Barriers to accurately measuring patients' dietary intake in hospitals using the visual estimation method.

Purpose Visual estimation, an easy-to-perform technique, is commonly used in hospitals to assess dietary intake in patients. The authors performed a qualitative study where the authors interviewed nurses and dietitians about their perceptions of barriers to accurately measuring patients' dietary intake in hospitals using the visual estimation method. The paper aims to discuss these issues. Design/methodology/approach Ten dietitians and ten clinical nurses responded to 30-minute individual interviews in Tokyo, Japan, in September 2014. Each interview was conducted using a common protocol of open-ended questions focusing on the challenges of the visual estimation method and barriers to accurately measuring patients' dietary intake as part of their routine work. The tape-recorded interviews were transcribed and analyzed based on grounded theory. Findings Five main categories emerged: hospitals, meals, colleagues, raters, and patients. Various individual barriers such as skill, attitude, knowledge, and others that had not been considered in previous studies also emerged. External barriers that were out of the raters' control, such as shortage of time, human resources, financial ability, and others, emerged from the "hospitals" category. Research limitations/implications Research participants were all females and many of them had less than ten years of experience. Practical implications In addition to standardizing the visual estimation process, medical staff need to overcome various other internal and external barriers to accurate measurements. Originality/value This is the first study to articulate some important barriers that influence reliability and validity when measuring patients' dietary intake by visual estimation methods in typical clinical settings.