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Health Promotion International Advance Access published November 1, 2016
Health Promotion International, 2016, 1–12
doi: 10.1093/heapro/daw084
Justasubtledifference?Findingsfroma
systematicreviewondefinitionsofnutrition
literacy and food literacy
1, 2 1
CorinnaKrause *,KathrinSommerhalder ,SigridBeer-Borst and
1
ThomasAbel
1 Downloaded from
Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, CH-3012 Bern,
2
Switzerland and Health Division, Bern University of Applied Sciences, Murtenstrasse 10, CH-3008 Bern,
Switzerland
*Corresponding author: corinna.krause@ispm.unibe.ch
Summary http://heapro.oxfordjournals.org/
Nutrition literacy and food literacy have become increasingly important concepts in health promotion.
Researchers use one or the other term to describe the competencies needed to maintain a healthy
diet. This systematic review examines whether these terms are synonymous or if their meanings are
substantially different.
We searched major bibliographic databases (Web of Science, PubMed, ScienceDirect, CINAHL,
SocIndex and ERIC) for publications that provided an original definition of nutrition or food literacy.
Then we used Nutbeam’s tripartite health literacy model as an analytical grid. The definitions we by guest on December 7, 2016
found included specific competencies, which we mapped to the domains of functional, interactive, or
| downloaded: 4.1.2023critical literacy.
In the 173 full-text publications we screened, we found six original definitions of nutrition literacy, and
13originaldefinitionsoffoodliteracy.Sevenfoodliteracydefinitionswereintegratedintoaconceptual
framework. Analysing their structure revealed that nutrition literacy and food literacy are seen as spe-
cific forms of health literacy, and represent distinct but complementary concepts. Definitions of nutri-
tion literacy mainly described the abilities necessary to obtain and understand nutrition information.
Definitions of food literacy incorporated a broader spectrum of theoretical and practical knowledge
andskills. To be food literate also means to apply information on food choices and critically reflect on
theeffectoffoodchoiceonpersonalhealthandonsociety.Sincefoodliteracyisbasedonamorecom-
prehensive understanding of health behaviours, it is the more viable term to use in health promotion
interventions.Forthepracticalimplication,aharmonizationofthedifferentdefinitionsisdesirable.
Keywords:healthliteracy,food,nutrition, systematic review
INTRODUCTION 2004). Improving dietary habits of the population is a
Given the central role of nutrition in health and chronic societal and multifaceted task, which demands an under-
https://doi.org/10.7892/boris.91204disease prevention, shaping dietary patterns is of par-standing of the social context, but also food related
ticular importance for public health (Nishida et al., skills and abilities of individuals. In this regard,
source: C
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2 C. Krauseetal.
nutritional science and education researchers are cur- Each form represents competencies that increase the
rently discussing the concepts of nutrition literacy and awareness, motivation, and ability of individuals as they
foodliteracy. engage with individual, family, community, and society
Today, researchers use one or the other term to de- health issues (Nutbeam, 2000, 2008).
scribe the areas of competence upon which healthy diet- Wecreated an analytical grid based on this model of
ary behaviour depends; i.e., ‘nutrition literacy’ (Spronk functional, interactive, and critical health literacy to sys-
et al., 2014), or ‘food literacy’ (Brooks and Begley, tematically review definitions of nutrition literacy and
2014; Vaitkeviciute et al., 2015). So far, the terms are food literacy.
indistinct and each is defined variously and sometimes
inconsistently (Vaitkeviciute et al., 2015; Vidgen and METHODS
Gallegos, 2014).Thus, it is hard to extract specific out-
comes of health-promoting activities or interventions Searchstrategyandinclusioncriteria
from the literature on either nutrition literacy or food A systematic search of the literature was performed by
literacy, or to choose appropriate and scientifically one researcher (CK) using the terms ‘food literacy’ and
sounds tools for measuring those outcomes. ‘nutrition literacy’. Databases were searched from the Downloaded from
In order to achieve conceptual clarity, this paper earliest data of coverage (1974) to 31 December 2014.
aims to identify the constituent elements of nutrition lit- (Figure 1 illustrates the literature search and review
eracy and food literacy. This work will also help us iden- process).
tify important competencies covered by neither concept. We searched the following databases: Web of
To create a structured overview of the definitions Science, PubMed, ScienceDirect, CINAHL (Ebsco), http://heapro.oxfordjournals.org/
and competencies that nutrition and food literacy entail, SocIndex (Ebsco) and ERIC (Ebsco). We identified add-
Velardo (2015) recommends using the already estab- itional publications (scientific reports, dissertations) by
lished, and closely related, the concept of health literacy conducting a hand search of references in included
by Nutbeam. Nutbeam’s multicomponent concept of publications.
health literacy has gained increasing interest in health All references were saved in EndNote version X6.
promotion. Health literacy encompasses several skills Duplicates, indices, tables of contents, and publications
and competencies needed to make good decisions about not written in English, French, or German (formal inclu-
health. The Nutbeam’s concept has been applied in dif- sion criteria) were removed. We used poster abstracts
ferent settings (Nutbeam, 2000, 2008), including the and conference proceedings published in peer-reviewed by guest on December 7, 2016
realms of diet, health, and nutrition education (St Leger, journals for forward search by author name, but they
2001; Thomson and Hoffman-Goetz, 2012). The con- were not considered as full text publications. Backward
cept describes three forms of health literacy: functional, search was undertaken on the reference lists of retrieved
interactive and critical. We base our work on the de- articles and books by screening for the terms nutrition
scription of these forms by Smith et al. (2013): or food literacy in titles. The full text of the resulting
Functional health literacy includes the ability to ob- 173publications was screened for the terms nutrition lit-
tain, understand, and use factual health information. A eracy and food literacy. Once those terms were identi-
secondary outcome of functional health literacy is that fied in the text, we included only publications that
people know more about health issues. explained or defined nutrition literacy or food literacy.
Interactive health literacy includes the abilities to act The publications we finally included in the review pro-
and interact successfully to improve health, and to util- vided original definitions of nutrition or food literacy.
ize different forms of communication to obtain, provide,
and apply relevant health information. People with bet- Dataanalysis
ter interactive health literacy skills are more likely to be One researcher (CK) extracted, summarized, and tabu-
proactive agents in everyday health-related actions. lated the following key information from each publica-
Critical health literacy includes the ability to critic- tion that provided an explanation of nutrition or food
ally assess and reflect on health information and advice. literacy: author; publication year; explanation of the
This includes understanding and recognizing the wider term nutrition or food literacy; and, cited references.
social determinants of health. Improved critical health Based on the summary table, two reviewers (KS, SB) in-
literacy increases the likelihood that a person will inter- dependently reviewed each explanation the first author
pret and relate health information in their social had identified and determined if they provided a concise
context. definition, or a more comprehensive conceptual
Nutrition literacy and food literacy 3
PubMed Web of Science Science Direct EBSCO (CINAHL, ERIC, SocIndex)
N= 25 N= 47 N= 120 N= 26
(Nutriton/Food Literacy) (Nutriton/Food Literacy) (Nutriton/Food Literacy) (Nutriton/Food Literacy)
(17/ 8) (29/18) (78/42) ( 19/7)
N=218
Duplicates removed
N= 55
Excluded due to formal criteria
Abstracts, Conference Proceedings N=5
N=12
Downloaded from
N= 146
Forward searching http://heapro.oxfordjournals.org/
N=6
Backward searching
N=21
Screened by full text
N=173
Publica!ons providing no
explana!on
N=137 by guest on December 7, 2016
Explana!on of Explana!on of food
nutriton literacy literacy
N=11 N=25
No original No original
defin!on of defini!on of
nutri!on literacy food literacy
N=5 N=12
Original defini!on of Original defini!on of
nutri!on literacy food literacy
N=6 N=13
Conceptual
framework of food
literacy
N=7
Fig. 1: Flowchart of the literature search and review process.
4 C. Krauseetal.
framework. An exact statement or description of the na- Nutrition literacy was defined in the context of liter-
ture, scope, or meaning of nutrition literacy or food lit- acy surveys or studies (Blitstein and Evans, 2006;
eracy qualified as a definition. If a publication referred Watson et al., 2013; Zoellner et al., 2009) and research
to an existing definition of nutrition literacy or food lit- in nutrition education (Guttersrud et al., 2014;
eracy, we included only the definition from the original Neuhauser et al., 2007; Silk et al., 2008). Definitions of
source. We defined a conceptual framework as a theor- nutrition literacy were linked directly to existing defin-
etical structure that explained key factors, variables, itions or concepts of health literacy. Nutrition literacy
ideas, and presumed relationships of the concept. (Miles was understood as a ‘specific form of health literacy’
and Hubermann, 1994). If publications contained a def- (Blitstein and Evans, 2006), ‘similar to health literacy’
inition and a more detailed description of the associated (Silk et al., 2008), or ‘health literacy applied to the field
competencies of nutrition or food literacy, and identified of nutrition’ (Watson et al., 2013). Four of the six defin-
factors that influence the development of nutrition liter- itions of nutrition literacy (Blitstein and Evans, 2006;
acy or food literacy, or described the consequences of Neuhauser et al., 2007; Silk et al., 2008; Zoellner et al.,
acquiring these competencies, we considered the publi- 2009) adapted the U.S. Department of Health and
cation to have a conceptual framework. Human Services definition of health literacy (National Downloaded from
For our detailed analysis, we developed a matrix Research Council, 2004) by replacing the term ‘health’
based on Nutbeam’s forms of functional, interactive, with ‘nutrition’. They defined nutrition literacy as an in-
and critical health literacy that included the skills and dividual’s capacity to obtain, process, and understand
abilities named in Nutbeam’s concept (see basic nutrition information necessary for making appro-
Introduction). Three authors (CK, KS, SB) independ- priate nutrition decisions. http://heapro.oxfordjournals.org/
ently assigned competencies specified in definitions and The remaining two publications (Guttersrud et al.,
conceptual frameworks of nutrition literacy and food lit- 2014; Watson et al., 2013) referred to either Nutbeam’s
eracy to our analytical grid (see Appendix, Table A1). If (2000) or Peerson and Saunders (2009) definition of
definitions or conceptual frameworks referred directly health literacy.
to Nutbeam’s forms of health literacy, we used the same
assignment of competencies as the authors. Assigningskills and abilities of nutrition
literacy to functional, interactive and critical
health literacy
RESULTS Using the analytical grid, we found all definitions of nu- by guest on December 7, 2016
Weidentified 19 original definitions of nutrition literacy trition literacy contained elements of functional health
or food literacy (see Figure 1). For a detailed overview literacy. However, only one definition (Guttersrud et al.,
on definitions and conceptual frameworks of nutrition 2014) described skills that could be assigned to inter-
literacy and food literacy see Appendix, Tables A2–A4. active and critical literacy since this definition was based
on Nutbeam’s model of health literacy. Guttersrud et al.
Definitions of nutrition literacy (2014) used the terms ‘interactive’ and ‘critical nutrition
Six publications presented an original definition (see literacy’. For a general overview, see Table 1.
Appendix, Table A2), but none provided a conceptual
frameworkfornutrition literacy. Functional literacy
All definitions of nutrition literacy centered on an in- Definitions emphasized basic literacy and numeracy
dividual’s cognitive capacities and strongly emphasized skills, including the ability to get and process nutrition
basic literacy and numeracy skills needed to understand information to improve decisions about nutrition. Only
and use information about nutrition. They argue that twodefinitions offered concrete examples of these skills;
without these skills people cannot access and understand the ability to interpret front label packaging or menu
nutrition information and thus cannot build on nutri- labeling and the ability to understand basic nutrition
tional knowledge, which is one of the keys to healthier concepts (Neuhauser et al., 2007; Watson et al., 2013).
eating practices. Only one definition (Guttersrud et al.,
2014) introduced more skills, namely, the ability to Interactive & critical literacy
search and apply nutrition information and the ability to ‘Interactive nutrition literacy’ was described as ‘cogni-
communicate and act upon this information in the tive and interpersonal communication skills’ which are,
broader social environment to address nutritional bar- for example, needed to interact with nutrition coun-
riers in personal, social, and global perspectives. sellors. Moreover, interactive nutrition literacy was
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