• What is assessed?
• How is the measurement conducted?
• When is this method used?
• How are estimates of diet derived?
• Strength and limitations
• Populations
• Further considerations
• Resources required
• Instrument library
• Development of new tool/method
• References

The following outcomes can be assessed using a dietary checklist:

1. Frequency, amount, or other attributes of dietary consumption in a brief list of dietary items, including foods, food groups, and supplements
2. Adherence to a certain dietary intervention or a special dietary pattern
3. Likelihood of being exposed to food pathogens
4. Dietary habits or consumption of specific foods not likely to be captured in other methods
5. Group-level dietary consumption or exposure

A checklist that is designed for a specific purpose tends to be less detailed in contrast to other methods. The outcomes measured by a dietary checklist depend upon the design. Any outcomes can be assessed if targeted as indicated in Table D.11.1. For example:

1. In a clinical setting pertaining to anaemia, a checklist capturing major food sources and supplements of iron and vitamin B12 may be sufficient and allow calculation of the amount of the specific nutrients
2. In research on the effect of providing breakfast to those who tend to skip breakfast on health outcomes, a checklist to assess adherence to the intervention and related habits may be sufficient
3. In research on foodborne illness, a checklist can be about food consumption on a very specific occasion (e.g. “the wedding ceremony at Hotel X on 22 August 2015”)

A checklist can be used for an assessment of group-level exposure to certain foods in a certain environment. For example:

1. Vending machines for snacks, soft drinks, or plain water in a school
2. Types of foods sold in a restaurant or deli, such as raw meats, and foods that can cause allergic reactions
3. Marketing policy and practice of a local supermarket or stores in a school

Table D.11.1 Dietary outcomes assessed by dietary checklist.

* all are possible, except for the first one, but dependent on how a checklist is developed, and whether it is implemented with or without repeats. 

A dietary checklist can be either self-administered or interviewer-administered. A dietary checklist includes elements of a food frequency questionnaire (as it is based on a pre-printed food list). Respondents examine a list of foods, supplements, or other dietary items and cross-tabulate with attributes such as specified serving size (e.g. slices, teaspoons) and frequency of consumption, or both, ticking the boxes appropriately. An example of a dietary checklist is displayed in Figure D.11.1.

An assessor can administer a checklist to a respondent through face-to-face or phone interview. Alternatively, it may be preferable or required to send a checklist to a respondent through post or email and request him/her to complete it and send it back.

Use of blank space for each item and for an entire list is helpful to encourage a respondent to provide any information such as specific dietary patterns (e.g. vegan, a habit related to a religion, being on a weight-loss diet), alternative serving sizes for certain foods, and his/her key foods not listed. Sub-sections for a specific setting, e.g. ‘eating out and takeaway’ section, may help, depending on the aims of a checklist.

Figure D.11.1 Example of dietary checklist from the Low Income Diet and Nutrition Survey study. Note that this is one of five pages completed per day.
Source: [10].

Screening individuals for a specific dietary problem or intervention, for example:

1. to assess adherence to specific dietary patterns, for example, the Mediterranean diet [2,3].
2. to identify the need for education about unusual dieting.
3. to identify dietary behaviours or experiences associated with food poisoning, allergy, or dieting.
4. to implement a targeted intervention to reduce consumption of sugar-sweetened beverages.
5. to identify the need to encourage dietary consumption with family members.
6. to assess adherence to an intervention.

Categorical or continuous answers to each item, such as

1. Yes or No for consumption of certain foods, preference of foods or related behaviours, experiences of having meals in a dietary setting (e.g. a specific restaurant).
2. Frequency of consumption or a dietary practice over a certain period of time (e.g. frequency of snacking).

Answers can be combined for the purpose of a checklist

1. to estimate consumption of a food group.
2. to assess an overall degree of adherence to a certain intervention.
3. to estimate nutrient intakes from selected food items and supplements.

Strengths

1. Flexible to design a checklist and assess a targeted dietary habit or consumption. For instance, dietary assessment for foodborne illness often has a checklist to reflect this strength, to assess dietary exposure on a very specific occasion [4].
2. Low participant burden. For example, in the Low Income Diet and Nutrition Survey (LIDMS), respondents preferred the food checklist over a 24-hour recall and weighed food diary [5].

Limitations

1. Not useful to capture detailed dietary habits, or to answer many different clinical or epidemiological questions
2. A risk of systematic errors, which may result in recall bias, depending on the study design
3. A respondent may need to be literate, numerate, or both, depending on the study design. The LIDMS (Figure D.2.6) identified that the following requirements had been the most common issues: ticking the boxes (18%), understanding the portion sizes (18%), understanding what was required (16%), understanding a listed food consumed in a unique population only (15%), recording food eaten outside the home (15%) [5].

Table D.11.2 Characteristics of dietary checklists.

Considerations relating to the use of dietary checklists for assessing diet in specific populations are described in Table D.11.3.

Table D.11.3 Suitability of dietary checklists in different populations.

1. Trained fieldworkers can probe for missing items or any issues during and at the end of the implementation.
2. The food list must be designed for a specific purpose of research.

1. Trained fieldworkers to instruct respondents on how to complete the dietary checklist, monitor completion, and review the outputs at the end of the assessment
2. Depending on the study design and aims, the following items may also be required:
1. Additional questionnaire to aid interpretation.
2. Instructions on completion and return of the checklist.
3. Trained diet coders.
4. Nutrient database and analysis program.

A method specific instrument library is being developed for this section. In the meantime, please refer to the overall instrument library page by clicking here to open in a new page.

As a checklist can be flexible and tailored for a specific research aim, developing a checklist is often the last step in designing a study after all variables of interest have been identified. As a general rule in a questionnaire method, the following attributes should be confirmed:

1. Simplicity/clarity
2. Relevance to research aims
3. Completeness to assess target variables

Points to consider when drafting questions (adapted from [4]):

1. Clarify the aim of a checklist
2. Keep wording informal, conversational, and simple
3. Avoid jargon and sophisticated language
4. Avoid long questions (but vary question length)
5. Keep questions appropriate to the educational, social, and cultural background of respondents
6. Avoid leading questions linked to social or personal desirability
7. Avoid negative questions, questions beginning with “Why”, hypothetical questions
8. Limit each question to a single subject
9. Pay attention to sensitive issues
10. Check the adequacy of the list of possible responses to close-ended questions, and the need for open-ended questions

Whenever available and appropriate, the development needs to account for outcomes from dietary studies previously conducted in the same or similar populations. In the phase of finalising a checklist, a mock implementation is essential to confirm a time to complete and ease of completing the checklist.

1. Nelson M DK, Holmes B, Thomas R & Dowler E. Low Income Diet Methods Study: Project for Food Standards Agency. London: 2003.
2. Martinez-Gonzalez MA, Fernandez-Jarne E, Serrano-Martinez M, Wright M, Gomez-Gracia E. Development of a short dietary intake questionnaire for the quantitative estimation of adherence to a cardioprotective Mediterranean diet. Eur J Clin Nutr. 2004;58(11):1550-2.
3. Martinez-Gonzalez MA, Garcia-Arellano A, Toledo E, Salas-Salvado J, Buil-Cosiales P, Corella D, et al. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One. 2012;7(8):e43134.
4. World Health Organisation. Foodborne disease outbreaks: Guidelines for investigation and control. Geneva, Switzerland: World Health Organisation, 2008.
5. Holmes B, Dick K, Nelson M. A comparison of four dietary assessment methods in materially deprived households in England. Public Health Nutr. 2008;11(5):444-56.