Abstract
Statement of the Problem: Nutrition literacy, derived from health literacy, is the ability to understand basic information needed to make appropriate nutrition decisions. Critical nutrition literacy (CNL), the highest level of nutrition literacy, is defined as the ability to critically analyze and apply nutrition information. Although studies have explored the lower levels of nutrition literacy (functional and interactive), CNL has seldom been investigated. One instrument developed to measure CNL, the Critical Nutrition Literacy Tool (CNLT), was found to have strong psychometrical validity and reliability; however, the external validity of the instrument is unknown. Thus, the purpose of this research was to further examine CNL, through further validation of the CNLT, in a large sample of college students in the U.S. The aims of this paper are to: examine the relationship between CNL and dietary quality; examine its relationship to related constructs, such as critical decision making (CDM); and determine if an introductory level nutrition course designed to increase nutrition knowledge will also increase CNL. Methods: The methods utilized in this thesis were comprised of three studies. The first study was a secondary data analysis of a cross-sectional survey that examined the relationship between CNL and dietary quality. The second study was a randomized-control trial, using an existing online, problem-based learning program, where the relationship between CNL and CDM scores were evaluated. The third and final study was a secondary data analysis of a non- experimental, pre-post study design of a 4 credit, 13-week, academic course intervention, aimed to determine whether CNL could be increased. Critical nutrition literacy was measured using a validated, 7-item critical nutrition literacy scale.11 Items were evaluated using a 5-point Likert scale ranging from 1=strongly disagree to 5 = strongly agree. Critical nutrition literacy scores were then divided into tertiles to produce three distinct groups: lower critical nutrition literacy, moderate critical nutrition literacy and higher critical nutrition literacy. Summary of Results: This thesis is the first study to explore critical nutrition literacy (CNL), as it is related to dietary quality and critical decision making (CDM), in a diverse sample of college students. Although positive, critical nutrition literacy has little relationship with markers of diet quality, such as cups of fruits and vegetables and teaspoons of added sugars. As well, there was no significant relationship between CDM score, measured by critical decision-making skills, and CNL. It can be suggested that other factors may influence or mediate the relationship
Highlights
There was no significant difference between completers and non-completers by critical nutrition literacy (CNL) scores
When exploring CNL in relation to critical decision making (CDM) in Study 2, there was no significant relationship between critical thinking score, measured by critical decision-making skills, and CNL
When exploring the changeability of CNL skills in Study 3, it was found that a nutrition course significantly increased CNL from baseline to post-intervention
Summary
Limited health literacy among adults is a recognized public health problem.[1–6] Health literacy, the collection of skills necessary for accessing, understanding and processing health information,[1,2] is essential for making important health decisions and can lead to better health outcomes.[7–11] the health literacy field has grown during the past decade, most research does not explicitly focus on food or nutrition.[12,13] Nutrition literacy, a more specific set of abilities developed by Velardo[14] and derived from Nutbeam’s1 definition of health literacy, is concerned with the ability to understand basic nutrition information and services needed to make appropriate nutrition decisions.[13,15] Currently, three levels of nutrition literacy have been defined: functional nutrition literacy (applying information to a limited range of activities), interactive nutrition literacy (applying new information to changing circumstances), and critical nutrition literacy (critically analyzing information).[1,12,13] Validated instruments that measure functional[16] and interactive[17] literacy levels have been established in studies of cancer survivors[18], those with chronic disease[19], and parents of young children.[20]. Only two instruments have been developed to measure critical nutrition literacy (CNL).[21,22]. Naigaga et al[21] developed and validated an instrument to measure CNL in 15- to 16-year-old adolescents, known as the critical nutrition literacy evaluation scale (CNL-E).[21]. This survey measured adolescents’ perceived level of being able to critically evaluating nutrition information.[21]. This instrument was psychometrically validated using a younger sample of adolescents and does not explore how those with more advanced levels of nutrition education critically evaluate sources of traditional and online media.[21]
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