Developing Components of an Integrated mHealth Dietary Intervention for Mexican Immigrant Farmworkers: Feasibility Usability Study of a Food Photography Protocol for Dietary Assessment

• Published in: JMIR formative research 2024-12, Vol.8, p.e54664
• Main Authors: Fernandez, Isabel Diana, Yang, Yu-Ching, Chang, Wonkyung, Kautz, Amber, Farchaus Stein, Karen
• Format: Article
• Language: English
• Subjects: Adult; Beverages; Bilingualism; Cameras; Community; Consent; Diabetes; Diet; Emigrants and Immigrants; Farmers; Farmworkers; Feasibility Studies; Female; Health care access; Health disparities; Health education; Health literacy; Health services; Humans; Hypertension; Intervention; Mexican Americans; Mexico - ethnology; Middle Aged; Mobile Applications; Nutrition Assessment; Obesity; Overweight; Photography; Questionnaires; Smartphones; Socioeconomic factors; Telemedicine; Weight control; White; Womens health; Working hours
• ISSN: 2561-326X; 2561-326X
• DOI: 10.2196/54664

Rural-urban disparities in access to health services and the burden of diet-related noncommunicable diseases are exacerbated among Mexican immigrant farmworkers due to work demands, social and geographical isolation, literacy issues, and limited access to culturally and language-competent health services. Although mobile health (mHealth) tools have the potential to overcome structural barriers to health services access, efficacious mHealth interventions to promote healthy eating have not considered issues of low literacy and health literacy, and food preferences and norms in the Mexican immigrant farmworker population. To address this critical gap, we conducted a series of preliminary studies among Mexican immigrant farmworkers with the long-term goal of developing a culture- and literacy-specific smartphone app integrating dietary assessment through food photography, diet analyses, and a non-text-based dietary intervention. This study aimed to report adherence and reactivity to a 14-day food photography dietary assessment protocol, in which Mexican immigrant farmworker women were instructed to take photos of all foods and beverages consumed. We developed a secure mobile app with an intuitive graphical user interface to collect food images. Adult Mexican immigrant farmworker women were recruited and oriented to the photography protocol. Adherence and reactivity were examined by calculating the mean number of food photos per day over time, differences between the first and second week, and differences between weekdays and weekends. The type of foods and meals photographed were compared with reported intake in three 24-hour dietary recalls. In total, 16 Mexican farmworker women took a total of 1475 photos in 14 days, with a mean of 6.6 (SD 2.3) photos per day per participant. On average, participants took 1 fewer photo per day in week 2 compared with week 1 (mean 7.1, SD 2.5 in week 1 vs mean 6.1, SD 2.6 in week 2; P=.03), and there was a decrease of 0.6 photos on weekdays versus weekends (mean 6.4, SD 2.5 on weekdays vs mean 7, SD 2.7 on weekends; P=.50). Of individual food items, 71% (352/495) of foods in the photos matched foods in the recalls. Of all missing food items (n=138) and meals (n=36) in the photos, beverages (74/138, 54%), tortillas (15/138, 11%), snacks 16/36, 44%), and dinners (10/36, 28%) were the most frequently missed. Most of the meals not photographed (27/36, 75%) were in the second week of the protocol. Dietary assessment through food p