literacy and nutrition education

Food Literacy

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Children and food literacy

Food labels

• Food safety

Portion size

Weight management

Health literacy broadly refers to how people find, understand, and use health information and how organizations make it easier for people to do that. However, researchers continue to debate and define what it means to be nutritionally literate and food literate. While some researchers use nutritional literacy and food literacy synonymously, others distinguish the two and refer to nutrition literacy as going beyond understanding the origin of food, how it is cultivated and processed and its impact on health, to being able to act on nutritional information.

Below are summaries of research on nutritional and food literacy as well as summaries of research on the association between health literacy or health literacy best practices and food safety, portion size, weight management, and the use of food labels.

Ha, Killian et al. (2020) hypothesized that an intervention designed to enhance skepticism and critical thinking about food commercials would promote healthier food choices among children aged  8-12 years. Over a one-week period, 18 children attended four sessions in which they were exposed to food commercials interspersed with narrative interventions. Another 18 children in the control group were exposed only to the food commercials. All children were encouraged to think aloud during the sessions to share their attitudes about the commercials. The results suggest that the intervention effectively enhanced children’s cognitive skepticism and critical thinking toward commercials. However, the enhanced skepticism towards the commercials did not change the amount of snack food the children consumed.

Privitera et al. external icon  (2015) conducted a study in which children were asked to choose 4 out of 12 food items in a grocery aisle setting with emo-labels added (happy = healthy; sad = not healthy) and again without emo-labels. Children made overall healthier food choices when emo-labels were present, even when they knew about the unhealthy options available. Emo-labels may not only promote healthier food choices for children, but researchers contend that they may also be a good tool to help increase health literacy at an early age and potentially help reduce rates of childhood obesity.

A preschool program in Australia designed to increase children’s food literacy and encourage children to enjoy vegetables shows that food literacy begins at an early age. The curriculum consists of a one or two hour weekly session taught by dieticians, preschool staff, and volunteers. Whiteley & Matwiejczyk (2015) found that after the program, over 70% of children asked for and ate more vegetables and parents and preschool staff also reported that children were more knowledgeable about vegetables and had improved food literacy.

People who use nutritional information on food labels tend to make better dietary choices and have better health outcomes.

A 2015 study used eye-tracking glasses to measure adults’ visual attention to the nutritional information of food products during a food selection task. Front labels used a familiar red, yellow, and green sign and there was a sign with explanatory information near the product. Back labels were the usual nutrition label. Nutrition labels located on the front of products were more likely to be viewed by participants than those located on the back, suggesting that consumers may be more willing to read the shortened and simplified labels.

A 2014 study finds that young adults with poor health literacy are not likely to use food labels to select food products and are more likely to report an unhealthy diet. People with higher self-efficacy use food labels more often.  When people use the information on food labels regularly, they tend to have better dietary choices and have better health outcomes. Another study  also notes a correlation between poor food label comprehension and low literacy and numeracy skills.

Sinclair & Hammond (2013) investigated how well adults could understand nutritional information on food labels. The researchers found that although people self-report high levels of understanding, their actual level of understanding is much lower. Understanding was lowest among people with lower incomes and less education. People with higher education and higher income and White people were more likely to correctly calculate the percentage of daily calories a serving size of a food product would have based on a diet of 2,500 calories per day.

A 2012 study  examined the health literacy and nutrition behaviors of a sample of adults enrolled in the Supplemental Nutritional Assistance Program (SNAP). Race and parental status were found to be significant predictors of health literacy. Using the Newest Vital Sign (NVS) as their health literacy measurement tool, the researchers found that 37% of participants had adequate health literacy. Less than half of the participants reported using nutrition labels when purchasing food. Questions that required numeracy skills were the most challenging for participants.

Food Safety

Health-literate organizations make health information and services easier for people to find, understand, and use so people can make decisions. A  2022 study  by Kim and colleagues points out that making a specific piece of health information findable, a restaurant’s inspection score, is important when people make dining decisions. The authors learned that areas that post inspection scores in restaurants had a lower rate of foodborne illness outbreaks than areas that post scores online. Rates of foodborne illness outbreaks were highest in areas that did not post scores anywhere. The authors state, “Because access to this information is important to consumers, a favorable score may attract more consumers, whereas a less favorable score may provide food operators with additional incentive to improve their food safety performance.”

Chaudry and colleagues (2011) asked people with low literacy and numeracy skills to test digital apps that estimate portion sizes and track food intake. The researchers found that the participants could accurately estimate portion sizes using apps designed for liquids and shapeless foods, but participants had difficulty with apps designed for solid foods. For snacks, participants preferred hand gestures such as the shape of a fist to estimate portion size. The researchers defined snacks as foods that are typically eaten a little at a time and not present on a plate at once, such as pretzels,

A  study by Huizinga et al. external icon  (2009) found that although 91% of study participants reported completing high school, only 65% of them were accurate when asked to serve a single serving of food. Participants who overestimated how much food constitutes a single serving were much more likely to have low literacy and numeracy skills than adults who provided accurate estimates.

In a 2021 study , Sanders and colleagues provide the results of a health-literacy intervention for obesity prevention in early childhood. The study followed the children from the age of 2 months through 24 months. At each regularly scheduled well-child visit, parents of children in the intervention group received educational toolkits focused on childhood nutrition, while those in the control group received toolkits focused on injury prevention. The researchers consulted parents from a variety of racial and ethnic backgrounds when developing the toolkits. Physicians caring for the children in both groups received the same number of hours of training in teach-back and plain language. Compared to children in the control group, children in the intervention group experienced less weight gain in the first 18 months of life, but the difference did not persist through age 24 months. The researchers provide explanations as to why the difference did not persist.

Health Literacy Topics

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Nutrition Education

For more than a half century, the United States Department of Agriculture (USDA) – “the People’s Department” – has funded  nutrition education designed to improve safe food handling and preparation as well as the nutritional health and well-being of the population. In addition to providing general guidance through resources such as  MyPlate and  the Dietary Guidelines for Americans , USDA provides more specific nutrition education through programs for historically underserved populations. USDA also funds  research to increase understanding of healthful food and beverage choices and to refine and improve educational content, methodologies, and evaluation metrics. 

Importance of Nutrition Education

Nutrition education has been described as any combination of educational strategies, accompanied by environmental supports, designed to motivate, and facilitate voluntary adoption of food choices and other food- and nutrition-related behaviors conducive to health and well-being. Nutrition education is delivered through multiple venues and involves activities at the individual, community, and policy levels. Nutrition education also addresses critical issues such as food and nutrition security, food scarcity, food literacy, and food sustainability (Isobel Contento and Pamela Koch ( Nutrition Education: Linking Research, Theory, and Practice, Fourth Edition (2020)). From  social ecological lens , effective nutrition education draws upon the collective strengths and contributions of individuals, families, communities, organizations, and other sectors of society to have its greatest potential to change eating behaviors, as well as advance health equity and well-being.

NIFA’s Impact

NIFA’s role in delivering high-quality nutrition education is a part of  USDA’s four-pillar approach to Tackle Food and Nutrition Insecurity , one of the department’s current core priorities. In addition, NIFA’s contributions to improving nutrition education and the nutrition education workforce is highlighted in the historic  White House Conference on Hunger, Nutrition, and Health  and corresponding  National Strategy , both of which aim to end hunger, improve nutrition and physical activity, and reduce diet-related diseases and disparities. 

NIFA’s nutrition education program and research efforts are grounded in the  Dietary Guidelines for Americans ,  Physical Activity Guidelines for Americans , and other federal food and nutrition guidelines and priorities. NIFA-funded programs are content and relationship-based, learner-centered, culturally relevant, and dynamic. Respect for lived experience is a core value of NIFA’s nutrition education programs. This is demonstrated by the vital role of peer educators and adaptation of content and methods to embrace differences in foods, learning styles, eating practices, languages, and family and community dynamics of those participating. Attention is also given to food costs, and to the shopping, preparation, safety, and storage of foods.

Evaluation is critical to the success of NIFA’s nutrition education portfolio. Evaluation of processes, progress, and outcomes allow participants and programs to recognize and celebrate success, identify gaps and barriers, raise research questions, and guide future program directions. The  most recent EFNEP Impacts Report indicates the program reaches more than a half a million adults and families and more than 90% of adult EFNEP participants report improvement in what they eat each year. Similarly, the most recent  GusNIP Year 3 Impacts Report demonstrated positive changes on participants’ fruit and vegetable intake and food security. 

NIFA works closely with the  Cooperative Extension System, other program partners, and grantees to ensure that nutrition education programming and the science that supports it leads to improved food and nutrition behaviors for improved health outcomes.

In addition, NIFA coordinates with other federal, tribal, state, and local agencies in addition to a variety of organizations including professional societies and non-profit organizations to facilitate improved nutritional health and well-being across different sectors of society. Examples include but are not limited to: 

• Other federal nutrition assistance and education programs, such as the Food and Nutrition Service’s (FNS’)  SNAP-Ed , WIC, and Team Nutrition programs, and 
• Federal initiatives such as  FDA’s Closer to Zero , FNS’  WIC Modernization , and the REE-led  ASCEND initiative. 

NIFA also participates in the following federal coordinating committees, among others:

• The USDA Nutrition Promotion Work Group, 
• The USDA/HHS Dietary Guidelines Review Committee, and 
• The Interagency Committee on Human Nutrition Research . 

Key NIFA nutrition education relevant programs include: 

• Expanded Food and Nutrition Education Program (EFNEP) : Is the nation’s first nutrition education program. Supports families with young children and youth living below the federal poverty line and remains at the forefront of nutrition education efforts to address food and nutrition security.
• Gus Schumacher Nutrition Incentive Program (GusNIP) : Supports the research and evaluation of projects providing incentives to increase the purchase or procurement of more fruits and vegetables by income-eligible consumers.
• Community Food Projects : Supports community-led food projects including urban agriculture.
• Food and Agriculture Service Learning Program (FASLP) : Supports projects that aim to increase the knowledge of agriculture and connect schools, communities, students, and farmers to improve the nutritional health of children. 
• Agricultural and Food Research Initiative (AFRI) competitive grants program A1343 Food and Human Health : Supports investigations of the nutrients and contaminants in food and their impact on the gut microbiota.
• Agricultural and Food Research Initiative (AFRI) competitive grants program A1344 Diet, Nutrition, and the Prevention of Chronic Diseases : Supports projects that aim to improve food security and nutritional health outcomes for individuals and families through nutrition education approaches that include but are not limited to motivating or facilitating voluntary adoption of food and beverage choices, as well as other food and nutrition-related behaviors conducive to lifelong health and well-being. 
• NIFA and FNS WIC National Workforce Strategy Development : Aims to strengthen the diversity and cultural competency of the WIC workforce.   

Consumer Resources  –  USA.gov Government Benefits  explains how to apply for and find social support programs, including nutrition assistance.  Nutrition.gov  is a USDA sponsored website that offers credible information to help you make healthful eating choices. 

Nutrition Professional Resources  – The  USDA National Agricultural Library’s Food and Nutrition Information Center  provides access to a range of  resources from both government and non-government sources.

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• Open access
• Published: 22 April 2020

School-based interventions for promoting food and nutrition literacy (FNLIT) in elementary school children: a systematic review protocol

• Azam Doustmohammadian 1 , 2 ,
• Nasrin Omidvar 2 , 3 &
• Elham Shakibazadeh 4  

Systematic Reviews volume  9 , Article number:  87 ( 2020 ) Cite this article

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Food and nutrition literacy is a newly emerged concept to connect food-related knowledge and skills to healthy diets. Its promotion is important to protect children as they eat too many low-nutrient, high-energy foods . Food and nutrition literacy promotion needs multi-dimensional interventions. In the process of developing an intervention to promote food and nutrition literacy, the present review protocol aims to critically examine the evidence in the area of school-based interventions for promoting food and nutrition literacy (FNLIT) in elementary school children.

We will search PubMed/MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest (from inception onwards). Additional studies will be identified through manual searching of reference lists. Quantitative studies (e.g., randomized controlled trial, quasi-randomized trials, and cluster randomized trials) evaluating the effect of interventions to promote food and nutrition literacy in elementary school children (5–12 years old) will be included. Main outcomes will be food and nutrition literacy at functional, interactive, and critical levels. Secondary outcomes will be dietary intake indicators (e.g., healthy eating index, DDS) and health outcome measures (e.g., reduction in BMI and less weight gain). Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. The quality of the included studies will separately evaluate using the validated Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project (EPHPP). Data will be extracted by two reviewers from the identified relevant literature. Standard data synthesis and analysis will be used for the review.

This systematic review will summarize the evidence regarding the components, implementation methods, and effectiveness of the interventions of food and nutrition literacy promotion in elementary school children. The results of this review will provide a useful reference for policymakers and curriculum developers to assess education curricula and develop practical learning and teaching strategies to improve students’ food and nutrition literacy.

Systematic review registration

PROSPERO (CRD42019135118)

Peer Review reports

Non-communicable diseases (NCDs) are the major cause of mortality and morbidity globally [ 1 ]. The World Health Organization (WHO) has estimated that by 2020, NCDs will account for 80% of the global burden of disease [ 2 ]. In developing countries, including Iran, the prevalence of NCDs has increased over the past few years [ 3 ]. Most NCDs are associated with modifiable lifestyle factors [ 4 ]. It is well documented that high-risk behaviors such as meal skipping, unhealthy eating behaviors, and low physical activity is increasing among children and adolescents [ 5 , 6 , 7 , 8 ]. This has resulted in growing prevalence of overweight and obesity among children and adolescents in many countries [ 9 , 10 ].

Health literacy is considered as one of the most important personal skills to enable individuals to control health determinants. Nutbeam described health literacy as “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health” [ 11 ]. He highlighted the importance of achieving health literacy at functional, interactive, and critical levels [ 11 ]. Due to the wide scope of health issues, studies suggest that one should consider health literacy more specifically [ 12 ]. As a result, specific areas of health literacy, including food literacy and nutrition literacy, have been proposed and conceptualized. Studies that assessed the relationship between two concepts suggested a wide multifaceted topic that can be called food and nutrition literacy (FNLIT) [ 13 , 14 ].

Evidence shows that promoting FNLIT is a key factor in healthy food choice and following healthy eating patterns in children and adolescents [ 15 , 16 , 17 ]. Increasing evidence show that interventions to improve food and nutrition literacy can have a positive effect on the food and nutrition skills and dietary patterns including food selection, food preparation, increased fruit and vegetable consumption, increased self-efficacy in these areas, and improved diet quality [ 18 , 19 ].

Guided by Nutbeam’s hierarchical model of health literacy [ 11 ], food literacy/nutrition literacy have been categorized in three levels: (1) functional food/nutrition literacy is the knowledge and ability to obtain information from various sources and understanding and comprehending it as well as practical skills and strategies to promote health; (2) interactive food/nutrition literacy includes interpersonal skills with experts, peers, and other people to share and discuss necessary food and nutritional information; and (3) critical nutrition literacy refers to the ability to critically analyze food and nutrition information, understanding the food impact on the environmental as well as having the will to participate in actions to address barriers to nutritional health [ 11 , 20 , 21 , 22 , 23 ].

Functional literacy is considered as the lowest level and critical literacy as the highest [ 11 , 20 ]. In a study conducted in Iran, the cognitive and skills domains of FNLIT were identified for elementary school children. The cognitive domain included two subdomains, namely, understanding food and nutrition information, and nutritional health knowledge. The skills domain included seven subdomains examining functional FNLIT, interactive FNLIT, food choice literacy, critical FNLIT, and food label literacy. In this study, for the first time, components of FNLIT dimension were identified in elementary school children [ 14 ].

Due to the novelty of the concept of FNLIT, a comprehensive intervention to promote FNLIT, especially at the interactive and critical levels, has not been yet developed. Some of the interventions related to the promotion of food literacy/nutrition literacy mentioned in some studies are as follows [ 15 , 24 , 25 , 26 ]:

Educating individuals about portion sizes and daily food group, describing and learning how to read nutritional labels and apply them to one’s dietary change by training and video programs

Training in gardening and planting

Cookbooks that feature healthy recipes

Functional guideline for food purchasing using an empty grocery list in accordance with the traffic light-coded food labels

Media literacy/critiquing a food commercial

The promotion of FNLIT in children seems to be one of the most important elements in improvement of healthy dietary pattern and prevention of diet-related non-communicable diseases for several reasons. First, FNLIT is related to everyday living activities, i.e., food related activities, including eating [ 27 ]. Second, it “empowers individuals, households, and communities to protect diet quality through change and strengthen dietary resilience over time” [ 28 ]. Children who develop interactive and critical skills of FNLIT find it easier to manage their food choices, resolve conflict of their different interests, interact nutritional information with others, and participate in action to address barriers.

Third, based on the evidence, interventions in the early years of life are recommended to take advantage of the child learning ability and more possibility of successful stabilization of healthy behavior into adulthood [ 29 ]. The fourth rationale for the importance of FNLIT promotion is derived from its relevance in the context of school. Schools have direct contact with students for approximately 6 h each day and for up to 13 critical years of their social, psychological, physical, and intellectual development [ 30 ]. The school settings have been identified by the WHO as an ideal setting to teach children and adolescents about healthy dietary habits and help them to make healthy and informed food choices [ 31 ]. However, lack of documented policies and programs in the field of FNLIT is a problem, especially in developing countries.

According to the studies, FNLIT has multi-dimensional political, cultural, and social characteristics. This multi-dimensional nature of this concept confirms the need for multi-dimensional interventions to improve FNLIT [ 12 , 28 ]. The first step to develop this type of intervention involves referring to the evidence and modeling based on the effective and successful interventions [ 32 ]. This approach guides researchers to find ways to integrate components of prevention programs in ways that are acceptable and meaningful to the school setting and to evaluate results. Therefore, this review aims to collect interventional studies related to FNLIT promotion among school-age children through searching for relevant scientific literature. After the final selection and extraction of the data, components, implementation methods, and effectiveness of the interventions will be identified and reported in the form of a systematic review to be used as a guide in developing interventions with the same purpose.

The objectives of this study will be to systematically determine components within interventions that have an impact on children’s food and nutrition literacy (at functional, interactive, and critical levels) among elementary school children (5–12 years old).

The objectives of this study are to:

Determine components within interventions that have an impact on food and nutrition literacy (at functional, interactive, and critical dimensions) among elementary school children (5–12 years old).

Determine the implementation methods of food and nutrition literacy interventions (at functional, interactive, and critical dimensions) among elementary school children (5–12 years old).

Determine the effectiveness of interventions in promotion of FNLIT (at functional, interactive, and critical dimensions) among elementary school children (5–12 years old).

Study design

The present protocol has been registered within the PROSPERO database (registration number CRD42019135118) and is being reported in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement [ 33 ] (see checklist in Additional file 1 ). The proposed systematic review and meta-analysis will be conducted following the guidance in the Cochrane Collaboration Handbook of Systematic Reviews [ 34 ]. The methods and results will be reported in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [ 35 ].

Criteria for considering studies for this review

Types of studies.

Quantitative studies (e.g., case-control studies, pre-post studies, randomized controlled trial, quasi-randomized trials, and cluster randomized trials) evaluating the effect of interventions to promote food and nutrition literacy in elementary school children (5–12 years old) will be included.

Types of participants

We will assess all studies whose target group are elementary school students (5–12 years old).

Types of interventions

Any type of studies available in English featuring interventions that contain one or more components of food literacy/nutrition literacy [ 36 ], including understanding of food and nutrition information, knowledge of food and nutrition, the skill of finding information from various sources, meal and snack preparation, increasing the consumption of fruits and vegetables, reducing the consumption of prepared foods, healthy food choice, and the skill of reading and analyzing food labels in school setting, will be included in the review without considering the time limit. The studies that focus on nutritional interventions related to diseases such as type II diabetes and obesity will be excluded.

Types of outcome measures

Referring to Nutbeam’s tripartite model [ 11 , 21 ], which considers three levels of literacy (functional, interactive, and critical), the main outcomes evaluated in this review consist of food and nutrition literacy at functional, interactive, and critical levels. Examples of related behaviors at each level are as follows:

Functional food and nutrition literacy: improve meal planning, prioritizing healthy meal choices, reading nutrition facts labels , cooking skill confidence, and desire to fewer fast food meals. Increase in fruit and vegetable and whole grain consumption [ 37 ] and preparing fruits or vegetables in a new way [ 38 ].

Interactive food and nutrition literacy: family-child feeding interactions [ 37 ], skill of saying “no” to unhealthy food, and emotional skills [ 14 ].

Critical food and nutrition literacy: trying ethnic and unfamiliar food [ 39 ], food label literacy [ 40 ], improving school social environment, increasing school community connections [ 41 ], and engagement with issues of social justice and equity in food systems [ 42 ].

Successful interventions and those that include theories and hands-on activities to enhance literacy will be taken into account.

Secondary outcomes include improvement in diet quality (e.g., healthy eating index) [ 16 ], dietary intake indicators (e.g., DDS), reduction in BMI and less weight gain [ 43 ], and indicators of quality of life/wellbeing [ 44 ].

The study outcomes will not be a criterion to enter the study, and all the positive and negative outcomes will be checked.

Search methods for identification of studies

Electronic searches.

The primary source of literature will be a structured search of major electronic databases (from inception onwards): PubMed/MEDLINE, EMBASE, Scopus, Web of Science, and CENTRAL. The secondary source of potentially relevant material will be a search of the grey or difficult to locate literature, including ProQuest and Google Scholar. We will perform hand-searching of the reference lists of included studies, relevant reviews, or other relevant documents. The literature searches will be designed and conducted by the review team which includes two experienced health information specialists. The search will include a broad range of terms and keywords related to “food literacy,” “nutrition literacy,” “children,” “adolescents,” and “interventions”. A draft search strategy for multiple databases is provided in Additional file 2 .

Data collection and analysis

Selection of studies.

All the identified studies of different sources will be transferred to Endnote and systematically de-duplicated, and a merged library will be created. Two reviewers will independently screen the titles and abstracts according to a pre-defined inclusion criteria checklist and will exclude unrelated ones. In case of disagreement between the reviewers, the judgment of article inclusion in the study will be made by a third person. The full texts will be read by the two individuals separately, and the final decisions will be made based on the checklist of inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) flowchart [ 33 ] will be used to document the selection process.

Data extraction and management

A data extraction form will be designed and used to extract information from each study report. Information of interest will include the following:

Study characteristics: study design, year of publication, journal, year (or period) of study conduct, and geographical location of study conduct

Participant characteristics: sample size, age (e.g., mean with standard deviation, range), and gender

Intervention characteristics: intervention (name and type), intervention description (components of intervention, intervention duration/follow-up), and timing of post-intervention evaluation

Outcome results: data collection method (e.g., validated tools), main outcomes including improvement in FNLIT at functional, interactive, and critical literacy and secondary outcomes including improvement in diet quality (e.g., healthy eating index) [ 16 ], dietary intake indicators (e.g., DDS), reduction in BMI and less weight gain [ 43 ], and indicators of quality of life/wellbeing [ 44 ]

The content of each included studies will be extracted by two team members, independently, and potential conflicts will be resolved through discussion. Authors of primary publications will be contacted for data clarifications or missing outcome data, as necessary.

Assessment of risk of bias in included studies

Appraisal of study quality.

Two reviewers will separately evaluate the quality of the included studies using the validated Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project (EPHPP) [ 45 ]. This tool was developed in order to provide high-quality systematic reviews of articles relating to public health topics [ 46 ]. Eight aspects of quality are assessed: (1) selection bias, (2) study design, (3) confounders, (4) blinding, (5) data collection methods, (6) withdrawals and dropouts, (7) intervention integrity, and (8) analysis, leading to an overall methodological rating of strong, moderate, or weak [ 46 ]. The quality of all the included studies will be assessed by the first author. The second and third authors will each check one third of the publications for completeness and accuracy of the quality assessment. Differences in the quality assessment will be resolved by discussion among all of the authors.

Data synthesis

The data from each paper (e.g., study characteristics, context, participants, outcomes, and findings) will be used to build evidence tables of an overall description of included studies. If feasible and appropriate, data points from primary observational studies will be used to perform random effects meta-analyses. Since heterogeneity is expected a priori, we will estimate summary estimates (e.g., mean differences, standardized mean difference) and its 95% confidence interval using the random effects model. The random effects model assumes the study prevalence estimates follow a normal distribution, considering both within- and between-study variations. Forest plots will be used to visualize the extent of heterogeneity among studies. We will quantify statistical heterogeneity by estimating the variance between studies using I 2 statistic. The I 2 is the proportion of variation in prevalence estimates that is due to genuine variation in prevalence rather than sampling (random) error. I 2 ranges between 0 and 100% (with values of 0–25% and 75–100% taken to indicate low and considerable heterogeneity, respectively). We will also report Tau2 and Cochran Q test with a P value of < 0.05 being considered as statistically significant (heterogeneity). If quantitative synthesis is not appropriate, the findings will be summarized and discussed. Conclusions will be also formed on the basis of the power of each of the studies. After summarizing the results and providing conclusions that lead to improving interventional decision-making, the most successful and effective interventions will be identified .

Additional analyses

If sufficient studies are identified and data points are available, potential sources of heterogeneity will be investigated further by subgroup or meta-regression analysis according to baseline characteristics and methodological covariates. We plan to conduct analyses by sex (girls vs boys) [ 47 ], age (e.g., children vs adolescent, midpoint of age range as continuous variable) [ 36 , 47 ], type of study (RCT, case-control, pre-post, etc.), food literacy/nutrition literacy level (e.g., low, moderate or high), sample size (e.g., < 1000, 1000–5000, or > 5000 participants), and study quality (e.g., low/moderate vs high-risk of bias). Small study effects (or publication bias) will be assessed by inspection of the funnel plots for asymmetry and with Egger’s test [ 48 ] and Begg’s test [ 49 ], with the results considered to indicate potential small study effects when P values are < 0.10.

The combined impact of poor diet and being overweight and obesity rates continue to raise health and economic concerns around the globe. Dietary behavior change and obesity prevention interventions targeting at children are necessary in order to prevent the onset of chronic diseases later in life. Reducing current nutrition-related chronic diseases, such as childhood epidemic of obesity, requires improving their food and nutrition literacy [ 50 ]. A goal of food literacy is to bridge the gap between what children know and want to practice. As regards food skills needed for translating knowledge into practice, food and nutrition literacy can have a key role in fostering healthy eating behavior [ 51 ].

This systematic review will summarize the evidence regarding the components, implementation methods, and effectiveness of the interventions of food and nutrition literacy promotion in elementary school children. One potential by-product of this review is providing a useful reference for policymakers and curriculum developers to assess education curricula and develop practical learning and teaching strategies to improve students’ food and nutrition literacy. This review will provide insight on the extent to which health providers, educators, families, and students may have an important role in children’s healthy lifestyle behaviors and how their involvement in food and nutrition literacy promotion may contribute to healthier children.

There are several limitations of our planned systematic review methods.

The potential limitations at evidence source (study level) include the following:

Lack of studies that have assessed the effect of food literacy or nutrition literacy interventions on functional, interactive, and critical dimensions separately.

Lack of an adequate control or comparator group in studies, limiting the ability to determine the true effect(s) of the intervention.

Since many studies do not directly use the term food literacy or nutritional literacy, we may miss some interventions related to the improvement of some components of food and nutrition literacy. However, the search strategy in our study is highly sensitive to overcome this limitation.

The results of the review will be utilized to assess education curricula and develop practical learning and teaching strategies to improve students’ food and nutrition literacy in Iran which can be utilized by other countries as well.

This review is intended for publication in a peer-reviewed journal. Analyses and scripts will be made publicly available. Any changes to the protocol will be documented as well.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Abbreviations

Food and nutrition literacy

World Health Organization

Preferred Reporting Items for Systematic Review and Meta-Analysis Statement-Protocol Extension

Randomized controlled trial

Dietary diversity score

Body mass index

Effective Public Health Practice Project

Standard mean difference

Mean difference

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Acknowledgements

The authors hereby express their gratitude to the Shahid Beheshti University of Medical Sciences, National Nutrition and Food Technology Research Institute (NNFTRI). This review will be conducted by the approval and funding of the NNFTRI.

This review will be conducted by the approval and funding of the Shahid Beheshti University of Medical Sciences (grant number: IR.SBMU.NNFTRI.REC.1397.022). The funder had no role in developing the protocol.

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AD and NO conceived and designed the study. AD and ES developed the search strategy. AD prepared the initial draft of the protocol, which NO and ES revised. All authors read and approved the final protocol.

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Doustmohammadian, A., Omidvar, N. & Shakibazadeh, E. School-based interventions for promoting food and nutrition literacy (FNLIT) in elementary school children: a systematic review protocol. Syst Rev 9 , 87 (2020). https://doi.org/10.1186/s13643-020-01339-0

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The association and mediation role of Food and Nutrition Literacy (FNLIT) with eating behaviors, academic achievement and overweight in 10–12 years old students: a structural equation modeling

• Azam Doustmohammadian   ORCID: orcid.org/0000-0001-6249-2520 1 ,
• Nasrin Omidvar   ORCID: orcid.org/0000-0002-4061-0562 2 ,
• Nastaran Keshavarz-Mohammadi   ORCID: orcid.org/0000-0001-6475-3587 3 ,
• Hassan Eini-Zinab   ORCID: orcid.org/0000-0002-6895-034X 2 ,
• Maryam Amini   ORCID: orcid.org/0000-0002-5279-213X 4 &
• Morteza Abdollahi   ORCID: orcid.org/0000-0003-0310-2021 4  

Nutrition Journal volume  21 , Article number:  45 ( 2022 ) Cite this article

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Food and nutrition literacy is a key factor in shaping healthy dietary behaviors and may result in decreasing decrease the prevalence of overweight. Empirical research on food and nutrition literacy and its outcomes is limited, especially among children and adolescents. Thus, this study investigates the link between Food and Nutrition Literacy (FNLIT) with eating behaviors, academic performance, and overweight in 10–12 years old students in Tehran, Iran.

This study was performed through two phases: 1) Proposing a conceptual model of the relationship between FNLIT and its determinants and outcomes, based on the existing evidence and previous models, and 2) Testing the proposed FNLIT model through a cross-sectional study on 803 primary school students (419 boys and 384 girls, from 34 public and 10 private primary schools), aged 10–12 years using structural equation modeling. Demographic, socio-economic, and household food security characteristics were collected by interviewing the students and their mothers/caregivers using a questionnaire. FNLIT was measured by a self-administered, locally designed, and validated questionnaire.

The fit indices suggested a reasonably adequate fit of the data to the hypothesized model (χ 2 /df = 2.03, p  < 0.001, goodness of fit index (GFI) = 0.90, adjusted goodness of fit index (AGFI) = 0.88, comparative fit index (CFI) = 0.91, incremental fit index (IFI) = 0.91, root mean square error of approximation (RMSEA) = 0.04, standardized root mean residual (SRMR) = 0.06). SES was directly and positively related to FNLIT and its subscale in students. FNLIT score had a positive direct (non-mediated) relationship with healthy eating behavior and academic performance. This pattern was strongly reversed in unhealthy eating behavior. There was a full mediation relationship between FNLIT and overweight/obesity via healthy eating behaviors. SES predicted academic performance partially through the mediating effect of Food Label Literacy (FLL). The results indicated that despite the direct relationship between SES and academic performance, an indirect but negative relationship existed with food insecurity.

The finding also revealed the fully mediating role of Food Choice Literacy (FCL) in the relationship between demographic factors and healthy eating behaviors. Our study also found that Interactive Food and Nutrition Literacy (IFNL) protected unhealthy eating behaviors, and FCL predicted healthy eating behaviors in children.

Our study draws attention to FNLIT, especially the skills domain, including IFNL, FCL, and FLL, as the most important determinant of healthy eating behavior, academic performance, and weight status in school-age children reduces social inequalities in children’s development.

To ensure an adequate level of FNLIT, educators should assess and plan to enhance food literacy skills in children and adolescents.

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Introduction

Factors contributing to poor dietary habits are complex, and improving eating behavior requires an interdisciplinary approach that acknowledges the social context [ 1 ]. Among the different factors affecting eating behaviors, food literacy has recently been considered a key factor in improving diet quality, health, and well-being [ 2 ]. Food literacy is a construct that affects an individual’s ability to assess food and nutrition information, comprehend food labels, perform food safety precautions, use healthy cooking methods, apply dietary recommendations and make healthy food choices [ 3 , 4 , 5 ]. It may be a key factor in shaping dietary behaviors, specifically in children and adolescents [ 6 , 7 ]. Healthy eating behaviors are essential in maintaining physical health and promoting optimal learning and school achievement [ 8 ]. Food literacy may contribute to a person’s ability to feed themselves (and others) in a nutrition-promoting way [ 9 ]. Enhancing food literacy to decrease nutrition-related disease burden is a growing international role for public health practitioners. However, assessing the impact of food literacy programming and the link between food literacy and health outcomes is hindered by the lack of validated measurement tools [ 10 ].

Doustmohammadian et al. developed a validated FNLIT questionnaire that measures the key functional, interactive, and critical elements of FNLIT in 10–12 years old students [ 11 ]. Guided by Nutbeam’s hierarchical model of health literacy [ 12 ], food and nutrition literacy in children is consisted of cognitive domains, including Understanding Food and Nutrition Information (UFNI) and Nutritional Health Knowledge (NHK) and skill domain including Functional Food and Nutrition Literacy (FFNL), Interactive Food and Nutrition Literacy (IFNL) and Critical Food and Nutrition Literacy (CFNL).

Childhood is a unique life stage through which decision-making skills are developed. Food and nutrition literacy programs are ideal for this stage because they focus on building capacity to operationalize healthy decisions [ 13 ]. There have been few studies on food and nutrition literacy improvement among adolescents [ 7 ]. Several conceptual models targeting the adult population have been suggested that improving food literacy might influence eating behavior and well-being [ 5 , 14 ].

However, empirical research on food and nutrition literacy and its outcomes is limited [ 6 , 15 ]. Thus, any relationship between food literacy/nutrition literacy and eating behaviors, food insecurity, academic achievement, or other health outcomes targeting children needs to be clarified to inform stakeholders involved in intervention design and curriculum content in this age group. Structural equation modeling (SEM) is a set of linear simultaneous equations considered an appropriate statistical technique for identifying the direct and indirect (through mediators) relationship between potential and observed variables [ 16 , 17 ]. In SEM, individual differences and errors are also taken into account, which provides a more in-depth insight into the assessment of FNLIT, its determinants, and outcomes [ 18 ]. To date, no studies have used the SEM approach in this field. Therefore, the current study aimed to investigate the association between Food and Nutrition Literacy (FNLIT) components and eating behaviors, academic achievement, and weight status using the statistical approach of structural equation modeling (SEM), in elementary school children in Tehran, Iran.

Conceptual framework

The conceptual framework of the study was proposed based on a review of prior evidence and previously described conceptual models on food/nutrition literacy (Fig.  1 ).

Proposed model of the relationship between FNLIT and its determinants and outcomes in 10–12 years old students. Arrows starting from the same determinant factors are in the same color

Linking food literacy/nutrition literacy to socio-demographic factors [ 19 , 20 ], food security [ 21 , 22 , 23 ], weight status [ 24 ], and academic achievement [ 25 ] have been established in previous studies. The direct relationship between food or nutrition literacy and eating behaviors has been observed across several studies [ 6 , 26 , 27 ]. Chang et al. [ 28 ] theorized consumer capacities in the field of nutrition as factors that affect individuals’ food security and determined using a nutritional panel as a viable plan to reduce food insecurity. In addition, other studies focused on food literacy abstracted food security as a food literacy outcome [ 5 , 6 , 29 , 30 , 31 , 32 , 33 , 34 ]. They believed that the achievement of food literacy ensures access to a healthy diet. According to studies, food security is strongly related with children’s health and could affect anthropometrical indices [ 35 , 36 ]. Other researchers have assessed the relationship between food insecurity, academic achievement, and anthropometric status in elementary school children [ 35 ]. On the other hand, Magulod et al. [ 37 ] reported anthropometric status and dietary behavior as determinants of academic achievement. The existing literature highlighted a moderate association between food consumption and behaviors on school performance among children [ 38 ].

Several proposed conceptual models or frameworks attempted to describe the relationship between food literacy, individual determinants, and outcomes related to health [ 5 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. Although food literacy has been presented as an essential factor for healthy food choices and a powerful resource to improve individual and public health, Vidgen and Gallegos (2014) found an indirect link between food literacy and healthy nutrition. They believe that food security and the ability to prepare food can enhance food choice and pleasure, stimulating healthy eating behavior [ 5 ]. In most conceptual frameworks, the authors have particularly focused on the sociocultural as well as environmental factors [ 5 , 39 , 40 , 41 , 42 , 43 , 44 ].

Study design

This study used a population-based cross-sectional design, proposing a hypothesized model for explaining the relationship between FNLIT and its determinants and outcomes. Model fitness was addressed by testing the hypothesized conceptual model.

Settings and sample

The study was performed from November 2015 to May 2017 in Tehran, the capital of Iran. The sampling frame can be seen in Fig.  2 . The total eligible participants included 186,761 primary school children in the designated districts. Since there was no prior knowledge on the low FNLIT prevalence in primary school children to be estimated/examined for FNLIT, the P -value was 50% to obtain the highest P*(1-P) value for estimating the largest sample size. The sample size was determined to be at least 768 using the following formula, and 900 students were invited to increase statistical power further.

Study sampling frame

Finally, 803 students aged 10 to 12 years completed the survey (response rate = 89.2%, power = 88%). Time constraints were the main reason for non-participation. According to the general office of education in Tehran, there are three socioeconomic levels in 19-educational-districts of Tehran, namely affluent (north), semi-affluent (center), and deprived (south). A list of primary schools within the boundary of the mentioned districts provided by education department was used to start sampling. The students were selected through a three-stage cluster random sampling technique. Initially, according to the population density of the districts, nine districts (three from each socio-economic level) were selected. In the second stage, private and public schools were randomly allocated in each district with a probability proportional to the target sample size of each school. Finally, the students were randomly chosen from the fifth and sixth grades (aged 10–12 years) of the selected schools, and the ultimate participants were chosen from 34 public and 10 private primary schools. The excluded subjects’ characteristics did not differ significantly from those in the study.

Measurements

Food and nutrition literacy assessments.

A valid self-administered questionnaire was applied to measure food and nutrition literacy in 10–12 years old students (details of its development and validation are explained elsewhere [ 11 ]). It was a 46-item questionnaire and included the cognitive and skill domains. Two sub-scales of Understanding Food and Nutrition Information (UFNI, 10 items) and Nutritional Health Knowledge (NHK, 5 items) were identified in the cognitive domain. The skill domain consisted of four sub-scales, including Functional Food and Nutrition Literacy (FFNL), Interactive Food and Nutrition Literacy (IFNL), Food Choice Literacy (FCL), and Critical Food and Nutrition Literacy (CFNL), encompassing ten, seven, six and four items each, respectively. Finally, Food Label Literacy (FLL) was evaluated by four dichotomous questions. Based on the characterized scores of low (≤51), medium (> 51- < 74), and high (≥74), the FNLIT score ranged between 25.8 and 96.8 [ 19 ].

Assessment of eating behavior

The research team developed the eating behavior questionnaire based on the previous questionnaires [ 8 ]. For qualitative content validity, a panel of six experts (three nutritionists, one health education and health promotion, one sociologist, and one social medicine) examined the initial questionnaire. Items were modified based on the experts’ comments. Then it was pretested on 30 students (15 boys and 15 girls) to assess the questions’ content and clarity, and the unclear items were reworded. Using the questionnaire, interviewers asked about the frequency of eating sweets and salty snacks, fast foods, energy-free beverages (water, coffee, tea), energy-containing beverages (soft drinks, juices), and meals during the previous week. The regularity of mealtime was evaluated according to frequency intake of breakfast, lunch, and dinner during the past 7-day and divided into four groups, including every day a week; 3–6 times a week; 1–2 times a week; and never. Consumption frequency of snacks was measured by a four-response scale: more than or equal to three times a day, twice a day, once a day, and never. The frequency of drinking water in a day was reported as four groups of ≥5 cups a day, 3–4 cups a day, 1–2 cups a day, and zero cup a day. The students were also questioned about the frequency of having drinks (e.g., tea/coffee/hot cacao, soft drinks, and fruit juices), fast foods (e.g., sausage/hamburger, pizza, fried potato, and restaurant foods/fast foods), and snacks (e.g., sweet and salty snacks) over the last 7 days. The possible responses included: ≥5 times a week, 3–4 times a week, 1–2 times a week, and never.

Food security status

The status of household food security was measured by the valid USDA’s Household Food Security Survey Module, which assessed the ability of the households to obtain and conserve food during the previous 12-month. The survey module was translated into Farsi and validated in the Iranian context [ 47 , 48 ]. The USDA module consisted of 10 questions for households without and 18 questions for households with children and was completed face-to-face or by telephone with mothers. Based on the scale, the households were classified into four categories of food secure (FS) (raw score ranged between 0 and 2); food insecure (FI) without hunger (raw score ranged between 3 and 7); and food insecure (FI) with moderate hunger (raw score ranged between 8 and 12); food insecure with severe hunger (raw score ranged between 13 and 18). Due to the low prevalence of FI with moderate and severe hunger, they were pooled as one.

Academic achievement

The students’ teachers completed the author-designed questionnaire on academic achievement. Since children’s final grades were not available at the study time, this pretested, self-administered questionnaire was developed and used based on the teachers’ evaluations of the student’s achievement in class and with regard to the grades for mid-term assignments. The validity and consistency of the quantitative academic achievement were assessed using two evaluation approaches, including qualitative and quantitative. The teachers ( n  = 152) from 43 girls’ and boys’ primary schools assessed their students in math, reading, spelling, composition, science, and social-science using two scoring scales, including a quantitative scale of 0 to 20 points according to the grades attained in class and qualitative scale of 1 (very good) to 7 (very weak) points according to the teachers’ assessment of the student. The teachers were instructed to fill out the questionnaire.

Study covariates

Several baseline covariates, including age, birth order, family size, ethnicity, parental age, parental education, father’s job position, mother’s employment status, other income source(s) of family members, house ownership status, and receiving financial support were considered based on the available evidence [ 8 , 49 , 50 , 51 ]. Anthropometric measurements were taken, and age-and sex- standardized BMIz-score was calculated based on World Health Organization Child Growth Standards (WHO AnthroPlus, 2007) [ 52 ]. The weight status of students was reported as thin (BMIz-score < −2SD), normal (BMIz-score ≥ −2SD and ≤ 1SD), overweight (BMIz-score > 1SD and ≤ 2SD) and obese (BMIz-score > 2SD). All participants (students and their parents) signed a written informed consent before the study.

The demographic and socioeconomic status were evaluated by a structured questionnaire through interviews with children and verified by their parents and/or caregivers after that. Parents completed the food security (FS) questionnaire through face-to-face interviews. Telephone interviews were conducted for those who could not attend schools (because of child care needs, illness, work constraints, etc.).

Statistical analysis

the Kolmogorov–Smirnov test was used to assess the normal distribution of data. Categorical variables were presented as frequencies and percentages and compared using by χ2 test. In the current study, the hypothesized model of direct and indirect associations among observed and latent variables was identified and evaluated through the following steps:

Exploratory Factor Analysis (EFA)

EFA was used to explore two latent constructs of healthy and unhealthy eating behaviors. Principal Component Analysis (PCA) with orthogonal Varimax rotation was applied to estimate factor loadings influencing observed variables. Items with an absolute loading of 0.30 remained in the structural model of healthy and unhealthy eating behaviors.

Confirmatory Factor Analysis (CFA)

The CFA method was applied to verify the measurement model of academic achievement and healthy and unhealthy eating behaviors by testing the association among the observed variables and their underlying latent construct (s).

Structural equation modeling (SEM)

SEM was used to examine the multidirectional relationships and causal dependencies between a number of endogenous and exogenous variables of interest [ 53 ]. SEM also allows the construction of latent variables, which are not measured directly and estimated from measured variables [ 53 ]. The latent variables were demographic, socio-economic status, healthy and unhealthy eating behaviors, and academic achievement in the current study. Measurable variables were FNLIT, BMIzscore, and food insecurity. We calculated standardized regression weights, standardized total effects, direct and indirect effects. Model fit measures were used to assess how well the proposed model captured the covariance between all the model items or measures. Goodness-of-fit to ensure that the proposed model can adequately explain the data was assessed by several model fit indices including χ2, the ratio of the χ2 to degrees of freedom (CMIN/DF), goodness of fit index (GFI), Adjusted Goodness of Fit Index (AGFI), the Comparative Fit Index (CFI), the incremental fit index (IFI), the Root Mean Square Error of Approximation (RMSEA) and Standardised Root Mean Residual (SRMR). CFI > 0.90, RMSEA and SRMR≤0.10, and CMIN/DF < 4.0 are considered to represent an appropriate model fit to the data. For GFI, AGFI, and NFI, which range from 0 to 1.0, values > 0.90 show an appropriate model fit to the data [ 54 ]. Statistical significance of the direct effects, indirect effects, and total effects were evaluated using a bootstrapping procedure. The number of bootstrapping was set at 2000 times.

Statistical analyses were performed using SPSS 21.0 (SPSS Inc., Chicago, Illinois, and the United States) and AMOS 21.0 [ 55 ]. All P -values were two-tailed, and P-values < 0.05 were considered statistically significant.

Demographic and socio-economic characteristics of the study participants

A total of 803 students (419 boys and 384 girls) participated in the study. The mean age of students was 11.28 ± 0.65 years.

Girls and boys significantly differed in some demographic and socio-economic characteristics, including father’s education ( p  < 0.001), father’s job position ( p  < 0.001), and house ownership status ( P  = 0.005). Father illiteracy/low literacy (up to 5 years of education) was significantly more frequent in boys (15.5%) as compared to girls (5.5%). However, among boys, a higher proportion (21.6%) had fathers with higher-ranking job positions (employee/clerks) compared to girls (13.9%) ( p  < 0.001) and compared to girls (29%), a significantly higher proportion of the families of boys (36%) were tenants. Details on the background characteristics of the participants were described in Table  1 .

FNLIT status of the study participants

FNLIT level of the participants is shown in Fig. S 1 . Approximately 11.6% of students were categorized as having low FNLIT, while almost 25% had low scores in FNLIT skill domain, and the majority scored moderate to high in cognitive domain (97.4%). Among subscales of FNLIT skill domain, a high proportion of students had low scores in critical FNLIT (42.2%) and food label literacy (81.1%). However, they scored better in food choice literacy (only 7.8% scored low).

Confirmatory factor analysis

The fit indices for CFAs used to develop the constructs of eating behaviors (χ2/df = 2.65, GFI = 0.95, AGFI = 0.93, CFI = 0.90, IFI = 0.90, RMSEA = 0.05) and academic achievement (χ2/df = 3.91, RMSEA = 0.07, GFI = 0.98, AGFI = 0.95, CFI = 0.99, IFI = 0.99, RMSEA = 0.07), socio economic factor (χ2/df = 2.17, p  = 0.007, GFI = 0.98, AGFI = 0.96, CFI = 0.96, IFI = 0.96, RMSEA = 0.04) and demographic factor (χ 2 / df = 1.77, p  = 0.06, GFI = 0.99, AGFI = 0.97, CFI = 0.99, IFI = 0.99, RMSEA = 0.03) had acceptable fit to the data. All components were significantly related to their latent variables ( p  < 0.001). Mother education and mother age explained a higher proportion of the variance of the socio economic and demographic factors, respectively. Reading mark, the frequency of eating lunch per week and the frequency of sausage/hamburger explained a higher proportion of the variance of academic achievement, unhealthy and healthy eating behaviors, respectively (Fig.  3 ).

Results of Confirmatory Factor Analysis (CFA). Ellipses: latent variables; boxes: observed variables. All coefficients are standardized and have a p.value < 0.001. Fit indices of measurement model of Socio-economic status: χ 2 /df = 2.17, p  = .007, GFI = .98, AGFI = .96, CFI = .96, IFI = .96, RMSEA = .04. Fit indices of measurement model of Demographic status: χ 2 /df = 1.77, p  = .06, GFI = .99, AGFI = .98, CFI = .99, IFI = .99, RMSEA = .03. Fit indices of measurement model of Eating behaviors: χ 2 /df = 3.24, p  < .0001, GFI = .95, AGFI = .92, CFI = .89, IFI = .89, RMSEA = .05. Fit indices of measurement model of School achievement: χ 2 /df = 3.91, p  < .0001, GFI = .98, AGFI = .95, CFI = .99, IFI = .99, RMSEA = .07

Structure equation modeling

The proposed FNLIT model was tested after controlling for the possible confounding impact of the background variables (Figs.  4 and 5 ). The fit indices suggested a reasonably adequate data fit for the hypothesized model. The standardized regression weights (β) from the structural equation model are shown in Models 1 and 2. When the direct and indirect effects of FNLIT on dietary habits were examined (Model 1, Table  2 ), FNLIT score had a positive direct (non-mediated) relationship with healthy eating behavior (β = 0.13, P  = 0.005) and academic achievement (β = 0.23 P  < 0.001). This pattern was strongly reversed in unhealthy eating behavior (β = − 0.30, P  < 0.001). Socioeconomic status (SES), including mother’s job and education, school status (governmental), and the family size, was directly related to FNLIT score and overweight/obese in students (β = 0.13, P  = 0.006; β = 0.14, P  = 0.007 respectively), while also had direct (β = 0.30, P  < 0.001) and indirect (food insecurity mediated) relationship with academic achievement (β = − 0.40, P  < 0.001); β = − 0.12, P  = 0.008 respectively). There was a full mediation relationship between FNLIT and overweight/obese via healthy eating behaviors. FNLIT indirectly through healthy eating behavior, had a negative effect on overweight/obese (of FNLIT on healthy eating behaviors, β = − 0.13, p  < 0.01; of healthy eating behaviors on overweight/obese, β = −-0.10, p  < 0.05) (Fig.  4 , Table 2 ).

Linking FNLIT status to its determinants and related outcomes (Model 1). Note: Statistically non-significant associations are not shown. FNLIT, Food and Nutrition Literacy; χ2, Chi square; df, degree of freedom; GFI, goodness fit index; AGFI, adjusted goodness of fit index; CFI, Comparative Fit Index; IFI, Incremental Fit Index; RMSEA, root mean square error of approximation.; SRMR, Standardized Root Mean Square Residual. χ 2 /df = 2.03, p  < 0.001, GFI = .90, AGFI = .88, CFI = .91, IFI = .91, RMSEA = .04, SRMR = .06

Linking FNLIT’s subscales to its determinants and related outcomes (Model 2). Note: Statistically non-significant associations are not shown. Abbreviations: Cognitive subscales including: UFNI, Understanding Food and Nutrition Literacy; NHK, Nutritional Health Knowledge; Skill subscales including; FFNL, Functional Food and Nutrition Literacy IFNL, Interactive Food and Nutrition Literacy; FCL, Food Choice Literacy; CFNL, Critical Food and Nutrition Literacy; FLL, Food Label Literacy., χ2, Chi square; df, degree of freedom; GFI, goodness fit index; AGFI, adjusted goodness of fit index; CFI, Comparative Fit Index; IFI, Incremental Fit Index; RMSEA, root mean square error of approximation.; SRMR, Standardized Root Mean Square Residual. χ 2 /df = 1.93, p  < 0.001, GFI = .89, AGFI = .87, CFI = .91, IFI = .91, RMSEA = .04, SRMR = .06. * P  < .05

Model 2 demonstrated the linking of FNLIT’s subscales to its determinants and related outcomes (Fig.  5 ). Mother’s job and education, school status (governmental schools), and family size were the socio-economic determinants of “Understanding Food and Nutrition Information” (β = 0.10, P  < 0.05), “Food Choice Literacy” (β = 0.10, P  < 0.01), and “Food Label Literacy” (β = 0.19, P  < 0.01). SES predicted academic achievement partially through the mediating effect of “Food Label Literacy” (of SES on “Food Label Literacy”, β = 0.19, P  < 0.01; of “Food Label Literacy” on academic achievement, β = 0.11, P  < 0.05). The results indicated, despite the direct relationship between SES and academic achievement (β = 0.25, P  < 0.001), an indirect but negative relationship existed through food insecurity (of SES on food insecurity, β = − 0.42, P  < 0.001; of food insecurity on academic achievement, β = − 0.10, P  < 0.05). Demographic factors negatively affected unhealthy eating behaviors (β = − 0.29, P  = 0.001) and BMI Z-score (β = − 0.25, P  = 0.003).

Demographic factors, including mother’s age, ethnicity (fars), ethnicity (tork), grade, and gender, were the most important determinants of “Critical Food and Nutrition Literacy” (β = − 0.17, P  = 0.01), FCL (β = 0.16, P  = 0.02), unhealthy eating behaviors (β = − 0.29, P  = 0.001), and BMI Z-score (β = − 0.25, P  = 0.003). The finding also revealed the fully mediating role of “Food Choice Literacy” in the relationship between demographic factors and healthy eating behaviors (of demographic factors on “Food Choice Literacy”, β = 0.16, P  = 0.02; of “Food Choice Literacy” on healthy eating behaviors, β = 0.13, P  = 0.02). In our study, we also found that “Interactive Food and Nutrition Literacy” protected unhealthy eating behaviors (β = − 0.43, P  < 0.001), and “Food Choice Literacy” predicted healthy eating behaviors (β = 0.13, P  = 0.02) in children.

The fit indices suggested a reasonably adequate fit of the FNLIT’s subscale model (Fig. 5 ).

In the current study, the proposed FNLIT conceptual model was tested to describe the determinants and outcomes of FNLIT in primary school children.

Socio-economic determinants of the outcomes of FNLIT, eating behaviors, academic achievement, and overweight

Small family size, private schooling, mothers’ education, and occupation were the most important socio-economic determinants acting as the predictive factors of FNLIT and its subscales scores, including UFNI, FCL, and FLL. This finding is aligned with Sørensen et al., (2012) study, which reported the overall relationship between socio-economic status (parental education and occupation) and different forms of literacy (i.e., health literacy) in childhood and youth [ 56 ].

The evidence shows that family socio-demographic factors strongly influence children’s food literacy [ 57 ]. Parents, especially mothers, are important agents in the promotion of health, behavior, and abilities of their children; they create food environments and play a key role in structuring their children’s first experiences with food and eating through their own beliefs, food practices, perspectives, eating attitudes, knowledge, and understanding of the benefits of food and nutrients on health (1). The literature suggests that well-educated parents have a skill set that includes the ability to develop and facilitate children’s food and nutrition skills, for example, improving the critical thinking about media to defend from the persuasive influences of food advertisements (food and nutrition critical skills), opportunities to make food selections independently, such as by selecting a healthy snack at a convenience store after school using reading and understanding of food labels (food choice skills and food label literacy), obtain, interpret and apply of nutrition information (2, 3). The children of well-educated parents may better obtain, process, interpret and apply information that shapes their knowledge and attitudes about nutrition [ 58 ]. Parents can be role models for accessing and interpreting food and nutrition information and teaching children how to critically analyze the credibility and validity of information sources and media channels [ 59 ]. However, socioeconomic status has different impacts on food behavior and skills. Several studies have shown that communities with low socioeconomic status have more likely to make unhealthy food choices [ 60 ]. High socioeconomic status has also been linked with increased fruit and vegetables, dairy products, and other healthy foods among children and adolescents [ 58 ]. Families with a higher level of education may also promote greater investment in their children’s health. On the other hand, Larson et al. (2006) showed that greater involvement of children in food and nutrition skills/food literacy (food preparation and food shopping skill) is related to low socioeconomic status [ 24 ].

In addition to the significant direct effect of family SES on academic achievement, family SES indirectly affects academic achievement through FNLIT. The finding of several meta-analysis reviews [ 61 , 62 ] revealed that parents’ location in the socioeconomic structure substantially impacts students’ academic achievement. Family SES sets the stage for students’ academic achievement by directly providing resources at home and indirectly providing the social capital necessary to succeed in school.

The current research has documented that those children with a low family size, educated and employed mothers, and children in the private schools had a higher probability of being overweight/obese. On the other hand, SES indirectly impacted overweight/obesity through FNLIT and healthy eating behaviors (negatively).

Based on the results, the effect of SES on academic achievement was mediated by food insecurity. Several studies have reported low SES and its connection to food insecurity as a key risk factor for unfavorable academic achievement [ 63 , 64 , 65 ]. Food insecurity has been associated with poor psychosocial outcomes, mental health, cognitive development, and compromised dietary intake, potentially resulting in malnutrition and, subsequently, low academic achievement [ 38 , 64 , 66 ].

Our results suggest that although SES is a condition that is difficult to change, helping children develop the cognitive and skill domain of FNLIT may improve their weight status and academic achievement and reduce social inequalities in child education and health.

The impact of socio-demographic characteristics on children’s skills (FCL and CFNL) can be explained that parents are more involved in daily food-related decisions and activities, including meal planning, grocery shopping, and cooking, that can create environments to influence the nutritional skills of children [ 67 , 68 ]. Consistent with our results, models that focus specifically on children and young people emphasize the family’s demographic factors. The younger the child is, the more likely he/she is to rely on their parents' economic and social support [ 57 , 69 ].

Link between FNLIT, eating behaviors, academic achievement, and overweight

The relationship between healthy eating behaviors and overweight/obesity reduction has been shown in several studies [ 70 , 71 ]. According to studies, by placing children at the center of food production, cooking food, selling food, and sharing food with their community, food literacy programs are helping to develop their food and nutrition skills to understand food and the benefits of a healthy diet. It will lead to a positive shift in healthy eating behaviors and may affect obesity trends [ 7 , 72 ]. The current study also showed that FNLIT, especially in skills domain, is the essential determinant of healthy eating behavior. Regarding the association between FNLIT and eating behaviors, our findings are in line with interventional [ 73 , 74 ] and correlational studies [ 75 , 76 , 77 ] as well as systematic review [ 6 ].

Previous studies found that high food literacy/nutrition literacy is associated with the frequency of main meal consumption [ 78 ], preference for healthy foods, lower intake of fast food and packaged or processed snacks among school-age children and adolescents in developed and developing countries [ 79 , 80 ]. The limited awareness of FNLIT, functional, interactive, and food label literacy can create barriers to consuming a diverse and nutrient adequate diet [ 81 ]. Chung et al. (2017) stated that the unhealthy eating behaviors and lower quality of diet are related to the lack of food and nutrition knowledge, why and how food labeling information is read, and how healthy foods are prepared and safely saved to avoid food poisoning [ 26 ]. These are the so-called food and nutrition literacy concepts [ 5 , 51 ].

Researches indicated that building food literacy in children through school gardens contributes to increased academic achievement, engagement, and self-confidence [ 82 ]. This relationship can be explained from two perspectives. First, FNLIT can reduce barriers to healthy eating and may influence adolescents’ dietary intake [ 6 ]. On the other hand, some studies confirm the association between eating behaviors and academic achievement in school-age children [ 83 , 84 ]. Unhealthy eating patterns likely affect the intake of protein, vitamins, and minerals in both a quantitative and qualitative sense, jointly leading to metabolic consequences, which influence academic achievement negatively.

Adequacy of food choice literacy and food label literacy in children improves their ability to understand information about food items and food groups, read food labels, control their portions, and make informed decisions and healthy eating behaviors [ 9 ]. On the other hand, students with high critical skills are more involved in questioning and thinking critically to advance the various teaching fields [ 10 ]. These findings are consistent with our results on the mediating effect of food label literacy and food choice skills in promoting children’s eating behaviors.

The large study sample provided sufficient power to probe relatively small effects. In addition, this study enables us to minimize the confounding effects of other factors on the relations between FNLIT to eating behavior, academic achievement, and overweight/obesity by considering numerous covariates and their interactions using standardized regression analyses. To the best of our knowledge, the present study is the first to investigate the direct and indirect link between FNLIT, eating behaviors, academic achievement, and overweight in children. However, several limitations merit consideration. First, it is impossible to establish causal association due to the cross- sectional research design. However, SEM does let us evaluate the dose-response of the interrelationships of the variables. Second, our study population was not representative of the Iranian school population, meaning that our results may not be generalizable to the wider population of Iranian school children. The third is the memory bias that may occur when a self-reported dietary assessment method such as dietary recalls is applied. Furthermore, the impact of unmeasured confounders cannot be excluded entirely.

Future research with longitudinal design will be needed to elucidate the mechanisms involved in this relationship. Moreover, interventions to determine the relationship between change in food and nutrition literacy scores for before and after outcome variables are necessary.

This research positions FNLIT within a conceptual model of its determinants and outcomes in primary school children and proposes an evaluation framework to guide investment and practice. These are critical foundations to further works in this field. The study results highlight groups within the school population who are at adequate levels of FNLIT, including having mothers with high-education levels, employed mothers, small family sizes, and children with private schooling children. These results serve as a general reminder that children (and their families) have highly varying educational needs that school educators and policymakers should consider new strategies based on this. In addition, our study draws attention to FNLIT, especially the skills domain, including IFNL, FCL, and FLL, as the essential determinant of healthy eating behavior, academic achievement, and weight status in school-age children and may reduce social inequalities in children’s development.

To ensure an adequate level of FNLIT, educators should assess and plan to enhance the food literacy skills of children and adolescents. Without a complete understanding of food, nutrition, and health, children and adolescents cannot gear up to improve their eating habits and diet quality. The current findings suggest that interventions targeting FNLIT improvement may effectively improve children’s eating behaviors, school academic achievement, and weight status. Stakeholders, including the government, food manufacturers, health providers, educators, and the food industry, should also play their roles to achieve a more significant reach and impact on the community.

Availability of data and materials

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

• Food and nutrition literacy

Food and nutrition information

Nutritional health knowledge

Functional food and nutrition literacy

Interactive food and nutrition literacy

Critical food and nutrition literacy

Food choice literacy

Food label literacy

Structural equation modeling

Socioeconomic status

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Acknowledgments

The authors hereby express their gratitude to the Shahid Beheshti University of Medical Sciences, National Nutrition and Food Technology Research Institute (NNFTRI), Dr. Fatemeh Mohammadi-Nasrabadi, and all coordinators and interviewers, and all the students who participated in this study. This research was conducted with the approval and funding of the NNFTRI.

This research was conducted by a grant from the research council of NNFTRI.

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Nastaran Keshavarz-Mohammadi

Department of Nutrition Research, National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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AD was responsible for collecting, analyzing, and interpreting the data, drafting and editing the article. NO, NKM, HE-Z carried out the study design and analysis. AD, NO, NKM, MA1, MA2, and HE-Z participated in conceiving and designing the research, revising the article, and collecting data. All authors read and approved the final manuscript.

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Food and nutrition literacy status in 10–12 years old students in Tehran.

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Doustmohammadian, A., Omidvar, N., Keshavarz-Mohammadi, N. et al. The association and mediation role of Food and Nutrition Literacy (FNLIT) with eating behaviors, academic achievement and overweight in 10–12 years old students: a structural equation modeling. Nutr J 21 , 45 (2022). https://doi.org/10.1186/s12937-022-00796-8

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Nutrition Literacy in America

By Christian Maino Vieytes, Doctoral Student, Division of Nutritional Sciences, University of Illinois at Urbana-Champaign.

Nutrition Literacy

The rise in overweight and obese adults has led to devastating increases in rates of heart disease, stroke, and cancer. These worrying statistics are the source of much anguish for public health professionals who worry about nutrition literacy remaining low in the United States.

Nutrition literacy is defined as “the degree to which people have the capacity to obtain, process and understand basic nutrition information” (1). The importance of nutrition literacy stems from its ability to inform and modify eating practices across different populations. Higher nutrition literacy, which can be measured objectively using surveys formulated by academic researchers, has been associated with the consumption of a higher-quality diet, rich in fruits and vegetables (2). Furthermore, in general, lower health literacy has been shown to negatively predict several indicators of health status, such as significantly more hospitalizations and greater use of emergency care services among those with low nutrition literacy (3).

Given that nutrition literacy is an integral part of overall health, the need to educate Americans on nutrition-related issues has become an authoritative goal to combat the rise in chronic disease and minimize adverse effects on our health care system.

The Evolving Nature of Dietary Knowledge

As with any other science, nutritional science is subject to change and evolution. A likely explanation for why nutritional literacy remains low is confusion and public mistrust stemming from the evolving-nature of this science (4). Dietary fat, for instance, was once vilified. The consensus amongst researchers has since shifted, and the source of the fat should not be overlooked (5). The recommendation is now that foods rich in monounsaturated fats, such as avocados, should be consumed in place of foods high in saturated fats, such as red meat and processed meats. Additionally, there has been a movement in government policy and academics for changing nutrition recommendations to be food-based as opposed to nutrient-based (6,7).

The Dietary Guidelines for Americans

The main way food policy is communicated to the public is through the  Dietary Guidelines for Americans , whose first iteration was realized in 1980 with the release of  Nutrition and Your Health: Dietary Guidelines for Americans (7). The goal of these and the current guidelines is to provide Americans with a resource for making healthier food choices and inform food policy choices made at the local, state, and federal government levels (8). Forty years have passed since the inception of these national guidelines. The program is now ready to introduce the ninth iteration in its set of recommendations in the 2020-2025 Dietary Guidelines for Americans .

Despite the measures taken by the federal government to modify nutrition policy in the United States through the  Dietary Guidelines for Americans  program, nutrition literacy has remained low. Other influential factors, such as a lack of diet and lifestyle education in public school curricula and the lack of emphasis on nutrition education for medical doctors, are notable.

A significant reason why we lack the arsenal of nutrition knowledge necessary for making healthy choices is that we, simply, were never taught this knowledge. Dietary habits are formed early in childhood. This fact, alone, underscores the need to develop better educational programs for children early on in their elementary education.

The research has demonstrated that habits, along with nutrition-related diseases, such as type 2 diabetes, acquired during a child’s formative years track with them into adulthood (9). However, many barriers preclude teachers from delivering nutrition education in the classroom. Primarily, we find that because this type of knowledge is not found on standardized testing, it is not as likely to be emphasized in curricula. Nevertheless, several lines of research studying the effects of nutrition education programs on children’s’ dietary consumption have shown that they are, indeed, effective (9).

The Physician

Many Americans obtain health knowledge directly from their primary care or specialist physicians. Yet, most medical doctors receive little to no training in matters of nutrition. Levels of nutrition literacy amongst physicians also remain low (10,11). This is a sizable concern, given that diet plays a massive role in preventing chronic illnesses such as heart disease (11,12).

Bolstering Nutrition Literacy

Despite the forces that work against our acquisition of nutrition knowledge, the beauty of learning is that it only takes a little motivation and a list of resources to read and learn from. With the advent of the internet, there have been a multitude of sources to obtain nutrition education. Given the rise of fad diets and erroneous sources, it is recommended that only authoritative sources be used when researching matters of nutrition.  This means obtaining information and data from government or non-governmental organizations. Several links to reputable organizations and websites will be provided below.

Nutrition knowledge is  powerful! Empowering individuals with this knowledge is critically important for preventing illness and slowing the chronic disease epidemic we face in our nation. Yet, it is never too late to become educated, increase your nutrition literacy, take control of your health, and pass that knowledge on to your peers and the generations to come.

The Academy of Nutrition and Dietetics

The Food and Drug Administration

nutrition.gov

The Physicians Committee For Responsible Medicine

The World Health Organization

Harvard T.H. Chan School of Public Health

The American Heart Association

The Food Literacy Center Blog

• Zoellner J, Connell C, Bounds W, Crook L, Yadrick K. Nutrition literacy status and preferred nutrition communication channels among adults in the Lower Mississippi Delta. Prev Chronic Dis. 2009 Oct;6(4):A128.
• Taylor MK, Sullivan DK, Ellerbeck EF, Gajewski BJ, Gibbs HD. Nutrition literacy predicts adherence to healthy/unhealthy diet patterns in adults with a nutrition-related chronic condition. Public Health Nutr. 2019;22(12):2157–69.
• Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011 Jul 19;155(2):97–107.
• Garza C, Stover PJ, Ohlhorst SD, Field MS, Steinbrook R, Rowe S, et al. Best practices in nutrition science to earn and keep the public’s trust. Am J Clin Nutr. 2019 01;109(1):225–43.
• Liu AG, Ford NA, Hu FB, Zelman KM, Mozaffarian D, Kris-Etherton PM. A healthy approach to dietary fats: understanding the science and taking action to reduce consumer confusion. Nutr J. 2017 Aug 30;16(1):53.
• Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002 Feb;13(1):3–9.
• Mozaffarian D, Rosenberg I, Uauy R. History of modern nutrition science-implications for current research, dietary guidelines, and food policy. BMJ. 2018 13;361:k2392.
• Watts ML, Hager MH, Toner CD, Weber JA. The art of translating nutritional science into dietary guidance: history and evolution of the Dietary Guidelines for Americans: Nutrition Reviews©, Vol. 69, No. 7. Nutr Rev. 2011 Jul;69(7):404–12.
• Cotton W, Dudley D, Peralta L, Werkhoven T. The effect of teacher-delivered nutrition education programs on elementary-aged students: An updated systematic review and meta-analysis. Prev Med Rep. 2020 Dec;20:101178.
• Kiraly LN, McClave SA, Neel D, Evans DC, Martindale RG, Hurt RT. Physician Nutrition Education. Nutr Clin Pract. 2014 Jun;29(3):332–7.
• Aggarwal M, Devries S, Freeman AM, Ostfeld R, Gaggin H, Taub P, et al. The Deficit of Nutrition Education of Physicians. Am J Med. 2018;131(4):339–45.
• Aspry KE, Van Horn L, Carson JAS, Wylie-Rosett J, Kushner RF, Lichtenstein AH, et al. Medical Nutrition Education, Training, and Competencies to Advance Guideline-Based Diet Counseling by Physicians: A Science Advisory From the American Heart Association. Circulation [Internet]. 2018 Jun 5 [cited 2020 Sep 9];137(23). Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000563  

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• Published: 16 December 2022

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

• Özge Mengi Çelik   ORCID: orcid.org/0000-0002-0298-9591 1 &
• Remziye Semerci   ORCID: orcid.org/0000-0003-1999-9179 2  

BMC Nursing volume  21 , Article number:  359 ( 2022 ) Cite this article

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

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

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

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

Peer Review reports

What is known about the topic?

▪ Diet-related diseases as non-communicable diseases are highest proportion of overall mortality.

▪ Nutrition literacy and nutrition knowledge decrease risk of the diet-related diseases.

▪ Nurses and nursing students have a more important role to increase the public’s level of nutrition literacy and nutrition knowledge.

What does this paper add?

▪ It is little known about the relationship between nursing students’ nutrition literacy and nutrition knowledge

▪ The nutrition knowledge and nutrition literacy levels of nursing students correlated with each other.

▪ Developing students' nutritional knowledge levels and nutritional literacy will contribute to the prevention of non-communicable diseases.

Introduction

Poor nutrition quality and unhealthy eating habits are major risk factors for chronic illnesses such as obesity, diabetes, cardiovascular disease, and several malignancies [ 1 ]. Therefore, dietary risks have received more attention during the last decade [ 2 ]. Dietary risk factors were responsible for 7.9 million deaths and 187.7 million disability-adjusted life years in 2019 [ 2 ]. Additionally, non-communicable diseases (NCDs) accounted for the highest proportion of overall mortality (74.4%) in 2019, growing by 20.5 percent from 2009 to 2019, meaning 7.1 million more deaths in 2019 compared to 2009 [ 3 ]. The World Health Organization has determined many policies regarding NCDs, but in a study covering 194 countries, it was reported that one-third of the 19 policies proposed in 2020 (32.8%) were implemented [ 4 ]. Therefore, it is critical to promote approaches that take into account both the environment and the consumption of healthy foods to prevent NCDs and the morbidities caused by these diseases [ 5 ]. One of the most important strategies is to increase the nutrition literacy and nutritional knowledge of society.

Nutrition literacy and nutrition knowledge have emerged as critical components in promoting and maintaining healthy eating behaviors [ 6 , 7 ]. Health literacy is defined as the degree to which individuals obtain, understand, and use basic health information and services to make informed health decisions [ 8 , 9 ]. Nutrition literacy is a special component of health literacy [ 7 ]. Even though nutrition literacy has developed as a unique type of health literacy, academics continue to focus on component skills and capacities in light of conversations about what it means to be nutrition and health literate [ 10 ]. In general, it is defined as an individual's capacity to obtain, process, and understand basic nutritional information necessary to make appropriate dietary decisions [ 1 , 11 ]. Individuals with adequate nutrition literacy have basic nutritional knowledge and have the skills to understand information about nutrients and food groups, read the food label and do portion control. It is very important to increase the level of knowledge about nutrition in the prevention and reduction of nutrition-related NCDs [ 12 , 13 ]. In this context, it is critical that nurses, the health professionals, determine the nutrition literacy and nutrition knowledge level of the society and provide consultancy and training in this direction.

Nurses play an important role in protecting and improving health and increasing the quality of life [ 14 ]. It is an important group of healthcare professionals involved in the delivery of nutritional care to patients and they work closely with patient groups and have opportunities to identify at-risk health behaviors. Nurses who provide nutritional care to patients need to determine their nutrition knowledge levels and accordingly, individuals with low nutrition knowledge need to improve their nutrition knowledge [ 15 , 16 ]. Also, nurses have an increasingly prominent role in NCDs prevention and management. Nurses who play a role in the prevention and treatment of NCDs should have a high level of nutrition literacy and be able to transform this knowledge into their lifestyle practices. However, studies show that nurses are at risk of being overweight and obese [ 17 , 18 , 19 ]. It is very important to prevent this situation by increasing the nutrition literacy and nutrition knowledge of nurses beginning with undergraduate education [ 17 , 20 ].

In Turkey, studies that examine nutrition literacy and nutrition knowledge among nursing students are limited. Considering the nursing students, who are defined as the young population, it is very important to have a high level of nutrition knowledge in this age group for the society of the future to be healthy. In this context, this is aimed to examine the nutrition literacy and nutrition knowledge level of nursing students.

Study questions

What is the nutrition literacy level of the nursing students?

What is the nutrition knowledge level of the nursing students?

Is there a relationship between nutrition literacy and the nutrition knowledge level of nursing students?

Study design

This cross-sectional and descriptive study design was used in this study. The study was conducted with 309 nursing students between January-March 2022 at the Faculty of Health Sciences, Department of Nursing.

Participants

The sample comprised 690 nursing students from the Faculty of Health Sciences, Department of Nursing at a university in Turkey. The G*Power software (Version 3.1.9.6) was used to analyze the sample's size [ 21 ]. Because there is no similar study, the effect size of the study was aimed to be a poor or medium correlation between nursing students’ nutrition literacy and nutrition knowledge level. Based on the effect size |ρ|= 0.20, correlation: point biserial model, according to the with two tail, α err prob = 0.05, Power (1-β err prob) = 0.95, the sample size was calculated 262. Considering the data loss, the sample was increased by 20% and the study was required 314 nursing students. Five students were excluded from the study because they filled in the questionnaires and scales incompletely. Therefore, the study was completed with 309 nursing students. The post-doc analysis was performed after the study, with correlation: point biserial model, according to the with two tail, effect size |ρ|= 0.45, α err prob = 0.05, and the sample = 309, the power of the study was determined to 99%.

The inclusion criteria of the study were being nursing students, being able to speak Turkish, volunteering to participate in the research. The exclusion criteria were filling in the data in completely and wanting to leave the research at any stage of the research.

Ethical considerations

Ethical approval with the decision number 25/23 dated 27.12.2021 from Trakya University Faculty of Medicine Dean's Office of Ethics Committee for Non-Invasive Scientific Research before data collection. The researchers wrote to the nursing students the aims and methods of this research in an online google survey, explaining that confidentiality was protected and participation in the research was completely voluntary. Informed consent was obtained from all participants included in the study. Individuals who ticked the "I consent to participate in this study voluntarily" tab at the beginning of the web-based questionnaire were included in the study. In addition, the students were informed that they could leave the research at any time without giving any reason. All procedures in the study were carried out following the Declaration of Helsinki.

Data collection

The study data were collected with ‘Information Form’, ‘Anthropometric Measurements’, ‘Nutrition Knowledge Level Scale for Adults (NKLSA)’ and ‘'Evaluation Instrument of Nutrition Literacy on Adults (EINLA)’. Researchers create data collection tools through google surveys. With the help of the academic staff in the nursing department, necessary explanations were made and shared with the students in the WhatsApp groups of each course. This data collection method has been preferred in order not to exchange materials and maintain social distance in accordance with the pandemic rules.

Data collection measurements

Information form.

The form was created by the researchers according to the literature [ 17 , 22 , 23 ]. The socio-demographic characteristics of the individuals were asked about their age, gender, what grade they were studying in, and whether they had taken any courses on nutrition at the university. From the nutritional habits of the individuals, the main meal and snack consumption status of the individuals was evaluated. The form consisted of seven questions.

Anthropometric measurements

Anthropometric measurements (body weight and height) of the individuals were questioned based on the statement. Individuals were informed about how to take anthropometric measurements in the questionnaire form. Body mass index (BMI) was calculated by dividing the body weight by the square of the height [ 24 ]. If the body mass index is less than 18.50 kg/m 2 , individuals are classified as underweight, between 18.50–24.99 kg/m 2 as normal (healthy weight), between 25.0–29.99 kg/m 2 as overweight, and 30.0 kg/m 2 or higher as obese [ 25 ].

Nutrition knowledge level scale for adults

The first part of the 'Nutrition Knowledge Level Scale for Adults' was used to evaluate the nutritional knowledge level. The scale was developed by Batmaz and Güneş [ 26 ] in 2018 and its Turkish reliability and validity study was conducted. The first part of the scale, 'Basic Nutrition Information', consists of 20 questions. The answers were scored as ‘I strongly agree’ 4 points, ‘agree’ 3 points, ‘undecided’ 2 points, ‘disagree’ 1 point and ‘strongly disagree’ 0 points. Questions 1, 3, 6, 8, 13, 16, 19 and 20 are scored in reverse on the scale. The maximum score that can be obtained under the heading of basic nutrition knowledge is 80. The knowledge level of the participants with a basic nutrition knowledge score of less than 45 is evaluated as ‘bad’, the knowledge level of those between 45–55 points as ‘medium’, those between 56–65 points as ‘good’, and those with 65 points above as ‘very good’ [ 26 ].

Evaluation instrument of nutrition literacy on adults

The nutrition literacy status of individuals was determined with the 'Evaluation Instrument of Nutrition Literacy on Adults’. The scale was developed by Cesur et al. [ 12 ] and its Turkish validity and reliability study was conducted. The scale consists of 35 questions. Each correct answer in the scale is worth ‘1’ and wrongly answered questions are worth ‘0’. The total score of the scale ranges from 0 to 35 points. Nutrition literacy level is classified as ‘insufficient’ between 0–11 points, ‘borderline’ between 12–23 points, and ‘sufficient’ between 24–35 points out of the total score. The scale comprised five sections.

First section

There are 10 questions about ‘general nutrition information. Nutrition literacy level is scored between 0–3 points as 'insufficient', between 4–7 points as ‘borderline’ and between 8–10 points as 'sufficient'.

Second section

There are 6 questions about ‘reading comprehension and interpretation’. Nutrition literacy level is scored between 0–2 points as 'insufficient', between 3–4 points as ‘borderline’ and between 5–6 points as 'sufficient'.

Third section

There are 10 questions about ‘food groups’. Nutrition literacy level is scored between 0–3 points as 'insufficient', between 4–7 points as ‘borderline’ and between 8–10 points as 'sufficient'.

Fourth section

There are 3 questions about ‘serving sizes’. Nutrition literacy level is scored 0–1 point as 'insufficient', 2 points as ‘borderline’ and 3 points as 'sufficient'.

Fifth section

There are 6 questions about ‘reading food labels and basic mathematics’. Nutrition literacy level is scored between 0–2 points as 'insufficient', between 3–4 points as ‘borderline’ and between 5–6 points as 'sufficient' [ 12 ].

Statistical analysis

The analyses eliminated cases with missing data for the primary research variables. The Statistical Package for the Social Sciences (version 22.0) software was used for analyses. Data were evaluated with descriptive statistics such as mean, standard deviation, number and percentage. Distribution analysis of the data was performed using the histogram, coefficient of variation ratio, Skewness, Kurtosis and Kolmogorov–Smirnov tests. Mann–Whitney U test and Kruskal Wallis test were used in independent groups for comparison. The relationship between numerical variables was evaluated with the Spearman correlation coefficient. A p-value of less than 0.05 was considered to be statistically significant.

The general characteristics of the nursing students are given in Table 1 . A total of 309 (53 male, 256 female) nursing students participated in the study. The average age of the students is 20.2 ± 1.3 years, and the average BMI is 22.4 ± 3.7 kg/m 2 . 69.9% of the students have a healthy body weight. 27.2% of the students participating in the study had taken a course on nutrition at the university. The number of main meals consumed is 2.4 ± 0.5 and the number of snacks is 1.5 ± 1.0 by the students.

The nutrition knowledge levels of individuals are given in Table 2 . The mean score for nutrition knowledge is 56.6 ± 6.8 points. 6.1% of the students have a bad nutrition knowledge level, 34% have a medium nutrition knowledge level, 50.5% have a good nutrition knowledge level and 9.4% have a very good nutrition knowledge level.

The nutrition literacy status of individuals is given in Table 3 . The total nutrition literacy score is 28.6 ± 4.4 points and 91.6% of the students have a sufficient nutrition literacy level according to the total score. When the scores obtained according to the sub-sections of the scale were evaluated, it was determined that the majority of the students (73.1%, 82.8% and 92.6%, respectively) had sufficient nutrition literacy levels in the sections of general nutrition information, reading comprehension and interpretation, and food groups. While only 13.6% of the students have sufficient nutrition literacy about serving sizes, 52.8% of the students have sufficient nutrition literacy levels in reading food labels and basic mathematics.

The nutrition knowledge level and nutrition literacy status of individuals according to some parameters are given in Table 4 . No significant difference was found in the nutrition knowledge score and nutrition literacy total score of the students according to gender, class, taking nutrition course and BMI classification ( p  > 0.05).

The relationship between nutrition knowledge level and nutrition literacy status is given in Table 5 . There was a statistically significant positive correlation between the nutrition knowledge score and the nutrition literacy total score and the nutrition literacy sub-sections.

In addition, the relationship between BMI and nutritional literacy and nutritional knowledge level was evaluated, and no statistically significant difference was found between BMI and nutritional literacy total score ( p  > 0.05) and nutrition knowledge score ( p  > 0.05). (data not shown in the table).

This study is very important in terms of defining the nutrition literacy and nutrition knowledge levels of nursing students and examining the relationship between nutrition literacy and nutrition knowledge levels. The important finding is it was found a significant correlation between nursing nutrition literacy and nutrition knowledge levels. It was determined that as the nutrition knowledge levels of nursing students increased, the nutrition literacy levels of nursing students also increased.

In recent years, the dramatic increase in diet-related NCDs has been linked to obesogenic settings, which promote the excessive consumption of unhealthy foods while limiting opportunities for physical exercise [ 2 , 4 , 5 ]. For this reason, it is critically important to inform society about nutrition and to implement interventional strategies that will increase the level of nutrition literacy [ 4 , 14 ]. It is important that nurses, who have an important role in the implementation of strategies to improve public health and in making decisions, are given training that will increase their nutrition knowledge and nutrition literacy level, starting from their undergraduate education [ 27 ]. Thus, nursing students with high nutrition knowledge and nutrition literacy will know to consult society as the nurses of the future before they graduate. In this study, it was found that 50.5% of the nursing students had good nutrition knowledge levels. Unfortunately, 40.5% of them had medium or bad nutrition knowledge levels. In a study by Chepulis and Mearns [ 17 ], they stated that nursing students’ had bad nutrition knowledge levels. In a systematic review, it was reported that nurses' nutrition knowledge has increased with experience, they have poor knowledge of providing medical therapy [ 14 ]. Similarly, Cho et al. [ 22 ], examined nurses’ e-health literacy and they found that nurses had poor knowledge about nutrition. According to all the studies’ results, it was said that nurses and nursing students have moderate or poor nutrition knowledge. In Turkey, most of the nursing curriculum has ‘Nutrition Lessons’, but most of them are related to diseases and the lesson’s duration is two or three hours a week. Our study showed that this lessons’ content should be revised, and it is included general nutrition knowledge to support public health not just for unhealthy people also it is covered, healthy people. This highlights nutrition content as being critical for inclusion in a nursing curriculum.

In the present study, most of the nursing students (91.6%) have sufficient nutrition literacy. However, only 13.6% of students have adequate nutrition literacy in portion sizes and 52.8% in food label reading and basic math. Mehri et al. [ 28 ], stated that nursing students’ nutrition literacy is low. In a study that examined nurses’ e-health literacy, it was emphasized that while nurses have a high level of e-health literacy, they have low nutrition literacy [ 22 ]. Nurses, being the main group of health professionals [ 29 ], are well placed to manage and support patients' basic nutrition care requirements in their various work environments and cultures. In hospitals, this may involve eating problems, dehydration, and/or malnutrition [ 30 ], which adds to longer hospital stays and an increased risk of death if left untreated [ 31 ]. Therefore, improving patients’ health outcomes is an important responsibility of the nurses [ 27 ]. However, according to Chao et al. [ 32 ], student nurses' knowledge on this subject is quite limited. Insufficient nutrition literacy has been one of the main barriers to providing adequate, high-quality nutritional care, to their patients. It is very important to plan trainings after undergraduate education to increase the confidence and motivation of nursing students to provide nutritional care to patients [ 32 , 33 ]. Therefore, nursing students’ nutrition literacy should be increased during the undergraduate and post-graduate to increase public health outcomes and life quality of patients.

It was emphasized that nutrition knowledge and nutrition literacy correlated with each other [ 27 ]. In this context, in this present study, it was found a positive correlation between the nutrition knowledge score and the nutrition literacy total score and sub-sections scores. Similar to our results, Kim et al. [ 34 ], stated that the dietary attitudes of the nursing students’ correlated positively with nutrition knowledge. Liao et al. [ 35 ], reported that nutrition literacy explained 17.2% of the total variance of healthy-eating behaviors of college students. Uysal et al. [ 36 ], conducted their study with 905 students in nursing, law and Islamic sciences departments and it was determined that health literacy correlated with nutrition knowledge. In a line of the literature, it can be said that, if nurse educators increase nursing students’ nutrition knowledge, students’ nutrition literacy will increase. Current undergraduate nursing nutrition education is inadequate to meet the requirements of nurses as future health professionals in providing nutritional care according to the needs of patients or themselves. It is critical to prepare for the training required to support nurses' and their own long-term health, as well as to develop their professional competence to meet contemporary nutritional concerns [ 36 ]. Therefore, nursing students’ ability to obtain, process and understand nutrition information and skills needed to make appropriate nutrition decisions should be improve from the undergraduate and nutrition lesson should be include in the nursing curriculum.

This research reports the findings of a study that evaluated nursing students' nutrition knowledge levels, as nurses are in a superior position to guide as nutrition instructors and advisors by interacting with their patients in discussions that enhance their knowledge regarding disease prevention and treatment via nutrition. It has been determined that the nutrition knowledge and nutrition literacy levels of nursing students are related to each other, therefore, clinical and general nutrition should be given more place in the curriculum of nurses. The findings of this study show that nursing students need nutrition-related courses in nursing curricula in order to improve their nutritional literacy levels, as well as improve their nutritional knowledge and prevent NCDs. The implications of this study are significant for the nursing curriculum.

Limitations

This study has some limitations. Firstly, the study included a small sample size. The response rate was also approximately 45% which to an extent may not give a wider representation of the study participants. Secondly, we aimed to evaluate the relationship between nursing students' nutritional knowledge and nutritional literacy. For this reason, we did not add the factors affecting the nutritional knowledge and nutritional literacy levels of nursing students to the questionnaire. It is recommended that future studies examine the factors affecting the nutritional knowledge and nutritional literacy levels of nursing students.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available due to privacy or ethical restrictions, but are available from the corresponding author on reasonable request.

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Acknowledgements

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval with the decision number 25/23 dated 27.12.2021 from Trakya University Faculty of Medicine Dean's Office of Ethics Committee for Non-Invasive Scientific Research before data collection. Informed consent was obtained from all participants included in the study.

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Mengi Çelik, Ö., Semerci, R. Evaluation of nutrition literacy and nutrition knowledge level in nursing students: a study from Turkey. BMC Nurs 21 , 359 (2022). https://doi.org/10.1186/s12912-022-01146-z

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Assessing nutrition literacy and nutrition counseling proficiency following an interdisciplinary culinary medicine elective

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• 1 Department of Cell Biology and Physiology and Preventative Medicine and Public Health, Edward Via College of Osteopathic Medicine, Auburn, AL, USA.
• 2 1383 College of Nursing at Auburn University , Auburn, AL, USA.
• 3 Department of Clinical Affairs in the Discipline for Pediatrics, Edward Via College of Osteopathic Medicine, Auburn, AL, USA.
• 4 Department of Pharmacology, Edward Via College of Osteopathic Medicine, Auburn, AL, USA.
• 5 College of Education, 1383 Auburn University , Auburn, AL, USA.
• 6 Edward Via College of Osteopathic Medicine, Auburn, AL, USA.
• PMID: 38676937
• DOI: 10.1515/jom-2023-0094

Context: Culinary medicine (CM) is a growing field of education that aims to bridge the gap between the clinical need for nutritional counseling and the lack of education on the topic. Healthcare professionals can aid in nutrition-related noncommunicable disease (NCD) prevention by improving a patient's dietary behavior. However, the presence of nutrition education in healthcare curricula is lacking. Early evidence indicates that CM could address this gap.

Objectives: The objectives of this study are to determine if the provision of an interdisciplinary CM elective will improve student knowledge and confidence with counseling on nutrition and culinary principles, and to improve personal dietary habits of students.

Methods: This was a one-group pretest-posttest quasi-experimental design. First- and second-year osteopathic medical students (OMS) and nurse practitioner students were recruited to participate in a CM elective via email. Participants were excluded if they were not in good academic standing at their respective institutions. Twelve individuals (n=8 medical; n=4 nursing) were enrolled in the course. Participants completed pre- and postcourse surveys to determine changes in nutrition literacy (Nutrition Literacy Assessment Instrument [NLit42]), nutrition counseling proficiency (Nutrition Survey for Family Practitioners), and dietary quality (Automated Self-Administered 24-h dietary assessment tool; ASA24 ® ). A two-sided, paired t test was conducted to determine changes in outcome variables.

Results: All 12 participants completed the precourse assessments, and 8 participants completed the postcourse assessments. Culinary activity attendance was 94.5 %. Participants exhibited a statistically significant increase in their overall nutrition literacy scores after completing the CM elective (p=0.006). Literacy subcategories indicated that the improvement came from the participant's ability to understand household measurements (p=0.005) better. Increases in self-reported proficiency were observed for participants' confidence to counsel on nutrition and prevention/wellness (p=0.02) and macronutrients in health and food safety (p=0.01). No statistically significant changes in the personal dietary pattern or quality were observed.

Conclusions: The interdisciplinary CM elective improved nutrition literacy and some aspects of counseling proficiency. Although small shifts in dietary variables were observed, the elective did not statistically improve participants' dietary pattern. However, some changes that were observed may lead to clinically relevant outcomes if maintained long-term. These findings are encouraging. Implementing CM as an educational tool could improve healthcare practitioners' ability to understand and counsel patients on nutrition to prevent the nutrition-related NCDs.

Keywords: culinary medicine; medical education; nutrition counseling.

© 2024 the author(s), published by De Gruyter, Berlin/Boston.

Food literacy:  Considerations depending on the life context with Dr. Maude Perreault Nutrition Conversations

Food and nutrition literacy are concepts that may be important factors in supporting healthful dietary habits. Building these skills and knowledge at a young age is important for skill retention, confidence in food practices and supporting lifelong healthy eating habits. Dr. Maude Perreault is a Registered Dietitian and Assistant Professor at Université de Montréal. Her clinical and research interests are centered around family nutrition, and how we can support children and parents to have healthy eating behaviors. Dr. Perreault has also supported parents through her online private practice, with a focus on helping parents team up and tackle “picky eating” with their toddlers. More recently, she has developed an interest for food literacy as a way to explore the skills required to feed ourselves in the complex food system, and where inequalities might lie. Through her research and clinical work, Dr. Perreault’s mission is that everyone can enjoy eating, with autonomy, for their own well-being and that of their community. In this episode, Dr. Perreault discusses the emerging results around food literacy and considerations when it comes to teaching kids about it as well as in the context of chronic health diseases requiring dietary changes, namely celiac disease.

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• Describes pedagogical approaches to foster 21st century skills
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Table of contents (15 chapters)

Front matter, introduction.

• Maria Dobryakova, Isak Froumin

The World Is Changing, and Education Is Changing with It

A framework of key competences and new literacies.

• Maria Dobryakova, Isak Froumin, Gemma Moss, Norbert Seel, Kirill Barannikov, Igor Remorenko

Canada (Ontario): A Unifying Theme for Canadian Education Is Equity

• Michele Peterson-Badali, Elisabeth Rees-Johnstone, Evelyn Wilson, Bev Freedman, Denese Belchetz, Karen Grose et al.

China: Fostering Students with All-round Attainments in Moral, Intellectual, Physical and Aesthetic Grounding

• Huanhuan Xia, You You

England: Knowledge, Competences and Curriculum Reform—Why the English Case Stands Out

• Gemma Moss, Ann Hodgson, Susan Cousin

Republic of Korea: Cultivating Key Competences

• Junehee Yoo, Euichang Choi, Dongil Kim, Kyunghee So, Chan-Jong Kim, Il Lee et al.

Finland: Improving Pupils’ Opportunities for Experiencing the Joy of Learning, for Deep Learning, and for Good Learning Achievement

• Jarkko Hautamäki, Raisa Ahtiainen, Natalia Gustavson, Risto Hotulainen, Sirkku Kupiainen, Marja Tamm et al.

Poland: The Learning Environment that Brought About a Change

• Maciej Jakubowski, Jerzy Wiśniewski

Twenty-First Century Skills and Learning: A Case Study of Developments and Practices in the United States

• Michael Russell, Henry Braun, Binbin Zhu

Russian Federation: At a Conceptual Crossroads

• Kirill Barannikov, Maria Dobryakova, Isak Froumin, Igor Remorenko

Pedagogical and School Practices to Foster Key Competences and Domain-General Literacy

• Maria Dobryakova, Norbert Seel

A Modern Aspect of Instrumental Literacy: Coding

• Suhas Parandekar, Eugeny Patarakin, Gulcan Yayla

How to Integrate New Literacy in the Curriculum—Example of Environmental Literacy

Maria Dobryakova

How Countries Reform Their Curricula to Support the Development of Key Competences

• Kirill Barannikov, Igor Remorenko, Isak Froumin
• Learning Objectives
• New Literacies
• Canadian Education
• Education in China
• Education in the UK
• Cultivating Key Competences
• Education in Republic of Korea
• Education in Finland
• Education in Poland
• Twenty-First Century Skills and Learning
• Education in USA
• Education in Russia
• Key competencies
• 21st Century Curriculum
• Curriculum Reform
• Transversal Competences
• Functional Literacy
• Digital literacy
• Competence-based Education
• Critical Thinking

About this book

This edited book is a unique comprehensive discussion of 21 st  century skills in education in a comparative perspective. It presents investigation on how eight very different countries (China, Canada, England, Finland, Poland, South Korea, the USA and Russia) have attempted to integrate key competences and new literacies into their curricula and balance them with the acquisition of disciplinary knowledge. Bringing together psychological, sociological, pedagogical approaches, the book also explores theoretical underpinnings of 21 st  century skills and offers a scalable solution to align multiple competency and literacy frameworks.

The book provides a conceptual framework for curriculum reform and transformation of school practice designed to ensure that every school graduate thrives in our technologically and culturally changing world. By providing eight empirical portraits of competence-driven curriculum reform, this book is greatresource to educational researchers and policy makers.

Editors and Affiliations

Isak Froumin

Kirill Barannikov, Igor Remorenko

Jarkko Hautamäki

About the editors

Maria Dobryakova  graduated from the Moscow School of Social and Economic Sciences and Manchester University (M.A. in Sociology) and defended her Ph.D. in social stratification at the Institute of Sociology of the Russian Academy of Sciences. Since 2006 and until 2022 she worked at the National Research University Higher School of Economics, where she headed and coordinated a number of large-scale projects in education, social sciences, as well as publications and translation projects. Prior to that, she had worked at the Independent Institute for Social Policy (as head of publications) and the Ford Foundation (Higher Education and Scholarship program). 

Isak Froumin  headed the Institute of education at the National Research University Higher School of Economics in Moscow (Russia)—the first graduate school of education in Russia—from 2009 to 2021. After beginning his career as a principal of Kransnoyarsk University Laboratory School  (Russia), he worked as the Lead Education Specialist at the World Bank, and the advisor to the Minister of Education and Science of Russian Federation. He is a fellow of the International Academy of Education.

Kirill A. Barannikov  is the vice-rector for strategy, Moscow City University. He is working in MCU since 2015 and has led a number of projects over Moscow schools and the university development. Among the most striking projects are the online platform for teachers to create curricula (www.prok.edu.ru), the electronic platform for assessing the quality of the educational environment (www.ecers.ru, www.sacers.ru), internet service for supporting and developing initiatives  (www.zamisli.pro). Over the past ten years, he headed the center for distance education of children with disabilities of the Pedagogical Academy of Postgraduate Education, the center of curricula design and standards of the Academy of Social Management. He coordinated over 40 research projects of the Department of Education of the City of Moscow, the Ministry of Education and Science of Russia. The main areas of interest are competency models in school education, issues of standardization and curricula design in an international context, change management in schools and universities. 

Jarkko Hautamäki  graduated from University of Helsinki (majors in experimental psychology and social psychology) and defended his Ph.D. Dissertation (Measurement and Distribution of Piagetian Stages of Thinking) in University Joensuu. He became a full professor in Special Education in Helsinki University, served also the dean and founded and directed Helsinki University Center for Educational Assessment. He is the honorary professor of Faculty of Psychology at Moscow State University, member of the Finnish Academy of Science and Letters and member of The Russian Academy of Educational Sciences. His research interests include human development and schooling for thinking, interventions and special education and applying the science of development into schooling. He lives in Helsinki, Finland. 

Gemma Moss  is the professor of Literacy at UCL Institute of Education. She has been the president of the British Educational Research Association (2015–17), was a member of the European Education Research Association Council (2016–18), was director of the Centre for Critical Education Studies at the Institute of Education (2007–11) and was director of the International Literacy Centre at the Institute of Education, UCL (2017-22).  Her main research interests are in literacy as a social practice; literacy policy; knowledge transfer and knowledge exchange; evidence-informed practice and curriculum design; pedagogy and new technologies; primary assessment; and gender and literacy attainment.  Her research includes running multi-site ethnographic case studies, combining quantitative and qualitative methods in innovative ways and using rapid evidence assessment systematic review processes to bring knowledge to bear on contentious questions in education, where funders require rapid answers.  

Igor M. Remorenko  has been holding the post of the rector of the Moscow City University since 2013. He has a Ph.D. and full-doctor degree in Education. From 2009 to 2011, he held the post of the director of the Department of the State Policy and Legal Regulations in Education, Department of the State Policy in Education, Department of the Strategic Development of the Ministry of Education and Science of the Russian Federation; supervised the top-priority national project “Education” and programs to support the innovative development of the higher education institutes. From 2011 to 2013, he is the deputy minister of Education and Science of the Russian Federation. He is the author of a number of the scientific publications, two monographs. He participates in the researches in the field of educational policy, development of managerial approaches in education and multiple international and national projects in the sphere of education.

Bibliographic Information

Book Title : Key Competences and New Literacies

Book Subtitle : From Slogans to School Reality

Editors : Maria Dobryakova, Isak Froumin, Kirill Barannikov, Gemma Moss, Igor Remorenko, Jarkko Hautamäki

Series Title : UNIPA Springer Series

DOI : https://doi.org/10.1007/978-3-031-23281-7

Publisher : Springer Cham

eBook Packages : Education , Education (R0)

Copyright Information : The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023

Hardcover ISBN : 978-3-031-23280-0 Published: 23 August 2023

Softcover ISBN : 978-3-031-23283-1 Due: 23 September 2023

eBook ISBN : 978-3-031-23281-7 Published: 22 August 2023

Series ISSN : 2366-7516

Series E-ISSN : 2366-7524

Edition Number : 1

Number of Pages : VI, 426

Number of Illustrations : 18 b/w illustrations, 27 illustrations in colour

Topics : Curriculum Studies , Study and Learning Skills , International and Comparative Education , Educational Policy and Politics

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Health Extension for Diabetes is an education and support program that connects participants to clinical resources through partnerships with Certified Diabetes Care and Education Specialists. Through eight sessions, participants can improve their knowledge of diabetes, behaviors associated with diabetes management, and diabetes-related health outcomes.

Setting the Table for Healthy Eating is a two-lesson program to help participants understand how to use the nutrition facts label to make healthier choices when grocery shopping and eating away from home. Lesson topics include understanding the Nutrition Facts panel on food items and bringing nutrition into everyday life.

Cooking for a Lifetime of Cancer Prevention consists of two lessons to help participants understand and practice lifestyle guidelines for cancer prevention. Lessons emphasize nutrition recommendations to reduce cancer risk and the importance of screening for breast, cervical, and colorectal cancer.

Color Me Healthy is an exciting media of color, music, and exploration of the senses to teach children to make wise food choices and that physical activity can be fun. The education stimulates all senses of young children ages 4 and 5: touch, smell, sight, sound, and taste. This high-energy education is a favorite of young children.

Right Bite: Cooking School for Diabetes is a multilesson program to help participants learn meal planning and food preparation methods to reduce calories, control carbohydrates, modify fat, and increase fiber so those affected by diabetes can manage their blood glucose and blood pressure.

Emotional Well-Being

Master of Memory is a six-lesson series that encourages participants to recognize how they can impact and evaluate their memory function and find ways that may help address some of those factors. Participants can increase their confidence and readiness to take steps to improve memory functioning.

Mind Matters includes several lessons, brief activities, and resources to teach mindful strategies for reducing stress and promoting self-care and mental wellness to middle-school students. Mindfulness activities can be used to prevent violence, address chronic absenteeism, and build a culture of wellness among adolescents.

Maternal, Infant, and Child Health

Breastfeeding Friendly Child Care Certification helps child care providers support breast feeding families by becoming certified through a multilevel program of education with policy and environmental changes. A 2-hour training gives providers the knowledge to encourage breastfeeding families; each attendee receives two professional development hours honored and endorsed by the Department of Human Resources. All child care providers may apply for this free, 2-year certification. Breastfed babies are healthy babies.

Breastfeeding Education is an eight-lesson program designed for pregnant and early postpartum women and individuals in their support system. Lessons cover health during pregnancy, breastfeeding, and starting babies on solid foods. The sessions are interactive and include hands-on activities.

Safe Sleep Initiative is a project in collaboration with the Children’s Hospital of Alabama to reduce the number of sleep-related infant deaths in the state. Through a single lesson, caregivers learn the importance of safe sleep, particularly the importance of babies sleeping alone, on their back, and in a crib.

Personal Financial Management

Financial literacy.

iCare Kids serves fourth and fifth grade students in the classroom. The series aims to educate, enable, and empower youth to become financially responsible, develop their full leadership potential, and promote an understanding of philanthropic engagement. The fivelesson series topics include dreams, goals, money smart, philanthropy, and legacy.

Money Goals provides strategies and tools to help adults successfully manage personal finances. Topics include healthy habits regarding spending plans, credit, savings, and debt. Topics are to be taught as a series of three sessions, not provided as a single program.

WISE 101: Money Management helps participants acquire the financial capability to create a budget, save money, and manage debt. It can help people feel more confident about finances and plan for the short and long term. In this hour workshop, participants are guided through eight steps to create a personalized money management plan (or budget). Using the accompanying resource—a user-friendly money management calendar—as a guide, the participants are equipped with the skills needed to track expenses and income, develop a personal money plan (budget), manage their plan, and adjust for planned and unexpected expenses.

Money Smart for Adults provides must-have strategies to help adults successfully manage personal finances. Information includes spending plans, credit, savings, identity theft/scams, and banking. This course can be taught as a four- or five-program series or as single lessons.

Alabama Money Podcast launched in January 2023 with six episodes released by June 2023. Extension professionals discuss topics to help you create financial independence. The podcast is available on Apple Podcasts. Google Podcasts, Spotify, and Stitcher.

Family and Child Development

Digital and in-person parenting education.

Just in Time Parenting Newsletter Visit JITP.info to view or download 40 newsletters covering the early years, prenatal to 5 years of age. Tips, information, and ideas for fun are presented by the national JITP team. You can subscribe to this free newsletter in English or Spanish.

24/7 Dad is a must to help fathers improve their parenting skills and become nurturing and supportive dads. Information is provided as a six-lesson series.

Tuning in to Kids Parenting Education is a six-session research-based program offering ways to understand and motivate children to develop emotional intelligence. Evidence shows behavioral improvements and more confidence. Fathers, mothers, and any caregiver or child care provider will learn effective communication and calming techniques. New in 2024: Facilitator Certification Training!

Fathering in 15 is a free online tool to help fathers build parenting skills.

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Alabama Extension Human Sciences Team

Revised February 2024, Alabama Extension Human Sciences 2024 Program Guide , FCS-2500

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• Alabama Extension Human Sciences Program Guide

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