TY  - JOUR
AU  - Lee, Lachlan
AU  - Hall, Rosemary
AU  - Stanley, James
AU  - Krebs, Jeremy
PY  - 2024
DA  - 2024/4/15
TI  - Tailored Prompting to Improve Adherence to Image-Based Dietary Assessment: Mixed Methods Study
JO  - JMIR Mhealth Uhealth
SP  - e52074
VL  - 12
KW  - dietary assessment
KW  - diet
KW  - dietary
KW  - nutrition
KW  - mobile phone apps
KW  - image-based dietary assessment
KW  - nutritional epidemiology
KW  - mHealth
KW  - mobile health
KW  - app
KW  - apps
KW  - applications
KW  - image
KW  - RCT
KW  - randomized
KW  - controlled trial
KW  - controlled trials
KW  - cross-over
KW  - images
KW  - photo
KW  - photographs
KW  - photos
KW  - photograph
KW  - assessment
KW  - prompt
KW  - prompts
KW  - nudge
KW  - nudges
KW  - food
KW  - meal
KW  - meals
KW  - consumption
KW  - behaviour change
KW  - behavior change
AB  - Background: Accurately assessing an individual’s diet is vital in the management of personal nutrition and in the study of the effect of diet on health. Despite its importance, the tools available for dietary assessment remain either too imprecise, expensive, or burdensome for clinical or research use. Image-based methods offer a potential new tool to improve the reliability and accessibility of dietary assessment. Though promising, image-based methods are sensitive to adherence, as images cannot be captured from meals that have already been consumed. Adherence to image-based methods may be improved with appropriately timed prompting via text message. Objective: This study aimed to quantitatively examine the effect of prompt timing on adherence to an image-based dietary record and qualitatively explore the participant experience of dietary assessment in order to inform the design of a novel image-based dietary assessment tool. Methods: This study used a randomized crossover design to examine the intraindividual effect of 3 prompt settings on the number of images captured in an image-based dietary record. The prompt settings were control, where no prompts were sent; standard, where prompts were sent at 7:15 AM, 11:15 AM, and 5:15 PM for every participant; and tailored, where prompt timing was tailored to habitual meal times for each participant. Participants completed a text-based dietary record at baseline to determine the timing of tailored prompts. Participants were randomized to 1 of 6 study sequences, each with a unique order of the 3 prompt settings, with each 3-day image-based dietary record separated by a washout period of at least 7 days. The qualitative component comprised semistructured interviews and questionnaires exploring the experience of dietary assessment. Results: A total of 37 people were recruited, and 30 participants (11 male, 19 female; mean age 30, SD 10.8 years), completed all image-based dietary records. The image rate increased by 0.83 images per day in the standard setting compared to control (P=.23) and increased by 1.78 images per day in the tailored setting compared to control (P≤.001). We found that 13/21 (62%) of participants preferred to use the image-based dietary record versus the text-based dietary record but reported method-specific challenges with each method, particularly the inability to record via an image after a meal had been consumed. Conclusions: Tailored prompting improves adherence to image-based dietary assessment. Future image-based dietary assessment tools should use tailored prompting and offer both image-based and written input options to improve record completeness. 
SN  - 2291-5222
UR  - https://mhealth.jmir.org/2024/1/e52074
UR  - https://doi.org/10.2196/52074
DO  - 10.2196/52074
ID  - info:doi/10.2196/52074
ER  -