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DAPA Measurement Toolkit

 

Diet checklists

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The following outcomes can be assessed using a dietary checklist:

  • Frequency, amount, or other attributes of dietary consumption in a brief list of dietary items including foods and supplements
  • Adherence to a certain dietary intervention or a special dietary pattern
  • Likelihood of being exposed to food pathogens
  • Dietary habits or consumption of specific foods not likely to be captured in other methods
  • Group-level dietary consumption or exposure

A checklist that is designed for a specific purpose tends to be less detailed in contrast to other methods. The outcomes measured by a dietary checklist depend upon the design. Any outcomes can be assessed if targeted as indicated in Table D.2.17. For example:

  • In a clinical setting pertaining anaemia, a checklist capturing major food sources and supplements of iron and vitamin B12 may be sufficient and allow calculation of amount of the specific nutrients
  • In research on an effect of providing breakfast to those who tend to skip breakfast on health outcomes, a checklist to assess adherence to the intervention and related habits may be sufficient
  • In research on foodborne illness, a checklist can be about food consumption in a very specific occasion (e.g. “the wedding ceremony at Hotel X on 22 August 2015”)

A checklist can be used for an assessment of group-level exposure to certain foods in a certain environment. For example:

  • Vending machines for snacks or soft drinks or plain water in a school
  • Types of foods sold in a restraint or deli, such as raw meats and foods that can cause allergic reactions
  • Marketing policy and practice of a local supermarket or stores in a school

Table D.2.17 Dietary outcomes assessed by dietary checklist.

Dietary dimension Possible to assess?
Energy and nutrient intake of total diet Yes
Intake of specific nutrients or food Yes
Infrequently consumed foods Yes
Dietary pattern Yes
Habitual diet Yes
Within-individual comparison Yes
Between-individual comparison Yes
Meal composition Yes
Frequency of eating/meal occasions Yes
Eating environment Yes
Adult report of diet at younger age Yes

A dietary checklist can be either self-administered or interview-administered. A dietary checklist includes elements of a food frequency questionnaire (as it is based on a pre-printed food list). Respondents examine a list of foods, supplements, or other dietary items and cross-tabulate with attributes such as specified serving size (e.g. slices, teaspoons) or frequency of consumption or both, ticking the box appropriately. An example of a dietary checklist is displayed in Figure D.2.6.

An assessor can administer a checklist to a respondent through face-to-face or phone interview, alternatively it may be preferable or required to send a checklist to a respondent through post or email and request him/her to complete it and send it back.

Use of blank space for each item and for an entire list is helpful to encourage a respondent to provide any information such as specific dietary patterns (e.g. vegan, a habit related to a religion, being on a weight-loss diet), alternative serving sizes for certain foods, and his/her key foods not listed. Sub-sections for a specific setting, e.g. ‘eating out and takeaway’ section, may help, depending on aims of a checklist.

Figure D.2.6 Example of dietary checklist from the Low Income Diet and Nutrition Survey study. Note that this is one of five pages completed per day.
Source: [10].

Screening individuals for a specific dietary problem or intervention: For example:

  • to assess adherence to specific dietary patterns, for example the Mediterranean diet [7, 8]
  • to identify needs for education about unusual dieting
  • to identify dietary behaviours or experiences associated wtih food poisoning, allergy, or dieting
  • to implement an targeted intervention to reduce consumption of sugar-sweetened beverages
  • to identify needs to encourage dietary consumption with family members
  • to assess adherence to an intervention

Categorical or continuous answers to each item, such as

  • Yes or No for consumption of certain foods, preference of foods or related behaviours, experiences of having meals in a dietary setting (e.g. a specific restaurant).
  • Frequency of consumption or a dietary practice over a certain period of time (e.g. frequency of snacking)

Answers can be combined for the purpose of a checklist

  • to estimate consumption of a food group
  • to assess an overall degree of adherence to a certain intervention
  • to estimate nutrient intakes from selected food items and supplements

Key characteristics of dietary checklists are described in Table D.2.18.

Strengths

  • Flexible to design a checklist and assess a targeted dietary habit or consumption. Dietary assessment for foodborne illness often has a checklist to reflect this strength, to assess dietary exposure in a very specific occasion [11].
  • Low participant burden. For example, in the Low Income Diet and Nutrition Survey, respondents preferred the food checklist over a 24-hour recall and weighed food diary [6].

Limitations

  • Not useful to capture detailed dietary habits to answer many different clinical or epidemiological questions
  • Dependent upon an implementation, there is the risk of recall bias
  • Dependent upon an implementation, a respondent may need to be literate, numerate, or both. The LIDMS study (Figure D.2.6) found the following issues to be most common: ticking the boxes (18%), understanding the portion sizes (18%), understanding what was required (16%), finding the food on the list including ethnic minority foods (15%), recording food eaten outside the home (15%) [6].

Table D.2.18 Characteristics of dietary checklists.

Consideration Comment
Number of participants Any
Cost of development Low
Cost of use Low
Participant burden Low
Researcher burden of data collection Low
Researcher burden of coding and data analysis Low
Risk of reactivity bias Yes
Risk of recall bias Yes
Risk of social desirability bias Yes
Risk of observer bias Yes
Participant literacy required Depends on whether interviewing or not
Suitable for use in free living Yes
Requires individual portion size estimation Depends on design

Considerations relating to the use of dietary checklists for assessing diet in specific populations are described in Table D.2.19.

Table D.2.19 Suitability of diet assessment by dietary checklists in different populations.

Population Comment
Pregnancy Suitable.
Infancy and lactation Requires proxy.
Toddlers and young children May require proxy or adult assistance.
Adolescents Suitable.
Adults Suitable.
Older Adults May require proxy depending on cognitive function.
Ethnic groups Suitable, if developed for the purpose.
Other
  • Trained fieldworkers can go through a dietary checklist, probing for missing items, during and at the end of the recording period
  • The food list must be designed for a specific purpose of research
  • Trained fieldworkers to instruct respondents on how to complete the dietary checklist, monitor completion and review the outputs at the end of the assessment
  • Depending on a design and aims, the following items may also be required:
    • Additional questionnaire to aid interpretation
    • Instructions on completion and return of the checklist
    • Trained diet coders
    • Nutrient database and analysis program

A method specific instrument library is being developed for this section. In the meantime, please refer to the overall instrument library page by clicking here to open in a new page.

As a checklist can be flexible and tailored for a specific research aim, developing a checklist is often the last step in designing a study after all variables of interest have been identified. As a general rule in a questionnaire method, following attributes should be confirmed.

  • Simplicity/clarity
  • Relevance to research aims
  • Completeness to assess target variables

Points to consider when drafting questions (adapted from [11]):

  • Clarify the aim of a checklist
  • Keep wording informal, conversational and simple
  • Avoid jargon and sophisticated language
  • Avoid long questions (but vary question length)
  • Keep questions appropriate to educational, social and cultural background of the respondents
  • Avoid leading questions linked to social or personal desirability
  • Avoid negative questions, questions beginning with “Why”, hypothetical questions
  • Limit each question to a single subject
  • Pay attention to sensitive issues
  • Check the adequacy of the list of responses to closed-end questions and needs for open-ended questions

In a phase of finalising a checklist, mock implementation is essential to confirm time to complete and ease of filling the checklist.

References

  1. Finch S DW, Lowe C, Bates CJ, Prentice A et al National Diet and Nutrition Survey: people aged 65 and over. Vol 1. Report of the diet and nutrition survey. London: 1998.
  2. Gregory J FK, Tyler H, Wiseman M. The Dietary and Nutritional Survey of British Adults. London: 1990.
  3. Gregory JR CD, Davies PSW, Hughes JM, Clarke PC. National Diet and Nutrition Survey: children aged 1.5 to 4.5 years. London: 1995.
  4. Gregory JR LS, Bates CJ, Prentice A, Jackson LV, Smithers G, Wenlock R, Farron M. National Diet & Nutrition Survey: Young People aged 4-18 years. Volume 1: Report of the Diet and Nutrition Survey. London: 2000.
  5. Holland B UID, Buss D.H. Cereals and Cereal Products The third supplement to McCance & Widdowson’s The Composition of Foods 4th edition. London: Royal Society of Chemistry & Ministry of Agriculture, Fisheries and Food; 1998.
  6. Holmes B, Dick K, Nelson M. A comparison of four dietary assessment methods in materially deprived households in England. Public Health Nutr. 2008;11(5):444-56.
  7. Martinez-Gonzalez MA, Fernandez-Jarne E, Serrano-Martinez M, Wright M, Gomez-Gracia E. Development of a short dietary intake questionnaire for the quantitative estimation of adherence to a cardioprotective Mediterranean diet. Eur J Clin Nutr. 2004;58(11):1550-2.
  8. Martinez-Gonzalez MA, Garcia-Arellano A, Toledo E, Salas-Salvado J, Buil-Cosiales P, Corella D, et al. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One. 2012;7(8):e43134.
  9. Ministry of Agriculture FaF. Food Portion Sizes 2nd edition. London: 1998.
  10. Nelson M DK, Holmes B, Thomas R & Dowler E. Low Income Diet Methods Study: Project for Food Standards Agency. London: 2003.
  11. World Health Organisation. Foodborne disease outbreaks: Guidelines for investigation and control. Geneva, Switzerland: World Health Organisation, 2008.