Exploring the Definition and Components of Food and Nutrition Literacy in Lower Secondary School Students: A Qualitative Study | BMC Nutrition

The objective of exploring the perspective of all stakeholders on the definition of FANLit was achieved through the bottom-up qualitative approach. The concept of FANLit in this study consisted of cognitive knowledge, fundamental, interactive and critical skills related to food and nutrition. This is useful for the decision on the consumption of healthy foods. This concept is consistent with Bloom’s taxonomy which stated that knowledge is the fundamental cognitive skill and refers to the retention of specific and discrete pieces of information, such as facts and definitions, or methodology. Applying knowledge, understanding and using skills or techniques in new situations through the third level application of Bloom’s Learner Taxonomy is a way to practice and maintain timely behavior. [35]. The definition of FANLIt with cognitive knowledge, functional, interactive and critical skills was consistent with previous literature and Nutbeam’s health literacy model [10, 14, 16, 23]. These dimensions are essential because they could influence the health of adolescents and reduce the risks of developing diseases in the future, in particular non-communicable diseases.

To be specific, the first theme of FANLit was knowledge of food and nutrition knowledge with food and nutrition knowledge, and understanding of food and nutrition. This theme indicates that knowledge is the initial level of cognitive behavior [35]. This also shows that understanding is the representation of knowledge. Therefore, knowledge and understanding must be included in the definition of FANLit. This is consistent with previous literatures indicating that health literacy had a set of knowledge and skills or a hierarchy of functions in the definition [36, 37]. Similarly, scholars have agreed to have a body of knowledge and understanding in the definition of FANLit [14, 23, 24, 36,37,38,39]. This concept could be related to the translation of knowledge into practice, which corresponds to procedural knowledge and judgment skills in food and nutrition. [40]. The content of knowledge and understanding of food and nutrition includes definition, types, components and sources of foods, nutrition, food safety, quantity, sources, functions of nutrients , nutrition labeling and the effects of foods and nutrients on health. This content is congruent with declarative knowledge which represents understanding of factual information about food and nutrition, while procedural knowledge represents understanding of nutritional indicator which influences reasonable food consumption choices and actions. [41]. This is the fundamental knowledge to interpret various food and nutrition issues in order to establish an appropriate food consumption practice for one’s own health.

FANLit’s second theme was a functional food and nutrition literacy skillset with access to food and nutrition information, food selection and food preparation skills. This theme stated that FANLit was a basic skill in translating knowledge and understanding to application in accessing information, selecting and preparing food and nutrition. This result agrees with Nutbeam [9] proposing the three-level model of functional health literacy, interactive health literacy, and critical health literacy. Findings from a study by Ashoori M, et al. [23] are similar to this study in that the majority of functional skills relate to the application of basic food and nutrition knowledge, food purchasing and storage, meal preparation skills, food production and environmental sustainability skills. Consistent with previous studies, access to food and nutrition, information, food selection [38, 42, 43]food preparation skill [24, 38, 39]and daily food and nutrition planning and management [42, 43] are included in the FANLit definition.

The third FANLit theme was an interactive food and nutrition literacy skill set with communication, sharing and discussion regarding health and nutrition with others (peers, family, academics, healthcare providers, etc.). This theme explained that food consumption was a daily activity of people, and most students lived with their parents or guardians. It is also an interaction with their peers and teachers at school. Therefore, the social skills of this group to communicate and share information about food and nutrition have been developed. This result is consistent with food and nutrition [20, 24, 38]sharing knowledge and discussing health and nutrition related topics with others [38]. When the interactive competence of FANLIt is reached, the application of new information will lead to a change in their practices and behaviors. The interrelation between functional skills and interactive skills in FANLIt is about the ability to combine food and nutrition information with interactive social skills to adapt to a new situation.

FANLit’s fourth theme was a critical food and nutrition literacy skill set with information used in decision making, healthy food selection, and healthy budgeting. This theme indicated that this skill is the advancement of translating factual knowledge, procedural knowledge, and social skills into practice, such as preparing a budget to purchase healthy foods. This information is shown in the participants’ response that several social media influenced decision-making on food consumption. As in previous studies, these components affect healthy food selection [24, 38, 39] and effective budgeting [42, 43].

In this study, there are four themes and 12 sub-themes in cognitive knowledge and skills. As for the skill domain, it conforms to Nutbeam’s hierarchical model of health literacy, including functional, interactive, and critical literacy. [9]. The views of the various types of stakeholders were different due to their roles, responsibilities and perceptions. For example, while students shared their understanding of food preparation skills and communication with teachers and health care providers, school health nurses shared their understanding of the nutrition flag. and public health practitioners with nutrient information and food selection skills. This information is complementary with the other perspectives of definition of FANLIt and its component of all stakeholders. These results could be beneficial for the development of the FANLit assessment instrument among lower secondary students. FANLit results are critical because diet is linked to activities of daily living. Understanding FANLit could increase cognitive knowledge, functional, interactive, and critical skills that lead to better management of their food choice, interaction with others about food and nutrition information, and critical decision-making about food consumption for their own health.

The use of a qualitative approach to explore and understand the question of FANLit is considered the strength of this study. Diverse perspectives from the national and regional levels were included. Nevertheless, the specific context of the subjects of this study could be considered a limitation. The results of this study may be useful to inform the further development of the FANLit assessment instrument among junior high school students in Thailand. Moreover, the results could be used as a guideline for future programs aimed at improving the eating and dietary behavior of young adults.

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