Example of an interview protocol based on the PANCAKE project 1

Transcription

1 Example of an interview protocol based on the PANCAKE project 1 1 The content of this Appendix is used with permission of the PANCAKE project. (Ocké et al., 2012)

2 Table of Contents 1 Introduction Background and aim Dietary assessment of children Characteristics of the food diaries Personnel Dietary software Interview protocol Field work and administration scenario First home visit... 6 First home visit: Instruction and understanding for completing the one-day food diary... 6 First home visit: Measurement of generally used household measures... 7 First home visit: Administration of the CAPI General Questionnaire and distribution of the Food Propensity Questionnaire... 8 First home visit: Confirmation of the appointment for the first telephone completion interview... 8 First home visit: Conformation of the appointments for the second record day en recall day Telephone calls... 9 First telephone call: First completion interview... 9 Second telephone call: Reminder of second record day Second home visit... 9 Second home visit: Measurement of weight and height of the subject... 9 Second home visit: Second completion interview Second home visit: Checking of the Food Propensity Questionnaire Second home visit: Handing over incentive Dietary assessment of adults Training of the national coordinating dietician/researcher Training interviewers General Design of the training References... 11

3 1 Introduction 1.1 Background and aim EU Menu is the study for the assessment of nutrient intake and food consumption among children and adults in Europe. The current recommendation of the dietary assessment method to be used are as follows (EFSA, 2014): Children s age group (aged 3 months to 9 years) The dietary assessment method chosen for the children s age group (aged 3 months to 9 years) in the survey is the two non-consecutive one-day food diaries followed by an interview with the parent/caretaker completing, checking and entering the data. The method includes a food propensity questionnaire (FPQ) as well. Adolescents and adult s age group (aged 10 to 74 years) The dietary assessment method chosen for the adolescents and adult s age group (aged 10 to 74 years) in the survey is the two non-consecutive 24-hour dietary recalls. The method includes a FPQ as well. The current protocol describes the interviewer instructions for these dietary assessment methods, with short descriptions of the complementary action points during contact between the interviewer and the respondent. 2 Dietary assessment of children 2.1 Characteristics of the food diaries The one-day diary has been developed for three different age groups: a) infants 3-12 months, b) toddlers and children 12 months - 9 years and. All diaries are open (no pre-coded food lists). Where in this protocol children are mentioned, toddlers are included. During the first home visit it will be explained to the parents exactly what kind of information about food and drink consumed is to be recorded, to prepare them for filling in the diary. The infants food diaries are structured according to the type of food: breast-feeding, infant formula and other foods and drinks. Time and place of consumption will be registered, but no eating occasions. The diaries for the children are structured according to eating occasions. Time and place of consumption will be registered too. The food diary is structured in columns to register detailed characteristics of the foods and drinks consumed. This is to diminish missing information as much as possible during the completion interview and data entry. More details will be asked for during the completion interview with the dietary software. The one-day food diary of infants and children are included as Appendices and For food quantification

4 a picture book and other methods such as measuring by weight or volume, household measures or units will be used. For data entry of the diaries a dietary software matching should be used. The interview protocol needs to be modified as needed taking into account the selected dietary software to be used in the survey. 2.2 Personnel The field work should be performed by interviewers with a thorough nutritional background, preferably graduate dieticians or nutritionists (or possibly student dieticians or nutritionists in the final stage of their study) or by other well-trained interviewers with very good interviewing background. It is important to provide communication training for interviewers with nutritional background and for experienced interviewers with no nutrition background a thorough training in foods, food consumption related issues as well in the food consumption data collection method selected for the survey. All interviewers have to be thoroughly trained in interview techniques of the selected software program and all the different aspects of the study. A dietician/nutritionist with ample experience in food consumption studies and (if possible) the dietary software used is needed for the training, coordination and supervision of the interviewers (fieldwork supervisor). Also this coordinating dietician/nutritionist should receive a tailored training about the data collection method/software. Furthermore, an experienced database manager is required. 2.3 Dietary software The software specific procedures for the computer-assisted personal or telephone (CAPI/CATI) interviews need to be clear early in the planning stage of the survey. General and technical instruction for interview needs to be obtained from the selected dietary software provider before the training of the field work staff. 2.4 Interview protocol Field work and administration scenario After appointments have been made with the respondents, the field work is performed in the steps described below: 1. First home visit The subject is visited by the interviewer. This home visit consists of: a. Instruction for completing the food diary. b. Measurement of generally used household measures. c. Administration of the computer-assisted personal interview (CAPI) general questionnaire and distribution of the Food Propensity Questionnaire (FPQ). d. For infants, measurement of weight and height of the subject

5 e. Confirmation of the appointment for the telephone interview on the day after completing the food diary, or with a maximum of one day or exceptionally two days in between. f. Confirmation of the appointments for recording and face-to-face interview of the second record day. Materials that the interviewer will need for the first home visit: day-1 and day-2 food diaries and instruction booklet appropriate for the subject age, (in case of breast-feeding two day-1 and day- 2 diaries and instruction booklets are needed, both for mother and infant), two food recording booklets for out of home consumption, picture book, pencil, laptop with CAPI questionnaire, FPQ, household weighing scale, form to record the weighing data of household measures, and only for infants: body weighing scale and infantometer and recording form for height and weight. This home visit should be performed preferably the day before the first food diary, with a maximum of one day or exceptionally two days in between. The visit is expected to take about 45 minutes. 2. Telephone call to execute a completion interview The subject has kept a food diary on the fixed day. The day after, or with a maximum of one day or exceptionally two days in between, the first CATI completion interview in combination with the food diary is executed by telephone. The telephone call is expected to take about 30-45minutes. 3. Second telephone call as a reminder Call the care taker of the subject to remind her/him to record the consumption of food and drink in the day-2 diary. 4. Second home visit This home visit consists of: a. Measurement of weight and height of the subject (second measurement in case of infants). b. The second completion interview in combination with the food diary. c. Checking of the Food Propensity Questionnaire. d. Handing over the incentive to the subject or to the parent or care taker and taking along day-1 and day-2 diaries and food recording booklets for out of home consumption. Materials that the interviewer will need for the second home visit: laptop with the dietary software, body weighing scale, stadiometer and/or infantometer, registration form for height and weight, completed form with generally used household measures (optional) from first home visit, questionnaire, incentive. This home visit should take place preferably the day after the second food diary or with one day or exceptionally two days in between. The visit is expected to take about minutes. The combinations of home visits and possible telephone interviews may also been organised differently, when only the weight and height measurements as well as the instructions to fill in the diaries and questionnaires is organised in a way that the participants are fully aware of the tasks and the home visits and/or telephone calls will not become a burden for the participants.

6 2.4.2 First home visit First home visit: Instruction and understanding for completing the one-day food diary Beforehand the interviewer makes an appointment for the first home visit with the parent/ caretaker that usually takes care of the nutrition of the infant/child or with the breast-feeding mother. The following materials have to be handed over and explained: a one-day food diary, a food recording booklet for out of home consumption, a picture book for quantification (local version). The diary also includes examples on how to complete the information. All materials should be shown and further explained. In advance the interviewer fills in on the front page of the day-1 food diary: the ID-number, day of birth and sex of the participating subject, and the day of the week, date, month and year of the record day. Also the front page of the recording booklet is filled in: name of the child (first name and first letter of last name), ID number, day of the week and date. Contact information is included on the introduction page of the diary. If the appointment concerns a child that is at least 7 years old and capable of giving information to the parent/care taker, the child can also be involved in the instruction, especially with respect to the food consumption out of home. This is particularly recommended, because in this way the child will be motivated as well. Aspects to explain and discuss with the parent/care taker: The subject should stick to the agreed date of the record day, as noted on the front page of the diary, even when this is a special day, for instance because of parties or some illness or when the day is less convenient. This is important, because all days are assigned randomly over the total study population, in order to get representative results. Show the structure of the diary Explain all aspects mentioned in the written instruction, with special attention to out of home consumption for infants/children. Ask the parent to request cooperation from out of home care takers (at day-care, school, etc.). Hand over the food recording booklet for out of home consumption with short instruction. Ask the parent to check whether this booklet was (completely) filled in, and if not, let them ask and fill in the (additional) information. If, according to the parent, the child is capable to assist, he/she can help filling in the records or telling what he or she ate or drank. -Means of quantification. Explain the different ways to quantify the consumption (household measures, ml/grams, picture book, units). Show the picture book and explain how to use it. Pay attention to the size of the plate on the pictures, the ruler, the type of foods and use for comparable foods (as explained below the pictures); the full number-letter combination that should be written down. If the subject wants to weigh or measure volumes of foods and drinks her/himself while completing the diary (and has the appropriate equipment) this is fine, but the subjects is not requested to do so.

7 -Consumed quantity. Mention that the quantity that really is consumed should be recorded, not the quantity served. This also applies for the section Other foods and drinks in the diary for infants. Of infant formulas the quantity prepared and the quantity left-over should be written down; for breast-fed infants the quantity of breastfeeding is not asked for. -Description of foods and drinks. Show the column description of food or drink in the diary to further describe the details of the foods. Explain what type of information is needed. Ask the care taker to keep empty packages from industrial foods consumed. Explain the special pages for home-made recipes. Show the dietary supplement pages. Ask to copy the full brand and product name from the package. Show the examples of a complete diary. Emphasize that it is only an example on how to fill in the diary, not on how their child or the mother should eat. Practice the way of recording on an empty page of the diary (separate sheet), by letting the subject (or mother/care take of subject) complete the previous eating occasion of today. Help and explain where necessary. If it is an extensive eating occasion it does not have to be fully completed. Stop if you are confident that the subject understands the intention. Ask whether there are any questions. Show the phone number in the diary when problems occur. First home visit: Measurement of generally used household measures After explaining the use of the diary the interviewer should ask which household measures (glasses/cups/bowls etc.) are commonly used by the subject for (semi)liquid foods and drinks. Ask the subject/care taker to get them so they can be measured. Record on the measuring form a further description of the household measurement and the different types of foods and drinks it is used for. Ask the subject or care taker to actually use them on the record day. A household weighing scale is used to weigh the content of the household measurements with water. The scale should have a weighing capacity of 2 kg and an accuracy of 1 gram, and it should have the possibility to tare (put to zero in between). The household measurements used for the following foods should be measured (optional): All liquid foods/drinks in glasses, cups, bowls etc. Sauces and gravy served with sauce/gravy spoons. Sugar in coffee and tea and added to other foods. The measuring form and a detailed weighing instruction is included in appendix 14. If the weighing takes too long (more than 10 minutes), restrict the measuring to the measures most often used.

8 First home visit: Administration of the CAPI General Questionnaire and distribution of the Food Propensity Questionnaire Collecting the general background data and the FPQ data may be carried our on paper or may be collected with a computer-administered system. Here, a protocol for a CAPI data collection procedure is described. The general background data questionnaire contains questions on personal characteristics, dietary supplement use and specific dietary habits. It may be conducted in an interview and directly entered in a laptop or it may be collected on paper and entered later to the survey datasets. A paper version of the FPQ is handed over. The subject is requested to complete it before the second home visit. Both for the general questionnaire and the FPQ it is important for the children and infants that it is administered to the person who spends most of the time with the child. First home visit: Confirmation of the appointment for the first telephone completion interview After finishing instructions and data collection the interviewer confirms the appointment for a telephone interview on the day after the record day, or with a maximum of one day or exceptionally two days in between. Note down date and time of the appointment on the introduction page of the day-1 diary. First home visit: Conformation of the appointments for the second record day en recall day At the end of the visit the interviewer hands over the appropriate day-2 diary and food recording booklet for out of home and confirms the appointment for the second record day, about 2-3 weeks later. ID-number, day of birth, day of the week and date of the second record day should be noted on the front page of the day-2 diary, as well as the name of the child (first name and first letter of last name), ID number, day of the week and date on the front page of the second food recording booklet for out of home. Furthermore, the interviewer confirms the appointment for the second home visit for a face-to-face completion interview, preferably the day after the second record day or with a maximum of one day or exceptionally two days in between, and note it down on the introduction page of the day-2 diary. Ask the subject to keep the picture book for the second record day and ask him/her to follow the same procedure to involve day-care or other care takers in noting down consumed food and drinks.

9 2.4.3Telephone calls First telephone call: First completion interview The first completion interview with a dietary software is conducted by telephone. The subject is asked to have the diary, the food recording booklet and picture book within reach and use it during the interview. The dietician conducts the CATI interview without having this written information. The interview covers mainly the food consumption during the 24 hours in question, but also other information depending on the software application, may be asked. During the 24-hour recall interview at least the following information are collected: eating occasions, times of consumption, place of consumption, foods consumed, descriptors of the foods consumed, quantity of the food consumed, special diet, special day, probing questions are asked to check completeness of the reported foods and certain quality checks of the interview (e.g. intake of energy and macronutrient intakes based on gender and age and compared to normal range of intakes). The protocol for a CATI interview needs to be tailored at local level based on the software application used. Before ending the telephone call remind the parent/care taker which date the second record day and the second home visit will take place. Ask him or her to keep the day-1 diary, the food recording booklet for out of home and the picture book. Second telephone call: Reminder of second record day Preferably one day before the second record day, or with a maximum of one day or exceptionally two days in between, the interviewer calls the parent/care taker of the subject to remind her/him to record the food intake on the next day in the day-2 diary. Ask if the day 2-diary, food recording booklet for out of home and picture book are still within reach. If not, make new appointments (same days of the week) and send new specimen of the day-2 diary, food recording booklet for out of home and picture book Second home visit Second home visit: Measurement of weight and height of the subject Only for infants weight and height may be measured at both home visits, unless recent data (14 days ago at the most) are available from the registration booklets of the regular infant health check. Then these data and the date of measurement can be copied on the form for registration. For toddlers and children, weight and height only have to be measured at the second home visit. The instructions for measuring weight and height and the separate form to record the data are included as separate Appendices.

10 Second home visit: Second completion interview During the second home visit the same procedure for the completion interview should be executed. The only difference is that it is now conducted face-to-face, and the interviewer therefore also has access to the completed diaries and food recording booklets. Second home visit: Checking of the Food Propensity Questionnaire The FPQ has to be checked on completeness and uncertainties. If the subject did not complete it yet, it has to be conducted by interview. Second home visit: Handing over incentive If all aspects of data collecting in scenario 2 are fulfilled the interviewer will hand over an incentive (if allowed by the local regulations) to the subject and the care taker according to the local appointments. The interviewer receives both the day-1 and day-2 diaries and both food recording booklets for out of home consumption and sends them to the local survey secretariat. 3 Dietary assessment of adults The dietary assessment method chosen for the adolescents and adult s age group (aged 10 to 74 years) in the survey is the two non-consecutive 24-hour dietary recalls. The method will include a food propensity questionnaire as well. The interview in the adult population groups follow the same procedures as with children, but the adults should not be aware that their food intake from the previous day will be asked. The interviews may take place either at home or in a study centre depending on the local organisation of the survey. It is recommended to have at least one face-to-face interview in the population group > 10 years old to ensure comprehensive reporting by the respondent. Also, telephone (or in special circumstances also Internet-based, e.g. Skype) interviews may be applied if a tested method is available and if a face-to-ace encounter is not feasible. During the interviews, in addition to the 24-hour recalls, also socio-demographic background information and FPQ information will be collected. The answering of the questionnaires may be self-administered or interviewed, but also in case of self-administered answering, the questionnaires need to be carefully checked during the interviews. Whether the questionnaires are sent home before the interviews or handed to the participants during the interview visit needs to be decided based on the local conditions. The protocol of the 24-hour recall interview depends on the software application used. During the 24-hour recall interview at least the following information are collected: eating occasions, times of consumption, place of consumption, foods consumed, descriptors of the foods consumed, quantity of the food consumed, special diet, special day, probing questions are asked to check completeness of the reported foods and certain quality checks of the interview (e.g. intake of energy and macronutrient intakes based on gender and age and compared to normal range of intakes). More information on adult interview protocols are available in the Annexes of the final report of the EFSA-funded PILOT-PANEU project (Ambrus et al., 2013).

11 4 Training of the national coordinating dietician/researcher The national coordinating dietician/researcher should be experienced in carrying out dietary surveys and the general protocols of such surveys. Special training will be needed, if a new dietary software will be applied in the data collection. In such a case the software provider needs to provide in depth training in all aspects of the protocol, from customisation and use of the software up to management and export of the dietary data files to be collected. In addition, the training will cover the design of the Quality control and data processing after data collection. Help-desk functions of the software provider need to be agreed upon. Time for additional questions and discussion should be reserved as part of the training. The coordinator should have prepared questions for the training session based on the training manual. The proposed time schedule for the interviewer training is discussed. 5 Training interviewers 5.1 General The aim of the training is to inform the interviewers of the aim and context of the survey and to obtain practical experience of all steps of the data collection. To gain reliable food consumption data using any dietary software, it is important that the interviewers are well trained. The interviewers should have good knowledge on national eating habits, foods on the market, recipes and preparation methods. In most countries this will be nutritionists or dieticians carrying out the interviews. They should be experienced in dietary assessment methods. When experienced interviewers without nutrition background are employed, even more emphasis needs to be put to the national dietary habits and local food information. It is important also to train the interviewers with nutrition background in communication, especially how to approach survey participants and assure smooth, accurate and effective interview sessions. 5.2 Design of the training The specific training includes: -a training given in which the dieticians/interviewers are more closely informed of the organization of the food consumption study, receive information on all tasks for the data collection (and if applicable recruitment) and interviewing skills, and in which they meet and practice with the dietary software and other possible tools to be used in the data collection. The duration of the training is planned based on the background of the field work staff, the tools (especially the dietary software) to be used and other aspects of the survey protocol. The training needs to contain both theory and practice. Very important part is to gain experience with the food list used in the dietary software and the food descriptors to be collected. Interviews need to be practiced and the trainer needs to follow the quality of the interviews. Evaluation of the performance of the field work throughout the survey is advised. References Ambrus Á, Horváth Zs, Farkas Zs, Cseh J, Petrova S, Dimitrov P, Duleva V, Rangelova L, Chikova- Iscener E, Ovaskainen M-L, Pakkala H, Heinemeyer G, Lindtner O, Schweter A, Naska A, Sekuła W,

12 Guiomar S, Lopes C and Torres D, Pilot study in the view of a Pan-European dietary survey adolescents, adults and elderly. Available online: EFSA (European Food Safety Authority), Guidance on the EU Menu methodology. EFSA Journal 2014;12(12):3944, 81 pp. doi: /j.efsa Ocké M, de Boer E, Brants H, van der Laan J, Niekerk M, van Rossum C, Temme L, Freisling H, Nicolas G, Casagrande C, Slimani N, Trolle E, Ege M, Christensen T, Vandevijvere S, Bellemans M, De Maeyer M, Defourny S, Rupich J, Dofkova M, Rehurkova I, Jakubikova M, Blahova J, Piskackova Z and Maly M, PANCAKE Pilot study for the assessment of nutrient intake and food consumption among kids in Europe. Supporting Publications 2012, EN-339, 120 pp. Available online: