Formative evaluation was conducted for the Personal Health Behaviors Overview (PHBO) survey to evaluate nutrition behaviors with image-based questions in low-income populations. Forty-nine low-income adults from nutrition education classes were invited to participate with n = 42 included in the analysis. Participants completed the PHBO survey while an interviewer recorded observations. Upon completion, participants were asked questions regarding each PHBO survey item. Most participants completed the survey in an average of 4 minutes. The majority said the photographs of food made it easier to answer questions. Less than half indicated that the visuals depicting frequency made questions easier. While participant responses were aligned with the aims of the PHBO question being asked, some suggestions were offered for improvements of photographs. While this formative evaluation research indicates additional validation is necessary before use of these PHBO questions, the image-based simple question technique is a possible solution for efficient and effective nutrition assessments in low-income, limited literacy populations.



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