Development and Mixed Methods User-Testing of the Healthy Eating Index (HEI) Report for Feedback to Research Participants.

Abstract

Background: The Healthy Eating Index (HEI) is a measure of diet quality that has been used in nutrition surveillance, epidemiology and health outcomes research, evaluation of interventions and policies, research on the food stream, and to advance statistical methods for dietary assessment. Although the HEI is familiar to researchers, there are opportunities to adapt it and further extend its application in participant and patient-facing communications that recommend healthy eating. The HEI Report was developed as a return-of-results feature for the National Cancer Institute's (NCI) Diet History Questionnaire (DHQ) III.

Objective: The objective of this study was to user-test a HEI Report that provides information on how individualized intakes compare to population-level dietary guidance.

Design: This was a cross-sectional mixed-methods user-testing study involving eye-tracking and qualitative data. Two rounds of user testing were performed and the HEI Report was modified based on user feedback after each round.

Participants: /Setting: From March 31 to October 4, 2021, twelve adult participants (six per round of user testing) completed both eye-tracking and qualitative interviews remotely nationwide.

Main outcome measures: The main outcome measures were feasibility and acceptability.

Statistical analyses: All qualitative data were transcribed verbatim and recommended changes were categorized into high priority, low priority, and optional desired changes that would affect design but not comprehension. Eye tracking data were used to aid interpretation of qualitative data.

Results: The report's content (e.g., simplified instructions, resources page, title page, personalized phrasing) and design (e.g., graphical depictions, key, colors) were modified based on user-testing feedback.

Conclusions: The HEI Report was designed, usability tested, and launched in the NCI's Diet History Questionnaire (DHQ) III. The HEI Report may be used to return value to participants as part of an effective participant engagement and retention plan in human research studies.