This study describes exposure to health information and MHL among Thai youth, and examines factors related to F&V consumption. The majority of Thai youth in this sample were exposed to health-related content through the Internet, and the participants had a moderate level of MHL. When considering each element of MHL, Thai youth had limited capacity for analytical thinking. The test of the research hypothesis about F&V consumption found that exposure health information and MHL were the most important predictors of F&V intake. Other factors, including GPA, and health status influenced fruit consumption; age, place of residence, GPA, amount of pocket money, and BMI were associated with vegetable consumption.
The MHL score of Thai youth was around 37. The researchers found that Thai youth had relatively low analytical scores when considering the MHL domains. This finding is consistent with the Program for International Student Assessment (PISA), which is periodically conducted in countries around the world. According to PISA data, Thai students had low literacy, where 'literacy’ refers to a student's competence in applying knowledge and skills in core subjects to daily life, and having the ability to analyze, reason, and communicate effectively to identify the core content and interpret/assess it accurately (35). Thus, MHL reflects a child’s competence, and literacy is related to teaching and learning methods which help to develop analytical and reasoning skills. Thailand and ASEAN neighboring countries (e.g., Malaysia, Indonesia, Philippines) employ teaching methods requiring minimal critical thinking skill (36–38). Therefore, the PISA scores for these countries is relatively lower than Singapore and China, where active learning and problem solving are more heavily practiced in school (39–42). Therefore, an appropriate teaching and learning approach is essential for boosting MHL among Thai youth.
This study found an association between exposure to health information (types and frequency), and frequency of F&V consumption. This result is consistent with studies in nine European countries (Austria, Belgium, Denmark, Iceland, the Netherlands, Norway, Portugal, Spain, Sweden). Those studies found that youth with a higher frequency of exposure to F&V information through various media (particularly TV, Internet, print media) had higher F&V intake (43–45). In addition, youth who are exposed to health-related content via media become inherently more familiar with the concepts and messages. This understanding informs the decision to consume F&V (43). Moreover, the Thai study found that the higher the MHL score, the more likely that a youth will consume F&V. The findings confirm that the concept and outcome measures relate to HL, with the potential to improve healthy eating behavior, or changing F&V consumption for the better (46). In addition, the findings of this study correspond to similar studies in the USA, Taiwan, and Thailand in that HL was an essential factor influencing F&V intake frequency among youth (16, 47, 48). However, the level of F&V consumption by Thai youth is still worrisome, as only 2–3 in 10 Thai youth eat enough F&V to meet the recommended amount (49). That said, improved HL should boost F&V intake (47). What is more, improved MHL should result in Thai youth eating more F&V on a more frequent basis .
Youth with a higher GPA had a greater frequency of F&V consumption than those with a lower GPA. This result is consistent with studies in Canada and Iceland which found that higher academic performance of high school students (grade 7–9) was associated with greater F&V consumption (50, 51). This may be due to the probability that youth with a higher GPA are also superior in cognition, attentiveness, memory, extraction, and reasoning (52). In addition, cognitive processes are the steps for using knowledge, combining knowledge with new knowledge, and making decisions based on that knowledge (53). Therefore, youth with a higher GPA will be in a better position to understand, analyze, and evaluate health information which, in turn, may prompt them to consume F&V more than those with a lower GPA.
This study found a negative association between place of residence, pocket money, and vegetable consumption. A survey of purchasing behavior among primary grade 6 students in Thailand found that most students had 21–40 baht (US$ 0.60–1.20) a day for snacks, and were more likely to buy unhealthy food and beverages with their allowance. Typically, Thai youth tended to purchase sweetened drinks (91.7%), snacks (67.9%), bakery goods (46.4%), and sweets (39.3) (54) in convenience stores, which are primarily located in urban areas. What is more, most convenience stores in Thailand do not carry fresh F&V (55). This behavior can be seen among youth in China, Ghana, and the UK (14, 56, 57). In this study, health status was associated with fruit consumption. Youth with a chronic illness consumed more fruit than youth without illness, possibly because they were aware of their compromised health status and the need for good self-care behaviors (58, 59). Moreover, parents and families are likely to be more concerned about a child’s health condition if s/he suffers from a chronic condition (60). This supposition corresponds with the theory of family self-management of chronic disease, in that the family is the primary healthcare provider. The individual or sufferer is involved in managing their health care, and family members are involved in caring for and supporting the ill person to maximize their quality of life and enable them to live in harmony with their family and peers (61, 62).
Although the sample is nationally-representative, the data collection was cross-sectional. Thus, it is not possible to draw conclusions about causality between the independent and dependent variables. Also, the survey did not collect the amount of F&V consumed per serving or time period. Thus, this study can only describe the frequency of F&V consumption, and cannot conclude whether youth had enough F&V. The study did not include other factors which are probably significantly related to F&V intake, such as youth attitude toward F&V, F&V availability at home, and the socio-demographic characteristics of their parents (10, 14). Hence, future studies should measure those variables in addition to the amount of F&V consumed per serving or time period, among other potential determinants and outcome variables.