Predicting willingness to consume healthy brand foods using the theory of planned behavior: the role of nutritional literacy

Introduction

The willingness to consume healthy foods has highlighted the growing importance of health, even more so when it comes to food choice, and predicting the willingness to consume foods of a healthy brand represents an action that leads to the practice of conscious eating habits, but what is behind this willingness? To answer this question and based on previous studies such as the theory of planned behavior and nutritional literacy, this study aimed to build a predictive model through an empirical study to examine the influence of nutritional literacy (NL) on attitude (ATT), subjective norm (SN) and perceived behavioral control (PBC), as well as to determine the influence of the three variables of the theory of planned behavior (TPB) on the willingness to consume healthy brand foods (WCHBF) in the Peruvian market.

Methods

The research focused on the population that stated that they were consumers of the Unión brand (a brand whose value proposition is the sale of healthy foods), obtaining 482 consumers. The study was conducted under a quantitative, non-experimental, cross-sectional design approach.

Results

The results support the existence of a positive and significant effect of NL on ATT, SN, and PBC, finding the exact behavior of SN and PBC in WCHBF; however, in the proposed model, it is observed that ATT has no impact on WCHBF.

Conclusion

Applying strategies that lead to a change in consumer behavior towards healthy brands is a matter of time and will. In this context, the findings indicate that nutritional literacy plays an essential role in the willingness to consume healthy foods, which sheds more light on the design of educational interventions and awareness campaigns that independently inform about nutritional benefits and empower consumers, allowing them to make informed and healthy choices.

The Effect of Sociodemographic and Anthropometric Variables on Nutritional Knowledge and Nutrition Literacy

Nutrition literacy, which is one of the important components of health literacy, includes basic nutritional information and understanding, interpreting and having the ability to make healthy decisions on nutrition-related issues. This study aims to dwell upon the relationship between sociodemographic and anthropometric variables and nutritional knowledge and nutrition literacy. A total of 1600 people aged 19-64 years, 934 women and 666 men, voluntarily participated in the research in the capital city of Turkey. The mean age is 28.2 ± 10.9 years. More than half of the participants (57.4%) have a university graduate/postgraduate education level, and 66.2% are unemployed. This cross-sectional study evaluated demographic information, anthropometric measurements, nutritional information and nutrition literacy. Nearly all the respondents (94.6%) were determined to have sufficient nutrition literacy. Body mass index (BMI) and age were negatively associated with nutrition literacy, whilst nutrition knowledge was positively associated. Respondents with nutrition education at school had the highest nutrition knowledge and nutrition literacy scores, and primary school graduates had the lowest. Participants who received nutrition education scored higher in all the subgroups of the GNKQ. Age, gender, marital status, education status, employment status, BMI and nutrition education were significantly associated with nutrition literacy. The results will be useful in developing food and nutrition policies that will pave the way for making decisions on the most useful themes of health and nutrition campaigns.

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.

Development and assessment of a nutrition literacy scale for patients with end-stage kidney disease undergoing dialysis and its correlation with quality of life

OBJECTIVES

To construct a valid and reliable Nutritional Literacy Scale for patients with end-stage kidney disease (ESKD) receiving dialysis and evaluate associations between nutrition literacy and quality of life.

METHODS

A total of 208 ESKD patients receiving dialysis were selected for this study. Nutrition literacy evaluation items were drafted based on dietary guidelines for chronic kidney disease (CKD), Literature reviews and expert consultation. Scale reliability and validity were then assessed. Factors influencing nutrition literacy and the associations among nutrition literacy, nutritional status, and quality of life were evaluated.

RESULTS

The scale consists of 28 items with a scale-level content validity index of 0.91 and item-level content validity indices ranging from 0.83 to 1.00. Factor analysis identified 4 common factors (dimensions) named nutrition knowledge, cognitive attitude, behavioral practice, and information acquisition ability that collectively explained 56.31% of literacy score variation. The overall Cronbach's α coefficient of the scale was 0.83, the dimensional Cronbach's α coefficients ranged from 0.79 to 0.87, and the retest reliability was r = 0.73 (p < 0.05). Age, education level, residence (urban vs. Rural) , occupational status and dialysis modalities were significant factors influencing nutrition literacy. Nutrition literacy score was negatively correlated with SGA score and positively correlated with serum albumin and prealbumin concen- trations, and with SF-36 quality of life score (all p < 0.05).

CONCLUSIONS

This new Nutrition Literacy Scale demonstrates high reliability and validity for Chinese ESKD patients undergoing dialysis. The nutrition literacy is influenced by age, education level, residence, occupational status and dialysis modalities, associated not only with nutritional status but also with quality of life.

Memory Abilities Are Selectively Related to Food Label and Numeracy Nutrition Skills

OBJECTIVE

We investigated the relationship between nutrition literacy, diet quality, carotenoid status, and cognition.

METHODS

Adults aged 37.5 ± 17.0 years (n = 52) completed the 42-item Nutrition Literacy Assessment Instrument (NLit). The Dietary History Questionnaire III was analyzed to determine the Healthy Eating Index. Skin carotenoids were assessed as a diet quality biomarker. Selective attention, relational memory, and pattern separation abilities were assessed using the flanker, spatial reconstruction, and mnemonic similarity tasks, respectively. Statistical adjustments included age, sex, education, and body mass index.

RESULTS

No correlations were observed for NLit scores and NLit subscales with Healthy Eating Index and skin carotenoid status. However, the NLit's food label and numeracy subscale was related to greater pattern separation abilities (ρ = 0.33, r2 = 0.11, P = 0.03).

CONCLUSIONS AND IMPLICATIONS

Comprehension of food labels and numeracy information was associated with memory abilities. Future work is needed to test whether targeting working memory and attentional processes during memory retrieval in larger samples may facilitate the acquisition of nutrition knowledge.

Mother's Nutrition Literacy and Offspring Anemia: A Comparison Study in a Single Center

OBJECTIVE

It is known that mother's knowledge about nutrition is associated with the prevalence of anemia in their children. The aim of this study was to evaluate the frequency of iron deficiency without anemia (ID), iron deficiency anemia (IDA), and anemia in children according to the level of mother's nutrition literacy (NL).

MATERIALS AND METHODS

A cross-sectional study was conducted in a well-child outpatient clinic. The study included healthy children aged between 24 and 59 months and their mothers. Scores of the mothers on the Nutrition Literacy Assessment Tool for Adults and children's anthropometric z-scores, dietary diversity and Mediterranean Diet Quality Index scores, and children's hemoglobin and ferritin levels were collected. Two-group comparison analysis was performed.

RESULTS

Ninety mother-child pairs were included. While 36 mothers (40%) had borderline and 54 (60%) mothers had adequate NL, 15 children (16.7%) had ID, 5 (5.6%) children had IDA, and a total of 18 children (20%) had nutritional anemia. The percentage of wasted children was higher in the group with borderline NL (13.9% vs. 1.9%, P = .036). The percentage of children with ID, IDA, or other nutritional anemia was not different between the borderline and adequate NL groups (30.6% vs. 40.7%, P = .326).

CONCLUSION

The frequency of ID, IDA, or other nutritional anemia in children does not differ significantly between mothers with borderline and adequate NL. Increasing NL of mothers could be a step toward reducing the burden of child undernutrition.

Stakeholders, Relationships, and Coordination: 2015 Baseline Study of Needed Enablers for Bridging Agriculture-Nutrition Gaps in Nigeria

BACKGROUND

Renewed efforts by the Nigerian government to address malnutrition have led to nutrition actions by several sectors, including the agriculture sector. However, the success of these actions depends on the characteristics of the stakeholders involved, including their relationships and coordination.

OBJECTIVE

This article reports a 2015 study of nutrition-sensitive agricultural stakeholders in Nigeria that assessed what the stakeholders do, where they work and how they are organized to improve nutrition. The study provides a baseline for assessing progress and measuring stakeholder and coordination changes in the Nigerian nutrition-sensitive agriculture landscape.

METHODS

Semi-structured interviews (n = 17) and focus group discussions (n = 2) were held with federal, state, and local government level stakeholders; reviews of stakeholder program documents were also conducted.

RESULTS

The study identified 7 groups of nutrition-sensitive agriculture stakeholders and several coordination challenges. Political leadership, advocacy and provision of material and human resource support by nongovernmental organizations, and donor interest and funding have been vital for mobilizing nutrition-sensitive agriculture. Still, although stakeholders frequently highlighted that nutrition was an important consideration in their interventions, nutrition goals and activities and/or indicators to measure outcomes were not regularly communicated. Also, while coordination mechanisms existed, there appeared to be minimal actual cross-sectoral partnerships because of inadequate trust, competition, and conflicts over institutional turf and mandates.

CONCLUSIONS

Needed enablers for improving nutrition-sensitive agriculture in Nigeria included improved stakeholder nutrition literacy, as well as enhanced stakeholder engagement facilitated by role definition, clarification, and consensus. Exploring different approaches to coordination may also be necessary.

Development and Validation of Nutrition Literacy Assessment Instrument for Chinese Lactating Women: A Preliminary Study

This study focused on the development and validation of a nutrition literacy assessment instrument for Chinese lactating women (NLAI-L). A comprehensive literature review and group discussion by experts in relevant fields were adopted to determine the dimension, topics and questions of NLAI-L. Content validity was evaluated by a panel of experts. The exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were used to evaluate the construct validity. Cronbach's α and split-half reliability were applied to examine the reliability of NLAI-L. The final NLAI-L consisted of 38 questions covering three dimensions: knowledge, behavior and skill. The EFA revealed four sub-domains for knowledge, one sub-domain for behavior and four sub-domains for skill. The results showed that NLAI-L had satisfactory content validity (CVI = 0.98, CVR = 0.96), good reliability (Cronbach's α coefficient = 0.84) and acceptable construct validity (χ2/df = 2.28, GFI = 2.81, AGFI = 0.79, RMSEA = 0.057). In the application part, the average NL score was 46.0 ± 9.3. In multivariate linear regression, education level, age, postnatal period and occupation were the potential influencing factors of NL for Chinese lactating women. The study established an effective and reliable assessment instrument for Chinese lactating women (NLAI-L) through qualitative and quantitative methods. The establishment of NLAI-L will provide an effective tool for exploring the role of NL in health or disease and provide a basis for the formulation of targeted nutrition interventions.

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.

Food and Nutrition Literacy: Exploring the Divide between Research and Practice

This study addresses the growing recognition of the importance of food and nutrition literacy, while highlighting the limited research in this field, particularly the gap between research and practice. A bibliometric analysis of publications on food and nutrition literacy research from the Scopus database was carried out. Endnote 20, VOSviewer, and Harzing's Publish or Perish were used to analyze the results. The growth of publications, authorship patterns, collaboration, prolific authors, country contributions, preferred journals, and top-cited articles were the bibliometric indicators used. Subsequently, articles aimed at measuring food or nutrition literacy-implemented programs were analyzed. Existing studies have primarily concentrated on defining and measuring food or nutrition literacy. Although interventions targeting food and nutritional literacy have shown promise in promoting healthy eating, further research is required to identify effective approaches in diverse populations and settings. This study emphasizes the need for additional research to measure intervention program efficacy to enhance the policies and practices in this critical area of public health. These findings underscore the importance of understanding food/nutrition literacy and developing effective interventions to promote healthy eating habits. By bridging the research-practice divide, this study provides valuable insights for policymakers, practitioners, and researchers to address the gaps and improve food/nutrition literacy in various contexts.

Demographic Dynamics and the Changing Faces of Nutrition Literacy in India: A Tryst with the Transition among Communities Over Two Decades

Aims and Objective

The development of a nation depends on well-nourished individuals. A country's economic independence also depends on adequate food supply for all sections of its population and the proper selection of the right kinds of food, called nutritional literacy. This review will show the transition of dietary selection and practices across India over the last two decades and its impact on health.

Materials and Methods

We conducted a literature search to review the evidence of the last two decades. The literature search was done using the PubMed search engine and the MeSH words "Nutrition Literacy, Dietary Practices, Diet Transition, Nutrition transition, India and Food pattern." Evidence from the last two decades was collectively reviewed, and observations on the transition in nutrition literacy were summated.

Results

The literature search revealed 18 articles, out of which 13 articles were included in this review based on inclusion-exclusion criteria. Nine were review articles, and five were cross-sectional studies. The studies done over the last two decades on nutrition culture revealed that most of the studies related to transition have been done during the second decade of the twenty-first century. Most have found that the shift has been happening more among the urban poor and rural rich people. Indian diets have diversified and shifted away from cereals towards processed food.

Conclusion

It was found that there is a shift in feeding preferences in diet-deprived sections in India. The findings are similar in rural and urban areas where the poor fall prey to the food fads, make poor nutrition choices, and gradually develop chronic ailments. Such a transition over the years clearly shows that a malnourished child, having faulty feeding practices, becomes prey to the triple burden of hidden hunger, lack of nutrition, and repercussions of chronic non-communicable diseases, including dental ailments.

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.

Evaluation of a Media Training Workshop for Nutrition Students and Trainees in Nova Scotia

Gaps in communication training have been identified in Canadian and international academic and practicum dietetics programs. A workshop was developed to pilot supplementary media training to nutrition students/trainees studying in Nova Scotia. Students, interns, and faculty from two universities participated in the workshop. Data on perceived learning, media knowledge/skill use, and workshop feedback were collected immediately post-workshop using a mixed-form questionnaire. A modified questionnaire was administered eight months post-workshop to obtain information on utility of the perceived acquired knowledge/skills. Closed-ended responses underwent descriptive analysis, while open-ended responses underwent thematic analysis. Twenty-eight participants completed the questionnaire post-workshop, and six completed it at follow-up. All participants rated the workshop positively (7-point Likert scale) and reported learning something new (perceived). Perceived learning emphasized general media knowledge/skills and communication skills. Follow-up data suggested participants had applied perceived media knowledge/skills in message development and media and job interviews. These data suggest that nutrition students/trainees may benefit from supplementary communications and media training and provide a stimulus for ongoing curriculum review and discussion.

Nutrition literacy levels of mothers with children aged five and below and the body mass index of their children

This study aims to investigate the nutrition literacy levels of mothers with children aged five and below and the body mass index of their children (BMI). This descriptive study was carried out in a city located in eastern Turkey between June and August 2021. The sample was composed of 235 women who were calculated using the sampling method with an unknown target population, and participants were included in the sample using the convenience sampling method. Data collection tools were the Socio-demographic Form and Evaluation Instrument of Nutrition Literacy in Adults. Data were analyzed in SPSS, using descriptive statistics, Kolmogorov Smirnov test, Mann Whitney U-test, and Kruskal Wallis test. While 92 percent of participating mothers had a sufficient level of nutrition literacy, 46 percent of children had normal BMI. The Evaluation Instrument of Nutrition Literacy on Adults mean score was higher in those who had a high socio-economic level, had a disease that required regular medicine use, reported having sufficient knowledge about nutrition, and accept health workers as a reliable source of information (p < .05). This study found that nutrition literacy was affected by variables such as socio-economic level, knowledge about nutrition, and the sources of information chosen. In addition, it was determined that the BMI of the children was not affected by the nutritional literacy level of their mothers.

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.

Status and correlates of food and nutrition literacy among parents-adolescents' dyads: findings from 10 Arab countries

Background

Food literacy is capturing the attention worldwide and gaining traction in the Arab countries. Strengthening food and nutrition literacy among Arab teenagers are important promising empowering tools which can protect them from malnutrition. This study aims to assess the nutrition literacy status of adolescents with the food literacy of their parents in 10 Arab countries.

Methods

This cross-sectional study involving a convenient sample of 5,401 adolescent-parent dyads (adolescents: mean age ± SD: 15.9 ± 3.0, females: 46.8%; parents: mean age ± SD: 45.0 ± 9.1, mothers: 67.8%) was launched between 29 April and 6 June 2022 in 10 Arab nations. The Adolescent Nutrition Literacy Scale (ANLS) and the Short Food Literacy Questionnaire (SFLQ) were used to meet the study aims.

Results

More than one-quarter (28%) of adolescents had poor nutrition literacy, with 60% of their parents being food illiterate. The top three countries with nutritionally" less literate" adolescents were Qatar (44%), Lebanon (37.4%), and Saudi Arabia (34.9%). Adolescents' age, gender, education level, primary caregivers, employment status, and the inclusion of nutrition education in the schools' curriculum predicted the nutrition literacy levels of Arab adolescents. Besides, parental weight status, health status, parent's food literacy level, and the number of children per household were significant determinants too. Adolescents studying at a university and having parents with adequate food literacy had the highest odds of being nutritionally literate (OR = 4.5, CI = 1.8-11.5, p = 0.001, OR = 1.8, CI = 1.6-2.1, p < 0.001, respectively).

Conclusion

Nutrition literacy inadequacy among Arab adolescents is a prioritized challenge to be tackled.

Food and nutrition literacy: a predictor for diet quality and nutrient density among late adolescents

BACKGROUND

Evidence regarding an individual`s food and nutrition literacy (FNL), and its impact on dietary behaviours, could guide the development of more effective interventions. This study sought to examine the association between FNL and its components with diet quality and nutrient density among Iranian senior highschool students.

METHODS

In this cross-sectional study, 755 senior high school students were recruited from high schools in Tehran, Iran. FNL was assessed using the Food and Nutrition Literacy Assessment Tool (FNLAT), a selfadministered questionnaire which has been locally designed and validated. Dietary assessment was performed by obtaining two 24-hour dietary recalls. Healthy Eating Index-2010 (HEI-2010) and nutrient-rich food index 9.3 (NRF9.3) were calculated to evaluate diet quality. Socioeconomic status, anthropometric measures, and the health status of participants were also assessed.

RESULTS

Higher FNL score was significantly correlated with higher HEI-2010 (β = 0.167, p < 0.001) and NRF9.3 (β = 0.145, p < 0.001) scores. Subgroup analysis indicated that these associations were significant only among males, but not females. Regarding components of FNL, skill dimension of FNL was a stronger predictor for HEI- 2010 (β = 0.174, p < 0.001) and NRF9.3 (β = 0.153, p < 0.001) than knowledge (β = 0.083, p = 0.054 for HEI-2010 and β = 0.107, p = 0.01 for NRF9.3).

CONCLUSIONS

FNL may be a significant predictor of diet quality and nutrient density among late adolescents. To improve the effectiveness of food and nutrition education, emphasis must be placed on skill development.

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.

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.

Association between Nutrition Literacy and Bangladeshi Adults' Healthy Eating Behaviors: Evidence from the Nutrition Literacy Study 2021

This study investigated the association between healthy eating behaviors and nutrition literacy in a sample of Bangladeshi adults. A cross-sectional survey was conducted among 400 adults from two districts of Bangladesh (Dhaka and Chattogram). Data were generated by in-person interviews using a structured questionnaire. The Nutrition Literacy Scale and National Dietary Guidelines for Bangladesh were used to assess nutrition literacy and healthy eating behaviors, respectively. Multiple linear regression models were used to observe the association. The mean score for healthy eating behavior was 21.8 (SD = 4.8, Range: 5−33) on a scale of 34. A moderate positive correlation was found between nutrition literacy and healthy eating behavior of participants (r = 0.28, p < 0.001). The adjusted regression model showed that a 1 unit increase in nutrition literacy reflected an increase in the healthy eating behavior score of participants by 0.22 units (β = 0.223, p < 0.001). Findings showed an association between nutrition literacy and eating behaviors in Bangladeshi adults. Future research could be carried out to establish a causal relationship that may help inform the necessity of educational interventions for Bangladeshi adults to assist with meeting national nutrition-related targets.

Virtual Reality and Powerpoint Grocery Store Tours: Equally Effective in Improving Self-efficacy in Randomised Control Trial

PURPOSE

Compare computer-based virtual reality (CBVR) and voice-over PowerPoint (PP) grocery store tours (GST) on adult nutrition literacy (NL) and healthful food purchasing self-efficacy (HFPSE).

DESIGN

Participants (n = 68) recruited from University worksite wellness program and randomly assigned to CBVR or PP (CBVR = 35; PP = 33).

INTERVENTION

Four-week culinary/nutrition education program. Initial three weeks provided identical education for both groups. Week four implemented GST intervention using CBVR or PP.

MEASURES

NL and HFPSE surveys before, after, and three-months post from the start of program.

ANALYSIS

Intent-to-treat (ITT) analysis with RMANOVA (95% confidence intervals [CI] and effect sizes) to examine change in NL and HFPSE between CBVR and PP groups over 4-week intervention and 3-month retention period.

RESULTS

43 of 68 participants [CBVR (n = 19) and PP (n = 24)] were included in analyses. Both groups significantly improved HFPSE over time (P<.001, CBVR = 46.23% PP = 33.34%), but there were no differences between groups (P = .21) or group by time interaction (P = .31). NL did not change for either group (P = .83, CBVR = 1.11%; PP = .12%) nor were there differences between groups (P = .07).

CONCLUSIONS

CBVR and PP GST significantly improved and maintained higher HFPSE scores.

Higher Diet Quality in Latina Women during Pregnancy May Be Associated with Sociodemographic Factors

Acculturation contributes to low diet quality and can foster health inequities for Latina women during pregnancy. Conversely, nutrition literacy (NL) increases diet quality and could promote health equity. This study assessed the associations between the diet quality, acculturation, and NL of Latina women (n = 99) participating in the Assessment of Docosahexaenoic Acid On Reducing Early Preterm Birth (ADORE) study. Acculturation and nutrition literacy factored together tended to modify diet quality, but this was not statistically significant. Diet quality was associated with acculturation, age, and nativity. Most (76.8%) demonstrated low nutrition literacy. Women who were bicultural and were born in Latin American countries other than Mexico had lower diet quality scores than women who had lower acculturation and were born in Mexico. Women who were 35 years or older had better diet quality than those who were younger. Future studies are needed to explore diet quality differences for pregnant Latina women with high nutrition literacy and high acculturation, as well as for women from the Caribbean, Central and South American countries living in the US, to promote nutrition and maternal health for Latina women.

Development and validation of a novel short-form nutrition literacy measurement tool for Chinese college students

Objectives

To develop and validate a short-form nutrition literacy (NL) assessment tool for Chinese college students based on a 43-item NL measurement scale.

Methods

To develop and validate short-form NL scale, 1359 college students were surveyed, the data were analyzed using exploratory factor analysis, linear regression analysis, Item analysis, confirmatory factor analysis, and Pearson correlation.

Results

The 12-item short-form NL scale (NL-SF12) was developed using factor analysis and regression analysis, which accounted for 96.4% of the variance. The correlation coefficient between the NL-SF12 and NL-43 was 0.969, indicating satisfactory criterion-related validity. The NL-SF12 had a Cronbach's α of 0.890, suggesting strong internal consistency reliability, and content validity index was greater than 0.9, indicating that each domain accurately reflects the connotation of nutrition literacy. The model-data fit and convergent validity of the confirmatory factor analysis results were both good.

Conclusion

The NL-SF12 is an effective measurement tool with a good reliability and acceptable validity to assess comprehensively NL for college students, and is applicable to quick, widespread use in population study and practice with low respondent burden.

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.

Nutrition literacy and its related demographic factors among workers of Taraz Steel company, Chaharmahal and Bakhtiari, Iran

Background

Nutrition is critical to prevent some chronic diseases. Nutrition literacy refers to ability to gain, understand and evaluate nutrition facts to choose appropriate foods. Nutrition literacy has recently drawn the attention of professionals with respect to health promotion. The purpose of this study was to investigate nutrition literacy and potentially related demographic factors among workers of a steel company in Chaharmahal and Bakhtiari province, southwest Iran.

Methods

In this descriptive-analytical study in 141 workers of Taraz Steel company in 2021, participants were selected by convenience sampling and a self-report nutrition literacy scale nativized to Iranians was used to collect data. Data were analyzed by SPSS 22 using Mann-Whitney U test, Kruskal-Wallis test and Spearman's correlation coefficient.

Results

About 75% of workers had adequate nutrition literacy and around 24% inadequate nutrition literacy. The highest percentage of mean score was obtained for determination of food groups (85.4%) and the lowest for calculation of food units (47%). The mean score of nutrition literacy was significantly higher in people with higher education (P = 0.020). Also, people with adequate monthly salary attained a higher mean score on determination of food groups (P = 0.021) and higher overall nutrition literacy (P = 0.003) compared to other people. No relationship was observed between nutrition literacy and body mass index as well.

Conclusion

Most workers have adequate nutrition literacy but their scores on calculation of food units are relatively low. It is essential for policymakers to collect information on the level of nutrition literacy in different populations, especially Iranian workers, to reduce the prevalence of nutrition-related chronic diseases.

Ghanaian Female Adolescents Perceived Changes in Nutritional Behaviors and Social Environment After Creating Participatory Videos: A Most Significant Change Evaluation

Background

Understanding the influence of participatory video-making on the nutrition-related behavior of video creators may help shape nutrition education interventions.

Objectives

This study assessed the perceived value and influence of a participatory video intervention among participants and stakeholders.

Methods

A 2018-2019 cluster randomized controlled trial (registered at clinicaltrials.gov as NCT03704649) selected 20 schools (10 intervention, n = 181; 10 control, n = 170) in 1 Ghanaian rural district, enrolled adolescent girls aged 13-16 y, and provided a nutrition curriculum. Each intervention school also participated in 2 series of activities designed to help adolescents plan, film, and screen 2 nutrition-related videos. The Most Significant Change method involved intervention participants and local stakeholders to assess the value and influence of the intervention - a secondary outcome of the trial. Project staff collected 116 stories of change from the adolescents. Stories described shifts in 4 domains: participant, peer, and family behavior, and structural changes in the school. The project team used a selection rubric to identify 14 stories that reflected heightened nutrition literacy. Staff conducted interviews with the 14 adolescents whose stories were selected to elaborate on details and perceived resonance. Finally, local stakeholders assessed the stories to identify the 4 most significant changes of the intervention - 1 per domain. A separate thematic analysis identified emerging patterns of motivation and action across the 14 interviews.

Results

The chosen Most Significant Change stories revealed how adolescents found creative solutions to acquire iron-rich foods, encouraged neighbors to eat iron-rich foods, taught their family new agricultural practices, and promoted change in their school canteen. Local stakeholders valued stories that addressed common community nutrition issues in a creative and sustainable way, whereas adolescents prioritized stories that showed a change in health outcomes.

Conclusion

Stories of change revealed that the intervention promoted a transformative influence; participants modified their eating habits, lifestyle, and their environment.

Development and Validation of the Young Adult Nutrition Literacy Tool

OBJECTIVE

To create a tool to measure college students' functional, interactive, and critical nutrition literacy.

DESIGN

(1) Focus group: item generation, (2) expert review, (3) exploratory factor structure analysis, (4) item refinement and modification, (5) factor structure validation, and (6) criterion validation.

SETTING

Two land-grant college campuses.

PARTICIPANTS

College students aged between 18 and 24 years.

MAIN OUTCOME MEASURES

Survey data was used to assess nutrition literacy.

ANALYSIS

Exploratory factor analysis, confirmatory factor analysis (CFA), item response theory (IRT) analyses, and correlations.

RESULTS

One-hundred and twenty-three items were generated and tested in an online survey format. Items were eliminated on the basis of face validity, expert feedback, exploratory factor analysis, and CFA/IRT. The 3 measures (functional, interactive, and critical) were analyzed separately. All 3 measures showed reasonable model fit in the CFA/IRT models. Criterion validity showed small to medium effect sizes between measures and fruit/vegetable intake. Reliability estimates met reasonable standards for each measure.

CONCLUSIONS AND IMPLICATIONS

The Young Adult Nutrition Literacy Tool is a novel instrument that measures all 3 domains of nutrition literacy. Strengths include a rigorous 6-step development process, reasonable psychometric properties, and a large breadth of items.

Carbohydrate Knowledge Observed to be Low in Vietnamese Women With Gestational Diabetes Mellitus

OBJECTIVE

To assess carbohydrate knowledge of Vietnamese women with gestational diabetes mellitus (GDM) and explore factors associated with carbohydrate knowledge.

METHODS

Vietnamese women (n = 100) with GDM completed an online questionnaire about self-efficacy in managing blood glucose, the habit of regularly self-monitoring blood glucose activities at home, and an adapted culturally tailored carbohydrate quiz for the target population.

RESULTS

Participants (30 ± 4 years) answered on average 51% of the carbohydrate knowledge questions correctly, showing most difficulty in identifying honey, milk, and orange juice as carbohydrate sources. Only 46% of participants correctly identified carbohydrate content on nutrition labels, and 58% practice self-monitoring blood glucose activities at home. Carbohydrate knowledge was positively associated with self-efficacy in blood glucose management (r² = 0.101, P = 0.003) and practicing self-monitoring blood glucose (r² = 0.064, P = 0.013).

CONCLUSIONS AND IMPLICATIONS

There is a need to provide nutrition education about carbohydrate knowledge and blood glucose control to Vietnamese women to manage GDM.

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.

The Association Between Bangladeshi Adults' Demographics, Personal Beliefs, and Nutrition Literacy: Evidence From a Cross-Sectional Survey

Background

Poverty and health illiteracy, combined with inappropriate systems to track disease and infection rates, contribute to children-and-mothers' poor adherence to nutrient-rich foods intake in Bangladesh. Although risk factors for child and pregnant women malnutrition have been explored, the relationship between Bangladeshi adults' nutrition literacy and their demographics and personal beliefs remains unknown. The purpose of this study was to examine the association between adults' nutrition literacy, demographics and personal beliefs in a large sample of Bangladeshi adults.

Methods

Four hundred adults from two districts (Dhaka and Chattogram) of Bangladesh participated in a cross-sectional survey. Data were collected by interviews using a structured questionnaire containing the Nutrition Literacy Scale. Multiple linear regression models were employed to analyze associations between nutrition literacy and related factors.

Results

The mean nutrition literacy score was 21.6 (SD: 3.7; range: 11-32) on a scale of 32. Multiple linear regression revealed that being a businessman (β = 1.66, p = 0.013) or private employee (β = 1.08, p = 0.030), having a higher family income (β = 1.17, p = 0.009), and a higher educational level were positively associated with higher nutrition literacy scores compared to their counterparts. Participants who had ever completed a nutrition-related course (β = 4.95, p < 0.001), and who perceived themselves as having a need for accessing nutrition-related information were positively associated with the higher nutrition literacy compared to their counterparts.

Conclusion

Findings from this study suggest the need for an integrated response plan involving educational interventions and accessible dietary plans targeting adult populations to enhance their nutritional literacy.

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.

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.

Nutrition Literacy Measurement Tool With Multiple Features for Chinese Adults

BACKGROUND

Nutrition literacy is an emerging term which is increasingly used in policy and research. Progression is limited by the lack of an accepted method to measure nutrition literacy in Chinese adult, even research in this area is growing.

OBJECTIVE

The objective of this study is to develop a valid instrument to assess nutrition literacy in Chinese adults.

METHODS

The process involved 2 steps: constructed nutrition literacy conceptual framework, and developed potential items of scale based on literature review; and conducted 2 rounds of Delphi consultation to select items of the preliminary questionnaire.

RESULTS

In Delphi survey, the content validity index for each domain, level, and dimension of nutrition literacy was 1.0, coefficient of variation was less than 0.10, and Kendall's coefficient of concordance was greater than 0.83. All of the 2 domains, 3 levels, and 6 dimensions initially formulated by our research team were reserved in the conceptual framework of nutrition literacy. Furthermore, a 43-item nutrition literacy measurement scale was established. Each item kept in the final scale reaches a high degree of concentration and a high degree of coordination, with the mean of importance ranging from 4.38 to 5.00.

CONCLUSIONS

A nutrition literacy measurement scale with multiple features was established for Chinese adults, providing an operationalized tool to assess comprehensively nutrition literacy for research and practice in the field of nutrition, diet, and health.

Nutrition Literacy Tailored Interventions May Improve Diet Behaviors in Outpatient Nutrition Clinics

OBJECTIVES

Nutrition literacy examines the intersection of nutrition knowledge and skills; however, no evidence shows interventions tailored to nutrition literacy deficits affect diet behaviors. This study examined the effects of nutrition interventions tailored to individual nutrition literacy deficits on improving diet-related behaviors.

METHODS

Five outpatient clinics were randomized to 2 arms. The nutrition literacy and diet behaviors of patients were assessed before intervention with a dietitian and again 1 month later. Intervention-arm dietitians received patient nutrition literacy levels and tailored interventions toward nutrition literacy weaknesses. Differences in diet behaviors between arms were analyzed using Mann-Whitney U-tests and within-arms using Wilcoxon signed-rank tests.

RESULTS

Intervention-arm patients improved 10 of 25 measured diet behaviors; control-arm patients improved 6 behaviors. Similarly, intervention-arm patients reported increased green vegetable consumption from baseline to follow-up (z = 2.00; P = 0.04).

CONCLUSIONS AND IMPLICATIONS

Nutrition interventions tailored toward nutrition literacy deficits may play an important role in improving patient diet behaviors.

Wanting More, Seeing Less: Hunger Reduces Calorie Evaluations

Calorie estimates play an important role in the regulation of food consumption. Lower calorie estimates contribute to increased consumption, and consequently increase the risk of obesity. The current work presents a novel contribution demonstrating the biasing effect of hunger on calorie evaluations. Study 1 (N = 70) was a field study, where participants visiting a cafeteria estimated calories in four baked goods, with measures taken of their hunger level and their having had lunch. Study 2 was a lab study, where half of the participants (N = 65) fasted for five hours prior to the study, and then estimated calories in three baked goods. Study 1 found lower calorie estimations by hungry participants (M = 255.52, SD = 112.55) relative to lower hunger participants (M = 311.94, SD = 135.85): F(1, 67) = 6.07, p = 0.02. In study 2, the average estimated calories was lower for fasting participants (M = 253.11, SD = 126.13) than for non-fasting participants (M = 301.75, SD = 145.26). The studies demonstrate that motivations generated by physical state (hunger) alter calorie evaluations. This finding is surprising given that motivation generally leads to estimating more of a desired quantity. The study also presents a novel domain of biases in calorie estimation. This reduction in calorie estimates due to hunger may occur if calories are assessed relative to needs, or serve to allow people to justify increased food consumption. Accounting for such biases, particularly in cases of low nutrition literacy, is important in order to reduce the overeating that may be generated by calorie estimation biases.

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.

Low health literacy and perceived stress in adults: is there a link?

OBJECTIVES

Mental stress, low health literacy (HL) and nutrition literacy (NL) are associated with serious negative health outcomes. The aim of this study was to investigate HL and NL levels, in relation to levels of perceived stress, in adults.

METHODS

This cross-sectional study was conducted in the urban area of the Attica region, Greece. The sample consisted of 1,281 individuals, aged ≥ 18 years. The European Health Literacy Questionnaire 47, the Greek version of the Nutrition Literacy Scale and the Perceived Stress Scale 14 were used. Socio-demographic characteristics were also assessed. Nonparametric Mann-Whitney U and Kruskal-Wallis tests, Pearson chi-square and multiple linear regression models were used.

RESULTS

The sample's perceived stress mean value (SD) was 26.47 (7.27) with women scoring statistically significantly higher than men. The mean HL and NL scores were 32.28 (8.28) and 22.11 (5.67), respectively. Linear regression analysis has shown that perceived stress was significantly negatively associated with HL (p < 0.001) but not with NL levels (p = 0.675) after adjusting for a series of confounding variables.

CONCLUSIONS

Low health literacy seems to be very significantly associated with high levels of perceived stress. The reasons behind this association require further investigation.

Nutrition Literacy Mediates the Relationships between Multi-Level Factors and College Students' Healthy Eating Behavior: Evidence from a Cross-Sectional Study

College students experience new pressures and choices as they transition to independent living and can easily develop unhealthy eating habits, resulting in obesity and obesity-related chronic diseases in later life. This study aimed to test the hypothesis that nutrition literacy (NL) mediated the relationship between multi-level factors influencing healthy eating behavior identified from the social-ecological model and healthy eating behavior of college students. A four-part questionnaire was completed by 412 participants recruited from six different four-year universities in Taiwan (effective response rate = 85.8%). Data were analyzed using descriptive statistics, an independent samples t-test, hierarchical multiple regression, and mediation analysis. The results indicated that the students’ mean nutrition literacy score was 4.32 (SD = 0.78, range = 1–6). In the social-ecological framework, nutrition literacy significantly predicted healthy eating behavior (β = 0.28, p < 0.001; ΔF = 32.54, p < 0.001; ΔR² = 0.05) with control variables of background, intrapersonal, interpersonal, environmental, and macrosystem factors. Nutrition literacy mediated the effects of seven factors on healthy eating behavior across four levels. These findings suggested that strengthening influential multi-level factors associated with healthy eating behavior not only enhanced NL, but also improved individuals’ healthy eating behavior.

Healthy Schoolhouse 2.0 Health Promotion Intervention to Reduce Childhood Obesity in Washington, DC: A Feasibility Study

Childhood obesity prevalence trends involve complex societal and environmental factors as well as individual behaviors. The Healthy Schoolhouse 2.0 program seeks to improve nutrition literacy among elementary school students through an equity-focused intervention that supports the health of students, teachers, and the community. This five-year quasi-experimental study follows a baseline–post-test design. Research activities examine the feasibility and effectiveness of a professional development series in the first program year to improve teachers’ self-efficacy and students’ nutrition literacy. Four elementary schools in Washington, DC (two intervention, two comparison) enrolled in the program (N = 1302 students). Demographic and baseline assessments were similar between schools. Teacher participation in professional development sessions was positively correlated with implementing nutrition lessons (r = 0.6, p < 0.001, n = 55). Post-test student nutrition knowledge scores (W = 39985, p < 0.010, n = 659) and knowledge score changes (W = 17064, p < 0.010, n = 448) were higher among students in the intervention schools. Students who received three nutrition lessons had higher post knowledge scores than students who received fewer lessons (H(2) =22.75, p < 0.001, n = 659). Engaging teachers to implement nutrition curricula may support sustainable obesity prevention efforts in the elementary school environment.

Nutritional Literacy Among Uninsured Patients With Diabetes Mellitus: A Free Clinic Study

Objective

Evaluate nutrition literacy in uninsured subjects with diabetes mellitus (DM) who presented to free diabetes management classes. 

Design 

This single-site, cross-sectional observational study recruited thirty subjects from a free clinic for uninsured patients to attend diabetes mellitus, self-management classes. Before starting the classes, DM care-related data were collected, and subjects were administered the Nutrition Literacy Assessment Instrument (NLit). The assessment covers six subscales in nutrition and categorizes results into three possible categories: the likelihood of poor nutrition literacy (NLit Score ≤ 44), the possibility of poor nutrition literacy (NLit Score- 45-57), and the likelihood of good nutrition literacy (NLit score ≥ 58). 

Results 

Median glycated haemoglobin (HbA1c) was 7.45% for study participants. The mean NLit score was 38.1 (SD ± 9.4), correlating with a likelihood of poor nutrition literacy. All participants had either likelihood or the possibility of poor nutrition literacy based on the NLit Assessment. There were no participants who scored in the range of likelihood of good nutrition literacy. Subjects who scored in the range of likelihood of poor nutrition literacy had a significantly higher mean HbA1c (8.6 %) than those who scored in the possibility of poor nutrition literacy (6.9 %, p=0.005).

Conclusions

Poor nutrition literacy is associated with worse glycemic control among uninsured subjects with diabetes mellitus.

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.

Parental health literacy and nutrition literacy affect child feeding practices: A cross-sectional study

BACKGROUND

Health literacy (HL) and nutrition literacy (NL) are important issues to consider, in the provision of health care to children and the establishment of healthy eating behaviors.

AIM

The study investigates the possible role of HL and NL levels of Greek parents, in parental Feeding Practices (PFP).

METHODS

This is a cross-sectional study which was conducted in the urban area of the Attica region, Greece. The sample consisted of 402 parents (68.4% mothers). Parents completed the Greek version of Comprehensive Parental Feeding Questionnaire, the European Health Literacy Questionnaire 47 and the Greek version of the Nutrition Literacy Scale. Sociodemographic and anthropometric characteristics were also assessed. The non-parametric tests Mann-Whitney and Kruskal Wallis, the chi-square test and linear regression models were applied.

RESULTS

The median for HL and NL were 33.69 and 24.00, respectively. Mothers applied the "child control" practice more frequently than fathers (p = 0.015). Linear regression analysis revealed that HL was associated positively with "healthy eating guidance" and "monitoring" (p = 0.009 and p < 0.0001, respectively) and negatively with "emotion regulation/food as reward" and "child control" (p = 0.037 and p = 0.015, respectively). NL was associated positively only with "healthy eating guidance" (p = 0.009), positively but marginally with "monitoring" (p = 0.051) and negatively with "emotion regulation/food as reward" (p = 0.020).

CONCLUSIONS

Higher parental levels of HL and NL are significantly positively associated with better parental feeding practices in Greece.

Nutrition Literacy among Adolescents and Its Association with Eating Habits and BMI in Tripoli, Lebanon

(1) Background: Adolescence is a period of increased autonomy and independent decision making; it determines health behaviors that can persist into the future. Individual factors like food choices and unhealthy lifestyle have an essential role in the development and prevention of obesity among adolescents and are associated with the nutrition literacy of parents and other adults. While the association of parents' nutrition literacy with adolescent BMI has been addressed, there is still a scarcity of studies that examine the effect of adolescents' nutrition literacy on their eating habits and body mass index (BMI) status. (2) Methods: A cross-sectional study was conducted that included 189 adolescents (68 with overweight and obesity and 121 with normal weight) aged between 14-19 years from four private schools in Tripoli, Lebanon. A self-administered questionnaire that included the Nutrition Literacy Assessment Instrument (NLAI) and the Adolescent Food Habits Checklist (AFHC) was used. Anthropometrics were measured using standardized procedures. The association between nutrition literacy, food habits and BMI was assessed using a chi squared test for independence and Poisson regression analysis where suitable. (3) Results: Results indicated no association between all five components of nutrition literacy and body mass index categories. Furthermore, there was no association between the Adolescent Food Habits Checklist and overweight or obese BMI status (RR = 0.947, 95%CI: 0.629-1.426) (p = 0.796). No association was observed between nutrition literacy and food habits, except for an inverse association with macronutrients literacy. (4) Conclusions: In conclusion, the study indicated that there was no association between the components of nutrition literacy with body mass index or with food habits, except for macronutrient literacy.

Nutrition Literacy of Portuguese Adults-A Pilot Study

Nutrition is an essential factor in the prevention and treatment of some chronic diseases. For this reason, the population must know about nutrition, healthy food, and dietetics so that the promotion of healthier eating habits can lead to a consequent decrease in chronic disease incidence. That said, the present study aimed to assess nutrition literacy in the Portuguese population. Three hundred thirty participants aged between 18 and 65 years old were included in an observational, quantitative, and cross-sectional research. After the analysis, it was found that the vast majority of the study population (65.2%) had a good level of nutrition literacy. The participants having upper educational qualifications, following a specific diet, presenting an adequate BMI, having family members trained in the field of nutrition, and those who studied or worked in the field of health sciences reported a higher level of nutrition literacy. In conclusion, it seems to be essential to identify the population groups with the lowest nutrition knowledge so that it would be possible to apply personalized measures and to promote better literacy, reducing the prevalence and incidence of diseases and improving quality of life.

College Students' Views on Functional, Interactive and Critical Nutrition Literacy: A Qualitative Study

This research aimed to uncover how the nutrition literacy domains (functional, interactive, critical) influence the dietary decisions of young adults in college. For this qualitative study, undergraduate college students aged 18-24 years old (n = 24) were recruited to participate in focus groups. The focus group transcripts were independently coded for primary and secondary themes using a grounded theory approach and a basic thematic analysis. Four focus groups with 5-7 participants per group were conducted. The three domains of nutrition literacy emerged in the focus groups with two themes per domain. Themes within functional nutrition literacy included 'food enhances or inhibits good health' and 'components of a healthy diet'; themes within interactive nutrition literacy included 'navigating the college food environment' and 'awareness of food marketing on dietary behavior'; themes within critical nutrition literacy included 'critical appraisal of nutrition information' and 'awareness of societal barriers to good health'. Understanding how the different nutrition literacy domains relate to college students' food choices can inform future researchers on how to appropriately assess nutrition literacy and design programs aimed at improving dietary behaviors of college students.

Understanding How Nutrition Literacy Links to Dietary Adherence in Patients Undergoing Maintenance Hemodialysis: A Theoretical Exploration Using Partial Least Squares Structural Equation Modeling

Dietary non-adherence is pervasive in the hemodialysis (HD) population. Health literacy is a plausible predictor of dietary adherence in HD patients, but its putative mechanism is scarcely studied. Thus, this study aimed to establish the causal model linking nutrition literacy to dietary adherence in the HD population. This was a multi-centre, cross-sectional study, involving 218 randomly selected multi-ethnic HD patients from nine dialysis centres in Klang Valley, Malaysia. Dietary adherence and self-management skills were assessed using validated End-Stage Renal Disease Adherence Questionnaire and Perceived Kidney/Dialysis Self-Management Scale, respectively. Validated self-developed scales were used to gauge nutrition literacy, dietary knowledge and Health Belief Model constructs. Relationships between variables were examined by multiple linear regressions and partial least squares structural equation modeling. Limited nutrition literacy was evident in 46.3% of the HD patients, associated with older age, lower education level, and shorter dialysis vintage. Dietary adherence rate was at 34.9%. Nutrition literacy (β = 0.390, p < 0.001) was an independent predictor of dietary adherence, mediated by self-efficacy (SIE = 0.186, BC 95% CI 0.110-0.280) and self-management skills (SIE = 0.192, BC 95% CI 0.103-0.304). Thus, nutrition literacy-enhancing strategies targeting self-efficacy and self-management skills should be considered to enhance dietary adherence in the HD population.

Revision and Psychometric Validation of a Survey Tool to Measure Critical Nutrition Literacy in Young Adults

OBJECTIVE

To refine and psychometrically validate the Revised Critical Nutrition Literacy Tool in a young adult sample.

METHODS

Young adults recruited from 3 universities completed the 11-item Critical Nutrition Literacy Tool claims scale. Exploratory factor analysis, confirmatory factor analysis (CFA), and item response theory were used to validate the Critical Nutrition Literacy Tool. Omega and Cronbach α assessed reliability.

RESULTS

A total of 1,718 participants completed the survey. Results from exploratory factor analysis and CFA analyses suggested that a 2-factor, 7-item instrument showed a reasonable fit to the data based on the comparative fit index and standardized root mean residual values, χ²(13) =161.64, P < .001, comparative fit index = 0.90, root mean square error of approximation = 0.11, standardized root mean residual = 0.07. All items loaded well onto the factors from the CFA and item response theory perspectives. The full measure and both factors showed questionable (>0.60) or acceptable (>0.70) internal consistency.

CONCLUSIONS AND IMPLICATIONS

A revised 2-factor instrument capturing (factor 1) critical appraisal of media and (factor 2) evidence-based sources of nutrition information demonstrated sound psychometric characteristics. Further item testing is necessary for different populations, and item development is warranted to capture Internet/social media sources and the relationship among critical nutrition literacy, dietary behaviors, and health outcomes.

The Effectiveness of the Good Affordable Food Intervention for Adults with Low Socioeconomic Status and Small Incomes

Good Affordable Food (GAF) is a small-group nutrition education intervention for adults with low socioeconomic status and small incomes. It aims to empower participants to save money on groceries and consume healthier diets. This paper reports the short-term and longer-term effects on behavioural determinants and self-reported behavioural changes. A quasi-experimental control group design was applied with a baseline measurement, a post-test immediately after the intervention, and a follow-up measurement after six months. The study included 237 participants (intervention group: n = 131; control group: n = 106) at baseline, 197 at post-test, and 152 at follow-up. Data were collected by telephone, mostly using closed interview questions. Positive short-term and longer-term effects were found for attitude towards the costs of healthy foods, food label use, and the use of liquid butter or oil to prepare hot meals. Short-term intervention effects related to knowledge towards saving money on groceries, self-efficacy towards healthy eating, portion size awareness, and mindful eating. GAF was effective in changing some determinants and behaviours related to cost and food consumption, however, mostly in the short term. Thereby, it is an example of combining pricing and health information in nutrition education that developers of effective nutrition education for low-income groups can build on.