A Qualitative Investigation to Underpin the Development of an Electronic Tool to Assess Nutrition Literacy in Australian Adults

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Abstract

Nutrition literacy is linked to health via its influence on dietary intake. There is a need for a tool to assess nutrition literacy in research and dietetic practice. We sought guidance from nutrition professionals on topic areas and features of an electronic nutrition literacy assessment tool for Australian adults. 28 experienced nutrition professionals engaged in a range of nutrition and dietetic work areas participated in six focus groups using a semi-structured interview schedule. Data were analysed using an inductive approach using NVivo 10 (QSR International, Pty Ltd., Doncaster, Australia, 2012). Key areas identified to assess nutrition literacy included specific nutrients versus foods, labels and packaging, construction of the diet, knowledge of the Australian Dietary Guidelines and Australian Guide to Healthy Eating, understanding of serve and portion sizes, ability to select healthier foods, and demographics such as belief systems and culture. Exploitation of electronic features to enhance visual and auditory displays, including interactive animations such as “drag and drop” and virtual reality situations, were discussed. This study provided insight into the most relevant topic areas and presentation format to assess the nutrition literacy of adult Australians. The visual, auditory, and interactive capacity of the available technology could enhance the assessment of nutrition literacy.

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Most cited references 39

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Health literacy interventions and outcomes: an updated systematic review.

Nancy D Berkman, Stacey L Sheridan, Katrina Donahue … (2011)

To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined. We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010. We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence. We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and whites. The strength of evidence of numeracy studies was insufficient to low, limiting conclusions about the influence of numeracy on health care service use or health outcomes. Two studies suggested numeracy may mediate the effect of disparities on health outcomes. We found no evidence concerning oral health literacy and outcomes. Among intervention studies (27 randomized controlled trials [RCTs], 2 cluster RCTs, and 13 quasi-experimental designs), the strength of evidence for specific design features was low or insufficient. However, several specific features seemed to improve comprehension in one or a few studies. The strength of evidence was moderate for the effect of mixed interventions on health care service use; the effect of intensive self-management inventions on behavior; and the effect of disease-management interventions on disease prevalence/severity. The effects of other mixed interventions on other health outcomes, including knowledge, self-efficacy, adherence, and quality of life, and costs were mixed; thus, the strength of evidence was insufficient. The field of health literacy has advanced since the 2004 report. Future research priorities include justifying appropriate cutoffs for health literacy levels prior to conducting studies; developing tools that measure additional related skills, particularly oral (spoken) health literacy; and examining mediators and moderators of the effect of health literacy. Priorities in advancing the design features of interventions include testing novel approaches to increase motivation, techniques for delivering information orally or numerically, "work around" interventions such as patient advocates; determining the effective components of already-tested interventions; determining the cost-effectiveness of programs; and determining the effect of policy and practice interventions.

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The Nuances of Health Literacy, Nutrition Literacy, and Food Literacy.

Stefania Velardo (2015)

Health literacy, defined as the ability to access, understand, and use health information, has been identified as an international public health goal. The term nutrition literacy has emerged as a distinct form of health literacy, yet scholars continue to reflect on constituent skills and capabilities in light of discussions regarding what it means to be food literate and health literate. This viewpoint argues that a comprehensive conceptualization of nutrition literacy should reflect key elements of health literacy and food literacy constructs. Nutbeam's tripartite model of health literacy is employed to explore competencies that are likely to facilitate healthy food relationships.

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Nutrition and health literacy: a systematic review to inform nutrition research and practice.

Elena Carbone, Jamie Zoellner (2012)

Health literacy is defined as the degree to which individuals obtain, process, and understand basic health information and services to make informed health decisions. Health literacy is a stronger predictor of health than age, income, employment, education, and race. Although the field has grown during the past decade, most health literacy research does not explicitly focus on food or nutrition, and dietetics practitioners often remain unaware of patients' health literacy level. The purpose of this systematic review was to summarize the literature on nutrition and health literacy to enhance dietetics practitioners' awareness of the importance of health literacy in practice and research. Of the 33 studies reviewed, four focused on measurement development, 16 on readability assessments, and 13 on individual literacy skills assessments. Collective evaluation revealed four noteworthy gaps, including the need to use more comprehensive assessment approaches that move beyond readability and numeracy to address the full spectrum of health literacy factors; the need to apply more robust experimental studies to examine the effectiveness of health literacy interventions among individuals, communities, health care providers, and health care systems; the need to explore the moderating and mediating roles of an individual's health literacy status on nutrition outcomes; and the need to examine long-term effects of health literacy interventions on nutrition outcomes. This article defines health literacy gaps and opportunities in nutrition research and practice, and calls for continued action to elevate the role of dietetics practitioners in addressing health literacy. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Nutrients

Journal ID (iso-abbrev): Nutrients

Journal ID (publisher-id): nutrients

Title: Nutrients

Publisher: MDPI

ISSN (Electronic): 2072-6643

Publication date (Electronic): 23 February 2018

Publication date Collection: February 2018

Volume: 10

Issue: 2

Electronic Location Identifier: 251

Affiliations

[1 ]Faculty of Science, University of Sydney, Camperdown, Sydney, NSW 2006, Australia; amcassar@ 123456hotmail.com (A.M.C.); gareth.denyer@ 123456sydney.edu.au (C.S.D.)

[2 ]Faculty of Health Sciences, University of Sydney, 75 East St, Lidcombe, Sydney, NSW 2141, Australia; helen.oconnor@ 123456sydney.edu.au

[3 ]Boden Institute of Obesity Nutrition Physical Activity and Eating Disorders, University of Sydney, Camperdown, Sydney, NSW 2006, Australia

[4 ]Charles Perkins Centre, University of Sydney, Camperdown, Sydney, NSW 2006, Australia

Author notes

[* ]Correspondence: janelle.gifford@ 123456sydney.edu.au ; Tel.: +61-041-117-8987

Article

Publisher ID: nutrients-10-00251

DOI: 10.3390/nu10020251

PMC ID: 5852827

PubMed ID: 29473889

SO-VID: a5ce039e-9807-44b4-a0e6-89edf86e6d19

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

A Qualitative Investigation to Underpin the Development of an Electronic Tool to Assess Nutrition Literacy in Australian Adults

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Karger: Nutrition and Dietetics

Most cited references 39

Health literacy interventions and outcomes: an updated systematic review.

The Nuances of Health Literacy, Nutrition Literacy, and Food Literacy.

Nutrition and health literacy: a systematic review to inform nutrition research and practice.

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