Just a subtle difference? Findings from a systematic review on definitions of nutrition literacy and food literacy

Cross-cultural adaptation and validation of the short nutritional literacy scale for young adults (18-35years) and analysis of the influencing factors

OBJECTIVES

This study translated the short nutrition literacy scale for young adults (18-35 years) into Chinese, examined its reliability and validity, and analyzed its influencing factors.

METHODS

The scale was translated using a modified Brislin translation model. A convenience sample of 508 cases was selected for the survey. Content validity, structural validity, Cronbach's alpha coefficient, and test-retest reliability were used to evaluate the scale's reliability and validity. To screen the factors influencing nutrition literacy in young people.

RESULTS

The Chinese version of the Item-Level Content Validity Index (I-CVI) was 0.833 ~ 1, and the Scale-Level Content Validity Index/Average (S-CVI/Ave) was 0.908. The cumulative variance contribution of the scale was 51.029%, and the model was generally well-fitted. The Cronbach's alpha coefficient and retest reliability of the scale were 0.826 and 0.818. The results showed that the level of education, mother's education, nutrition-related courses, and frequency of attention to nutritional health information were the factors influencing the nutritional literacy of young people.

CONCLUSION

The Chinese version of the S-NutLit Scale can effectively assess the nutrients of young Chinese people. Low levels of education, low levels of education of mothers, lack of exposure to nutrition-related courses, and low frequency of attention to nutritional health information can lead to lower levels of nutritional literacy among young people.

Turkish version of a short nutrition literacy scale for young adults: cultural adaptation and validation

Background

Recent changes in nutrition trends may lead to health issues. In particular, the unhealthy eating habits of young adults suggest that future generations may be at risk. Therefore, the importance and necessity of nutrition literacy is becoming increasingly apparent.

Purpose

The purpose of this study was to create a Turkish version of a short nutrition literacy (S-NutLit-Tr) scale for young adults developed by Vrinten et al (2023).

Methods

This research involved 115 young adults from Istanbul Gelişim University, who were selected through convenience sampling, a non-probability sampling method. After the original S-NutLit scale was translated into Turkish, the validity and reliability of the determined factor structure were tested on 115 young adults. Internal consistency was examined with the Cronbach Alpha coefficient. Confirmatory factor analysis was employed to validate the two sub-scale structures. Finally, measurement invariance was tested concerning participants' gender, aiming to ascertain whether the scale captured equivalent characteristics across different groups.

Results

As a result of the reliability analysis conducted with the scale of S-NutLit-Tr, the Cronbach Alpha coefficient was obtained as 0.86 for the scale of S-NutLit-Tr. Additionally, it was found to be 0.84 and 0.77 for the "information skills" and "expert skills" sub-scales, respectively. Accordingly, the scale of S-NutLit-Tr was found to be reliable. To examine the two sub-scale factor structures of the S-NutLit-Tr scale, fit indices were examined: χ2/df (1.246), GFI (0.923), IFI (0.975), TLI (0.967), CFI (0.974), RMSEA (0.046), and SRMR (0.055) and it was observed that the indices were within acceptable limits. In the analysis results obtained through the multi-group confirmatory factor analysis for measurement invariance, it was observed that the ∆CFI and ∆TLI values across all indices were less than or equal to 0.01. Consequently, it was observed that the item-factor structure, factor loadings, variances, covariances, and error variances of the scale were equivalent for both male and female young adults.

Conclusion

The study found that the scale of S-NutLit-Tr for young adults was a valid and reliable measurement tool in Turkish culture.

Exploring students' perception of subjective food literacy: A model of educational practice

Introduction

Latest research showed that lower levels of food literacy led to poorer health outcomes and highlighted the importance of nutrition education to improve food literacy for the population. Although evidence at the global level exists, the scientific literature on food literacy in Romania is scarce; therefore, this article aims to explore the perception of subjective food literacy as an outcome of an educational model in a sample of university students from Romania.

Methods

The present study used a qualitative inductive approach using focus groups to explore the results from an educational "learning-by-doing" model regarding the perception of subjective food literacy. The sample consisted of 64 second-year students who participated in a class taught by one of the authors between October 2019 and February 2020 and later agreed to participate in the focus groups. All focus groups were audiotaped following participants' permission and transcribed verbatim. Data was analyzed with the QSR Nvivo 12 Pro software package using an inductive thematic analysis.

Results

Several themes and sub-themes emerged from the focus groups discussing prior information of participants regarding nutrition, change in nutrition knowledge (information about plant protein, information about soy and soy products, information about sugar and its effects on health, and additional nutrition information), modified perception of nutrition and food, dietary habits, short-term behavior changes, and aspects that helped them to have more information about nutrition (construction of the health campaign, pre-testing materials, and support offered by the professors). All participants reported acquiring new information about food and nutrition, modified perceptions about nutritional habits, and even reported short-term behavioral change as an outcome of the educational model.

Conclusions

Educational models using a learning-by-doing approach and combining formal and non-formal education can potentially affect students' subjective food literacy. Future research should explore university students' food literacy using evidence-based educational models.

Development of food literacy in children and adolescents: implications for the design of strategies to promote healthier and more sustainable diets

Food literacy has emerged as a key individual trait to promote the transformation of food systems toward healthy and sustainable diets. Childhood and adolescence are key periods for establishing the foundations of eating habits. Different food literacy competencies are acquired as children develop different cognitive abilities, skills, and experiences, contributing to the development of critical tools that allow them to navigate a complex food system. Thus, the design and implementation of programs to support the development of food literacy from early childhood can contribute to healthier and more sustainable eating habits. In this context, the aim of the present narrative review is to provide an in-depth description of how different food literacy competencies are developed in childhood and adolescence, integrating the extensive body of evidence on cognitive, social, and food-related development. Implications for the development of multisectoral strategies to target the multidimensional nature of food literacy and promote the development of the 3 types of competencies (relational, functional, and critical) are discussed.

Status and associated factors of food and nutrition literacy among young adults aged 15-44 years in Shenzhen City, China

Background

Food and nutrition literacy (FNL) plays an important role in young adults' dietary habits and nutrition. This study aimed to investigate FNL status and its associated factors among young adults aged 15-44 years in Shenzhen.

Methods

A cross-sectional survey of 5,390 participants was conducted in June 2021. FNL was measured using the Food and Nutrition Literacy Questionnaire for Chinese Adults (FNLQ). A generalized linear model was employed to analyze the factors associated with FNL.

Results

The median FNL score (total score = 100) was 68.00, which was below the adequate level of 80. FNL was divided into the two different domains of knowledge and skills, with significantly different scoring rate of 85.30 and 67.77%, respectively. The overall proportion of respondents with adequate FNL was 19.52%. The FNL score was significantly higher among the participants who were female (β = 2.665; 95% confidence interval [CI]: 2.031-3.299) and with higher education levels (β ranging from 5.632 [CI: 3.845-7.419] to 10.756 [CI: 8.973-12.538]), healthcare-related work experience (β = 4.197; CI: 3.557-4.837) and a higher economic status (β ranging from 0.753 [CI: 0.079-1.426] to 6.217 [CI: 5.208-7.227]). Those who were divorced or with an unknown marital status (β = -8.438; CI: -9.701, -7.175), abnormal body mass index (thin [β = -2.115; CI: -3.063, -1.166], overweight [β = -1.427; CI: -2.254, -0.600]), and suffering from chronic diseases (single disease [β = -3.483; CI: -4.485, -2.480], multimorbidity [β = -5.119; CI: -5.912, -4.327]) had significantly lower FNL scores.

Conclusion

Generally, the level of FNL among young adults in Shenzhen, China, was relatively low. Thus, nutrition education programs targeted at promoting improved FNL status call for additional emphasis, especially in subgroups with lower scores.

A cross-sectional study on the moderating effect of self-efficacy on the relationship between sociodemographic variables and nutrition literacy among older adults in rural areas of North Sichuan

Objective

The purpose of this study is to examine the moderating role of self-efficacy among rural elderly individuals in northern Sichuan Province in the relationship between certain sociodemographic variables and nutritional literacy.

Methods

Convenience sampling was used to select 264 elderly individuals aged 60 and above from rural communities in Cangxi County, Guangyuan City, Yilong County, Nanchong City, and Bazhou District, Bazhong City, Sichuan Province. A self-designed questionnaire, including sociodemographic variables, the General Self-Efficacy Scale (GSES), and the Nutrition Literacy Questionnaire for the Elderly (NLQ-E), was administered through face-to-face interviews using a paper-based version. The relationships between sociodemographic variables, self-efficacy, and nutritional literacy in the elderly were analyzed using SPSS 26.0 and the Process plugin to examine the relationships between variables and to test for moderation effects.

Results

(1) There were significant differences in nutrition literacy scores among elderly people of different ages, genders, marital statuses, educational levels, personal monthly living expenses, dental conditions, and number of chronic diseases (p < 0.05). (2) When elderly individuals have lower self-efficacy, their nutritional literacy is lower as they become older, and they have poorer nutritional literacy with a higher number of chronic diseases.

Conclusion

General population demographic data has a significant impact on the nutritional literacy level of elderly people in rural areas of northern Sichuan. Self-efficacy plays a moderating role in the relationship between age and nutritional literacy, as well as the relationship between the number of chronic diseases and nutritional literacy.

The association of highly processed food consumption with food choice values and food literacy in Japanese adults: a nationwide cross-sectional study

BACKGROUND

Highly processed food (HPF) consumption is increasing globally and has become a prominent public health concern. However, the relationship between HPF consumption and food choice values and food literacy is unknown. This study aimed to examine the association of HPF consumption with food choice values and food literacy.

METHODS

This cross-sectional study used data from a nationwide questionnaire survey conducted in 2018 among 2232 Japanese adults aged 18-80 years. We assessed eight food choice values (accessibility, convenience, health/weight control, tradition, sensory appeal, organic, comfort, and safety) using a 25-item scale, and food literacy characterised by nutrition knowledge (using a validated 143-item questionnaire), cooking and food skills (using 14- and 19-item scales, respectively), and eight eating behaviours (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness, and slowness in eating, using the 35-item Adult Eating Behavior Questionnaire). HPF consumption was estimated using a validated brief diet history questionnaire. The associations between HPF consumption and age, body mass index, energy intake, and each score on food choice values and food literacy were evaluated by multiple linear regression.

RESULTS

In males, one standard deviation increase in scores for cooking skill and satiety responsiveness was associated with an increase in HPF consumption by 22.1 g/4184 kJ (95% confidence interval (CI): 6.6 to 37.5) and 15.4 g/4184 kJ (95% CI: 6.0 to 24.7), respectively. In females, one standard deviation increase in age and scores for safety and nutrition knowledge corresponded to a decrease in HPF consumption by - 16.4 g/4184 kJ (95% CI: - 23.4 to - 9.3), - 9.9 g/4184 kJ (95% CI: - 19.1 to - 0.7), and - 11.1 g/4184 kJ (95% CI: - 17.0 to - 5.3), whereas one standard deviation increase in the satiety responsiveness score corresponded to an increase in HPF consumption by 13.1 g/4184 kJ (95% CI: 6.8 to 19.4).

CONCLUSIONS

This cross-sectional study suggests that several aspects of food choice values and food literacy were associated with HPF consumption in Japanese adults. Further studies are needed to confirm our findings in a broader context.

Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study

BACKGROUND

The worldwide prevalence of type 2 diabetes (T2D) has increased in the past decade, and it is projected to increase by 126% by 2045 in Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health interventions to support diabetes care.

OBJECTIVE

This study aimed to apply the Behavior Change Wheel (BCW) framework to develop text messages to influence food literacy in adults with T2D in urban Kenya.

METHODS

The 8 steps of the BCW framework guided the development of text messages: (1) Define the problem in behavioral terms; (2) select target behaviors; (3) specify the target behaviors based on who needs to perform the behaviors, what needs to change, and when, where, how often, and with whom; (4) identify what needs to change; (5) identify intervention functions; (6) select policy categories; (7) select behavior change techniques (BCTs); and (8) select the mode of delivery. Recent exploratory studies in Kenya and other low- and middle-income countries provided information that was used to contextualize the intervention.

RESULTS

In step 1, the behavioral problem was defined as unhealthy dietary patterns among adults with T2D. In step 2, based on a qualitative study in the target population, the target behavior was selected to be evaluation of reliable sources of information, and selection and preparation of healthy food. In step 3, unhealthy dietary patterns were selected. In step 4, 10 domains of the Theoretical Domains Framework were identified, and in step 5, 5 intervention functions were linked to the domains and unhealthy dietary patterns were specified. In step 6, communication and regulations were identified as policy categories, while in step 7, 9 BCTs were selected from the Behavior Change Technique Taxonomy version 1. In step 8, the most suitable mode of delivery was determined to be mobile text messages. A total of 36 mobile text messages were developed based on the 9 BCTs.

CONCLUSIONS

This study shows the step-by-step application of the BCW framework to develop mobile text messages to influence food literacy in adults with T2D.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/48271.

Evaluation of the nutrition literacy assessment questionnaire for college students and identification of the influencing factors of their nutrition literacy

BACKGROUND

Nutrition health has become a major public health issue in both high and middle-income countries. Nutrition literacy is an important indicator to evaluate the effect of public health intervention and one of the important concepts in health promotion. Thus, this study aimed to verify the reliability and validity of a nutrition literacy assessment questionnaire (NLAQ) and investigate the associated factors of nutrition literacy among college students.

METHODS

We conducted a cross-sectional online survey of college students from April to November 2022 in Wuhan (N = 774). We employed the Cronbach's alpha coefficient, exploratory and confirmatory factor analysis to evaluate the reliability and validity. We used latent profile analysis to classify the nutrition literacy. We conducted Chi-square test and binary logistic regression to identify the influencing factors.

RESULTS

The Cronbach's alpha coefficient of the NLAQ and its dimension was ranging from 0.837 to 0.909. The common factors were consistent with the original dimensions. All indicators met the requirements (χ2/df = 6.16 < 8, GFI = 0.929, NFI = 0.939, CFI = 0.948, RMSEA = 0.082 < 0.1). College students' disciplines (χ2 = 7.769, P = 0.021), mothers' education level (χ2 = 26.599, P < 0.001), and fathers' occupation type (χ2 = 11.218, P = 0.024) had impacts on nutrition literacy.

CONCLUSION

The NLAQ has good reliability and validity, and could be used as a measurement tool to evaluate college students' nutrition literacy. Schools and families should take targeted measures to improve the college students' nutrition literacy.

The level of food literacy and its association with food intake and obesity status among Seoul citizens: results from Seoul Food Survey 2021

BACKGROUND/OBJECTIVES

Food literacy (FL) is a crucial skill for selecting sustainable and healthy food options, necessitating the identification of vulnerable groups in the community using valid measurement tools. Identifying weak domains in FL is essential for enhancing the overall FL. This study examined the FL levels of Seoul citizens based on their sociodemographic characteristics and assessed the relationship between FL, food intake, and weight status.

SUBJECTS/METHODS

This study utilized the data from the Seoul Food Survey, a cross-sectional study employing representative samples of Seoul citizens. Data collection occurred from September to October 2021, with 4,039 citizens aged 18 yrs and above participating in face-to-face surveys. Thirty-three FL items were assessed, comprising 14 items in the nutrition and safety (NS) domain, eight items in the cultural and relational (CR) domain, and 11 items in the socio-ecological (SE) domain. In addition, data on food intake sufficiency and obesity status were collected. The descriptive statistics, t-tests, analysis of variance, and logistic regression analysis were used for analysis.

RESULTS

Men, students, young adults, older citizens, and people experiencing food insecurity had the lowest scores for all the FL domains. The highest quartile group of NS scores had a higher probability of consuming adequate servings of vegetables and fruits, with significant linear trends observed (P for trend < 0.05). In all three FL domains, the odds ratio for obesity was significantly lower in the groups with high FL scores (P < 0.05).

CONCLUSIONS

A close relationship was observed between low FL, obesity, and food intake, even after controlling for other covariates. Vulnerable groups with low FL were also identified. Therefore, it is essential to develop programs to improve FL and the health and well-being of these groups.

Food literacy competencies in youth - a mini-review

Introduction

Young people's transition into adulthood is an opportunity in the life course to establish adequate eating behaviors, hence exploring food literacy competencies in this period of life is especially important. Food literacy has recently gained increased attention in adults, adolescents, and younger children, but less is published about youth. This paper aims to summarize what tools have been used to measure food literacy and the sub-competence nutrition literacy in youth aged 16-24 years in the previous 5 years.

Methods

A mini-literature review was conducted in MEDLINE and EMBASE via Ovid, in September 2022. Study eligible criteria; had to be an original article, using a tool to quantitatively assess food literacy and/or nutrition literacy, including participants between 16-24 years, full text available in English, published between 2017-2022.

Results

A total of 958 articles were identified, of which 385 duplicates were removed. Thus, 573 articles were screened by title/abstract. Finally, nine articles were eligible for data extraction of which four proposed a tool to measure food literacy and five proposed a tool to measure nutrition literacy.

Discussion and conclusion

Although four studies claimed to measure food literacy, none of these used tools comprehensive enough to measure all aspects of food literacy, and only one was validated in young people. This study shows that only few tools exist for the measurement of food literacy in youth, and those available are scant. Further work is needed to develop a food literacy tool for youth.

The nutritional literacy of breast cancer patients receiving chemotherapy and its association with treatment self-regulation and perceived social support

PURPOSE

Chemotherapy can lead to malnutrition and post-menopausal recurrence among breast cancer (BC) patients, who need to achieve nutritional literacy (NL) to cope. The objective of this study was to explore the NL level in Chinese BC patients receiving chemotherapy and its predictors including both internal motivation and the external environment.

METHODS

A total of 326 BC female patients from three hospitals were enrolled. Participants completed the Nutrition Literacy Measurement Scale for Chinese Adult (NLMS-CA), Chinese version from the Treatment Self-Regulation Questionnaire (TSRQ-C), and the Perceived Social Support Scale (PSSS) to assess NL, treatment self-regulation, and social support. Stepwise multivariate linear regression was used to identify the main factors of NL.

RESULTS

The total NL score was 151.31 ± 16.85, the "knowledge understanding" dimension had the lowest score. In the final regression model, patients with higher scores for "autonomous motivation" and "introjected regulation" on the TSRQ-C and "family support" and "other support" on the PSSS, higher educational levels and average monthly household incomes and endocrine therapy had higher NL levels (adjusted R2 = 66.7%, p < 0.05).

CONCLUSIONS

The overall NL score among Chinese BC patients receiving chemotherapy was satisfactory, but the knowledge understanding score was low. Higher autonomous motivation, introjected regulation, family support and other support scores, higher educational and household income levels, and endocrine therapy were predictors of NL in female patients. Interventions should be designed according to the specific performances and predictors of NL in female patients.

High nutrition literacy linked with low frequency of take-out food consumption in chinese college students

BACKGROUND

The excessive consumption of take-out food has increased the risk of nutrition-related chronic diseases. Nutrition literacy (NL) is an important influencing factor of food choice. This study aimed to explore the relationship between nutrition literacy and take-out food consumption.

METHODS

A cross-sectional study was conducted on 2130 college students in Bengbu, China. A self-reported questionnaire that included demographic information, lifestyle behavior, take-out food consumption, and nutrition literacy scale was used. Ordinal logistic regression models were used to analyze the association between nutrition literacy and take-out food consumption.

RESULTS

Of the students surveyed, 61.5% consumed take-out food at least once a week. NL was significantly associated with the frequency of take-out food consumption ≥ 4 times/week (OR = 0.995, 95% CI = 0.990-1.000); the difference specifically was discovered for applying skills, interactive skills, and critical skills. Moreover, students with high level NL ate less (Spicy) hot pot (OR = 0.996, 95% CI = 0.992-1.000), but more vegetable and fruit salad (OR = 1.009, 95% CI = 1.002-1.015).

CONCLUSIONS

NL, especially in applying skills, interactive skills, and critical skills, is not only associated with consumption frequency of take-out food among college students, but also links with types of take-out food consumption. Our findings emphasize that targeted interventions on nutritional skills literacy should be needed to improve dietary behaviors for student's good health.

Dietary Behavior and Its Association with Nutrition Literacy and Dietary Attitude Among Breast Cancer Patients Treated with Chemotherapy: A Multicenter Survey of Hospitals in China

Background

Chemotherapy often negatively impacts the nutritional status of breast cancer patients, and healthy dietary behaviors are important for patient wellbeing. With the guidance of the "Knowledge, Attitude and Practice model" (KAP model), the objective of this survey was to determine the frequency with which patients engage in healthy dietary behaviors and to explore the association between healthy dietary behaviors and nutrition literacy and dietary attitudes.

Methods

This study included a total of 284 breast cancer patients undergoing chemotherapy from three hospitals spanning three cities in China. Face-to-face interviews were conducted to collect demographic and clinical characteristics as well as the Dietary Nutritional Knowledge, Attitude and Practice Questionnaire (DNKAPQ) and the Nutrition Literacy Measurement Scale for Chinese Adult (NLMS-CA).

Results

Participants exhibited medium to high scores for nutrition literacy, dietary attitude and dietary behavior. Nutrition literacy (r = 0.505, p < 0.001) and dietary attitude (r= 0.326, p < 0.001) scores were both positively correlated with the total dietary behavior score. The total nutrition literacy score was positively correlated with the total dietary behavior score (r = 0.286, p < 0.001). In the univariate analysis, age, body mass index, living environment, education level, monthly family income, work status, menopausal status, number of comorbidities, relapse and endocrine therapy were significantly associated with dietary behavior (p < 0.05). In the multiple linear regression analysis, patients' dietary behavior was significantly associated with nutrition literacy (β = 0.449, p < 0.001) and dietary attitude (β = 0.198, p < 0.001). These two factors accounted for 28.6% of the variation in the patients' dietary behavior scores.

Conclusion

There is an important need for targeted dietary and nutritional interventions designed and implemented by health professionals to improve dietary behaviors. Intervention design and content should take the patients' nutrition literacy and dietary attitudes into consideration. In particular, women who are older, overweight, unemployed, and postmenopausal and live in rural areas, exhibit fewer comorbidities, have a lower family income and education level, have not relapsed and are currently receiving endocrine therapy are in urgent need of diet-specific intervention.

Nutrition literacy mediates the relationship between self-efficacy and eating behavior in young tuberculosis patients: A cross-sectional study

Objective

To assess the associations between self-efficacy, nutrition literacy and eating behavior, and to examine if nutrition literacy mediates the relationship between self-efficacy and eating behavior in young tuberculosis patients.

Methods

This cross-sectional study used a convenience sampling strategy to select 230 young tuberculosis patients at the Second Hospital of Nanjing (Public Health Medical Center of Nanjing), China, from June 2022 to August 2022. The data were collected using a demographic data form, the Eating Behavior Scale, the Food and Nutrition Literacy Questionnaire and the Tuberculosis Self-Efficacy Scale. Descriptive statistics, Pearson bivariate correlation analysis, Pearson partial correlation analysis, hierarchical multiple regression, and mediation analysis were conducted in the study.

Results

The mean self-efficacy score for young tuberculosis patients was 92.56 (SD = 9.89, range = 21 ∼ 105). The average nutrition literacy score for young tuberculosis patients was 68.24（SD = 6.75, range = 0 ∼ 100). The bivariate correlation analysis and partial correlation analysis found that self-efficacy was positively correlated with nutrition literacy (P < 0.01). The regression analysis showed that self-efficacy (F = 5.186, β = 0.233, P < 0.001)and nutrition literacy (F = 7.749, β = 0.545, P < 0.001) significantly predicted eating behavior. The three dimensions of nutrition literacy including nutritional knowledge (mediation effect ratio = 13.1%, 95% CI =  - 0.089; -0.005), preparing food (mediation effect ratio = 17.4%, 95 %CI = 0.011; 0.077) and eating (mediation effect ratio = 54.7%, 95 %CI = 0.070; 0.192) mediated the relationship between self-efficacy and eating behavior in young tuberculosis patients.

Conclusion

Nutrition literacy mediated the relationship between self-efficacy and eating behavior. To promote healthy eating behavior among young tuberculosis patients, interventions aimed at improving self-efficacy and nutrition literacy should be conducted.

Adaptation of the Food Literacy Questionnaire for school children to Turkish: validity and reliability study

Food literacy is the ability to understand the nature of food and its level of importance, to obtain, process, analyze, and use information about food. This study aims to translate and cross-culturally adapt the Food Literacy Questionnaire for school children (FLQ-sc) into Turkish and to study its psychometric properties of reliability and validity. The study was conducted with 303 students aged 12-14 in Kayseri, Turkey. A pilot study was conducted with 36 students, and a test-retest was conducted with 219 students, 2 weeks after the first study was performed. Data were collected with the sociodemographic data form and FLQ-sc. Linguistic, content, face, and construct validity were evaluated for validity. Cronbach's alpha and intraclass correlation coefficients (ICCs) were calculated for the reliability evaluation. Model validity was tested with confirmatory factor analysis. Root mean square error of approximation (RMSEA), χ2/SD, and goodness-of-fit index (GFI) statistics were in good agreement. Comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square error of approximation (SRMR) statistics were at acceptable levels (RMSEA = 0.033, χ2/SD = 1.324, GFI = 0.958, CFI = 0.944, TLI = 0.939, SRMR = 0.063). The Cronbach's alpha coefficient for the total scale score was quite good (0.795). The ICC for test-retest reliability was good (0.874) for the total scale score.  Conclusion: The Turkish version of the Food Literacy Questionnaire for school children (FLQ-sc) is a valid and reliable measurement tool and can be used to evaluate food literacy levels in Turkish children aged 12-14. What is Known: • It is important to acquire knowledge and skills in food literacy from childhood because the behaviors learned during childhood and adolescence regarding food intake and preparation continue into adulthood. • In addition to the limited scales evaluating the food literacy levels of children, there is no scale evaluating the food literacy levels of Turkish children between the ages of 12 and 14. What is New: • The Turkish version of FLQ-sc is a valid and reliable scale for evaluating the food literacy levels of Turkish school children. • Scale is a suitable tool to ensure the comparison of food literacy levels in different student groups and measure abstract concepts such as education.

Development of the health literacy assessment instrument for chronic pain patients: A Delphi study

AIM

To develop health literacy assessment instrument for patients with chronic pain.

DESIGN

Qualitative methods based on Delphi technique, assessed against the CREDES checklist.

METHODS

A 2-round Delphi method was adopted in this study. The panel consisted of 19 experts.

RESULTS

The health literacy assessment instrument for chronic pain patients was constructed, which contained 3 dimensions (functional health literacy, interactive health literacy and critical health literacy) and 41 items. The positive coefficients of two rounds Delphi were 100.00% and 89.5%, respectively. The authority coefficient of experts was 0.848 and 0.858, respectively. The coordination coefficients of dimension and items were 0.222 and 0.364, respectively.

CONCLUSIONS

The health literacy assessment instrument dimensions and items for patients with chronic pain based on a Delphi method are valid. This instrument is suitable for investigating the health literacy level of patients with chronic pain.

What is the level of nutrition literacy of Saudi adolescents? A national wide exploratory cross-sectional study

Background

Despite being a prolific research topic, studies evaluating nutrition literacy in the Arab world are scant and still nonexistent in the Kingdom of Saudi Arabia. Therefore, a national study was launched with the aim to (1) assess nutrition literacy among Saudi adolescents aged 10-19 years old and (2) determine its correlates.

Methods

A cross-sectional study was launched across all Saudi provinces between 29 April and 6 June 2022, enrolling a convenience sample of 2,115 adolescents (mean age = 16.8 ± 2.5; girls: 48.7%). An online self-administered questionnaire was disseminated to eligible participants to collect relevant data.

Results

Study findings showed that nearly half of the adolescents (44.6%) had poor nutrition literacy. The male gender doubled the risk of adolescents having poor nutrition literacy (OR = 2.0, CI = 1.5-2.5, p < 0.001). Northern border residents were 14 times more likely to be nutritionally illiterate, in contrast to adolescents residing in Riyadh (OR = 14.0, CI = 7.3-28.0, p < 0.001). Adolescents were more likely to be nutritionally illiterate if they were underweight or overweight (OR = 2.7, CI = 1.6-4.7, p < 0.001; OR = 2.2, CI = 1.7-2.9, p < 0.001). School students had 2 times more risk of having poor nutrition literacy, in contrast to those who were enrolled in universities (OR = 1.8, CI = 1.4-2.4, p < 0.001). Nutrition illiteracy was 4 times higher among adolescents having caregivers else than their parents (OR = 3.9, CI = 2.2-6.9, p < 0.001). Parental education level also contributed to determining adolescents' nutrition literacy status.

Conclusions

It has become essential to courage the development of supportive school environments in Saudi Arabia to promote nutrition education and improve adolescents' nutrition literacy. Without a doubt, this calls for taking a holistic approach on the part of education and health ministries, nutrition professionals, educators, parents, and, most importantly, the teenagers themselves, who must have the desire and motivation to learn.

A cross-sectional exploratory study of food literacy among Saudi parents of adolescent children aged 10 to 19 years

Introduction

Parental food literacy is fundamental in laying a solid foundation for healthy eating among their children. This study aimed to (1) evaluate the current state of food literacy among Saudi parents of 10-19 years old adolescent children, and (2) determine the correlates associated with parental food literacy.

Methods

This cross-sectional study was conducted between April and June 2022, with a convenience sample of 1845 Saudi parents (mean age = 45.1 ± 11; mothers: 56%). A Short Food Literacy Questionnaire (SFLQ) was used to meet the study aims.

Results

Findings showed that around 46% of parents had poor food literacy. Fathers were 2.4 times more likely than mothers to be food illiterate (OR = 2.4, CI = 1.9-3.0, p < 0.001). Parents residing in Riyadh, Northern borders, Jawf, or Ha'il had a three times higher risk of being food illiterate than those residing in other provinces (OR = 3.2, CI = 2.6-3.9, p < 0.001). Parental overweight or obesity increased their risk of being food illiterate by 60% (OR = 1.6, CI = 1.3-2.1, p < 0.001). Healthy parents, in contrast to those having a chronic disease (s), had a 60% higher probability of food illiteracy (OR = 0.4, CI = 0.3-0.6, p < 0.001). Educated parents had a three times higher risk of being food illiterate (vs. uneducated parents, OR = 3.0, CI = 1.6-5.8, p = 0.001). Parents making less than 3000 Saudi Riyal (SR) per month (<798 USD/779 EUR) were 40% more likely to be food illiterate than those who reported 3000-25000 SR (798-6652 USD/779-6499 EUR) (OR = 0.6, CI = 0.4-0.9, p = 0.02), and 70% more likely to be food illiterate than those making more than 25000 SR (>6652 USD/6497 EUR) (OR = 0.3, CI = 0.2-0.6, p < 0.001). Parents who lived in crowded households were twice as likely to be food illiterate as those who did not (OR = 1.9, CI = 1.5-2.4, p < 0.001).

Conclusion

The current study findings should be employed in future programming and policy-making approaches to reach Saudi parents for necessary food literacy interventions. These interventions could include bolstering their confidence while cooking, buying groceries, reading nutrition labels, and integrating them into nutrition education lessons with their children in school settings.

Development and evaluation of an intervention to improve food and nutrition literacy among Iranian Kurdish primary school children: An application of intervention mapping approach

Background

Food and nutrition literacy (FNLIT) is a relatively new term that is used to define the knowledge, skills, and behaviors necessary to achieve a healthy diet. Improving food and nutritional literacy in children is a necessary solution to eliminate nutritional disorders in this age group. The purpose of this study was to design, implement and evaluate an intervention to improve food and nutrition literacy in children aged 10-12 years old based on an intervention mapping (IM) approach.

Methods

This experimental study was performed in three phases. Through the first phase, an intervention was developed using the (IM) approach. In the second phase, the intervention was implemented for 6 months, and in the third phase, the intervention outcomes were evaluated and compared with the control group through a randomized controlled trial among 300 participants (each control and intervention group = 150).

Results

Before the intervention, there was no significant difference between the control and intervention groups in all subscales of FNLIT. After the intervention, there was a significant difference between the control and intervention groups in all subscales of FNLIT (P < 0/001). There were no differences between the two groups in terms of the FNLIT scores at baseline (P > 0.05). However, after 6 months of intervention, a significant difference was observed between the two groups (intra-group differences) (P < 0.001). Such a difference was not identified in the control group after 6 months also the results show the impact of socioeconomic factors and parental literacy on the average score of students' FNLIT and after the intervention, a significant difference was observed between the scores of control and intervention groups in all subscales of the FNLIT (P < 0.001).

Conclusions

The school-based intervention developed and evaluated in this study provides a basis for future programs targeting the improvement of FNLIT in children, especially in poor and deprived areas such as Kurdistan province.

Clinical trial registration

Iranian Clinical Trials Registry (IRCT) Code: 32094.

Development and validation of a short nutrition literacy scale for young adults

Background

Due to their high media use, young adults are frequently exposed to contradictory or even erroneous nutrition information. To properly handle and critically assess nutrition information, young adults (both general population and patient populations) need adequate levels of nutrition literacy. Currently there is a lack of suitable instruments to measure nutrition literacy in young adults (18-25 years). Therefore the aim of this study was to develop and validate a Short Nutrition Literacy (S-NutLit) scale for use in this age group.

Methods

Development and validation of the S-NutLit consisted of six phases: (1) item generation based on literature, (2) expert assessments to evaluate content validity, (3) cognitive interviews with the target population to assess face validity and readability, (4) pre-test to reduce the number of items, (5) validation survey to assess dimensionality with exploratory factor analyses, internal reliability with Cronbach alpha, construct and criterion validity by examining associations with age, gender, education level, health literacy, general literacy, dietary behaviors and physical activity with correlations, ANOVAs, and t-tests, (6) two-week follow-up survey to assess test-retest reliability with intra-class correlations.

Results

Starting from an initial pool of 53 items, expert assessments and cognitive interviews led to the reformulation, removal, and construction of items. Young adults aged 18-25 years participated in cognitive interviews (n = 12), pre-test (n = 101), validation survey (n = 300), and reliability survey (n = 92). The final S-NutLit consisted of 11 items rated on a 5-point scale distributed across two subscales (i.e., information skills and expert skills). Cronbach alpha values ranged from 0.79 to 0.83 and intraclass correlations from 0.61-0.79 (p < 0.001). Significant associations were observed with health literacy (r = 0.27, p < 0.001), general literacy and numeracy (r_s = 0.12, p = 0.046), and education level (r_s = 0.13, p = 0.025).

Conclusion

Findings indicate that the S-NutLit is a valid and reliable tool to assess nutrition literacy among young adults. The S-NutLit fills a gap in the field by offering a short measure of nutrition literacy and may be incorporated in digital technology to support the nutrition care process.

Nutrition literacy differs based on demographics among University students in Bengbu, China

Background

Nutrition literacy (NL) encompasses the knowledge and skills that inform individuals' food choices. This cross-sectional study explored factors associated with NL among Chinese university students in Bengbu, China.

Methods

A cross-sectional survey was carried out. Two thousand one hundred thirty-three university students were selected by stratified cluster sampling. A 43-item NL questionnaire was used to assess NL. Binary logistic regression was used to determine odds ratios (ORs) along with 95% confidence intervals (CIs) for NL and to test the interaction effects of multiple factors on total NL and its six dimensions.

Results

Of these participants, 1,399 (65.6%) were women and 734 (34.4%) were men. Students who were from urban areas (OR = 1.36, 95% CI: 1.08-1.72), were living with both parents (OR = 1.30, 95% CI: 1.02-1.65), and had high academic performance (OR = 1.85, 95% CI: 1.34-2.57) were more likely to report higher NL levels than did other students. The ORs for NL (OR = 1.60, 95% CI: 1.06-2.41), nutrition knowledge (OR = 1.51, 95% CI: 1.00-2.26), obtaining skills (OR = 1.76, 95% CI: 1.16-2.65), and critical skills (OR = 1.59, 95% CI: 1.05-2.39) were higher for medical students who had received nutrition education than for other students. The ORs for NL (OR = 2.42, 95% CI: 1.21-4.84), nutrition understanding (OR = 2.59, 95% CI: 1.28-5.25), and interactive skills (OR = 2.06, 95% CI: 1.04-4.08) were higher for only-child students and those with a monthly expenditure of >¥1500.

Conclusions

NL of university students differed in terms of place of origin, living arrangement, nutrition education, academic performance, and household income, and the findings imply that universities should have all students take a basic nutrition course to improve their NL.

Inequalities in the use of health services in a municipality in Southern Brazil in 2019: a cross-sectional study

OBJECTIVE

to assess inequalities in the use of health services in a municipality in Southern Brazil.

METHODS

This was a population-based cross-sectional study conducted with adults living in the urban area of the municipality of Criciúma, state of Santa Catarina, Brazil, between March and December 2019; the research outcomes were medical consultation, dental visit, nutritional counseling and the use of the Brazilian National Health System (Sistema Único de Saúde - SUS); the exposures were age, schooling and income; inequalities were analyzed using the Slope index of inequality and equiplots.

RESULTS

A total of 820 individuals were studied; medical consultation was higher (14.2 percentage points [p.p.]), and dental visit was lower (-29.5 p.p.), in older adults, when compared to young people; dental visit (41.1 p.p.) and nutritional counseling (18.0 p.p.) were higher in individuals with higher level of education, when compared to those with lower level of education; the use of SUS was higher in older adults (21.3 p.p.), with lower level of education (-61.2 p.p.) and lower income (-51.6 p.p.), when compared to their peers.

CONCLUSION

in order to develop public policies, these inequalities should be taken into consideration.

Japanese school children's intake of selected food groups and meal quality due to differences in guardian's literacy of meal preparation for children during the COVID-19 pandemic

In 2020, a state of emergency (SOE) was enforced by the Japanese government, which included temporary school closures with the aim of overcoming COVID-19 spread, which prevented access to school lunches. We evaluated the relationship between meal quality and guardians' literacy of meal preparation for a nationally representative sample of 1107 Japanese schoolchildren (aged 10-14 years) before, during, and after the SOE on the basis of 7 questions scored using a 5-point Likert scale. The guardians' literacy of meal preparation for children was divided into quartiles, with Q1 and Q4 including participants with the lowest and highest scores on food literacy, respectively. School lunch menu was handed out monthly to each household by their classroom teacher. The consumption of (i) meat, fish, or eggs and (ii) vegetables at least twice a day indicated "well-balanced dietary intake", which was less frequent in all four quartiles, especially for Q1 and Q2, during compared to before the SOE. The relative risk increases (95% CI) were Q1: -40.6% (-41.4% to -39.8%; p < 0.001), Q2: -34.0% (-34.7% to -33.3%; p < 0.001), Q3: -13.1% (-13.8% to -12.4%; p < 0.001), and Q4: -15.3% (-16.0% to -14.7%; p < 0.001), adjusted for sex, age, BMI, equivalent income adjusted for the number of household members, and educational level of parents. The interaction p was <0.001 for Q1-3 vs. Q4. Guardians with low total scores were significantly more likely to have less time, mental capacity, and financial ability to prepare meals after the SOE. Therefore, schoolchildren's meal quality deteriorated during the SOE, particularly among those with guardians with low food literacy even after adjustment for household income level and guardians' educational level.

Parent's food literacy and adolescents nutrition literacy influence household's food security and adolescent's malnutrition and anemia: Findings from a national representative cross sectional study

Introduction

Food and nutrition literacy are widely fundamental to improve the food security and reduce the double burden of malnutrition and iron deficiency in low- and middle-income countries.

Objectives

This study aimed (1) to assess the nutrition literacy (NL) of Lebanese adolescents and their parents' food literacy (FL), (2) to investigate the impacts of adolescents' NL and parental FL on (a) the household food security, (b) the adolescents' self-reported food security, and (c) the adolescents' nutrition status with a focus on malnutrition and anemia.

Methods

A national representative sample of 450 parent-adolescent dyads [parents: mean age ± standard deviation (SD) = 46.0 ± 7.0, mothers: 59.0%; adolescents: mean age ± SD = 15.0 ± 3.0, girls: 54.6%] were interviewed. Anthropometric and blood hemoglobin measurements were performed for adolescents. The Arab Family Food Security Scale and the Adolescent-Level Food Security Scale were used.

Results

Around 45.0% of the adolescents were nutritionally illiterate, and nearly half (47.8%) of parents had poor FL. Around 68.2 and 54.0% of the households and adolescents were food insecure, respectively. Moreover, 6.7, 4.7, 32.2, and 16.7% of the adolescents were stunted, thin, overweight/obese, and anemic, respectively. Poor parental FL increased the risk of household food insecurity (FI) by 2.7 times, p < 0.001. Adolescents' nutrition illiteracy increased their FI risk by 60.0% (p = 0.02). The number of offspring, household income, crowding status, and participants' residence also influenced the percentage of FI and malnutrition prevalence among households and adolescents.

Conclusion

Improvements in FL and NL are promising to mitigate FI malnutrition in Lebanon.

Evaluation of nutrition literacy and nutrition knowledge level in nursing students: a study from Turkey

OBJECTIVE

The determination of nutritional knowledge and nutrition literacy among nursing students will enable nursing departments to establish the needs and solutions to enhance nutrition education in their education programs. Therefore, this study is aimed to evaluate the nutrition literacy and nutrition knowledge level of nursing students.

METHOD

The study data were collected with 'Information Form', 'Anthropometric Measurements', 'Nutrition Knowledge Level Scale for Adults', and 'Evaluation Instrument of Nutrition Literacy on Adults'. Analyzes were performed using descriptive and nonparametric tests.

RESULTS

The score of nutrition knowledge is 56.6 ± 6.8 and 50.5% of them have a good nutrition knowledge level. The total nutrition literacy score is 28.6 ± 4.4 and 91.6% of them have a sufficient nutrition literacy level. It was no significant difference between students' characteristic features and nutrition knowledge score and nutrition literacy total score (p > 0.05). There was a statistically significant positive correlation between the nutrition knowledge score and the nutrition literacy total score and the nutrition literacy sub-sections scores (p < 0.05).

CONCLUSION

It has been determined that the nutrition knowledge and nutrition literacy levels of nursing students correlated with each other. To improve students' nutrition knowledge levels, as well as to improve their nutrition literacy and prevent non-communicable diseases nutrition lessons should be included in the curriculum.

Food Literacy and Dietary Intake in German Office Workers: A Longitudinal Intervention Study

Widespread patterns of poor dietary behavior are a key factor causing the increasing prevalence of chronic diseases around the world. Research has provided initial insights into the potential of food literacy (FL) to empower individuals to improve their dietary behavior. However, studies on FL interventions in working adults are scarce. The intervention delivered in this study was a comprehensive 3-week full time education-based workplace health promotion program (WHPP) that provided the participants with in-depth knowledge and skills regarding nutrition and health. We aimed to investigate the short- and long-term effects of the WHPP on FL and dietary intake (DI) and to examine the association between FL and DI in a sample of 144 German office workers (30.0% female). Using two random intercept mixed linear regression models, we found significant strong improvements for both FL (β = 0.52, p < 0.0001) and DI (β = 0.63, p < 0.0001) after the WHPP when compared to baseline. Significant long-term improvements at 18 months were strong for FL (β = 0.55, p < 0.0001) and weak for DI (β = 0.10, p < 0.0001). FL showed a significant moderate effect on DI across all measurement time points (β = 0.24, p < 0.0001). We conclude that well-designed WHPPs can induce long-term improvements in FL and DI, and that FL can be viewed as an asset to further expand food-related knowledge and skills and to enhance dietary behavior. Our study fills a gap of long-term findings regarding the role of FL in WHPPs and supports the idea of implementing FL in the development of comprehensive WHPPs to improve DI.

Association between the dietary literacy of children's daily diet providers and school-age children's nutritional status and eating behaviours: a cross-sectional study

BACKGROUND

Overweight and obesity rates have increased rapidly in Chinese school-age children, and previous studies have indicated that poor dietary literacy can lead to unhealthy eating behaviours. However, few studies have investigated the association between the dietary literacy of daily diet providers and the eating behaviours and nutritional status of school-age children raised by the providers. Thus, we aimed to explore this association.

METHODS

We collected data on the eating behaviours and nutritional status of children in two primary schools in Anhui Province, as well as the dietary literacy of their daily diet providers. T-tests, one-way ANOVA, chi-square tests, and multiple linear regression were used to analyse the association.

RESULTS

We found significant differences in the scores on the Questionnaire of Children's Daily Diet Providers' Dietary Literacy (QCDDPDL) by region, relationship with the child, age, and educational level of the daily diet provider (all p < .05). Moreover, the children in the low QCDDPDL score group were inclined to engage in unhealthy eating behaviours such as emotional undereating and overeating (p < .05). In addition, the incidence of overweight and obesity was higher in the low QCDDPDL attitude score group than in the high score group (p = .006).

CONCLUSIONS

Our study showed that the dietary literacy of diet providers may influence children's health and eating behaviours. Improving the dietary literacy of diet providers may promote the health status and eating behaviours of school-age children.

Development of a conceptual framework of food and nutrition literacy in children

BACKGROUND

This study aimed to develop a conceptual framework to better understand food and nutrition literacy and its dimensions and components among Iranian children.

METHODS

The study included three sub-studies. First, two qualitative studies were conducted to explore experts' and students' perspectives and experiences regarding the topic. A comprehensive qualitative literature review was then conducted to identify food/nutrition literacy definitions and its components in the relevant literature. The data of the above three sub-studies were compiled as text data and were analyzed utilizing MAXQDA₂₀₁₀ software.

RESULTS

Two main domains, including cognitive and skill domains, emerged from the data analysis. The cognitive domain consisted of food- and nutrition-related knowledge included four subcategories "nutrition knowledge", "lifestyle knowledge", "food safety knowledge", and "knowledge of food and its preparation") as well as "food and nutrition understanding". The skill domain consisted of three dimensions: "functional", "interactive", and "critical" food and nutrition literacy.

CONCLUSIONS

The developed framework highlights the importance of integrated application of all dimensions of food and nutrition literacy among this population group. It can assist policymakers and curriculum developers in assessing education curricula and developing effective strategies for teaching and learning to increase students' food and nutrition literacy.

Nutrition and Food Literacy in the MENA Region: A Review to Inform Nutrition Research and Policy Makers

BACKGROUND

Improving food and nutrition literacy is fundamental to tackling the Middle East and North Africa (MENA) region's enormous challenges, including malnutrition and food insecurity. To direct initiatives, it is crucial to assess the region's food and nutrition literacy. Thus, we aimed to review studies on food/nutrition literacy status in the MENA countries and illuminate the region's research gaps in these areas, in terms of assessment, policy, and program implementation.

METHODS

PubMed and Google Scholar databases were searched between 18 December and 8 May 2022, to identify relevant articles published up to 2022 in the MENA region.

RESULTS

Twelve studies were included in this review. Lebanon, Palestine, and Iran are the only three MENA countries where nutrition and/or food literacy were assessed. People in these countries mostly had inadequate food and/or nutrition literacy levels, especially in the skills rather than the cognitive domain. Food and/or nutrition literacy showed associations with food habits, food-label use, food-consumption patterns, school performance, food security, dietary diversity, and nutrient adequacy. The MENA countries developed no policies or programs to address food and nutrition literacy.

CONCLUSION

This review is a wake-up call for researchers and policymakers to develop a robust approach to combat food and nutrition literacy concerns in the MENA region.

The Relationships between Food Literacy, Health Promotion Literacy and Healthy Eating Habits among Young Adults in South Korea

The obesity problem has reached a critical level and is threatening not only personal health but also public health systems around the world. Obesity in young adults is especially rapidly growing and many studies have confirmed that the best prevention is developing healthy eating habits with the improvement of food and health promotion literacy competencies. In this context, this study diagnoses the present levels of food literacy and health promotion literacy among young adults and explores the relationships between both literacies and their healthy eating habits. A total of 325 young adults in South Korea participated in this research, and the results are as follows. First, all food literacy components, which are food and nutrition knowledge, food skills, and resilience, are positively associated with healthy eating habits. Second, health promotion literacy is also positively associated with young adults’ healthy eating habits. Lastly, unlike the primary information sources, gender has a moderating effect on the relationships between both literacies and healthy eating habits. This indicates that the government and educational sectors should propose more policy supports and solid education systems in order to help young adults develop their food and health promotion literacies for overall well-being in the future.

Validation of the Short Food Literacy Questionnaire in the Representative Sample of Polish Internet Users

Analogous to health literacy, food literacy can be defined as a set of cognitive and social skills associated with the ability to acquire and understand information about food and nutrition to make appropriate nutritional decisions. In the literature, several terms such as food, nutrition, or nutritional literacy are used in parallel, differing in some aspects of their meaning. Food literacy is an important measure of the effectiveness of nutritional education interventions and appropriate instruments for its measurement should be available in every society. The aim of this study was the assessment of the validity and testing of a proposed model of the Short Food Literacy Questionnaire (SFLQ) culturally adapted into Polish. The analysis was performed on data from an online survey in a representative sample of 1286 adult internet users. Exploratory (EFA) and confirmatory factor (CFA) analyses were performed on two different subsets obtained through random splitting of the initial dataset. The Polish version of the SFLQ had good internal consistency (Cronbach's α 0.841; Guttman split-half coefficient was 0.812). The EFA revealed that the tool had a three-factor latent structure. The distinguished dimensions were 'information accessing', 'knowledge', and 'information appraisal'. The subscales also showed acceptable internal consistency based on the values of the Cronbach's α coefficients (ranging from 0.768 to 0.845). The CFA confirmed a good fit of the three-factor model with at least five indexes achieving acceptable levels (CFI = 0.972, GFI = 0.963, AGFI = 0.940, NFI = 0.959, and RMSEA = 0.059). The validation of the Polish version of the SFLQ revealed, contrary to earlier reports, not a single but a three-factor structure of the instrument. The SFLQ will be an important tool for the assessment of the effectiveness of educational interventions and population studies analyzing the determinants of food literacy in Poland.

Spanish Validation of the Self-Perceived Food Literacy Scale: A Five-Factor Model Proposition

Food literacy is a combination of functional, critical, and relational skills that pave the way for navigating the food system properly, taking personally and contextually available resources into account. The aim was to validate the Spanish version of the self-perceived food literacy scale in university students to explore the factorial structure of it and to correlate food literacy with other variables. The sample was composed of 362 Spanish university students (314 women). The full questionnaire was administered online and also assessed adherence to a Mediterranean diet, impulsivity, and health-related quality of life for convergent validity testing purposes. Confirmatory factor analysis was conducted to determine the factor structure of the food literacy scale. The Spanish version of the scale showed good indices of internal consistency (Cronbach's α = 0.894). Confirmatory factor analysis revealed a five-factor model that had a better fit index than the seven-factor model of the original scale. External validity was assessed by showing significant correlations with the rest of the variables. Therefore, the Spanish version of the scale is a reliable and valid measure of food literacy. It could be used to promote policies at Spanish universities to improve the food-related behaviors of students.

Development of Nutrition Literacy Scale for Middle School Students in Chongqing, China: A Cross-Sectional Study

Background

Information on nutrition literacy of middle schoolers is limited and tools for measuring nutrition literacy of middle schoolers are inadequate. Nutrition literacy has a positive effect on health. Improving children's nutrition literacy can help them to master the necessary nutritional knowledge, develop a healthy lifestyle, and learn to supplement nutrition according to their own needs for healthy growth.

Objectives

To develop the Chongqing Middle school student Nutrition Literacy Scale (CM-NLS).

Methods

Three experiments were conducted. A theoretical framework and an initial item pool of CM-NLS were established based on the literature review. And the two-round Delphi method was used to explore the suitable acceptance indicators and items. Item evaluation and reduction were performed using the classical test theory. Then, the items in the final CM-NLS were tested for their validity and reliability amongst 462 middle school students. The construct validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The internal consistency reliability and split-half reliability were evaluated using Cronbach's alpha coefficients.

Results

The final CM-NLS consisting of 52 items that were based on three primary items (functional, interactive and critical) and six sub-items (obtain, understand, apply, interact, medial literacy and critical skill) was developed and validated. EFA suggested six factors explaining 69.44% of the total variance (Kaiser-Meyer-Olkin test = 0.916, Bartlett's test χ2 = 5,854.037, P < 0.001). CFA showed that the model fit the data adequately, with χ2/df = 1.911, root mean square error of approximation = 0.063, goodness-of-fit index = 0.822 and adjusted goodness of fit index = 0.790. The total CM-NLS Cronbach's alpha values of internal consistency and split-half reliability were 0.849 and 0.521, respectively, with reasonable reliability.

Conclusions

CM-NLS is a valid and reliable instrument for assessing nutrition literacy among middle school students in Chongqing. Specifically, it could be used by practitioners for needs assessment before the implementation of a nutrition education program.

Association Between Nutrition Literacy and Overweight/Obesity of Adolescents: A Cross–Sectional Study in Chongqing, China

Objective

The burden of overweight and obesity in adolescents is increasing rapidly. This study aimed to assess the association between nutrition literacy and overweight/obesity among adolescents in China.

Methods

This cross–sectional online study involving adolescents aged 10–18 years was conducted in September 2020 in 239 schools in Chongqing China. Overweight and obese adolescents were determined based on the International Obesity Task Force's recommended age–sex specific body mass index cutoff points. Nutrition literacy was measured using the “Nutrition literacy scale for middle school students in Chongqing (CM–NLS).” The CM–NLS included three subdomains (functional nutritional literacy, interactive nutrition literacy, and critical nutrition literacy). Multinomial logistic regression model was used to examine the association.

Results

A total of 18,176 adolescents (49.8% girls) were included. The prevalence of overweight and obesity was 9.6% and 17.0%, respectively. Compared with those having a low nutrition literacy score (below median), those with a high score were less likely to be overweight and obese. The odds ratio (95% CI) for overweight was 0.87 (0.79–0.97) (nutrition literacy) and 0.81 (0.73–0.90) (functional nutritional literacy). The corresponding figures for obesity were 0.84 (0.77–0.91) and 0.73 (0.67–0.80), respectively. Significant interaction existed between grade and nutrition literacy. The inverse association between nutrition literacy and overweight/obesity was significant among those in senior school but not among those in junior high school.

Conclusion

Nutrition literacy was inversely associated with overweight/obesity among adolescents, especially those attending senior high schools.

Dialogue as a tool of nutrition literacy in an agricultural intervention programme in Odisha, India

BACKGROUND

An ongoing action research nutrition literacy programme based on Freire's approach of raising critical consciousness through the use of dialogue as a pedagogic tool is being implemented as part of a nutrition sensitive agricultural intervention in tribal Odisha. One hundred and eight adults, referred to as Community Hunger Fighters (CHFs) underwent two modules of a residential training programme of two and a half days each, spread over two months. Through discussion they explored the reasons behind the lack of diversity in their daily diets and identified the social, economic and cultural barriers to food intake in the context of their own poverty. They undertook collective exercises in nutrition sensitive agricultural planning. The transformative behaviour of the CHFs was captured through observation, interviews and focus group discussion with a set of qualitative indicators.

RESULTS

The methodology of dialogue as a pedagogic tool generated a discussion about food security among the community. CHFs identified key messages and shared them with fellow villagers in imaginative ways. The process of critical reflection and analysis helped understand gender disparities, the bottlenecks in food production, brought in life style changes to improve food intake and created a demand for technical training for improving agricultural productivity. Thirty eight had started a nutri-garden and several took on leadership roles on other issues of importance besides food security.

CONCLUSION

Dialogue as a pedagogic tool for nutrition literacy in an agricultural intervention programme has the potential to facilitate a process of critical reflection on the socio cultural and economic barriers to food production and consumption thereby leading to transformative action.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s43170-022-00090-x.

[DNVF Memorandum Health Literacy (Part 2) - Operationalisation and Measuring of Health Literacy from a Health Services Research Perspective]

Das vorliegende „DNVF Memorandum Gesundheitskompetenz (Teil 2) – Operationalisierung und Messung von Gesundheitskompetenz aus Sicht der Versorgungsforschung“ des Deutschen Netzwerks Versorgungsforschung e.V. (DNVF) stellt die Fortführung des Memorandums „DNVF Memorandum Gesundheitskompetenz (Teil 1) – Hintergrund, Gegenstand und Fragestellungen in der Versorgungsforschung“ dar. Neben den allgemeinen Anforderungen an die Messung der Gesundheitskompetenz, beschäftigt sich dieses Memorandum auch mit den speziellen Anforderungen, wie die Abgrenzung zu verwandten Konstrukten, den Unterschieden zwischen performanzbasierten und Selbsteinschätzungsverfahren, den Unterschieden zwischen generischen und spezifischen Instrumenten, dem Einsatz von Screeninginstrumenten sowie der Messung der Gesundheitskompetenz bei speziellen Personengruppen. Weiterhin werden Besonderheiten bei der Messung der digitalen Gesundheitskompetenz, Potenziale qualitativer und partizipativer Forschungszugänge sowie forschungsethische Gesichtspunkte bei der Messung der Gesundheitskompetenz erarbeitet. Ein besonderer Wert wird auf den Praxisbezug gelegt, der am Ende der jeweiligen Abschnitte mit einem Fazit für die Versorgungsforschung aufgegriffen wird. Abschließend wird einen Blick auf Herausforderungen und Forschungsdesiderate im Zusammenhang mit der Messung von Gesundheitskompetenz im Rahmen der Versorgungsforschung geworfen.

Nutrition Literacy of Middle School Students and Its Influencing Factors: A Cross-Sectional Study in Chongqing, China

Nutrition literacy plays an important role in children's dietary habits and nutrition. This study aimed to analyse the status of nutrition literacy and its influencing factors amongst middle school students in Chongqing, China. “Nutrition literacy scale for middle school students in Chongqing” was used in 29 districts of Chongqing in September 2020. The scores of nutrition literacy and its' three sub-domains (functional, interactive and critical nutrition literacy) were divided into low and high groups based on their median scores. Binary logistic regression was used to measure the influencing factors of nutrition literacy. A total of 18,660 middle school students were included in this study. The median of nutrition literacy of middle school students was 61.68 (IQR = 14.37). Interactive nutrition literacy had the highest score (median = 70.00, IQR = 20.00), followed by functional nutrition literacy (median = 68.69, IQR = 14.14) and critical nutrition literacy (median = 45.83, IQR = 25.00). Students who were the minority (OR = 0.71, 95% CI = 0.637–0.785), in senior high school (OR = 0.51, 95% CI = 0.477–0.548), in rural areas (OR = 0.85, 95% CI = 0.790–0.911), receiving school meal support from the government (OR = 0.63, 95% CI = 0.591–0.664), with other caregivers' parenting (OR = 0.86, 95% CI = 0.805–0.914), with parents having a low level of education and with an abnormal BMI [thin (OR = 0.91, 95% CI = 0.837–0.990), overweight (OR = 0.87, 95% CI = 0.785–0.968), and obese (OR = 0.83, 95% CI = 0.767–0.902)] presented less probability of being a high level of nutrition literacy. Our results could assist public health authorities in developing strategies of nutrition literacy promotion for references and theoretical foundations.

The Association Between Adolescents' Food Literacy, Vegetable and Fruit Consumption, and Other Eating Behaviors

Adolescents’ intake of vegetables and fruits is generally low, and many demonstrate unhealthy eating behaviors. Food literacy may be key to improving adolescents’ nutrition. However, the relationship between food literacy, fruit and vegetable intake, and other healthy eating behaviors remains unclear, as well as how these relationships may differ among boys and girls. This study assessed the relationship between food literacy (including food skills and cooking skills), vegetable and fruit consumption, and other eating behaviors of adolescents. This cross-sectional study included 1,054 students, including 467 boys and 570 girls from five francophone high schools in New Brunswick, Canada. Quantitative data on students’ food and cooking skills, vegetable and fruit consumption, and other eating behaviors were collected with a self-reported questionnaire. Multilevel regressions were used to assess the relationship between food literacy, students’ consumption of vegetables and fruits, and other eating behaviors. Better cooking skills were associated with healthier eating behaviors and greater vegetable and fruit consumption for boys and girls. Better food skills were also associated with healthier eating behaviors and greater vegetable and fruit consumption among both genders. These findings highlight the importance of improving food literacy among adolescents. Public health interventions should focus on increasing cooking and food skills to improve adolescents’ nutrition.

A systematic scoping review of the literacy literature to develop a digital food and nutrition literacy model for low-income adults to make healthy choices in the online food retail ecosystem to reduce obesity risk

Adults with lower incomes are disproportionately affected by poverty, food insecurity, obesity, and diet-related non-communicable diseases (NCDs). In 2020-2021 amid the coronavirus disease 2019 (COVID-19) pandemic, the United States Department of Agriculture (USDA) expanded the Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot program to enable eligible participants to purchase groceries online in 47 states. This expansion underscores the need for SNAP adults to have digital literacy skills to make healthy dietary choices online. Currently, a digital literacy model does not exist to help guide USDA nutrition assistance policies and programs, such as SNAP. We conducted a systematic scoping review of the academic and gray literature to identify food, nutrition, health, media, financial, and digital literacy models. The search yielded 40 literacy models and frameworks that we analyzed to develop a Multi-dimensional Digital Food and Nutrition Literacy (MDFNL) model with five literacy levels (i.e., functional, interactive, communicative, critical, and translational) and a cross-cutting digital literacy component. Utilization of the MDFNL model within nutrition assistance policies and programs may improve cognitive, behavioral, food security, and health outcomes and support equity, well-being, digital inclusion, and healthy communities to reduce obesity and NCD risks.

What Is the Impact of Nutrition Literacy Interventions on Children's Food Habits and Nutrition Security? A Scoping Review of the Literature

Introduction: Nutrition literacy is a relatively new concept that seems to have a relevant role on the quality of people’s diets; however, we do not know the role of nutrition literacy interventions on children’s food habits and nutrition security. Methods: We conducted a literature review on four databases (PubMed, Embase, Web of Science, and Cochrane) and we considered studies describing the impact of interventions aimed at improving the quality of children’s diet. Results: A total of six articles were finally included. The total number of participants included in the studies was 4016, and the median study size was equal to 224 participants. Studies included in the review reflected a broad heterogeneity of interventions. Conclusions: The results were contrasting and revealed that the most effective type of nutrition literacy interventions included the following characteristics: technological components, involvement with multiple modalities, duration of more than 4 weeks, and face to face sessions.

How a 7-Week Food Literacy Cooking Program Affects Cooking Confidence and Mental Health: Findings of a Quasi-Experimental Controlled Intervention Trial

Obesity and mental health disorders are rising simultaneously with shifting dietary behavior away from home cooking, toward typically nutrition-poor and energy-dense convenience meals. Food literacy strongly influences nutrition choices. Community-based cooking interventions target barriers to healthy eating and facilitate development of food literacy skills, thereby potentially increasing preparation of home-cooked meals and positively influencing health. This study of 657 healthy Australian adults explored the efficacy of a 7-week cooking program in improving cooking confidence, whether this transferred to behavior surrounding food, and/or affected mental health. Significant post-program improvements in cooking confidence and satisfaction (all p &lt; 0.001, ηp2 1.12 large), ability to change eating habits (p &lt; 0.001) and overcome lifestyle barriers (p = 0.005) were observed for the intervention group but not control. Participation also improved mental and general health (all p &lt; 0.05, ηp2 0.02 small). No changes were observed for acquisition and consumption of food, or nutrition knowledge in either group. This 7-week cooking program built cooking confidence and improved general and mental health but did not change dietary behavior. To further improve nutrition related behaviors associated with better mental health, more effort is needed to recruit those with below-average nutrition knowledge and interest in cooking.

Evaluation of Dietary Quality Based on Intelligent Ordering System and Chinese Healthy Eating Index in College Students from a Medical School in Shanghai, China

We intended to precisely evaluate the dietary quality of male and female medical college students using canteen data from the “Intelligent Ordering System” (IOS), combined with the supplemental food frequency questionnaire (SFFQ) and the Chinese Healthy Eating Index (CHEI) in Shanghai, China, to explore the potential factors influencing dietary quality. A total of 283 college students with the average age of 24.67 ± 3.21 years and Body Mass Index of 21.46 ± 3.49 kg/m² in the medical school were enrolled in this study, and an online questionnaire investigation was conducted to collect the general information, lifestyle behavior, and SFFQ. The dietary data of the study participants from the school canteen were exported from the IOS of the Information Office of Fudan University. The CHEI consists of 17 components and the total score is 100, with a maximum score of each component of 5 or 10. We calculated each component score of the CHEI and aggregated the total score for male and female study participants. The Chi-square test and Wilcoxon rank sum test were employed in comparing the differences between the demographic characteristics and CHEI component scores of males and females. Univariate and multiple linear regression models were employed to examine the potential influencing factors of the total CHEI score. The CHEI median score was 66.65, and the component score for total grains was relatively low. Added sugars was the most overconsumed CHEI component. There were relatively serious deficiencies, based on the CHEI component scores, in fruits, soybeans, fish and seafood, and seeds and nuts in both sexes. Females had significantly higher CHEI scores than males (68.38 versus 64.31). The scores for tubers, total vegetables, dark vegetables, fruits, fish and seafood, dairy, and red meats were significantly higher in females than in males. Influencing factors including sex, education, dietary health literacy, and amount of time spent sedentarily were significantly associated with CHEI score. Our research revealed that the overall dietary quality needs to be further improved for college students at the medical school in Shanghai, China, with low intakes of total grains, fruits, soybeans, fish and seafood, and seeds and nuts, and high intakes of added sugars. Compared with males, females showed higher diet quality and conformed more strongly with the recommended Dietary Guideline for Chinese. Education, dietary health literacy, and amount of time spent sedentarily should be noted for improving the dietary quality of college students.

The Validation and Improvement of a Food Literacy Behavior Checklist for Food Literacy Programs

Food literacy is a multidimensional construct required to achieve diet quality. The Food Sensations^® for Adults (FSA) program aims to improve the food literacy of low to middle-income adults living in Western Australia and is funded by the Western Australian Department of Health. The original published behavior checklist used to measure change in food literacy has been revised based on experience of the facilitators and the iterative development of the program. This research sought to assess the validity and reliability of the improved food literacy behavior checklist. A total of 1,359 participants completed the checklist over an 18-month period. Content, face, and construct validity were considered in the re-development of the checklist. An exploratory factor analysis of the checklist identified three factors: (1) Plan and Manage, (2) Selection, and (3) Preparation. Cronbach’s alpha coefficients of 0.883, 0.760, and 0.868 were found for each of the three factors respectively. These coefficients indicated good internal consistency and were higher than those found in the original checklist analysis. An external validation was undertaken with the original food literacy behavior checklist, and a strong positive relationship between the two tools was found. In addition to being used to evaluate FSA, this revised and extensively validated tool could provide guidance to others evaluating similar food literacy programs and contribute to international measurement research.

Associations between socio-demographics, nutrition knowledge, nutrition competencies and attitudes in community-dwelling healthy older adults in Singapore: findings from the SHIELD study

Background

Nutrition literacy refers to an individual’s knowledge, motivation and competencies to access, process and understand nutrition information to make nutrition-related decisions. It is known to influence dietary habits of individuals including older adults. This cross-sectional study was designed to: (1) understand the nutrition knowledge, competencies and attitudes of community-dwelling older adults in Singapore, (2) examine the differences between their nutrition knowledge, and socio-demographic factors, competencies and attitudes and (3) identify factors associated with better nutrition knowledge in older healthy adults in Singapore.

Methods

A total of 400 (183 males and 217 females) nourished community-dwelling older adults aged 65 years and above took part in this study. Malnutrition Universal Screening Tool (MUST) was used to determine individuals who were at low risk of undernutrition. Nutrition knowledge, competencies, attitudes and sources of nutrition information were measured using a locally developed scale. Nutrition knowledge scores were summed to form the nutrition knowledge index (NKI). Associations between NKI, competencies, attitudes and socio-demographic variables were examined using Chi-square and Fisher’s exact tests. Factors associated with NKI were determined using a stepwise regression model with resampling-based methods for model averaging.

Results

Bivariate analyses found significant differences in NKI scores for gender, monthly household earnings, type of housing, the self-reported ability to seek and understand nutrition information and having access to help from family/friends. Females had higher NKI scores compared to males (p < 0.001). Compared to females, more males left food decisions to others (p < 0.001), and fewer males reported consuming home-cooked food (p = 0.016). Differences in educational level were found for competencies like the self-reported ability to seek (p < 0.001) and verify nutrition information (p < 0.001). Stepwise regression analysis showed that being female, Chinese, self-reported ability to understand nutrition information and having access to help from family/friends were associated with higher NKI scores.

Conclusions

Our study revealed that nutrition knowledge of older males in Singapore was lower than females and more left food decisions to others. Nutrition education programs could be targeted at both the older male, their caregivers and minority ethnic groups.

Trial Registration This study was registered on 7 August 2017 at clinicaltrials.gov (ref. NCT03240952).

Pool of items to measure Primary Health Care workers' knowledge on healthy eating

OBJECTIVE

To develop and validate a self-applicable instrument for measuring primary health care (PHC) workers' knowledge on healthy eating.

METHODS

A six-step methodological study to develop and validate a measurement instrument: item development based on the Brazilian Dietary Guidelines' chapters; content validation with a panel of experts; face validation with potential instrument users; online instrument reevaluation by participants of the content and face validation panels; online application of the instrument with PHC workers; confirmatory factor analysis for construct validation.

RESULTS

A first version with 25 items underwent content and semantic changes in the content and face validation panels, being reorganized into a second version with 22 items. In the reevaluation, participants considered 21 questions to be clear and representative of the Brazilian Dietary Guidelines, with one being excluded. This third version of the instrument underwent confirmatory factor analysis after being applied online with 209 PHC workers from all Brazilian macroregions. We excluded five items in this analysis: four due to bivariate empty cells and one due to low discrimination capacity. The final model, with 16 items loaded onto one dimension, returned good fit indices [χ2(104) = 119.047, p = 0.1486; RMSEA = 0.026 (90% CI = 0.000 to 0.046), Cfit = 0.979; CFI = 0.924; TLI = 0.913]; its information peak was below average.

CONCLUSIONS

The instrument proved to be valid and accurate for assessing PHC workers with below average knowledge of the Brazilian Dietary Guidelines. It might contribute to improving actions to promote healthy eating in Brazilian PHC settings by identifying the need for training health professionals.

Nutrition Literacy and Healthy Diet: Findings from the Validation of a Short Seniors-Oriented Screening Tool, the Spanish Myths-NL

A good level of nutrition literacy (NL) is proposed as a determinant factor for following a healthy diet. Improving seniors’ NL might be particularly pertinent to enhance the quality of their diets. This study aimed to systematically design and validate a short seniors-oriented questionnaire as a screening tool to evaluate NL. We developed the Myths-NL questionnaire, composed of 10 widespread nutrition myths, and checked for its content and face validity. An observational cross-sectional study was conducted to explore the validity and the test–retest reliability, involving a community-dwelling group of 316 individuals aged 65 years and over. Construct validity was proved by establishing both discriminant and convergent validity. Cronbach α = 0.61 and Spearman r = 0.79 (p = 0.02) demonstrated internal consistency and test–retest reliability. Participants who had secondary/university studies scored significantly higher compared with those with primary (p < 0.001), and a significant linear relationship (R2 = 0.044, p = 0.001) with a positive slope (β = 0.209) between Mediterranean Diet Adherence Screener (MEDAS) and Myths-NL scores was observed, proving construct validity. In conclusion, the Myths-NL questionnaire is a valid and reliable tool to screen NL in Spanish seniors and it might be useful as an assessment NL tool for designing and implementing lifestyle interventions to promote healthy eating.

'We are all in this together': Investigating alignments in intersectoral partnerships dedicated to K-12 food literacy education

BACKGROUND

Activities to foster food literacy in young people are increasingly common in schools, driven both by the public health sector and by curriculum mandates from education officials in government. In Canada, both Kindergarten-Grade 12 (K-12) classroom teachers and educators from community organisations deliver food literacy education programmes in schools, often framed as partnerships working in the interests of young people.

OBJECTIVE

The study examines the alignment between what both classroom teachers and community educators state are the desired outcomes for students of their food literacy education work and the topics/activities they engage in with students.

DESIGN SETTING AND METHOD

We surveyed and interviewed teachers and community educators in British Columbia, Canada, and utilised participant observation and secondary data from food literacy education network activities.

RESULTS

Shared food literacy education goals and topics/activities were evident in the responses of classroom teachers and community educators. Teachers framed their food literacy education programmes around the curriculum-as-plan - in this case, the provincial curriculum known as the BC Curriculum - and then enacted a lived curriculum that students experienced in the classroom. Community educators offered programmes that were initially designed to meet their organisation's focus, but which varied in terms of how much of the BC Curriculum was addressed.

CONCLUSION

Our results show broad alignment between teachers and community educators in food literacy education goals and practices; however, there is potential to increase this alignment and build stronger partnerships that support teachers in enacting the BC curriculum and meeting the needs of their students.

Association between thyroid disorders and COVID-19: a protocol for a systematic review and meta-analysis

Background

The novel coronavirus (COVID-19) epidemic initially appeared in Wuhan, Hubei Province, China, on 31 December 2019 and was spread rapidly worldwide. Most underlying diseases reported with COVID-19 patients are diabetes, hypertension, coronary heart diseases, and cerebrovascular disease. We do not know whether individuals with thyroid disease are at increased risk of COVID-19 infection.

Methods

Two experienced researchers will conduct an electronic search of the databases including PubMed/MEDLINE, the Cochrane Reviews, and the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and ProQuest, for articles published since October 2019. Clinical trials and observational studies will be included. Studies will be screened after de-duplication. A standardized data extraction form will be developed through discussions with the review team and will be revised after piloting. An appropriate risk of bias assessment tool will be used to assess the quality of studies. Two independent reviewers will assess the eligibility, extraction of detailed information, and quality assessment of studies. The results will be pooled for meta-analysis, subgroup analysis and/or descriptive analysis based on the included data conditions.

Conclusion

Results of this study will provide current evidence on the association of COVID-19 diseases with any thyroid disorders such as hypothyroidism, thyrotoxicosis, and thyroid cancer with or without radioiodine therapy. Findings will be disseminated in peer-reviewed publications and conference presentations.

Trial registration

PROSPERO registration number: CRD42020184289.

https://www.crd.york.ac.uk/PROSPERO/#recordDetails

Supplementary Information

The online version contains supplementary material available at 10.1186/s13044-021-00113-1.

Applying a Multi-Dimensional Digital Food and Nutrition Literacy Model to Inform Research and Policies to Enable Adults in the U.S. Supplemental Nutrition Assistance Program to Make Healthy Purchases in the Online Food Retail Ecosystem

The United States (U.S.) Department of Agriculture (USDA)-administered Supplemental Nutrition Assistance Program (SNAP) made substantial changes in response to the coronavirus disease 2019 (COVID-19) pandemic. These changes highlight the need to identify the digital literacy skills and capacities of SNAP adults to purchase healthy groceries online. We conducted a scoping review of four electronic databases, Google and Google Scholar to identify studies that measured food and nutrition literacy outcomes for U.S. adults. We applied a multi-dimensional digital food and nutrition literacy (MDFNL) model to assess six literacy levels and components. Of 18 studies published from 2006-2021, all measured functional and interactive literacy but no study measured communicative, critical, translational, or digital literacy. Six studies examined SNAP or SNAP-Education outcomes. Adults with higher food or nutrition literacy scores had better cognitive, behavioral, food security and health outcomes. We suggest how these findings may inform research, policies, and actions to strengthen the multi-dimensional literacy skills of SNAP participants and SNAP-eligible adults to support healthy purchases in the online food retail ecosystem.