Cognitive research enhances accuracy of food frequency questionnaire reports: results of an experimental validation study.
OBJECTIVE
To test whether changing a food frequency questionnaire (FFQ) on the basis of cognitive theory and testing results in greater accuracy. Accuracy was examined for 4 design issues: a) Grouping: asking about foods in a single vs multiple separate questions; b) different forms of a food: asking consumption frequency of each form of a food (eg, skim, 2%, whole milk) vs a nesting approach--asking frequency of the main food (eg, milk) and proportion of times each form was consumed; c) additions (eg, sugar to coffee): asking independent of the main food vs nested under the main foods; d) units: asking frequency and portion size vs frequency of units (eg, cups of coffee).


METHODS
Participants in two randomly assigned groups completed 30 consecutive daily food reports (DFRs), followed by 1 of 2 FFQs that asked about foods consumed in the past month. One was a new, cognitively-based National Cancer Institute (NCI) Diet History Questionnaire; the other was the 1992 NCI-Block Health Habits and History Questionnaire.


METHODS
623 participants, age range 25 to 70 years, from metropolitan Washington, DC. Statistical analyses performed Accuracy was assessed by comparing DFR and FFQ responses using categorical (percent agreement) and continuous (rank order correlation, discrepancy scores) agreement statistics.


RESULTS
Grouping: accuracy was greater using separate questions. Different forms of food: accuracy was greater using nesting. Additions: neither approach was consistently superior; accuracy of the addition report was affected by accuracy of the main food report. Units: both approaches were similarly accurate.


CONCLUSIONS
Accuracy of FFQ reporting can be improved by restructuring questions based on cognitive theory and testing.
Thompson
Frances E
FE
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7344, USA. tompsof@mail.nih.gov
Subar
Amy F
AF
Brown
Charles C
CC
Smith
Albert F
AF
Sharbaugh
Carolyn O
CO
Jobe
Jared B
JB
Mittl
Beth
B
Gibson
James T
JT
Ziegler
Regina G
RG
D000328:Adult; D000368:Aged; D003071:Cognition; D015930:Diet Records; D004034:Diet Surveys; D005247:Feeding Behavior; D005260:Female; D005502:Food / Q000145:classification; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards*