Methodologies, Techniques And Tools Used In Food Research With Children In my initial review of literature I came across a number of methodologies, techniques and

tools suitable for research with children. Table 21 outlines those most commonly used in both the qualitative and quantitative paradigms. In making my choices, the merits and limitations of each of these common data collection methods was considered in turn as will be explained below.

TABLE 21

Methods Most Commonly Used In Food Research With Children

Qualitative Quantitative

Observations Food records and Food recalls

One-to-one interviews Diet history

Focus Group interviews Food frequency questionnaires Draw and Write Technique Food rating techniques

3.1.2.1 Observations

Observation of children’s eating behaviours has a number of advantages, particularly with children too young to recall food intake accurately. Observation can provide accurate measures of type, frequency and quantity of food intake, as well as the social and physical context in which it occurs (McKenzie et al., 1991; Simons-Morton & Baranowski, 1991). It is also a potentially effective external validator or standard against which to measure other data collection methods, such as self-report. However, observation of large samples, or over long time periods, is labour intensive and expensive. In addition, observation is subject to sampling errors due to day-to-day, weekday-weekend and seasonal variation. Furthermore, obvious or intrusive observation is likely to result in measurement reactivity, thereby

preventing valid assessment and generalisation of results. Efforts which have been employed or were recommended for reducing reactivity are generally time-consuming or costly (Stunkard & Waxman, 1981; Baranowski et al., 1986; Davidson, Hayek, & Altschul, 1986; de Castro, 1997). These various drawbacks eventually precluded my use of observation as one of my research methodologies, despite its naturalistic approach.

3.1.2.2 One-To-One And Focus Group Interviews

One-to-one interviews and focus groups have been reported as particularly useful for data collection amongst populations who have limited literacy skills (Ross, 1995; Lytle et al., 1997; Kraak & Pelletier, 1998). In fact, one-to-one interviews have been widely used in food-related research with children, looking amongst others at their perception of foods, their food classification schemes, their interpretation of nutrition messages and verbalisation of food recalls (Contento, 1981; Michela and Contento, 1984; Neale, Otte & Tilston, 1994;

Murphy et al., 1995; Lytle et al., 1997; Turner, 1997; Neale, Otte & Tilston, 1998). Interviews with children usually do not last longer than 30 minutes and are generally structured or semi-structured. However, Singleton, Achterberg and Shannon (1992) have advised against the use of close-ended, forced-choice questions with young children, whilst Domel et al (1994) have recommended involving preference and visual imagery as retrieval mechanisms; for example prompting children to report foods eaten according to how much they liked or did not like them. Interviews with children are often combined with a task to make them more enjoyable, as well as to collect supplementary or complementary data. (See Table 22). A major disadvantage of one-to-one interviews is that they are labour and time intensive. This was a key consideration when I was deciding on my methodology, as I was the sole potential interviewer. Hence, my attraction to focus group interviews where a number of children could be reached simultaneously.

TABLE 22

Tasks And Props Used In Interviews With Children

Author(s) Goal Prop Or Task

Contento (1981) To gauge children’s behaviour related to nutritious and non-nutritious snacks

Children offered a snack to choose after the interview

Contento (1984) To uncover children’s

spontaneous classification of foods

Children asked to sort pictures of foods into piles by whatever criteria came to mind

Turner (1997) To explore children’s criteria for food classification

Children used a set of 30 food pictures

behaviours in relation to snacks, fruits and vegetables

Children presented with coloured photographs, illustrative material and coloured stickers for answering questions.

Several authors have outlined the value of focus groups for obtaining in-depth information and for allowing researchers to explore anticipated and unanticipated answers, or alternative explanations for a particular area of interest (Basch, 1987; Ramirez & Shepperd, 1988;

Glesne & Peshkin, 1992). Other researchers have highlighted the advantages of focus groups over one-to-one interviews (Stevenson & Lennie, 1992; Green & Hart, 1999). These advantages include that the group interview allows more interaction between respondents;

that participants in the group interview obtain immediate feedback on their own views as their stories are challenged, corroborated or marginalised by their peers; that the turnaround time and cost for group interviews is shorter than for individual in-depth interviews.

Focus group interviews have been used in health-related research with young children, being described as less intimidating than one-to-one interviews and having the added advantage that the group dynamic stimulates thinking and encourages respondents to build on each others’ responses (Stevenson & Lennie, 1992; Krueger, 1995; Betts, Baranowski &

Hoerr, 1996; Wood Charlesworth & Rodwell, 1997). Yet, Green and Hart (1999) have voiced their concern that restricting the conversation to one topic compromises naturalism as children would not normally discuss a specific topic in such depth. However, Howland et al (1989) concluded that focus groups can be effectively conducted with children “if the topics of discussion are relevant to their routine behaviours” (p.744).

At the start of my study, there were very few published studies involving the use of focus groups in food-related research with children. For example, one study had analysed children’s interpretation of nutrition messages (Lytle et al., 1997) and another two had

explored strategies for improving fruit and vegetable consumption (Baranowski et al., 1993;

Cullen et al., 1998). Similar to one-to-one interviews, a focus group setting which had worked effectively had involved no more than nine participants, was kept to under 30

minutes and engaged the children through the use of creative imagery, posters and collages.

Clearly the use of the focus group interview to explore food issues with young children was still a novel idea, and there was much scope for trial, variation and refinement of technique.

This potential for innovation together with its various other advantages, attracted me towards using focus group interviews as one of my methodologies.

3.1.2.3 The Draw And Write Technique

During the 1990s there had been a growing interest in the utilisation of the Draw and Write Technique (DWT) when working with children on health and food issues (Williams et al., 1989; McWhirther & Weston, 1994; Zivkovic et al., 1994; Oakley et al., 1995; Pridmore &

Bendelow, 1995; Pridmore & Lansdown, 1997; MacGregor & Currie, 1998; Porcellato et al., 1999). The DWT requires children to draw pictures and write a statement according to specific invitations read out loud in the classroom by the researcher. The invitations can be posed in the first or third person, though McWhirther and Weston (1994) have reported that the former works best for 6-8-year-olds and the latter for older children. When children do not wish to, or are unable to write, an adult scribe assists them. The various benefits of DWT include that it stimulates day-to-day school activity, it meets the requirements of a large-scale survey, it is a child-centred approach which enables all the subjects to participate at their own level (also if too young, or unable, to write), it provides insight into children’s belief systems at different stages of cognitive development and it is a quick way of identifying major categories of information.

However, there are certain limitations in using the DWT. What children draw is influenced by the ‘pictures’ they see in their environment and whether children’s drawings represent their own personally meaningful views, or are merely publicly acceptable representations is debatable (Backett-Milburn & McKie, 1999). Children might also draw what they find easy to depict (skills specific to drawing will evolve at different times and to different levels for children). Furthermore, recent lessons or experiences might affect what is depicted and the content of the drawings might be affected by friends’ proximity, or a desire to please the teacher. Researchers have also cautioned that younger children may not have literacy skills to add much to their drawings and, for them, ‘drawing and dialogue’ may be better. Other drawbacks are that younger children may not be able to articulate their ideas in such detail

as older pupils and there could be problems with eliciting non-conferred responses in the classroom setting (Pridmore & Bendelow, 1995; MacGregor & Currie, 1998). Moreover, the teacher and researcher must be careful to minimise the chances of influencing a child’s response. As a result, teachers need to be adequately briefed and this may be time-consuming. In addition, the DWT is often used in tandem with other data collection tools, such as complementary questionnaires (MacGregor & Currie,1998), follow-up semi-structured interviews with a sub-sample of the children (Porcellato et al., 1999), or class discussions focusing on recurring themes in the previous DWT exercise (Oakley et al., 1995). Once again, this renders the technique time-consuming.

Given these various disadvantages, I did not deem the DWT as very practical for my

research study. However, given its innovativeness and child-centred orientation, I did think it would be worth trialling.

3.1.2.4 Food Records And Food Recalls

Algert and Stumbo (1986) have defined a food record as a “written record made concurrently or immediately following the eating occasion” (p. 198). Names of food and drinks,

preparation method, condiments, source of the food, specific brand or restaurant names, times of eating and quantities are listed. Food and drinks are sometimes weighed before consumption for increased accuracy. A food record or recall may reflect anything from one meal to a whole month’s intake, although one to three days is the most common data collection period. Data is generally collected during one-to-one interviews, in person or over the phone.

The 24-hour recall has been used in a number of studies with children, focusing not only on nutrient intake (Lytle et al., 1996), but also on consumption of specific foods (Lytle et al., 1998; Reynolds et al., 1999). In general, positive reliability and validity of this procedure with elementary school children has been documented, although children sometimes had

difficulty quantifying the portion sizes of foods and both over-reporting and under-reporting were found in the portion size and in frequency of consumption of food (Emmons and Hayes, 1973; Van Horn et al., 1990; Lytle et al., 1993). Consequently, the 24-hour recall has also been combined with other data collection methods, such as observation at school and/or at home (Baranowski et al., 1986; Jonsson, Gummeson & Svensson, 1998), or parallel recordings by parents (Van Horn et al., 1990) in order to validate the data. Researchers have also cautioned that although a single recall is adequate for characterising consumption

for group comparisons, multiple assessment days minimise intra-individual variability and provide a more reliable estimate of a child’s typical dietary consumption (Blom et al., 1989;

Reynolds et al., 1999).

Overall, food records and recalls emerged as not being efficient tools for my study, as they provided much more detail than was required to reach my research goals. Moreover, in order to guarantee precision of responses, data collection would be extremely

time-consuming and labour intensive. On the other hand, the literature on this research method had shown that older primary school children were reliable chroniclers of their food intake and that recall was enhanced through use of visuals. This confirmed that some specific information on food intake patterns could be reliably sought from children with appropriate data collection tools.

3.1.2.5 Food Frequency Questionnaires Or Diet Histories

Given the findings on food records and recalls, I next considered the use of Food Frequency Questionnaires (FFQs) and diet histories. This technique requires respondents to report frequency of intake of a concise pre-established list of foods, often selected for their

contributions to intakes of nutrients or eating patterns of interest. Respondents are asked to indicate whether a food is usually consumed on a daily, weekly or monthly basis and how often it is eaten within that time-frame. They are also sometimes asked to report on portion size.

FFQs have often been used with schoolchildren (Persson & Carlgren, 1984; Baranowski et al, 1986; Crawford et al., 1994; Domel et al., 1994a, 1994b; Rockett, Wolf & Colditz, 1995;

Baranowski et al, 1997a). However they are not recommended for children less than 9 years of age without the assistance of parents or food providers, or without rigorous validation.

Used with young children, FFQs are prone to yield a high percentage of phantom foods and errors in food quantification. On the other hand, the participation of parents during data collection and the use of common food terms increase reliability, even producing better test-retest reliability than 24-hour recalls (Randall, 1991). In fact, one study involving the use of FFQs with US children found relatively high agreement between children’s reporting and validation methods and attributed this to parental participation in completing the form and use of common food terms (Baranowski et al., 1986).

Eventually, I judged the FFQ as a potentially useful tool for my research, given its efficiency in collection of information about general eating habits, yet despite its age-related drawback.

Table 23 summarises key points which I felt would help me construct an appropriate FFQ for use with children as based on Randall’s (1991) research. Table 24 outlines Teufel’s (1997) six-step process for creating and testing a culturally-competent FFQ. I was struck by this latter process which Teufel had advocated in order to decrease miscommunication and improve the validity of the data. In fact, a study by Hertzler (1983) had illustrated the potential presence of many sub-cultural groups when working with children and food. In designing a FFQ for use with children, she had reduced a list of 134 foods generated from 113 children’s food records to 20 foods by selection of those items consumed by 20% or more of the children being investigated. This was an interesting procedure and one which I felt would further help me construct a reliable FFQ.

TABLE 23

Constructing A Food Frequency Questionnaire For Use With Children

Aspect Of The Design Guideline

The Food List

Food names listed have to be very specific. Children are prone to interpret questions literally and may fail to recognise that a composite food group name (e.g. tomatoes) may include commonly consumed items (tomatoes in salads, in sauce etc.) Time Intervals

Time periods need to be fixed by meaningful start and end points.

Children conceive of the past as being “before now” and this may make it difficult for them to estimate frequency of food use during a specific interval.

Response Set

Children tend to respond affirmatively to authoritatively phrased questions by adults and will often adopt a response set when they are unsure of the question, do not have an opinion or are disinterested.

Context of Questioning Words used must be familiar to the child and consistent with the child’s definition of a given situation.

Structuring the Questionnaire

Easy questions or topics of interest should be broached first, with difficult or threatening questions asked last. Active participation such as a card sort approach may facilitate data collection.

(Adapted from Randall, 1991)

TABLE 24

Constructing A Culturally-Competent Food Frequency Questionnaire

Step Action

1 Development of a culture-specific food list 2 Determination of culture-specific food groups 3 Creation of a culture-specific database 4 Definition of culturally-defined portion sizes

5 Validation of questionnaire (e.g. comparison with 24-hour recalls) 6 Re-administration of questionnaire to test reliability

(Adapted from Teufel, 1997)

3.1.2.6 Food-Rating Techniques And Instruments

Instruments measuring multi-dimensional factors related to food choice have sometimes been used with adults, but less frequently with children (Lau, Krondl & Coleman, 1984;

Michela & Contento, 1986; Rappaport, 1992; Steptoe, Pollard & Wardle, 1995; Monteleone, Raats & Mela). Different foods have been rated on a number of attributes, such as pleasure, taste, health, convenience, familiarity, tradition, prestige, social influence and price. The advantage of this rating method is that it circumvents the need for respondents to give introspective reports on their motives, but it has the drawback of being time-consuming, inappropriate for large-scale research and potentially too challenging for some children if only semantics are used. So much so, rating methods developed for work with young children have generally been more task-oriented and used props, such as

smiling/neutral/frowning faces to assess food preferences (Birch & Sullivan, 1991), or cut-out circles of increasing size to denote a scale of ‘worst’ to ‘best’ foods (Michela & Contento, 1986). Reading up about food rating techniques, I considered them to be fairly attractive, as they could uncover children’s valuation of foods and make the data collection process more animated. Nonetheless, I was aware that the constructs tested would need to be clearly comprehended by the children, that any props would need to be neutral enough not to create bias and that one-to-one sessions would be necessary. At best I felt the technique could be used as a follow-up methodology with a small group of children, focusing on a specific food issue of interest which emerged from the data. Alternatively, a variation of the technique could be used as a complementary method where the children rated food-related information which they had already provided.

This initial review of the methodology, helped me establish a fairly clear idea as to which methods, techniques and tools I felt would help me reach my research goals, whilst simultaneously providing me with the opportunity to trial new approaches in food research with Maltese children. It also helped to sensitise me to different methodological processes and tool design features which would help ensure successful data collection. General advice for researchers to increase accuracy when working with children included that data

collectors need to minimise children’s fear of evaluation, assist with spelling and discourage teacher intervention (Torres, Cullen & Baranowski, 1999).