Abstract
BackgroundLarge proportions of children do not fulfil the World Health Organization recommendation of eating at least 400 grams of fruit and vegetables (FV) per day. To promote an increased FV intake among children it is important to identify factors which influence their consumption. Both qualitative and quantitative studies are needed. Earlier reviews have analysed evidence from quantitative studies. The aim of this paper is to present a systematic review of qualitative studies of determinants of children's FV intake.MethodsRelevant studies were identified by searching Anthropology Plus, Cinahl, CSA illumine, Embase, International Bibliography of the Social Sciences, Medline, PsycINFO, and Web of Science using combinations of synonyms for FV intake, children/adolescents and qualitative methods as search terms. The literature search was completed by December 1st 2010. Papers were included if they applied qualitative methods to investigate 6-18-year-olds' perceptions of factors influencing their FV consumption. Quantitative studies, review studies, studies reported in other languages than English, and non-peer reviewed or unpublished manuscripts were excluded. The papers were reviewed systematically using standardised templates for summary of papers, quality assessment, and synthesis of findings across papers.ResultsThe review included 31 studies, mostly based on US populations and focus group discussions. The synthesis identified the following potential determinants for FV intake which supplement the quantitative knowledge base: Time costs; lack of taste guarantee; satiety value; appropriate time/occasions/settings for eating FV; sensory and physical aspects; variety, visibility, methods of preparation; access to unhealthy food; the symbolic value of food for image, gender identity and social interaction with peers; short term outcome expectancies.ConclusionsThe review highlights numerous potential determinants which have not been investigated thoroughly in quantitative studies. Future large scale quantitative studies should attempt to quantify the importance of these factors. Further, mechanisms behind gender, age and socioeconomic differences in FV consumption are proposed which should be tested quantitatively in order to better tailor interventions to vulnerable groups. Finally, the review provides input to the conceptualisation and measurements of concepts (i.e. peer influence, availability in schools) which may refine survey instruments and theoretical frameworks concerning eating behaviours.
Highlights
Large proportions of children do not fulfil the World Health Organization recommendation of eating at least 400 grams of fruit and vegetables (FV) per day
Conclusions and recommendations for research This review reveals a series of potential determinants of fruit and vegetable intake among children of which our current knowledge is limited
The qualitative studies suggest for example, that even when children have a high taste preference for fruit and vegetables they will not eat them if it is not convenient
Summary
Large proportions of children do not fulfil the World Health Organization recommendation of eating at least 400 grams of fruit and vegetables (FV) per day. To promote an increased FV intake among children it is important to identify factors which influence their consumption Both qualitative and quantitative studies are needed. Epidemiological evidence for the health benefits of a diet rich in fruit and vegetables is substantial [1-3] Despite this fact large proportions of children and adolescents do not meet the World Health Organization goal of a daily intake of at least 400 grams of fruit and vegetables [4-6]. To enable the development of relevant, effective fruit and vegetable promoting intervention programs and policies targeting children and adolescents it is important to identify the various factors which may influence their consumption of fruit and vegetables and both qualitative and quantitative studies are needed [10]. In the first part of this review the evidence from 98 quantitative studies of fruit and vegetable intake among children and adolescents was analysed [11]. The determinants for high consumption levels of fruit and vegetable supported by the strongest evidence were female gender, low age, high socioeconomic position (SEP), high preferences for fruit and vegetables, high parental intake of fruit and vegetables and high availability/accessibility of fruit and vegetables at home
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