Our study developed a questionnaire to assess the food and nutrition literacy in Chinese school-age children, including five knowledge and skill dimensions, and 19 core components. The total questionnaire had high internal consistency (Cronbach’s α = 0.698). Exploratory factor analysis of skill components extracted 5 factors which were included in the conceptual framework, but a little different model. The commonality was more than 0.20 for all components. The Pearson correlation coefficients between dimensions (knowledge and understanding, selecting food, eating) and total questionnaire were more than 0.6, that indicated strong correlation. Using the questionnaire to assess the food and nutrition literacy and its related factors in school-age children, the results showed the literacy was low; not only social demographic characteristics, but also the home food environment were the predictors of food and nutrition literacy in school-age children.
Improving dietary habits demands food related skills and abilities of individuals, and an understanding of the social context. In this regard, nutritional science and education researchers are currently discussing the concepts of nutrition literacy and food literacy. A systematic review (2018) on definitions of nutrition literacy and food literacy revealed that that nutrition literacy and food literacy are seen as specific forms of health literacy, and represent distinct but complementary concepts. Definitions of nutrition literacy mainly described the abilities necessary to obtain and understand nutrition information, and food literacy incorporated a broader spectrum of theoretical and practical knowledge and skills to apply information on food choices and critically reflect on the effect of food choice on personal health and society. Since food literacy is based on a more comprehensive understanding of health behaviors, it is the more viable term to use in health promotion interventions. In this study, the term “food and nutrition literacy” was used, and defined as “collection of inter-related knowledge, skills and behaviors required to plan, manage, select, prepare and eat foods to meet needs and determine food intake”. We focused not only the ability of access and understand nutrition information, but also the ability to judge and apply nutrition information and the ability to communicate and act upon this information in the broader social environment, to address nutritional barriers in personal, social, and global perspectives. Based on the conceptual framework we developed the Food and Nutrition Literacy Questionnaire for Chinese School-age Children (FNLQ-SC) by literature review, experts interview and qualitative consensus study, which included five dimensions of food and nutrition knowledge, the ability of access, selection, preparing of food and healthy eating, as well as three levels of functional, interactive and critical literacy. Literatures showed all definitions of food and nutrition literacy contained elements of functional literacy, but only a few definition described skills that could be assigned to interactive and critical literacy since this definition was based on Nutbeam’s model of health literacy . And core elements of all conceptual frameworks included practical knowledge and skills to regulate food intake, including skills for planning meals, selecting, and preparing food. The Nutrition Literacy Assessment Instrument (NLAI) for American adults included the following domains: appreciation of relationships between nutrition and health, knowledge of macronutrients, food measurement skill, numeracy and label reading, and skill in grouping like foods . Australian experts identified eleven components of food literacy, which were grouped into four domains: planning and management; selection; preparation; and eating. The Food and Nutrition Literacy (FNLIT)  for elementary school children in Iran measured two domains with 6 subscales, including: 1) cognitive domain: understanding and knowledge; 2) skill domain: functional, food choice, interactive, and critical skills. Overall, despite the domain, dimension and components are different according to different food and nutrition definitions, the conceptual framework is similar, and future research should focus on multi-dimensional tool including interactive and critical literacy, and access, selection and preparation of food besides healthy eating.
We used Cronbach’s α coefficient to analyze the internal consistency. The total Cronbach’s α was 0.698, that indicated the total questionnaire had high internal consistency. But the Cronbach’s α coefficient of various dimensions was low, ranged from 0.148 to 0.452. A possible explanation for the low internal consistency values of dimensions is that internal consistency reliabilities values depend on the number of items in the scale . Since the “planning” “selection” “preparation of food” dimensions consisted of two, four and two components respectively, this could have resulted in lower internal consistency values. Additionally, There are many other possible reasons for a low alpha value, such as poor inter-relation between components and heterogeneous constructs, the sample size, or content cross in different dimensions. But the lower reliability estimates will not necessarily negate the value of the dimensions, since expert panel rated the components as relevant. Without evidence of acceptable internal consistency, we recommend that the total score be used instead of the subscale (dimension) scores.
Considering the knowledge and skill dimensions was based on different theoretical framework, so some studies independently analyzed the variables of cognitive and skills domains by exploratory factor analysis (EFA). In the study only skill components were analyzed and extracted 5 factors with eigenvalue more than 1. The EFA model was a little different with the conceptual framework of the study, which identified five skill dimensions as “selecting and eating”, “access and preparation”, “food label and measurement”, “picky eating”, “eating snacks”. Preliminarily the “picky eating” and “eating snacks” were not developed as separate dimension in the conceptual framework, both of which were included in “eating” dimension, despite they are important eating behavior for children. Considering the conceptual framework was developed logically through literature review, expert interview and consistency study, which shouldn’t be modified easily, especially in an unlogical model. Later we will modify or remove the questions to adjust the framework. Components analysis showed the factor loading of some components was lower than 0.40, but the commonality was more than 0.20 for all components. And removing any components did not result in an increase in Cronbach’s alpha coefficient, which indicated each component had high internal consistency with total questionnaire.
Using above developed questionnaire, we assess the food and nutrition literacy level in 4359 school-age children of grade 3 ~ 8. The results were similar to other studies. The FNLIT assessment of 803 students aged 10–12 years from elementary schools in Tehran city of Iran showed that more than half of the children (69%) had high levels of FNLIT in the cognitive domain, but in the skills domain, very few (3%) scored highly. Our study also showed the score of knowledge was more than that of skill dimensions in school-age children. The FNLIT study identified some associations between the total FNLIT and its subscales and sociodemographic variables including gender, parent’s education and age, birth order. Their results indicated that girls feel more able to exert choice and control over food and nutrition decisions than boys, but may be less able to do so in practice. Our results also showed the total literacy of girls were higher than boys, but the critical literacy was lower than boys (P > 0.05). Additionally, our results showed the home food environment was significantly correlated with children's food and nutrition literacy. The total score of food nutrition literacy was higher for the children who often had fruits at home, rarely ate out, eating without screen, and communicated food and nutrition information with families frequently (P < 0.05). Overall, these results are a general reminder to schools of the different learning needs of children from different family backgrounds, children in rural areas and younger age, with a large number of family children and poor family economic status and food environment, should be the main target population of nutrition education and nutrition improvement. The study highlights the need for continuous improvement in the nutrition education curriculum of schools in China, particularly highlighting the importance of giving greater attention to the development of practical food and nutrition skills alongside more traditional food and nutrition knowledge. Additional studies are needed to more fully assess and understand the predictors of FNLQ-SC.