).
Figure 2
Figure 2
Screenshot example of attempting to move to the next beverage category without first answering the question from the interactive multimedia beverage intake questionnaire (IMM-BEVQ-15).
Figure 3
Figure 3
Flow Diagram of Analytical Sample Size.
Figure 4
Figure 4
Bland-Altman analysis of IMM-BEVQ-1 and Dietary Recalls for (a) total beverage fl oz; (b) total beverage kcal; (c) total sugar-sweetened beverage fl oz; and (d) total sugar-sweetened beverage kcal. All values are log-transformed. The center line represents the mean difference and the upper and lower lines indicate the mean ± 1.96 standard deviation.
Figure 4
Figure 4
Bland-Altman analysis of IMM-BEVQ-1 and Dietary Recalls for (a) total beverage fl oz; (b) total beverage kcal; (c) total sugar-sweetened beverage fl oz; and (d) total sugar-sweetened beverage kcal. All values are log-transformed. The center line represents the mean difference and the upper and lower lines indicate the mean ± 1.96 standard deviation.
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References

    1. Thompson F.E., Subar A.F. Dietary Assessment Methodology. In: Boushey C.J., Coulston A.M., Rock C.L., Monsen E.R., editors. Nutrition in the Prevention and Treatment of Disease. Academic Press; San Diego, CA, USA: 2001. pp. 3–14. Chapter 1.
    1. Johnson R., Soultanakis R., Matthews D. Literacy and Body Fatness are Associated with Underreporting of Energy Intake in US Low-Income Women Using the Multiple-Pass 24-h Recall: A Doubly Labeled Water Study. J. Am. Diet. Assoc. 1998;98:1136–1140. doi: 10.1016/S0002-8223(98)00263-6. - DOI - PubMed
    1. Smith A.F. Cognitive psychological issues of relevance to the validity of dietary reports. Eur. J. Clin. Nutr. 1993;47:S6–S18. - PubMed
    1. Jonnalagadda S.S., Mitchell D.C., Smiciklas-Wright H., Meaker K.B., van Heel N., Karmally W., Ershow A.G., Kris-Etherton P.M. Accuracy of energy intake data estimated by a multiple-pass, 24-h dietary recall technique. J. Am. Diet. Assoc. 2000;100:303–308. doi: 10.1016/S0002-8223(00)00095-X. - DOI - PubMed
    1. Huizinga M.M., Carlisle A.J., Cavanaugh K.L., Davis D.L., Gregory R.P., Schlundt D.G., Rothman R.L. Literacy, numeracy, and portion-size estimation skills. Am. J. Prev. Med. 2009;36:324–328. doi: 10.1016/j.amepre.2008.11.012. - DOI - PMC - PubMed

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