Scottish Health Survey: content review outcomes report

Diet

The survey review focussed on the diet questions for children aged 2-15 which, up until 2023, asked about fruit and vegetable consumption and eating habits on an annual basis in the main interview.

All adults (aged 16+) are asked to take part in Intake24, an online food diary. Respondents are asked to complete their diary entries on the day of their health survey interview and a second time in the following week during which they are asked to give details about the food and drinks they’ve consumed the day before. Intake24 was last included in SHeS in 2021 and is included in the 2024 survey which is currently in field. The tool can be accessed at Intake24.  Changes to Intake24 were beyond the scope of the review.

The review paper noted that consideration was being made to using Intake24 for children going forwards, in place of the existing fruit and vegetable and eating habits modules.

FSS and PHS were strongly supportive of the move to ask children to complete Intake24 alongside adults and were keen for this to be included in SHeS in 2024 and 2027. FSS noted that ‘in addition to monitoring progress towards the Scottish Dietary Goals and supporting SG policy on other food and drink groups of interest, a survey in 2024 will help look at folate and folic acid intakes in the population, prior to implementation of a folic acid fortification policy. The addition of folic acid to non-wholemeal wheat flour is proposed as a public health measure to reduce incidence of neural tube defect-affected pregnancies. The measure is currently out to consultation and is likely to come into force in 2025. A further survey of Intake24 through SHeS in 2027, would allow FSS to look at folate and folic acid intakes at two years post-implementation.’

Obesity Action Scotland, the SG Health Attitudes, Behaviours and Inequalities team (HABIT) and an individual were supportive of child diet questions being replaced with Intake24 but requested that we include Intake24 for adults and children on an annual basis.

In lieu of annual intake data, Obesity Action Scotland and the individual responding noted that it would be useful to include other diet monitoring questions such as questions covering fruit and vegetable consumption so there is some diet data on an annual basis. The SG HABIT team also provided support for this approach but noted that some of the current child diet questions are outdated and should be reviewed if they are to be retained or used in the years between Intake24 if it is not going to be annual. The individual who was supportive of using Intake24 with children requested that we retain a question about oily fish intake in the main survey.

GCPH suggested adding questions on the frequency of consumption of non-meat/plant-based food, however, there was no strong rationale provided for the need for a separate survey question on this and this information will be captured in Intake24 responses.

In their response, FSS noted that they are running a stand-alone survey of diet in children and young people (2-15 years), early in 2023. Following the review, the SHeS team reached out to FSS for more information about this survey and they explained that the survey would now run in 2023/2024 and use Intake24. It was then discussed more widely with policy colleagues, FSS and PHS and agreed that it would be unnecessary duplication to include Intake24 for children in SHeS in 2024 given the valuable information the FSS’ survey would provide. Despite the request from several organisations, it is not feasible to include Intake24 in SHeS on an annual basis due to the costs involved in administering the online food diary. We have therefore included Intake24 for adults only in 2024 and will include for both adults and children in 2027. To address the gap in data in the years between 2024 and 2027 we have agreed to include the child fruit & vegetable module in the main survey in 2025.