Food and nutrition education in private Indian secondary schools

Indian fathers' perceptions of young childcare and feeding - A qualitative study

The role of parents in fostering children's healthy habits is a robust area of research. However, most of the existing literature predominantly focuses on mothers' parenting practices. Given the emergence of nuclear, dual earning families and the recent surge in maternal employment in urban India, fathers' engagement in child rearing and feeding warrants attention. The purpose of this research was to document the views of Indian fathers about paternal parenting practices, with an emphasis on children's diet among other health behaviors. Thirty-three fathers of children aged 6-59 months from Kolkata, India took part in semi-structured interviews conducted either face-to-face or over Zoom/telephone in Hindi, Bengali, and English. The interviews were audio recorded, transcribed verbatim, and translated to English. The transcribed data were subjected to thematic analysis informed by the Template Analysis technique. Themes were detected using the NVivo software program. Overall, these Indian fathers played an important role in early childhood care and feeding as reflected in the following seven themes: (i) Involvement of fathers in various childcare activities; (ii) Implementation of responsive and non-responsive feeding practices; (iii) Concerns regarding fussy and slow eating; (iv) Concerns regarding excessive screen time; (v) Paternal vs maternal parenting; (vi) Barriers to routine engagement of fathers in childcare; (vii) Desire for more nutrition and health knowledge. This enhanced understanding of paternal parenting behavior supports the inclusion of fathers in future family-focused lifestyle interventions aimed at improving children's health outcomes, including their dietary habits.

Indian adolescents' perceptions of anaemia and its preventive measures: Aqualitative study

High prevalence of anaemia is a severe public health problem in several low- and middle-income countries like India. A qualitative inquiry was designed to understand the perceptions of adolescents regarding anaemia and anaemia prevention measures. Convenience sampling was employed to recruit 39 adolescents (19 girls; 20 boys) from Tikari, India. Interviews were carried out in the local language, audio-recorded and transcribed verbatim. Hemoglobin concentration was also assessed from a single drop of capillary blood using the HemoCue, and the participants were asked to share their Science/Biology and Home Science textbooks. Interview data was analysed thematically. Descriptive statistics were used to examine the distributions of the hemoglobin data while textbooks were analysed using content analysis to verify the coverage of anaemia and anaemia-related matter. Seven themes were identified: (i) Poor understanding of the term anaemia; (ii) Minimal discussion about anaemia in classroom; (iii) Limited knowledge about symptoms of anaemia; (iv) Limited awareness about prevention and cure of anaemia; (v) Perception of iron folic acid and deworming tablets among students; (vi) Lack of contribution of health workers in the prevention of anaemia; (vii) No knowledge of 'Anemia free India' programme. More than half of the sample had anaemia (16.7% mild anaemia, 33.3% moderate anaemia, 2.8% severe anaemia). Content analysis revealed that there was limited discussion about anaemia in both Home Science and Science textbooks. Behavioural interventions should focus on inculcating healthy culinary and dietary practices and addressing the gaps in knowledge and understanding of anaemia and its prevention among adolescents.

Indian fathers are involved in nurturing healthy behaviours in adolescents: A qualitative inquiry

BACKGROUND

Indian adolescents exhibit unhealthy food behaviours and inactive lifestyles which increase their risk of developing obesity and associated negative health consequences. The family food environment represents a vital setting to nurture healthy lifestyle behaviours in adolescents, with parents influencing their adolescents' dietary and physical activity behaviours. Yet, much of the existing evidence exploring parental influences predominantly focuses on mothers while fathers' engagement in instilling healthy dietary and physical activity behaviours is understudied, more so in the context of developing economies like India. Therefore, this qualitative study was designed to understand Indian fathers' views on instilling healthy behaviours in their children.

METHODS

Convenience sampling along with snowball sampling techniques were employed to recruit fathers of adolescents aged 10-19 years from Kolkata city, India. Informed by the research aim and review of literature, an interview guide was developed and pre-tested. Interviews were carried out either in person or virtually (Zoom/telephone) in English/Hindi/Bengali as per the preference of the participants. All interactions were audio recorded, transcribed verbatim, and translated to English for the purpose of data analysis. The transcripts were analysed thematically using NVivo software program. Themes were identified using both inductive and deductive approaches.

RESULTS

A total 36 fathers participated in the interviews. Seven main themes were identified: (i) Involvement of fathers in adolescent upbringing (i.e. engagement in meal preparation, food shopping, educational activities, physical activity); (ii) Family food environment (i.e. setting food rules, having meals with children, making food available); (iii) Challenges to instilling healthy behaviours in adolescents (i.e. adolescents' sedentary lifestyle and liking for unhealthy foods); (iv) Barriers to routine involvement in adolescent upbringing (i.e. time constraints due to paid employment, poor socio-economic status); (v) Adolescent nutrition education: (vi) Dual burden of malnutrition (i.e. awareness of malnutrition, no knowledge about government-led health programs for adolescents); (vii) Paternal knowledge.

CONCLUSIONS

The emerging themes reveal that Indian fathers played a crucial role in instilling healthy dietary and physical activity behaviour in their adolescents through various parenting practices such as purchasing nutritious food, enforcing food rules, disseminating nutrition-related knowledge, and encouraging adolescents to participate in moderate-to-vigorous intensity outdoor sports. This provides strong support for the inclusion of fathers in sustainable family-focused lifestyle interventions to maximise the nurturing care required by adolescents as well as assist in normalising the representation of fathers in health and welfare policies designed for adolescents.

How do adolescents classify foods as healthy and unhealthy?: A qualitative inquiry from rural India

Indian adolescents exhibit obesogenic dietary habits including low intake of fruits and vegetables and increasing consumption of fast food and carbonated beverages. Adolescents' classification of healthy and unhealthy foods is likely to have significant implications for their dietary behaviour, and consequently, their health. However, there is limited evidence about the ways Indian adolescents classify foods as healthy or unhealthy. Hence, this qualitative study was designed to explore how Indian adolescents classify nutritious or non-nutritious food choices. Convenience sampling was used to recruit the study participants from Tikari village in Uttar Pradesh, India. Underpinned by the social constructivist lens, the adolescents were interviewed face-to-face in Hindi. All the interactions were digitally recorded, transcribed verbatim, and translated into English prior to data analysis. Transcribed data were analysed thematically using inductive as well as deductive coding, and subsequently, conceptual themes were extracted. A total of thirty-nine adolescents (twenty boys; nineteen girls) aged 10-19 years participated in this qualitative inquiry. The adolescents classified healthy and unhealthy foods based on the following six themes: (i) Food groups and nutrients; (ii) Health and immunity; (iii) Type of ingredient; (iv) Place and time of food preparation; (v) Packaging; and (vi) Parental influence. These findings can inform school-based food literacy interventions to foster healthy dietary habits and cooking skills among Indian adolescents.

Promoting nutritional education in primary school children

BACKGROUND

Inadequate nutrition knowledge leads to poor dietary choices to the detriment of the overall health of individuals and populations due to the likelihood of the development of various ill health conditions such as obesity and malnutrition. Childhood is the stage that sets a nutritional precedent for life and the attitudes, and beliefs developed in childhood tend to last for the individual's lifespan. Therefore children should be provided with adequate nutritional knowledge to enable longer term healthier food choices.

AIM

This study aimed to devise an appropriate strategy for the promotion of nutrition education in primary school children and to evaluate the effectiveness of the intervention.

METHOD

A survey was used to assess the level of nutrition knowledge in children followed by the provision of nutrition education through sessions focusing on adopting easily understandable terms for nutrients and teaching at their level of understanding and education. Techniques such as audiovisual aids and question-and-answer sessions were used to make the sessions entertaining. The outcomes were evaluated through the same survey that was used pre-intervention. Data are presented from a quantitative analysis.

RESULTS

The outcomes of the first survey showed a major need for providing nutrition education to students as the students were barely aware of nutrients and the functions of foodstuffs and therefore made poor food choices. However, the post-intervention survey showed a significant improvement in nutritional knowledge, and the majority of the students knew how to make healthier food choices.

Indian adolescents' perceptions of packaged food and food labels - A qualitative inquiry

In the last two decades, India has witnessed a dramatic rise in the consumption of packaged foods, especially among adolescents. Food labelling is often recognised as an instrumental population-based approach which can enable consumers to make informed food choices by providing all the necessary details about the food product on the packaging. In the Indian context, where adolescent obesity and the ensuing non-communicable diseases are escalating, it is crucial to understand adolescents' views on the use of non-nutritious packaged foods and food labels. Therefore, the aim of this qualitative inquiry was to explore Indian adolescents' perceptions regarding the consumption of packaged food and use of food labels. Convenience sampling was employed to recruit 29 boys and 15 girls (aged 10-19 years) from rural Varanasi, India. Semi-structured, face-to-face interviews were conducted in the local language. Interview recordings were transcribed verbatim and translated to English. Narrative data were subjected to thematic analysis using NVivo software program. The adolescents reported frequent consumption of packaged food like potato chips, biscuits, chocolates, deep-fried Indian snacks both at school and home. Packaged foods were regarded as tasty, safe, and fresh. Brand name, date of expiry and cost were often read by the study respondents. Nevertheless, they reported difficulty in understanding other components of the label (e.g., nutrition information) and they were not aware of the negative impact of consuming unhealthy packaged foods. Nearly all the respondents insisted that food labels should be written in the local language for easy understanding. These emerging findings underscore the need to design school-based food literacy programs for vulnerable Indian adolescents to address obesity and diet-related complications in early adulthood.

Transformation in culinary behaviour during the COVID-19 pandemic: In-depth interviews with food gatekeepers in urban India

COVID-19 and its associated regulatory measures including lockdowns, curfews, and physical distancing norms have significantly affected individual's dietary and culinary behaviours. Although there is ample empirical evidence available on dietary changes within the Indian context, very limited evidence exists about the factors influencing these dietary modifications and changes in culinary behaviours during COVID-19 lockdown. Therefore, the aim of this qualitative study was to explore the views of Indian household food gatekeepers towards meal planning, food purchasing, and meal preparation during the pandemic and its associated lockdowns. A convenience sample of 34 female gatekeepers from the Mumbai metropolis participated in online interviews. Interviews were conducted in English and Hindi (then translated in English), audio-recorded and transcribed verbatim. Underpinned by Template Analysis technique, transcribed data were analysed manually and using the NVivo software program. The interview structure guided the development of themes. The emerging themes included were: Increased household cooking; Involvement of children and male members in food-related activities; Experimentation in the kitchen; Adoption of meal planning skills; Increase in online food shopping; Bulk buying; Shortage of food items; Reduced consumption of outside home food; Increased variety of home-cooked meals; Increase in snacking and overall food intake; Determinants of food choices; and Family meals-a new norm. In the light of these findings, developing family-focussed, web-based nutrition programs to enhance gatekeepers' and their families' food literacy including declarative and procedural nutritional knowledge would be beneficial. The importance of organisational culinary behaviours such as planning meals in advance, shopping with a food list should be promoted to prevent hoarding and subsequently reduce strain on the food supply system. With a surge in domestic cooking, low cost nutritious recipes with the use of local and seasonal produce should be emphasized promoting healthy eating among the gatekeepers and their family members. The inclusion of food studies in the school curriculum will facilitate the development of culinary skills among children and youth. Also, there is a need for further research and surveillance to strengthen understanding of sustainability of healthy culinary behaviours practiced during the pandemic.

Nutrition knowledge and its relation with dietary behaviour in children and adolescents: a systematic review

OBJECTIVES

This review explored the relationship between knowledge among children and adolescents and their dietary behaviour.

CONTENT

Potentially eligible original research articles were identified through a systematic search in PubMed, SCOPUS, Web of Science and WHO Virtual Health Library from 2000 to 2018. From the initial search, a total of 7,258 research articles were obtained. Duplicate studies were identified and removed. Observational studies on children and adolescents (5-19 years) of any gender, ethnicity and country were included in which the outcome measured was either a scoring of/ association between nutrition knowledge and practices. After screening using the inclusion criteria, 13 studies were selected for this paper.

SUMMARY AND OUTLOOK

Four studies reported non-significant association between overall nutrition knowledge and practices. Only two studies found a significant association, out of which one showed a weak association highlighting that nutrition knowledge is not sufficient to result in healthy eating. Other factors which showed significant but weak associations with knowledge/practices included age, gender, nutritional status and lifestyle, peer influence, parents'/guardians' knowledge, education and occupation level. The causal relationship couldn't be examined in the present review due to the cross-sectional nature of the studies. Besides imparting knowledge through nutrition education interventions, there is a need for holistic behaviour change strategies including supporting food skills like menu planning, food shopping and cooking to encourage healthy eating habits among children. These interventions should target children from an early age, involving family/parents, teachers and peers to facilitate improvement in the food environment for sustainable change.

Promotion of Healthy Eating in Spanish High Schools

Obesity and overweight are both public health problems, affecting increasingly younger populations. Promoting healthy eating should be a must in schools. Therefore, getting to know the eating habits of a population group as sensitive as adolescents and whether their schools apply an appropriate policy for their nutrition should be a priority. Therefore, the objective of this study was to discover whether the Secondary Education High Schools of Huelva and its province could be considered as centres that promote a healthy diet. A cross-sectional descriptive study was developed using a questionnaire comprising 39 indicators that were evaluated on 5 previously piloted subcategories of validated information. Data were obtained through a questionnaire presented to 200 key informants with four different profiles. The highest score for promoting healthy eating in the centres was related to the subcategory "School Curriculum", whereas the lowest means were those related to the Community category. No practical activities such as outings or cooking workshops were carried out. The low participation in activities promoting healthy eating habits, research and health training must be highlighted. Little attention was paid to compliance and monitoring of school cafeterias. Most of the studied Secondary Education High Schools did not meet the requisites to be considered promoters of healthy eating habits. Only three of the studied centres can be considered healthy-eating promoters. Institutional commitment is needed to favour the intersectorality of the different agents implied and to provide teaching units and other teaching profiles with the necessary resources, training, and tools to achieve integral and protective teaching activities aimed at promoting students' healthy eating habits.

Fiction Is Sweet. The Impact of Media Consumption on the Development of Children's Nutritional Knowledge and the Moderating Role of Parental Food-Related Mediation. A Longitudinal Study

Nutritional knowledge is an important cognitive facilitator that potentially helps children to follow a healthy diet. Two main information agents influence children’s development of nutritional knowledge: the media and their parents. While a high amount of media consumption potentially decreases children’s nutritional knowledge, parents may shape the amount of information children can gather about nutrition through their food-related mediation styles. In addition, children’s individual preconditions predict how children can process the provided nutritional information. This two-wave panel study with children (N = 719; 5–11 years) and their parents (N = 719) investigated the main effects and interplay of children’s amount of media consumption and their parents’ food-related mediation styles by performing linear regression analysis. Children’s individual preconditions were also considered. We measured children’s self-reported amount of media consumption, children’s age, sex, weight, and height (BMI). Additionally, in a parent survey we asked parents about how they communicate their rules about eating while especially focusing on active and restrictive food rule communication styles. As a dependent measure, we examined children’s nutritional knowledge at Time 1 and 2. The results show that the amount of media consumption has a negative effect on children’s nutritional knowledge over time. Parents’ restrictive or active food-related mediation asserted no main effects and could not lever out the negative effect of the amount of media consumption. Therefore, we argue that parents should limit children’s amount of media consumption to avoid the manifestation of misperceptions about nutrition.

"Do you think adolescents' food intake is satisfactory?" - Views of Indian parents and teachers

Adolescents develop food habits that affect both their present and future health. Underpinned by the stakeholder theory, this study was designed to explore the perspective of parents and nutrition educators regarding urban Indian adolescents' food habits. Thirty-two educators and 280 parents from five independent, English-speaking, secondary schools in Kolkata, India completed a paper-based instrument consisting of both closed and open-ended measures. Qualitative data were subjected to thematic analysis informed by the Template Analysis Technique. Descriptive and cross-tabulation analyses were employed to assess quantitative data. Three quarters (75%) of the respondents were dissatisfied with the ubiquitous consumption of energy-dense, nutrient-poor foods and sugar-sweetened beverages as well as the low intakes of healthy foods like fruits and vegetables among urban Indian adolescents. Six reasons were advanced for such unhealthy consumption including i) Proliferation of fast food retail outlets; ii) Hyper-palatability of fast food; iii) Marketing of fast food on electronic and social media; iv) Diminished household cooking practices; v) Lack of food knowledge; vi) Tendency to seek peer group acceptance. Both parents and educators suggested some healthy eating strategies aimed at improving the food and nutrition situation in Indian secondary schools to foster healthy eating among pupils. These included: i) Restrictions on the sale of unhealthy foods in school canteens; ii) Increased availability of attractive and palatable nutritious foods; iii) Discussion of the advantages of consuming healthy foods and inclusion of food preparation techniques in the school curriculum; iv) Home Economics coursework to be made mandatory for students. The findings suggest that Indian parents and teachers are likely to support changes to the food and nutrition curricula and to school food provision to foster healthy eating among adolescents.

Parents’ and teachers’ critique of nutrition education in Indian secondary schools

Purpose

Nutrition education plays a significant role in inculcating lifelong healthy dietary behaviours among adolescents. The purpose of this paper is to understand the opinions of parents and teachers regarding nutrition education in private Indian secondary schools.

Design/methodology/approach

A cross-sectional, self-administered, paper-based survey comprising both closed- and open-ended questions was completed by 32 teachers and 280 parents who were recruited from five private English-speaking secondary schools in Kolkata, India. Descriptive and cross-tabulation analyses were conducted to compare the responses of teachers and parents. Thematic data analysis informed by template analysis technique was performed to evaluate the qualitative data.

Findings

While the curriculum was considered interesting and easy to understand, the gendered nature of the curriculum, excessive rote learning and lack of synchrony between the curriculum and school food services were highlighted as shortcomings of the existing curriculum. The need for the dissemination of food skills either through a compulsory food and nutrition curriculum or through extra-mural activities was expressed by most respondents. Both these ideas were indicative of strong support and motivation for modification in the current curriculum.

Practical implications

These findings emphasise the support for a skills-focussed food and nutrition curriculum to inculcate experiential culinary skills and comprehensive nutrition knowledge in Indian adolescents, thus improving their nutritional and health profiles.

Originality/value

This is the first cross-sectional survey to investigate the views of parents and teachers about the status of food and nutrition education in private Indian secondary schools.

Barriers to Food Literacy: A Conceptual Model to Explore Factors Inhibiting Proficiency

Food literacy research typically conceptualizes food-related knowledge and skills as contributing to improved health and nutrition; however, there is limited research examining the process that leads to this improvement. This article reviews the literature reporting barriers to food literacy proficiency in order to examine the relationship between food-related knowledge, attitudes, and behaviors. Informed by these barrier types, its central objective is to develop a model of food literacy proficiency that highlights the relationship between nutrition education and health-related outcomes. This model will help researchers, educators, and nutrition professionals implement effective interventions with enhanced capacity to change food-related behaviors.

Senior Secondary School Food Literacy Education: Importance, Challenges, and Ways of Improving

Food literacy education at senior secondary school can provide both immediate and long-term benefits for adolescents. The exploration of multiple stakeholder groups’ opinions regarding the importance, roles, and challenges of school food literacy education, and their suggestions for its improvement, will help the design and execution of future food literacy-related curricula and programmes. This study explored a broad range of Australian and international food, health, and education professionals’ opinions regarding senior secondary school food literacy education through an online survey. One hundred and fifty-five food, health, and education professionals completed this survey between April and October 2017. Overall, the respondents strongly supported the need for food literacy education for senior secondary school students. Their suggestions for improving this form of education included: incorporation of relevant and up-to-date content, the presence of strong practical components, offering food literacy as compulsory subjects or the incorporation of food literacy concepts into compulsory core subjects. Moreover, they proposed the active contribution of both internal and external stakeholders in the planning and delivery of this education to upgrade its quality and relevance. Overall, the findings suggest that a wide range of food, health, and education professionals are highly supportive of senior secondary school food literacy education and their constructive suggestions should be considered in school food literacy education enhancement efforts. Education authorities should seek ways of involving different stakeholders, including food-related professionals, in the design and delivery of food literacy education, and future studies should explore the best mechanisms for such involvement.

Parents' and Teachers' Views of Food Environments and Policies in Indian Private Secondary Schools

School food environments and policies can play a pivotal role in inculcating healthy food habits among young people. This cross-sectional survey explored teachers’ and parents’ views of the role of school food environments and policies in promoting healthy food consumption among Indian adolescents. Thirty-two teachers and 280 parents from five private, English-speaking, secondary schools in Kolkata, India took part in a short questionnaire survey which included closed and open answer questions. Descriptive and chi-square analyses were performed to compare the responses of parents and teachers. Thematic data analysis underpinned by Template Analysis Technique was employed to examine the qualitative responses. The easy availability and accessibility of energy-dense, nutrient-poor foods, the limited availability of nutritious foods, the absence of written food policies, and inflated prices of nutritious foods were reported as problems in the Indian school food environment. However, the respondents also noted that schools restricted the sale of sugar-sweetened beverages and adopted hygienic food practices. Novel ideas for creating healthy school food environments and effective school canteen policies were also captured during the survey. These findings point to the need to create effective school food policies in Indian secondary schools to help adolescents eat healthily at school. Future research is required to test the feasibility of the implementation of school food policies.

Barriers to Nutrition Promotion in Private Secondary Schools in Kolkata, India: Perspectives of Parents and Teachers

School-based nutrition promotion is critical to the development of healthy eating habits in adolescents. Unfortunately, most Indian secondary schools do not support healthy eating among adolescents. Therefore, this study was designed to understand the perspectives of teachers and parents regarding the potential barriers to nutrition promotion in Indian secondary schools. Thirty-two teachers and 280 parents from five private English-speaking secondary schools in Kolkata, India took part in a cross-sectional survey. The paper-based survey instrument included both quantitative and qualitative items which were derived from previously published evidence. Descriptive and chi-square analyses were conducted on the quantitative data. Qualitative data were evaluated by thematic data analysis underpinned by the template analysis technique. Five main barriers to nutrition promotion emerged from the study. These included the perceived strong preference for energy-dense, nutrient-poor foods among students; lack of government canteen guidelines; limited engagement of parents, teachers, and adolescents in canteen operations; the widespread display of eye-catching food advertisements; and poor knowledge among canteen personnel with regards to healthy food preparation. These findings about the potential barriers to nutrition promotion provide useful directions for healthy school food policy implementation. Successful implementation of healthy school food policies can inculcate lifelong healthy eating habits among adolescents.

Secondary school students’ views of food and nutrition education in Kolkata, India

Purpose

School-based nutrition education programmes have the potential to reinforce healthy dietary behaviours in adolescents. The purpose of this paper is to understand the views of secondary school students in Kolkata, India, regarding the food and nutrition curriculum, food skill acquisition at school and home and barriers to learning food skills.

Design/methodology/approach

The sample of 1,026 year nine students was drawn from nine private, English-speaking secondary schools in Kolkata, India to participate in a cross-sectional, self-reported paper-based survey. Data analyses including descriptive statistics and χ2 analyses were performed.

Findings

The majority of the respondents (65.3 per cent) were female. Biology, Home Science and Life skills classes were the main places in which students acquired food and nutrition knowledge. Almost two-thirds of the respondents acknowledged the importance of acquiring food-related knowledge and skills. Approximately half (48.3 per cent) reported that the food and nutrition curriculum involved excessive memorisation while around the same proportion described the curriculum as interesting (47 per cent) and easy to comprehend (50.3 per cent). However, relatively few students said they enjoyed attending food and nutrition classes (38.7 per cent). Only a minority reported receiving food skills training, i.e. cooking skills (23 per cent), meal planning skills and food purchasing skills (12.3 per cent) at school. Despite some parental support received at home, time constraints (50.5 per cent) and lack of interest (26.3 per cent) were cited as prominent barriers to learning food skills.

Practical implications

These data underscore the need for a skills-focussed food and nutrition curriculum to improve Indian adolescents’ food-related skills, nutritional knowledge and dietary behaviours.

Originality/value

This is the first cross-sectional survey to investigate the delivery of nutrition education and food skills in the Indian school context.