title: How willing are adolescents to record their dietary intake? The mobile food record.
abstract: BACKGROUND
  Accurately assessing the diets of children and adolescents can be problematic. Use of technologies, such as mobile apps designed to capture food and beverages consumed at eating occasions with images taken using device-embedded cameras, may address many of the barriers to gathering accurate dietary intake data from adolescents.
  
  
  OBJECTIVE
  The objectives of this study were to assess the willingness of adolescents to take images of food and beverages at their eating occasions using a novel mobile food record (mFR) and to evaluate the usability of the user confirmation component of the mFR app, referred to as the "review process."
  
  
  METHODS
  Mixed methods combining quantitative and qualitative protocols were used in this study. Adolescents (11-15-year olds) attending a summer camp were recruited to participate in the study. First, the participants were asked to take images of foods and beverages consumed as meals and snacks for 2 consecutive days using the mFR app running on an iPhone and the number of images taken was noted. This was followed by focus group sessions to evaluate usability, which was analyzed by content and themes. After using the mFR, a think-aloud method was used to evaluate the usability of the mFR method for reviewing system-identified foods (ie, the review process). A usability questionnaire was administered at the end of all activities.
  
  
  RESULTS
  The mFR was accepted by the majority of the 24 boys and 17 girls (n=41) but varied according to gender and eating occasion. Girls were significantly more likely than boys to capture images of their eating occasions (Fisher exact test, P=.03). Participants were more likely to take images of their breakfasts (90%, 36/40) and lunches (90%, 72/80) and least likely to capture afternoon and evening snacks, 54% (43/80) and 40% (32/80), respectively. The major themes from the focus groups with regard to using the mFR were games, rewards, and the need to know more about why they were using the app. Results of the usability questionnaire indicated that including a game component would be important to increase willingness to use the mFR, and a high majority of the participants indicated a willingness to use the mFR for 7 days or more. The image review process was found to be easy to use except for some confusion with overlapping markers on the screen.
  
  
  CONCLUSIONS
  The adolescents' experiences with and feedback about the mFR highlighted the importance of increased training, reminders, entertainment (eg, games), and training with practice in using the device to capture complete dietary intake as part of their active lifestyles.
authors.affiliation: University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI, United States. cjboushey@cc.hawaii.edu.
authors.forename: Carol Jo
authors.identifier: http://orcid.org/0000-0001-7517-787X
authors.initials: CJ
authors.lastname: Boushey
authors.forename: Amelia J
authors.identifier: http://orcid.org/0000-0002-1534-467X
authors.initials: AJ
authors.lastname: Harray
authors.forename: Deborah Anne
authors.identifier: http://orcid.org/0000-0002-1094-1299
authors.initials: DA
authors.lastname: Kerr
authors.forename: TusaRebecca E
authors.identifier: http://orcid.org/0000-0001-5245-4643
authors.initials: TE
authors.lastname: Schap
authors.forename: Stacey
authors.identifier: http://orcid.org/0000-0002-0081-6136
authors.initials: S
authors.lastname: Paterson
authors.forename: Tanisha
authors.identifier: http://orcid.org/0000-0001-9477-4717
authors.initials: T
authors.lastname: Aflague
authors.forename: Marc
authors.identifier: http://orcid.org/0000-0002-5232-4213
authors.initials: M
authors.lastname: Bosch Ruiz
authors.forename: Ziad
authors.identifier: http://orcid.org/0000-0001-5716-0134
authors.initials: Z
authors.lastname: Ahmad
authors.forename: Edward J
authors.identifier: http://orcid.org/0000-0002-2909-7323
authors.initials: EJ
authors.lastname: Delp
keywords: adolescents; children; dietary assessment; mobile food record; novel technology