JMIR Publications

ABSTRACT

Background:

The Norwegian food-based dietary guidelines (Norwegian FBDG) aim to reduce the risk of lifestyle related chronic diseases and promote overall health in the general Norwegian population. A short and feasible digital questionnaire that measures individual lifestyle and benchmarks it against the Norwegian FBDG is highly needed. We have developed a short digital food frequency questionnaire, called DIGIKOST-FFQ, to assess dietary intake and other lifestyle factors according to the Norwegian FBDG. Included in the digital tool is an automated feedback for each participant, the DIGIKOST report, benchmarking their diet and lifestyle according to the recommendations. Qualitative evaluation give valuable feedback on the feasibility and usability of the assessment tool.

Objective:

We aimed to explore attitudes, perceptions and challenges in the completion of the DIGIKOST-FFQ. With regard to the DIGIKOST report we wanted to explore the participants’ perception and understanding of the feedback. Moreover, we also wanted to evaluate technical flow and the usability of the DIGIKOST-FFQ and the individual DIGIKOST report.

Methods:

Data was collected by 6 qualitative semi-structured focus group interviews, including both healthy individuals and cancer survivors. The transcripts were analyzed using a thematic analysis, based on the interview guide in the focus groups. The usability test was completed individually and conducted in video-meeting (Zoom) by a moderator and two observers taking notes. The results were analyzed based on predefined assignments and discussion with the participants about the interpretation of the DIGIKOST report.

Results:

A total of 20 individuals participated in the focus groups, divided into 3 groups of healthy individuals and 3 groups of cancer survivors. Each group consisted of 3-4 individuals. The usability test included another four healthy individuals. The responses from the focus group interviews were categorized into five main themes: (1) Completion time; average of 19.1 min (SD 8.3), should not take any longer, (2) Layout; easy to navigate, clear questions, challenging to report dietary intake, sedentary time and physical activity the last year, (3) Questions; introductive questions on habitual intake worked well, (4) Pictures; very helpful, some portion sizes were difficult to differentiate between, written information about how many grams a portion size is in addition to the picture would be helpful, (5) Motivation; getting an individual report on ones results and advises on how to adhere to the Norwegian FBDG was seen as motivating. The usability test showed that the users were able to seamlessly log in, give consent, and fill in the DIGIKOST-FFQ, and further, receive, print and read the DIGIKOST report. However, parts of the report were perceived as difficult to interpret.

Conclusions:

The DIGIKOST-FFQ was well received by the participants and they found it feasible in use. The benchmarking against the Norwegian FBDG was the main motivation to complete the questionnaire. Results from the usability test revealed a need for adjustments and updates to make the report more easily readable. Clinical Trial: The Norwegian Centre for Research Data (NSD) has approved the DIGIKOST-protocol and the informed consent (ref. no. 277679).