Food Literacy: Applying a food literacy framework to address

healthy eating programming in public health

Elsie Azevedo Perry, RD Public Health Nutritionist HKPR Heather Thomas, RD Public Health Dietitian MLHU

Disclaimer

The views expressed in this project update are those of the Locally Driven Collaborative Project (LDCP) team, and do not necessarily reflect those of Public Health Ontario.

Poll Question:

In what setting do you provide food literacy programming? • Public health

• Community health or family health

• School

• Not for profit organization

• For profit organization

• Other

• NA

Poll Question:

How are you involved in food literacy programming? • Program planning

• Resource development

• Support staff

• Facilitator

• Evaluation

• Other

• NA

Learning objectives

1. To learn about the key attributes of food literacy and how they are defined using common language.

2. To understand how the key food literacy attributes are interconnected when addressing healthy eating.

3. To apply the food literacy attributes as a framework in your work in food literacy program planning and evaluation.

Poll Question:

What words would you use to describe FOOD LITERACY?

Setting the context

• Large-scale food retail stores, fast food outlets and modernization of the global food system:

• Changed the food supply

• Changed the food environment

• Less time preparing food (‘deskilling’)

• Changes to food environment, eating behaviours, and deskilling: poor diet quality

decreased health and well-being

increased risk of chronic disease

Changing eating behaviours

Decline in food skills

• Less time spent preparing food and on domestic cooking skills (‘deskilling’).

• Evidence that improved food preparation skills improved diet quality.

Brown & Hermann, 2005; Hartmann et al.,2013; Larson et al., 2006; Mclaughlin et al., 2003;

Meehan et al., 2008; Smith et al., 2010; Wrieden et al., 2007

Food literacy emerges

• 2013 LDCP explored the meaning of food skills with high risk

youth, pregnant women, and young parents

• Other research in the field • Cullen, 2015

• Vaitkeviciute et al., 2014

• Vidgen, 2014

The need for…

• Comprehensive definition and indicators

• A measurement tool to: • Assess scope of problem • Tailor and target programming • Allocate limited resources effectively • Determine impact of food literacy programs • Identify gaps in current programming • Engage in effective advocacy efforts

Cullen, 2015; Vaitkeviciute et al., 2014; Vidgen, 2014

Research objectives: Year 1 (2016)

• To identify and summarize the attributes* of food literacy in the literature;

• To determine which attributes of food literacy, are priorities for measurement and tool development.

* ‘Attribute’ is the quality or feature regarded as a characteristic or inherent part of someone or something

Research objectives: Years 2-3 (2018-19) 1. To develop a food literacy measurement tool for

use with high-risk groups of youth (aged 16 to 19 years), young parents and pregnant women (aged 16 to 25 years).

2. To evaluate the tool with the identified target population, considering various facets of validity, reliability, sensitivity to change, and feasibility.

Def

inin

g Fo

od

Lit

era

cy

Scoping Review

Delphi Process

Scoping review

Research Question:

What attributes* of food literacy including food skills are identified in the literature?

* Attributes are defined as the quality or feature regarded as a characteristic or inherent part of someone or something.

Peer-reviewed articles n =19

Grey literature n =30

Total yield: n=49

Food Literacy Categories Food Literacy Attributes

Food and nutrition knowledge

• Food Knowledge • Nutrition Knowledge • Food Language • Nutrition Language

Food Skills • Food Techniques • Food Skills across the Lifespan

Self-efficacy & Confidence • Nutrition Literacy • Nutrition Self-Efficacy • Food Self-Efficacy • Cooking Self-Efficacy

Ecologic (beyond self)

• Socio-Cultural and Economic Influences and Eating Practices

• Food and Other Systems • Infrastructure and Population-

Level Determinants

Food Decisions • Dietary behaviour

Delphi process: Consensus building

Purpose: • Validating the language used to describe the

food literacy attributes;

• Confirming the relevance and importance in the public health context;

• Determining the priority attributes to be measured for program planning and policy work*.

Delphi participants

PARTICIPANT RELATIONSHIP* PARTICIPANT DISTRIBUTION

SECTOR Core Involved Supportive Peripheral

Public Health Units X 60%

Community/

Grass-roots partners and agencies

X X 20%

Non-governmental provincial organizations with focus on food literacy

X 10%

Academia X 5%

Educational agencies with focus on food literacy

X 5%

Non-health related government sector

X <5%

Private sector and/or charitable organization (e.g., industry)

X <5%

CORE

≥ 75% consensus on attribute relevance + importance

DESIRABLE

50-74% consensus on attribute relevance + importance

IRRELEVANT < 50 % consensus

on attribute relevance + importance

ROUND 3 Priority Ranking

ROUND 2 Consensus

building

ROUND 1 Consensus

building

Excluded from final

list

Included*

Excluded from final

list

Included*

Vigden, 2014

Food literacy attribute progression

Food literacy conceptual model

FOOD & NUTRITION

KNOWLEDGE

[Food knowledge;

Nutrition Knowledge;

Food & Nutrition

Language]

FOOD SKILLS

[Food Skills]

SELF-EFFICACY

&CONFIDENCE

[Nutrition Literacy;

Food & Nutrition Self-Efficacy;

Cooking Self-Efficacy;

Food Attitude]

FO

OD

DE

CIS

ION

S

[D

ieta

ry B

eha

vio

ur]

ECOLOGIC

(Beyond self)

[Food and Other

Systems;

Social Determinants

of Health]

INTRINSIC EXTRINSIC

PREDICTOR

Socio-cultural Influences and

Eating Practices

Key recommendations

• Shift dialogue from food skills to food literacy;

• Promote interconnected attributes rather than attributes considered only in isolation;

• Develop measurement tool.

Food literacy is a set of interconnected attributes organized into the categories of food and nutrition knowledge; food skills; self-efficacy/ confidence; food decisions; and ecologic (external) factors such as income security and the food system.

Interdependent Nature of the Attributes

Key findings:

• Knowledge + skills and being able to apply these

• Self-Efficacy and Confidence are needed + Access to External Resources • Food

• Equipment

• Income

• Educational opportunities

Call to Action: Five Recommendations

1. Support and adopt research findings.

2. Use comprehensive framework to review programs, services, or policy when planning, implementing and evaluating healthy eating public health initiatives.

3. Use the comprehensive food literacy framework to implement healthy eating programs in schools.

Call to Action: Five Recommendations

4. Support the development and testing of a tool for measuring food literacy.

5. Rebrand and promote community-based food programs as food literacy programs rather than those that address household food insecurity or food security.

.

Case scenarios Interactive Polling

Case Scenario 1:

A healthier recreation concession pilot project

• Healthier items placed on the menu.

• Strategic pricing and purchasing.

• Promotional campaign and activities (including taste-testing).

• Web based nutrition information developed by an RD.

• Sales of healthier food items increased.

• Advocacy for municipal policy.

What food literacy attribute (s) are being

addressed?

What food literacy attribute (s) are NOT

being addressed?

Question?

How is ‘Food Attitude’ being addressed?

Question?

Could the external attribute of ‘Food and Other Systems’ be

addressed better in this recreation concession pilot?

Case 1 Summary (Recreation Pilot)

Food Knowledge

Nutrition Knowledge

Food and Nutrition Language

Nutrition Literacy

Food and Nutrition Self-Efficacy

Food Attitude

Food and Other Dietary

Systems Behaviour

Case Scenario 2 City of Hamilton Food Strategy

• Strategic plan for actions over the next ten years to ensure a healthy, sustainable, and just local food system for all residents

Hamilton Pictogram

What food literacy attribute(s) are being

addressed?

Hamilton Pictogram

In the Hamilton Food Strategy example, are the

social determinants of health being addressed ?

Case 2 Summary (Hamilton Food Strategy)

Food Knowledge Food Skills Nutrition Knowledge Food and Nutrition Language

Nutrition Literacy

Food Attitude

Cooking Self-Efficacy

Food and Nutrition Self-Efficacy

Food and Other Systems Dietary

SDOH Behaviour

Case Scenario 3: Peterborough Public Health (PPH) Working with Priority Populations

• Long history of delivering and supporting food action programs.

• Specific vulnerable and priority populations targeted.

• Come Cook with Us program.

• Partner in the Nourish Project.

• New funding for rural communities to reach indigenous and new Canadians.

What food literacy attribute(s) are not being addressed?

Peterborough Public Health

Case 3 Summary (Peterborough Public Health)

Food Knowledge Food Skills N Nutrition Knowledge Food and Nutrition Language

Nutrition Literacy

Food Attitude

Cooking Self-Efficacy

Food and Nutrition Self-Efficacy

Food and Other Systems

SDOH

Case Scenario 4: North Bay Parry Sound District HU

Train the Trainer with Indigenous Communities

• Diabetes Prevention Project Indigenous Population.

• 4 modules for community kitchens.

• Hands on learning and application.

• Supportive, inclusive and positive environment.

• Financial support for community kitchens.

North Bay Pictogram

Which attribute(s) could be a

challenge to address?

Case 4 Summary (North Bay-Indigenous)

Food Knowledge

Nutrition Knowledge

Food and Nutrition Language

Nutrition Literacy

Food and Nutrition Self-Efficacy

Cooking Self-Efficacy

Food Skills

Poll Question:

• What programs do you offer that involve food literacy? (open ended)

Poll Question:

Are you involved in evaluating a food literacy program? • Yes

• No

Poll Question:

What do you evaluate? • # Participants

• Participant feedback re: program satisfaction/suggestions

• Participant learning – change in food or nutrition knowledge

• Participant behaviour - change in cooking skills, change in self-efficacy/confidence about cooking, change in food choices/menu planning/shopping, etc.

• Other

Next Steps:

Food Literacy Measurement Tool Development

Tool development

• Develop and validate/evaluate a tool for program evaluation

Benefits • Pre- and post- measurement tool • Compare across populations • Use it as a program planning tool • Provide baseline data on food literacy levels

within our communities

Acknowledgements • The LDCP Healthy Eating team would like to thank Public

Health Ontario for its support of this project.

• The team gratefully acknowledges funding received from PHO through the Locally Driven Collaborative Projects program.

• The team would also like to acknowledge our respective health units for allowing dedicated time to team members for this project.

• The Nutrition Resource Centre for supporting the development of this training webinar.

Project team Core Team/Agency Knowledge Users/Agency

Elsie Azevedo Perry, Haliburton Kawartha Pine Ridge District Health Unit (LEAD)

Mariel Muzoz, Windsor-Essex County Health Unit

Heather Thomas, Middlesex-London Health Unit (Co-lead)

Diana Chard, Hastings Prince Edward Public Health

Lucy Valleau, York Region Public Health Unit Carolyn Doris, Peterborough County-City Health Unit

Lyndsay Davidson, Chatham-Kent Health Unit Kelly Ferguson, Oxford County Public Health

Ella Manoweic, Toronto Public Health Laura Needham, Grey Bruce Health Unit

Jessica Love, North Bay & District Health Unit Lynn Roblin, Nutrition Resource Centre

Shannon Edmonstone, Perth District Health Unit Catherine Schwartz-Mendez, Thunder Bay District Health Unit

H. Ruby Samra, Hamilton Public Health Services Magdalena Wasilewska, Toronto Public Health

Julie Slack, Northwestern Health Unit Sonia Jean Phillippe, Ottawa Public Health

Academic Advisor: Sharon Kirkpatrick, University of Waterloo

HUB Librarian: Amy Faulkner, Simcoe Muskoka District Health Unit Research Consultants: EXEC Consulting

References Brown BJ, Hermann, JR (2005) Cooking classes increase fruit and vegetable intake and food safety behaviors in youth and adults. J Nutr Educ Behav (37: 104-105.

Cullen T, Hatch J, Martin W, Wharf Higgins J, & Sheppard R (2015) Food Literacy: Definition and framework for action. J Can Diet 76(3): 140-145.

Desjardins, E, et al. (2013) Making something out of nothing": Food Literacy among youth, young pregnant women and young parents who are at risk for poor health

Hartmann C, Dohle S, Siegrist M (2013) Importance of cooking skills for balanced food choices. Appetite 65: 125-31.

Larson NI, Perry CL, Story M, Neumark-Sztainer D. (2006). Food preparation by young adults is associated with better diet quality. J Am Diet Assoc; 106(12): 2001-2007.

McLaughlin C, Tarasuk V, Kreiger N. (2003). An examination of at-home food preparation activity among low-income, food-insecure women. J Am Diet Assoc; 103(11): 1506-12.

Meehan M, Yeh MC, Spark A. (2008). Impact of exposure to local food sources and food preparation skills on nutritional attitudes and food choices among urban minority youth. J Hunger Environ Nutr; 3(4): 456-471.

Smith KJ, McNaughton SA, Gall, SL, Blizzard L, Dwyer T, Venn AJ (2010). Involvement of young Australia adults in meal preparation: Cross-sectional associations with sociodemographic factors and diet quality. J Am Diet Assoc; 110: 1363-1367.

Vaitkeviciute R, Ball LE, Harris N (2015) The relationship between food literacy and dietary intake in adolescents: a systematic review. Public Health Nutr Mar;18(4), 649-58.

Vidgen H (2014)Food Literacy: What is it and does it influence what we eat? Available from https://eprints.qut.edu.au/66720/Helen_Vidgen_Thesis.pdf.

Wrieden WL, Snderson AS, Longbottom PJ, Valentine K, Stead M, Caraher M, Lang T, Gray B, Dowler E (2007). The impact of a community-based food skills intervention on cooking confidence, food preparation methods, and dietary choices – an exploratory trial. Public Health Nutr; 10(2): 203-211

Contact information Elsie Azevedo Perry eazevedoperry@hkpr.on.ca 905-885-9100 ext. 1218 Heather Thomas heather.Thomas@mlhu.on.ca 519-663-5317 ext. 2222

www.foodliteracy.ca

@FoodLiteracyCanada

@FoodLiteracyCAN

Questions