24 Hour Dietary Recall

1. 24 Hour Dietary Recall By: Melanie LuongNutrition Education Assistant Program

2. Outline • Purpose • Preparation • Opening the Interview • Conducting the Interview • Probing • Closing • Tips for getting better recalls

3. Purpose • Get an accurate & complete listing of all food/drink client consumed within last 24 hrs • Specifically: • What food/drink was consumed? • How much was consumed? • Time it was consumed? • How was it prepared? • How was it served? • Specifics of food (low fat, 1%, whole)

4. Preparation for interview • Review medical record & info • Make the environment comfortable • Keep desk neat • Choose private & quiet location, away from distractions • Set up the food models to help client recall amounts/portions

5. Opening the Interview • Build Rapport (sympathetic, trusting, & friendly relationship) • Greet client, use their name & appropriate title (Mr./Ms), ask them what they’d like to be called • children, use first name • Introduce yourself and title • the latter to express competence • Small talk: complement client for getting there on time • Express your interest to help • Encourage client to express themselves/ask burning questions

6. Opening the interview (cont’d) • Let client know you will do a 24 hr recall, explain: • What it is • Discuss purpose of what you will do with client info. • How long it will take • Have 1 hr, it should take 30-40 min • Privacy • Only staff will see client info., on a need to know basis to perform assessment

7. Opening the interview (cont’d) • Help client feel comfortable to encourage honesty • “Don’t be embarrassed to share what you ate – there are no “good” or “bad” foods and no one eats the right foods all the time.” • It can be hard to remember everything eaten in the last 24 hours, allow for questions & comments.

8. Conducting the interview • 3 step method • Step 1: Quick List • Get a list of all foods eaten w/out trying to determine amounts – go back and get amounts in step 2 • The client should tell you everything eaten or drunk, including snacks, coffee breaks, alcoholic beverages, even carbonated water – either eaten at home or away from home. • Step 2: Detailed Description • Get more complete info on foods already reported • “Do you remember anything else you ate or drank with this food?” • “What else did you have at this meal?” • “Was this (bread, vegetable) eaten plain or did you put something on it?” • Step 3: Review (at the end of interview) • Review the 24 hour list, ask if there’s anything else that he/she may have forgotten before or that you missed? • Determine if this intake is typical of most days. • Begin by asking open ended questions • Save close ended questions for later • Avoid leading questions (“You don’t drink whole milk, do you?”) • Avoid labeling meals, breakfast/lunch/dinner

9. Probing Techniques • Used to obtain more specific info • Encourages client to explain his/her answer • Encourages client to elaborate upon his/her answer • Helps client give a more specific answer • Time Probe • “What was the first thing you had to eat or drink when you got up in the morning?” • “Did you have anything to eat after midnight?” • Activities Probe • “While you were working around the house, did you take a break to have something to eat or drink?” • Did you watch TV last night? When you watched TV, did you eat anything? • “Did you stop on the way home from work for anything to eat or drink?”

10. Probing Techniques • Food Probe • Type of food – what type of milk • Form purchased – fresh/frozen/canned/dry • Method of prep – boiled/baked/fried/breaded • Brand name: commercial/ready to eat/brand • Parts eaten: whole item/half • Ingredients: If mixed dish, what ingredients used and amts • Addition to foods: was anything added to food during prep or at table? Was dressing added? Cream or sugar?

11. Closing the interview • End when objective has been achieved or when client is tiring • Review 24 hr food list with client (step 3) • Ask if this is typical daily intake • Discuss questions/comments client might have • Thank client for his/her patience & cooperation • Inform client on next steps: • You will be inputting their 24 hour recall information into a food processing program that evaluates their diet. • Next visit, you will review with client and provide counseling

12. Tips for better recalls • Be Patient • Be non-judgmental • Allow client to talk without interruptions • Allow for questions and comments. • Don’t approve or disapprove with body language or words • Use Food Models– ask the participant to point to serving sizes. • Use open ended questions. • Ask about added ingredients or condiments • Avoid Leading Questions

13. Different Types of Questions • Open or neutral questions- require a narrative or explanatory response; allows the client to talk about information that he/she feels is important. • Start with what, how or when or an open statement. • “Tell me about your favorite foods.” • “What is the first thing you have to eat or drink in the morning?” • Closed Ended questions- require only a yes or no answer and provide no additional information. Can be used to ask for specific information but fail to reveal anything else about a client’s attitude. Start with do you or have you. • “Do you salt your food at the table?” • “Have you tried to lose weight before?”

14. Different Types of Questions Cont’d • Leading questions- interviewer makes suggestions about the desired or expected answer • “You don’t drink whole milk, do you?” • What do you eat for breakfast?” • Behavioral questions- For the client to change undesirable eating habits, it is important to find out what he/she eats, not what he/she knows about choosing foods. • Behavioral questions are more useful for future counseling efforts than knowledge questions. • Behavioral questions use verbs that describe doing rather than knowing something. • Examples • Knowledge question: “What do you think about losing weight?” • Behavioral question: “What methods have you tried to lose weight?”

15. Strategies for refocusing the interview • Controlling Statement • Asking open or neutral questions may result in storytelling and take the interview off track. • Refocus the interview by using a “controlling statement” INTERVIEWER: How often do you eat out? CLIENT: Oh, my kids and I love this little Mexican restaurant down the street. They serve the best enchiladas… In a storytelling response such as this, the interviewer must use a controlling statement to focus the client to the question at hand. For example: INTERVIEWER: I’m sorry to hear that; but remember we were discussing how often you eat out. OR INTERVIEWER: You must really like that Mexican restaurant. How often do you eat there?

16. Reluctant/uncomfortable clients • Question-framing This strategy is needed for clients who are reluctant or uncomfortable to reveal their true habits/behaviors. Ask a series of “framed” questions, which allows the client to Hypothesize about an imaginary situation and therefore remove himself from a negative disclosure. For example: CLIENT (overweight): I never eat sweets. In fact, I seldom eat any dessert. INTERVIEWER: Let us for a moment imagine that you were at a friend’s party and the only desserts being served were cheese cake, chocolate mousse, and pecan pie. Which would you choose? Another example: CLIENT (a reluctant child): I don’t have favorite foods. INTERVIEWER: Let us pretend you were invited to spend a day at the beach with some friends. When asked to bring your own food, which foods would you bring?