Food Literacy Program Research Articles

Can addressing food literacy across the life cycle improve the health of vulnerable populations? A case study approach.

Food literacy programs aim to improve an individual's knowledge and skills in the planning, management, selection, preparation and eating of healthy foods. Unhealthy dietary patterns across the life cycle are associated with an increased risk of chronic disease. Foodbank WA's Healthy Food for All® (HFFA) team has made addressing health inequity a priority, by enhancing food literacy skills of vulnerable people across the lifespan. A case study approach was utilised to explore HFFA's suite of evidence-based food literacy programs: Food Sensations® (FS) for Parents (of 0-5year olds), FS for Schools (kindergarten to Year 12), Fuel Your Future (adolescents 12-18years), and FS for Adults (FSA) (18years and over). These programs are contextualised to meet the needs of vulnerable groups at all life stages. In the last decade the HFFA team have delivered 5047 food literacy sessions to over 62000 vulnerable Western Australians. Evaluation results demonstrate the FS programs are successful at improving vulnerable people's food literacy skills and dietary behaviours. For example, over 70% of participants make at least one positive food behaviour change after attending FSA. By targeting vulnerable people of all ages, HFFA's food literacy programs provide multiple opportunities for intervention, to enhance health behaviours, and therefore reduce risk of chronic disease. SO WHAT?: Food literacy programs are one effective strategy that is complementary in helping to address the health inequities in Australia. Government and broader community investment in food literacy initiatives is vital to improving the health outcomes of vulnerable populations.

The study protocol for a pseudo-randomised pre-post designed controlled intervention trial to study the effects of a 7-week cooking program on self-efficacy and biomarkers of health: the ECU lifestyle and biomarkers get connected study (ECULABJMOF) including the Jamie\u2019s Ministry of Food WA participant experience

BackgroundAustralia, like other nations, has experienced a shift in dietary patterns away from home cooking of nutritious foods, towards a reliance on pre-prepared convenience meals. These are typically energy-dense, nutrient-poor and contribute to the rising prevalence of obesity and chronic disease burden. The aims of this study were to evaluate whether a community-based cooking program instigated a change to participants’ skills, attitudes, knowledge, enjoyment and satisfaction of cooking and cooking confidence (self-efficacy).MethodsThe pseudo-random, pre-post study design consisted of an intervention and a control group. Participant recruitment and group allocation was based on their program start dates. Intervention participants were surveyed three times (baseline, 7 weeks and 6 months) and the control group were surveyed at baseline and 5 weeks. All participants were registered via an online website and were 18 years or over. Upon consent, participants were offered four levels of commitment, defined by different assessments. The minimum participation level included an online survey and levels 2, 3 and 4 involved attendance at a clinic with increasing functional, anthropometric and biomarker measurements. Primary endpoints were participants’ cooking confidence as a proxy for self-efficacy. Secondary endpoints were dietary intake, physical activity levels, body composition, anthropometry, blood, urine and faecal biomarkers of systemic, physical and mental health.DiscussionThe community cooking program provided participants with information and advice on food sourcing, preparation and nutrition to improve home cooking skills. The study was designed to explore whether food literacy programs are efficacious in improving participant physical health and well-being in order to combat the rise in obesity and diet-related disease. It will support future use of public health cooking program initiatives aimed at improving food literacy, self-efficacy and physical and mental health. The extensive data collected will inform future research into the relationship between diet, the gut-microbiota and human health.Trial registrationRetrospectively registered on 16.08.2019 with the Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12619001144101.Protocol version 4.

Identifying Who Improves or Maintains Their Food Literacy Behaviours after Completing an Adult Program.

Food Sensations for Adults is a free four-week nutrition and cooking program that teaches low- to middle-income individuals food literacy. This research aimed to compare demographic characteristics of participants who completed the program’s follow-up questionnaire three months after program completion and assess whether food literacy and dietary behaviour changes were improved or maintained. Statistical analysis methods used factor scores of the plan and manage, selection, and preparation domains to examine mean self-reported changes in food literacy. Tertile stratification methods calculated changes in participants who had low, middle, and high end-of-program food literacy scores, and multivariable regression analysis explored the associations. The follow-up results (n = 621) demonstrated a statistically significant factor score increase in plan and manage (3%) and selection (7.2%) domain scores, and a decrease in the preparation score (3.1%), and serves of consumed vegetables (7.9%), but were still significantly higher than at the start of the program. At follow-up, participants with low food literacy at the program end significantly improved their follow-up domain scores for plan and manage (60%) and selection (73.3%), and participants with moderate or high food literacy at the program end maintained their follow-up scores. A food literacy program can support adults to improve and maintain their food literacy behaviours and maintain dietary behaviour change; therefore, strategies to support this continued change must be considered.

012–Food Literacy: Can Pediatric Endocrinology Nurses Focus Upstream?

Background: American families are spending less time procuring, preparing and cooking meals at home. As well, there is less time dedicated to nutrition education in schools. Food literacy is defined as “a collection of inter-related knowledge, skills, and behaviors required to plan, manage, select, prepare, and eat foods to meet needs and determine food intake, as well as, the scaffolding that empowers individuals, households, communities or nations to protect diet quality through change and support dietary resilience over time.” Adolescents generally lack food literacy skills and increasingly consume food away from home with fast food meals and processed snacks. Approximately 1 in 3 adolescents in the U.S. are obese, increasing their risk for diabetes and cardiovascular disease. Upstream efforts continue to be explored to combat rising obesity rates. Programs that promote food literacy in adolescents have the potential to influence healthy lifestyles. Purpose: To inform pediatric endocrinology nurses about food literacy, its components, and existing food literacy education programs ready for implementation. Description of Topic: A literature review on food literacy was completed. High food literacy has been associated with improved eating of a healthy diet, including more fruits and vegetables and less fast food. Food literacy programs should address adolescents’ knowledge, skills, and attitudes to make healthy diet choices. Potential topics include gardening, recipe reading, food label reading, learning about healthy vs. unhealthy foods, food preparation and cooking, animal welfare, and farm to table slow food concepts. The USDA SNAP-Ed website provides well developed, user-friendly food literacy teaching ideas with accompanying learning objectives, lesson plans, and teaching strategies that could readily be implemented by pediatric endocrinology nurses. Clinical Implications: Pediatric endocrinology nurses typically provide care to adolescents with obesity and its related comorbidities. Pediatric endocrinology nurses have an opportunity to expand their practice to primary and secondary prevention of obesity, using upstream health education to promote adolescents’ food literacy. By partnering with schools, churches, Boys and Girls clubs, and Scouts troops, pediatric endocrinology nurses may offer health education, building food literacy skills in whole communities with the ultimate goal of slowing the rise in obesity rates. Food literacy has been described as “the ability of an individual to understand food in a way that they develop a positive relationship with it, including food skills and practices across the lifespan in order to navigate, engage, and participate within a complex food system. It's the ability to make decisions to support the achievement of personal health and a sustainable food system considering environmental, social, economic, cultural, and political components. The core of food literacy is the adolescent’s ability to use food knowledge and skills to make healthy dietary choices and encompasses aspects of planning and managing, selecting, preparing, and eating healthy foods.

Effectiveness of an Adult Food Literacy Program.

Nutrition education programs aim to improve food literacy domains covering the planning and management, selection, preparation and cooking and eating of healthy food. Reviews indicate programs are effective but acknowledge challenges with evaluation of community focused delivery. Food Sensations® for Adults (FSA) is a free four-week nutrition and cooking program targeted at low-to-middle income Western Australians who would like to improve their food literacy. The aim of this research was assess how effective FSA is in changing food literacy and selected dietary behaviours. Statistical analysis identified a significant increase in postprogram scores for domains of planning and management, selection and preparation using factor scores (n = 1092). The proportion of the score increase in the postprogram scores compared to the preprogram scores was 10–25%. There was also a significant increase in self-reported fruit and vegetable serve intake, equating to an average increase of ¼ serve/day of fruit and ½ serve/day of vegetables. Of those classified as low food literacy, 61–74% improved postprogram scores in the three domains. FSA is effective in improving food literacy and dietary behaviours and the results add to the evidence base as to how effective these programs can be and for whom they should be targeted for future success.

Identifying Participants Who Would Benefit the Most from an Adult Food-literacy Program.

Food literacy programs aim to improve behaviours required to achieve a quality diet. The objectives of this study were to assess the demographic, food literacy related and dietary behaviour of participants enrolling in Food Sensations® for Adults, a free four-week food literacy program and identify the subgroup of participants who benefit most. Cross-sectional pre-program questionnaire data (n = 1626) from participants enrolling in the program was used to stratify into low, middle and high food-literacy tertiles. Factor scores from a reliability analysis of food literacy behaviours were then used to produce a composite score). Participants were 80.2% female, 56% aged 26 to 45 years and 73.3% from low to middle socio-economic areas. Demographic characteristics were not a significant predictor of the lowest composite food-literacy group. Those with the lowest composite food-literacy tertile score were more likely to have lower self-rated cooking skills, a negative attitude to the cost of healthy foods, lower intakes of fruits and vegetables and a higher frequency of consuming takeaway food and sugary drinks. Food literacy programs must focus on recruiting those who have low self-rated cooking skills, who consider healthy foods expensive and have poor dietary intakes and will most likely to benefit from such programs.

Examining the Association between Food Literacy and Food Insecurity

Poor food literacy behaviours may contribute to food insecurity in developed countries. The aim of this research was to describe the apparent prevalence of food insecurity in adults at enrolment in a food literacy program and to examine the relationship between food insecurity and a range of independent variables. Individuals attending the Food Sensations® for Adults program in Western Australia from May 2016 to April 2018 completed a pre-program questionnaire (n = 1433) indicating if they had run out of money for food in the past month (food insecurity indicator), frequency of food literacy behaviours, selected dietary behaviours, and demographic characteristics. The level of food insecurity reported by participants (n = 1379) was 40.5%. Results from multiple logistic regression demonstrated that behaviours related to planning and management, shopping, preparation, and cooking were all statistically independently associated with food insecurity, in addition to soft/soda drink consumption, education, employment status, and being born in Australia. The results are salient as they indicate an association between food literacy and food insecurity. The implications are that food insecure participants may respond differently to food literacy programs. It may be necessary to screen people enrolling in programs, tailor program content, and include comprehensive measures in evaluation to determine effect on the impact of food literacy programs on different subgroups.

Evaluation of health promotion capacity gains in a state-wide rural food literacy intervention.

Building capacity to enhance health promotion intervention effectiveness is a desirable, difficult to achieve and rarely evaluated aspect of practice. This study aims to describe an approach for evaluating capacity building embedded in a state-wide health promotion intervention that had a primary objective of enhancing food literacy and secondary objective of building health promotion capacity. The multi-strategy rural food literacy intervention centred on a group-based, hands-on learning workshop series. Logic modelling, theory of change and clarification of the explicit assumption of the intervention relating to food literacy and capacity building objectives were documented. The evaluation approach acknowledged the complexity of the intervention that utilised a food literacy program as a vessel to build relationships, enabling capacity-building strategies over time, and used multiple forms of data to measure organisational, community and individual capacity. The development of a shared mixed method program evaluation plan was achieved through co-design. One-hundred and twenty-two peer facilitators were trained across 81 communities and reported increases in self-efficacy for health promotion action. There was broad awareness and support for the program within the organisation. The majority (75%) of communities involved in the intervention implemented at least one health promotion activity, demonstrating some health promotion capacity gain.

Evaluation Tool Development for Food Literacy Programs.

Food literacy is described as the behaviours involved in planning, purchasing, preparing, and eating food and is critical for achieving healthy dietary intakes. Food literacy programs require valid and reliable evaluation measures. The aim of this paper is to describe the development and validation of a self-administered questionnaire to measure food literacy behaviours targeted by the Food Sensations® for Adults program in Western Australia. Validity and reliability tests were applied to questionnaire item development commencing with (a) a deductive approach using Australian empirical evidence on food literacy as a construct along with its components and (b) adapting an extensively-tested food behaviour checklist to generate a pool of items for investigation. Then, an iterative process was applied to develop a specific food literacy behaviour checklist for program evaluation including exploratory factor analysis. Content, face, and construct validity resulted in a 14-item food behaviour checklist. Three factors entitled Plan & Manage, Selection, and Preparation were evident, resulting in Cronbach’s alpha 0.79, 0.76, and 0.81, respectively, indicating good reliability of each of these factors. This research has produced a validated questionnaire, is a useful starting point for other food literacy programs, and has applications globally.

Don't know, don't care or confused: what do Australian adolescents know about Australian Dietary Guidelines?

ABSTRACTWestern Australian adolescents are not adhering to the Australian Dietary Guidelines yet little research has considered what adolescents know about the Healthy Living Pyramid (HLP), the recommended daily serves. Four studies assessed nutrition-related knowledge or influences on food preference. Studies one and two investigated adolescent's perceptions of healthy and unhealthy food and what influences their food choice by conducting 24 gender-specific focus groups (n = 150, 12–16 years). Study three (n = 28, 13–14 year) assessed the test–retest reliability of a nutrition questionnaire that measured knowledge of the HLP and the recommended daily serves. Study four (n = 38, 12–16 years) measured changes in HLP knowledge after a six session community-based cooking and food-literacy program. Participant's knowledge about discretionary foods and vegetables was high, however, knowledge about intake of the other food groups especially grains was poor. Body image emerged as the strongest influence over food preference with media reinforcing girl's desire to be thin and boy's desire to be muscular.

"Just Say It Like It Is!" Use of a Community-Based Participatory Approach to Develop a Technology-Driven Food Literacy Program for Adolescents.

FuelUp&Go! is a technology-driven food literacy program consisting of six in-person skill building sessions as well as fitness trackers, text messages, and a companion website. A community-based participatory research approach was used with adolescents who were recruited to participate in a Kid Council. Qualitative data were collected about the use of surveys, program activities, recipes, technology and text messages, and music and incentives. Changes suggested by Kid Councilmembers informed the design and development of a pilot program. Participants were recruited for the pilot program and completed pre- and postintervention surveys. The results indicated food-related knowledge remained low but increased from baseline to follow-up. Attitudes toward vegetables and physical activity increased slightly. Self-reported participation in physical activity and consumption of sugar-added beverages moved in positive directions. These findings suggest that community-based participatory research approach is an effective approach to engage adolescents in the development of a technology-driven food literacy program.

Food provision among food relief agencies in rural Australia, and perceived barriers and enablers to provide healthy food.

Food insecurity affects 4-14% of Australians, and up to 82% of vulnerable groups. Food relief agencies commonly provide food parcels or food vouchers. Little research has been undertaken on food relief agencies within rural Australia. This study determined the type of food assistance provided by rural food relief agencies, and barriers and enablers to provide healthy food. Cross-sectional study, using telephone questionnaires with qualitative and quantitative aspects. Data were analysed using descriptive statistics and thematic analysis. Rural New South Wales, Australia. Representatives of 10 food relief agencies. Types of food assistance and food provided, and the barriers and enablers to provide healthy food to clients. Most agencies provided food hampers and perishable and non-perishable food. Rural food relief agencies had a greater capacity to provide non-perishable compared to perishable food. Grains, breads and cereals, and canned fruit and vegetables were most popular. Nine key themes emerged including 'Ability to purchase and provide healthy food', 'Ability to regulate food purchased or chosen by clients', 'Financial constraints of the agency' and 'Lack of storage'. There are many variables to consider in order to understand the capacity of rural food relief agencies to provide healthy food. There are also opportunities for food relief agencies to appraise current practices and make changes. Initiatives to improve storage facilities and food availability are key and include networking with local businesses, community organisations and government. Rural food relief agency clients could benefit from accessing food literacy and health programs like FoodREDi, OzHarvest NEST and SecondBite Fresh NED.

What are the determinants of food security among regional and remote Western Australian children?

Objective:To explore how determinants of food security affect children in regional and remote Western Australia (WA), across food availability, access and utilisation dimensions. Methods:The Determinants of Food Security framework guided the thematic analysis (using NVivo 10) of semi‐structured interviews with 20 key informants. Results:Food availability factors included availability, price, promotion, quality, location of outlets and variety. Food access factors included social support, financial resources, transport to food outlets, distance to food outlets and mobility. Food utilisation factors included nutrition knowledge and skills, children's food preferences, storage facilities, preparation and cooking facilities and time to purchase food. Conclusions:Key food availability recommendations include increasing local food supply options. Food access recommendations include ensuring equitable formal social support and empowering informal support options. Food utilisation recommendations include prioritising food literacy programs focusing on quick, healthy food preparation and budgeting skills. Implications for public health:Policymakers should invest in local food supply options, equitable social support services and experiential food literacy programs. Practitioners should focus child/parent programs on improving attitude, knowledge and skills.

Which ecological determinants influence Australian children's fruit and vegetable consumption?

This study investigated determinants of fruit and vegetable (F&V) consumption among regional and remote Western Australian (WA) children, using an Ecological Model of Health Behaviour. Semi-structured interviews were conducted with 20 key informants (Health Workers, Food Supply Workers, and School/Youth Workers) purposively sampled from across regional and remote WA. Interviews were transcribed, analysed thematically using QSR-NVivo 10 software, and embedded within an Ecological Model of Health Behaviour to demonstrate the multiple levels of influence on health. Key determinants of F&V consumption at the intrapersonal level included attitude and food literacy among children. Key interpersonal level determinants included role modelling and parental food literacy. Institutional determinants included health service provision, school nutrition education and food skill programs. F&V availability, community networks and health-promoting spaces were key themes affecting families at the community level. The public policy level influencer included implementation of a store policy within local food outlets. Study findings suggested participatory programs with an emphasis on parental involvement and role modelling could increase F&V intake among children living in regional and remote areas; while school curriculum linkages were essential for school-based programs. Policy makers should consider further investment in school food literacy programs and family programs that are delivered collaboratively. Further, support of local food supply options and support for healthy food policies in food outlets are critical next steps. This study contributes new knowledge to build the evidence base and facilitate the development of targeted strategies to increase consumption of F&V among children living in regional and remote areas.

Reliability and Validity of an Online Questionnaire to Measure Food Literacy in Primary School Children

Food literacy is a term used to describe the knowledge, skills and behaviors needed to achieve a healthy and environmentally friendly diet. Improving food literacy in children is gaining momentum as a strategy to address the issue of obesity in this age group. To our knowledge, there are no measures of food literacy in children. An online questionnaire for children aged 9‐10 years living in New Zealand (NZ) was developed based on the following components of food literacy; food origins, nutrition knowledge, and food skills. The 65‐item questionnaire underwent three phases of testing with revisions made after each phase. In Phase 1, the questionnaire was reviewed by an expert panel (n=11) to assess content validity; the content validity index for the questionnaire was 0.83, indicating good content validity. In Phase 2, the questionnaire was pre‐tested with children using cognitive interviews (n=4) and a focus group (n=4); the questionnaire was revised to ensure items were correctly interpreted by children to achieve face validity. In Phase 3, the questionnaire was pilot tested in children (n=85) at two primary schools on two occasions to assess reliability and validity; items that failed to meet item difficulty and discrimination criteria were removed. The internal consistency of each of the content sections was acceptable to good (Cronbach's alpha 0.69‐0.79) and the Intraclass Correlation Coefficients demonstrated good test‐retest reliability for each section (0.69‐0.83) and for the overall questionnaire (0.89). The final 42‐item questionnaire is a reliable and valid measure of food literacy in NZ school children, which is easily adapted for use in other countries, and shows promise as a tool for evaluating the efficacy of food literacy interventions or programs implemented in schools.