The analysis of the data from the two studies (expert study and student study) was merged into the themes developed in the first study. In expert and student studies, food and nutrition literacy has been shown to be highly contextual. The final analysis of data from three sub-studies identified thirteen components, and two main domains of cognitive domain and skill domain are shown in Table 2. Further explanations are presented below.
Knowledge related to food and nutrition
In the cognitive domain, food-related knowledge was the first concept that developed during the continuous analysis and comparisons of data. This concept represents the basic knowledge related to food and nutrition, which was essential for children according to the opinion of experts. This concept encompasses four components: food and nutrition knowledge, lifestyle knowledge, food safety knowledge, and food and food preparation knowledge. One of the UNICEF nutrition experts described: “Students of 5e and 6e are expected to know and understand basic food and nutrition information to make decisions to improve their diets and know how proper diet and nutrition play a role in preventing obesity.
Most experts felt that it was more important to have a comprehensive understanding of the basics of nutrition and dietary balance than more detailed information for this age group. A nutrition expert from the Ministry of Health and Medical Education said: “In my opinion, a student of 5e and 6e must know the basics of nutrition, i.e. he/she must know the food groups and their nutritional value, and he/she must be familiar with a varied and well-balanced diet, students must know what meals are and why and how they should eat meals; what are healthy snacks and why they should eat them….”.
Understanding food and nutrition information
Most experts believe that food and nutrition literacy means that students have the ability to apply food and nutrition information to the health situation, which requires understanding and interpreting often complex information about food and nutrition.
According to the students, the lack of food and nutrition information in simple, understandable language was a significant barrier to using this information. “Sometimes I don’t understand the nutritional information so I ask my teacher but sometimes he can’t explain things to me simply or even in terms I know. (5th grade student).
Areas of expertise
Functional Foods and Nutrition Literacy
According to experts’ opinions, the ability to research and identify reliable sources of nutritional information is one of the main skills required. Interviews indicated that most children asked their questions about food and nutrition information to parents, teachers and searched the Internet.
Nutritionists said that in addition to the ability to research required food and nutrition information, students should apply this information in their eating behaviors throughout their lives. This concept can be viewed as both a component and a potential outcome of food and nutrition literacy using the two studies. Regarding food choice skills, one of the students said: “when I want to buy something, I check the production and expiration date and the standard sign. I also check its ingredients”. (5th grade student)
Some of the students mentioned their skills in preparing certain foods such as; “Scrambled egg, Macaroni, Omelet and Escalope….(Grade 6 student).
Interactive food and nutrition literacy
According to expert opinion, increased confidence has contributed to new ways of communicating about food and nutrition issues with peers, friends and children, highlighting the social aspects of food and nutrition literacy. A nutritionist from a research site said that“There is a need to share food and nutrition information with others, because in interactive literacy we would like individuals to apply food and nutrition information in their relationships. This relationship can be with a nutritionist, teacher, parents, peers and…”
The ability to resist food cravings and non-nutritious foods and the ability to say “no” to unhealthy food temptations that two of the Ministry of Health nutritionists and one of the education system nutritionists described as conceptualized as included emotional skills in food and nutrition literacy skills.
Among participants’ statements, the ability to argue and disagree with non-nutritional behavior of peers and family was one of the skills included in this domain.
“One of the other skills is that if the family had unhealthy eating behavior then the person could convince them or be able to manage their own diet independently.” (A nutritionist from the education system)
Critical Food and Nutrition Literacy
The main components identified in this dimension were media literacy, knowledge of food labels, and decision-making and planning skills.
One of the concepts in the ongoing data analysis process was media literacy. Today we live in a world saturated with advertisements where the consumption of unhealthy foods and the promotion of unhealthy eating habits are promoted. Children, as loyal and persistent customers of food marketing, are exposed and deceived by these misleading advertisements. According to the experts in our study, the development of media literacy in children is an essential skill that enables them to evaluate and respond to media advertisements. In our study, most students did not trust ads and some of them thought they should investigate the trustworthiness of ads. A 5th grade student said: “The advertisements are not real, and most of them are wrong and sell their products. I saw an advertisement for a fruit juice saying that the fruit juice is made from real juice, but when I bought it and read its ingredients, it consisted of water, sugar and flavorings.
Knowledge of food labels
In the expert survey, participants discussed the importance of food labelling. They believed it was one of the best ways to convey nutritional messages at the point of sale. One of the nutritionists from the Ministry of Health, while recalling the establishment of compulsory traffic lights, declared that “Traffic lights are the first and most important guide in which the consumer can communicate with food products through colored markers. Traffic lights may be more convenient for children due to their simplicity.
Decision-making and planning skills under special conditions
Managing money and time to prepare healthy food, making healthy decisions in particular circumstances, and being able to plan for one’s own health, that of others and the surrounding environment, were the elements mentioned by the attendees. This component helps the individual minimize the impact of limited resources or other special situations on healthy food choices.
A total of twenty-nine studies were included in the final review. Of these, 21 studies simultaneously addressed definitions of food/nutrition literacy and its components. [5,6,7,8, 28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44]three studies only defined food/nutrition literacy [45,46,47] and 8 focusing on the conceptual framework of food/nutrition literacy and its components [7, 8, 30, 31, 36, 38, 47, 48] in young people and adults. Core elements of all food literacy frameworks included basic nutrition knowledge and the skills required to regulate food intake, plan meals, and select and prepare food. Only three food literacy frameworks included skills such as sharing information and interacting with others [7, 36, 38, 39]. All of the nutrition literacy definitions and half of the food literacy definitions were based on an existing definition of health literacy [6, 7, 31, 36, 38]. The most important components of “food literacy” were food skills, including management, food preparation and food selection, and critical literacy. [7, 38, 49, 50]. Slater (2013) introduced food literacy using Nutbeam’s idea of health literacy as a framework for school food and nutrition curriculum. . Based on the literature, all definitions of nutrition literacy focused on the cognitive abilities of individuals and placed a strong emphasis on the fundamental literacy and numeracy abilities needed to understand and use nutrition-related information (skills functional). However, none provided a conceptual framework for nutrition literacy. For a general overview, see Supplementary File 2.
Conceptual framework for food and nutrition literacy in children
Figure 2 shows the final framework developed in two domains of knowledge and skills but five dimensions. Each dimension included various components shown in Table 2.