Assessment of Nutritional literacy and Related Factor in Women Referring to Urban Primary Health Care Centers in Northeastern Iran

Document Type : Original Article

Authors

1 Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Nursing, Faculty of Nursing and Midwifery, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran.

Abstract

Background and Objectives: Women play an important role in choosing and preparing high-quality food suitable for family members' physical needs. This study was conducted to investigate the level of nutritional literacy and factors affecting it in women referred to urban primary health care centers in Mashhad in northeastern Iran.

Materials and Methods: In this descriptive- analytical study, the data of 440 women 15-65 years’ old who referred to urban primary health care centers in Mashhad were collected using standard evaluation instrument of nutrition literacy on adults (EINLA) from 2023 to 2024 and analyzed by Stata software version 17 using the Independent sample t-test, one-way ANOVA, Spearman’s correlation coefficient, and simple /multiple linear regression.

Results: The mean and standard deviation of age was 33.53±11.23. About 48.2% of the participants, had adequate nutrition literacy, and 5.5% had insufficient nutrition literacy. The highest score was related to the recognition of food groups and the lowest score was for the calculation of food units and nutritional calculation and reading of food labels. There is a significant relationship between variables of education level and job, with the participants' nutrition literacy status (P-value<0.001).

Conclusion: Many women visiting urban health centers in Mashhad lack adequate nutrition literacy, particularly those with low income and education, who should be prioritized in nutrition literacy interventions. Nutrition education should focus more on enhancing skills in calculating food units and analyzing food labels

Keywords

Acknowledgments: The authors of this article express their sincere gratitude to all the personnel of Mashhad University of Medical Sciences urban health care centers for their cooperation and participation.


Availability of data and materials: The dataset used for analysis during the current study is available from the corresponding author upon reasonable request.


Conflicts of interest: Not applicable.


Consent for publication: Not applicable.


Ethics approval and consent to participate: The study protocol was approved by the Vice Chancellor for Research of Mashhad University of Medical Sciences (Ethics code: IR.MUMS.FHMPM.REC.1401.213). The participants provided written informed consent and were assured of data confidentiality. All procedures performed in our study involving human participants were by the ethical standards of the institutional research committee and the 1964 Helsinki Declaration.


Funding: Not Found.


Authors’ contribution: F.S & N.P: proposed the idea for the project. E.M & H.R collected the data. F.N & R.Y: Prepared tables and performed data analysis. F.S wrote the initial manuscript & performed the scientific and writing editing. All authors reviewed the results and participated in the final manuscript.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

  1. Hemati M, Akbartabar Toori M, Shams M, Behroozpour A, Rezaei A. Measuring nutritional literacy in elementary school teachers in Yasuj: A cross-sectional study. Armaghane danesh. 2018;23(1):124-33.
  2. Wilson SL, Gallivan A, Kratzke C, Amatya A. Nutritional status and socio-ecological factors associated with overweight/obesity at a rural-serving US-Mexico border university. Rural and Remote Health. 2012;12(4):1-15. https://doi.org/10.22605/RRH2228
  3. Al-Jawaldeh A, Abbass MM. Unhealthy dietary habits and obesity: the major risk factors beyond non-communicable diseases in the eastern mediterranean region. Frontiers in nutrition. 2022;9:817808. https://doi.org/10.3389/fnut.2022.817808 PMid:35369054 PMCid:PMC8970016
  4. Organization WH. Global health risks: mortality and burden of disease attributable to selected major risks: World Health Organization; 2009.
  5. Chen SH, Cheng HY, Chuang YH, Shao JH. Nutritional status and its health‐related factors among older adults in rural and urban areas. Journal of advanced nursing. 2015;71(1):42-53. https://doi.org/10.1111/jan.12462 PMid:24894954
  6. Zhang LiYan ZL, Lu YuHan LY, Fang Yu FY. Nutritional status and related factors of patients with advanced gastrointestinal cancer. 2014. https://doi.org/10.1017/S000711451300367X PMid:24388608
  7. Robinson MK, Mogensen KM, Casey JD, McKane CK, Moromizato T, Rawn JD, Christopher KB. The relationship among obesity, nutritional status, and mortality in the critically ill. Critical Care Medicine. 2015;43(1):87-100. https://doi.org/10.1097/CCM.0000000000000602 PMid:25289931
  8. Heshmat R, Abdollahi Z, Ghotbabadi FS, Rostami M, Shafiee G, Qorbani M, et al. Nutritional knowledge, attitude and practice toward micronutrients among Iranian households: the NUTRI-KAP survey. Journal of Diabetes & Metabolic Disorders. 2015;15:1-5. https://doi.org/10.1186/s40200-016-0260-8 PMid:27709106 PMCid:PMC5050604
  9. Farahmand M, Tehrani FR, Amiri P, Azizi F. Barriers to healthy nutrition: perceptions and experiences of Iranian women. BMC public health. 2012;12:1-7. https://doi.org/10.1186/1471-2458-12-1064 PMid:23227832 PMCid:PMC3542289
  10. Spronk I, Kullen C, Burdon C, O'Connor H. Relationship between nutrition knowledge and dietary intake. British journal of nutrition. 2014;111(10):1713-26. https://doi.org/10.1017/S0007114514000087 PMid:24621991
  11. King L, Watson WL, Chapman K, Kelly B, Louie JC, Hughes C, et al. Do we provide meaningful guidance for healthful eating? An investigation into consumers' interpretation of frequency consumption terms. Journal of nutrition education and behavior. 2012;44(5):459-63. https://doi.org/10.1016/j.jneb.2011.12.004 PMid:22591579
  12. Mengi Çelik Ö, Karacil Ermumcu MS, Ozyildirim C. Turkish version of the 'food and nutrition literacy questionnaire for Chinese school-age children'for school-age adolescents: a validity and reliability study. BMC Public Health. 2023;23(1):1807. https://doi.org/10.1186/s12889-023-16732-2 PMid:37716935 PMCid:PMC10505319
  13. Aktas N, Ozdogan Y. A study of the state of knowing the nutritional literacy concept in Turkey. Researchers World. 2016;7(2):46. https://doi.org/10.18843/rwjasc/v7i2/04
  14. Taylor MK, Sullivan DK, Ellerbeck EF, Gajewski BJ, Gibbs HD. Nutrition literacy predicts adherence to healthy/unhealthy diet patterns in adults with a nutrition-related chronic condition. Public health nutrition. 2019;22(12):2157-69. https://doi.org/10.1017/S1368980019001289 PMid:31146797 PMCid:PMC6827561
  15. Burrows TL, Lucas H, Morgan PJ, Bray J, Collins CE. Impact evaluation of an after-school cooking skills program in a disadvantaged community: back to basics. Canadian Journal of Dietetic Practice and Research. 2015;76(3):126-32. https://doi.org/10.3148/cjdpr-2015-005 PMid:26280792
  16. Doustmohammadian A, Omidvar N, Keshavarz-Mohammadi N, Eini-Zinab H, Amini M, Abdollahi M, et al. Low food and nutrition literacy (FNLIT): a barrier to dietary diversity and nutrient adequacy in school age children. BMC research notes. 2020;13:1-8. https://doi.org/10.1186/s13104-020-05123-0 PMid:32532341 PMCid:PMC7291429
  17. Abdi F, Atarodi Z, Mirmiran P, Esteki T. Review of nutritional status in Iranian population. Focus Sci. 2016;2(3):1-4. https://doi.org/10.20286/focsci-020332
  18. Damari B, Abdollahi Z, Hajifaraji M, Rezazadeh A. Nutrition and food security policy in the Islamic Republic of Iran: situation analysis and roadmap towards 2021. East Mediterr Health J. 2018;24(02):177-88. https://doi.org/10.26719/2018.24.2.177 PMid:29748947
  19. Goshtaei M, Ravaghi H, Sari AA, Abdollahi Z. Nutrition policy process challenges in Iran. Electronic physician. 2016;8(2):1865. https://doi.org/10.19082/1865 PMid:27053992 PMCid:PMC4821298
  20. Namdar A, Naghizadeh MM, Zamani M, Montazeri A. Exploring the relationship between health literacy and fast food consumption: a population-based study from southern Iran. BMC Public Health. 2021;21:1-10. https://doi.org/10.1186/s12889-021-10763-3 PMid:33879106 PMCid:PMC8056591
  21. Sobhani SR, Omidvar N, Abdollahi Z, Al Jawaldeh A. Shifting to a sustainable dietary pattern in iranian population: current evidence and future directions. Frontiers in Nutrition. 2021;8:789692. https://doi.org/10.3389/fnut.2021.789692 PMid:35004817 PMCid:PMC8727882
  22. Naghashpour M, Mansouri S, Vadizadeh A, Cheraghian B, Fallahi R, Vaziri F. Determinants of nutritional knowledge, attitude, and practice among southwestern Iranian households: A community-based study. Nutrition and health. 2020;26(2):93-102. https://doi.org/10.1177/0260106020905419 PMid:32180506
  23. Hejazi J, Mohtadinia J, Kolahi S, Ebrahimi-Mamaghani M. Nutritional status among postmenopausal osteoporotic women in North West of Iran. Asia Pacific journal of clinical nutrition. 2009;18(1):48-53.
  24. Esmaillzadeh A, Azadbakht L. Food intake patterns may explain the high prevalence of cardiovascular risk factors among Iranian women. The Journal of nutrition. 2008;138(8):1469-75. https://doi.org/10.1093/jn/138.8.1469 PMid:18641193
  25. Mirmiran P, Mohammadi-Nasrabadi F, Omidvar N, Hosseini-Esfahani F, Hamayeli-Mehrabani H, Mehrabi Y, Azizi F. Nutritional knowledge, attitude and practice of Tehranian adults and their relation to serum lipid and lipoproteins: Tehran lipid and glucose study. Annals of nutrition and metabolism. 2010;56(3):233-40. https://doi.org/10.1159/000288313 PMid:20375546
  26. Sasanfar B, Toorang F, Rostami S, Yeganeh MZ, Ghazi ML, Seyyedsalehi MS, Zendehdel K. The effect of nutrition education for cancer prevention based on health belief model on nutrition knowledge, attitude, and practice of Iranian women. BMC Women's Health. 2022;22(1):213. https://doi.org/10.1186/s12905-022-01802-1 PMid:35672814 PMCid:PMC9175379
  27. Ahmadi F, Karamitanha F. Health literacy and nutrition literacy among mother with preschool children: What factors are effective? Preventive medicine reports. 2023;35:102323. https://doi.org/10.1016/j.pmedr.2023.102323 PMid:37576847 PMCid:PMC10413137
  28. Karimi E, Haghighatdoost F, Mohammadifard N, Najafi F, Farshidi H, Kazemi T, et al. The influential role of parents' socioeconomic status and diet quality on their children's dietary behavior: Results from the LIPOKAP study among the Iranian population. BMC pediatrics. 2023;23(1):188. https://doi.org/10.1186/s12887-023-04000-6 PMid:37085814 PMCid:PMC10120167
  29. Akbari F, Azadbakht L. A systematic review on diet quality among Iranian youth: focusing on reports from Tehran and Isfahan. Archives of Iranian medicine. 2014;17(8):0-.
  30. Cesur B, Koçoğlu G, Sümer H. Evaluation instrument of nutrition literacy on adults (EINLA) A validity and reliability study. Integr Food Nutr Metab. 2015;2(1):127-30. https://doi.org/10.15761/IFNM.1000114
  31. Yarmohammadi P, Morowatisharifabad MA, Rahaei Z, Khayyatzadeh SS, Madadizadeh F. Nutrition literacy and its related demographic factors among workers of Taraz Steel company, Chaharmahal and Bakhtiari, Iran. Frontiers in Public Health. 2022;10:911619. https://doi.org/10.3389/fpubh.2022.911619 PMid:36033775 PMCid:PMC9412198
  32. Myers L, Sirois MJ. Spearman correlation coefficients, differences between. Wiley StatsRef: Statistics Reference Online. 2014. https://doi.org/10.1002/9781118445112.stat02802
  33. Rothman KJ, Greenland S, Lash TL. Modern epidemiology: Wolters Kluwer Health/Lippincott Williams & Wilkins Philadelphia; 2008.
  34. Al-Hosseini MK, Khoshgoo M, Taghizadeh R, Tanha K, Shidfar F. Investigating the level of nutrition literacy and its accompanying factors in seminary students of Qom city in 2019 (Iran). 2020.
  35. Shams M, Boostani F, Maleki M, Shariatinia S, Mousavizade A, Hemmati M. Nutrition literacy in adults and its related factors: A cross-sectional study in Kohgiloyeh and Boyer-Ahmad Province, Iran. Journal of Health. 2020;11(1):77-87. https://doi.org/10.29252/j.health.11.1.77
  36. Michou M, Panagiotakos DB, Lionis C, Costarelli V. Sex and age in relation to health and nutrition literacy levels in a sample of Greek adults. International Journal of Health Promotion and Education. 2020;58(5):229-41. https://doi.org/10.1080/14635240.2019.1681289
  37. Aihara Y, Minai J. Barriers and catalysts of nutrition literacy among elderly Japanese people. Health promotion international. 2011;26(4):421-31. https://doi.org/10.1093/heapro/dar005 PMid:21307024
  38. Patel P, Panaich S, Steinberg J, Zalawadiya S, Kumar A, Aranha A, Cardozo L. Use of nutrition literacy scale in elderly minority population. The Journal of nutrition, health and aging. 2013;17(10):894-7. https://doi.org/10.1007/s12603-013-0355-6 PMid:24257573
  39. Bahramfard T, Salehi SO, Toori MA, Pourmahmoudi A, Jowshan M, Parvin S, et al. Nutritional literacy status and its related factors in students of Yasuj University of Medical Sciences. Clinical Nutrition and Hospital Dietetics. 2020;40(4):55-62. https://doi.org/10.12873/404malekzadeh
  40. Sharifnia F, Ghaffari M, Rakhshanderou S. Nutritional literacy measurement among Iranian elderly population. Journal of Advanced Biomedical Sciences. 2022. https://doi.org/10.18502/jabs.v11i4.8627
  41. Hann CS, Rock CL, King I, Drewnowski A. Validation of the Healthy Eating Index with use of plasma biomarkers in a clinical sample of women. The American journal of clinical nutrition. 2001;74(4):479-86. https://doi.org/10.1093/ajcn/74.4.479 PMid:11566646
  42. Liao L-L, Lai I-J, Chang L-C. Nutrition literacy is associated with healthy-eating behaviour among college students in Taiwan. Health Education Journal. 2019;78(7):756-69. https://doi.org/10.1177/0017896919836132
  43. Al Tell M, Natour N, Alshawish E, Badrasawi M. The relationship between nutrition literacy and nutrition information seeking attitudes and healthy eating patterns among a group of palestinians. BMC Public Health. 2023;23(1):165. https://doi.org/10.1186/s12889-023-15121-z PMid:36694185 PMCid:PMC9875392
  44. Svendsen K, Torheim LE, Fjelberg V, Sorprud A, Narverud I, Retterstøl K, et al. Gender differences in nutrition literacy levels among university students and employees: a descriptive study. Journal of nutritional science. 2021;10:e56. https://doi.org/10.1017/jns.2021.47 PMid:34367630 PMCid:PMC8327390
  45. Michou M, Panagiotakos DB, Lionis C, Costarelli V. Socioeconomic inequalities in relation to health and nutrition literacy in Greece. International journal of food sciences and nutrition. 2019;70(8):1007-13. https://doi.org/10.1080/09637486.2019.1593951 PMid:30935258
  46. Sanlier N, Kocaay F, Kocabas S, Ayyildiz P. The effect of sociodemographic and anthropometric variables on nutritional knowledge and nutrition literacy. Foods. 2024;13(2):346. https://doi.org/10.3390/foods13020346 PMid:38275713 PMCid:PMC10814858
  47. Hemmer A, Hitchcock K, Lim YS, Kovacic MB, Lee S-Y. Development of food literacy assessment tool targeting adults with low income. Journal of nutrition education and behavior. 2021;53(11):966-76. https://doi.org/10.1016/j.jneb.2021.05.007 PMid:34426065 PMCid:PMC8922242
  48. Rothman RL, Housam R, Weiss H, Davis D, Gregory R, Gebretsadik T, et al. Patient understanding of food labels: the role of literacy and numeracy. American journal of preventive medicine. 2006;31(5):391-8. https://doi.org/10.1016/j.amepre.2006.07.025 PMid:17046410
  49. Viswanathan M, Hastak M, Gau R. Understanding and facilitating the usage of nutritional labels by low-literate consumers. Journal of Public Policy & Marketing. 2009;28(2):135-45. https://doi.org/10.1509/jppm.28.2.135
  50. Gibbs HD, Ellerbeck EF, Gajewski B, Zhang C, Sullivan DK. The nutrition literacy assessment instrument is a valid and reliable measure of nutrition literacy in adults with chronic disease. Journal of nutrition education and behavior. 2018;50(3):247-57. e1. https://doi.org/10.1016/j.jneb.2017.10.008 PMid:29246567 PMCid:PMC5845801
  51. Ahmadi A, Torkamani P, Sohrabi Z, Ghahremani F. Nutrition knowledge: application and perception of food labels among women. Pakistan journal of biological sciences: PJBS. 2013;16(24):2026-30. https://doi.org/10.3923/pjbs.2013.2026.2030 PMid:24517023
  52. Li Q, Piaseu N, Phumonsakul S, Thadakant S. Effects of a comprehensive dietary intervention program, promoting nutrition literacy, eating behavior, dietary quality, and gestational weight gain in Chinese urban women with normal body mass index during pregnancy. Nutrients. 2024;16(2):217. https://doi.org/10.3390/nu16020217 PMid:38257110 PMCid:PMC10820561
  53. Akkartal Ş, Gezer C. Is nutrition knowledge related to diet quality and obesity? Ecology of food and nutrition. 2020;59(2):119-29. https://doi.org/10.1080/03670244.2019.1675654 PMid:31590573
  54. Li S, Zhu Y, Zeng M, Li Z, Zeng H, Shi Z, Zhao Y. Association between nutrition literacy and overweight/obesity of adolescents: a cross-sectional study in Chongqing, China. Frontiers in Nutrition. 2022;9:893267. https://doi.org/10.3389/fnut.2022.893267 PMid:35634378 PMCid:PMC9134066
  55. Gholabi F, Mohammad Baqer AA, Aghayari Hir T, Akram H. Association between nutrition literacy and diet with obesity. Payesh (Health Monitor). 2019;18(4):393-404.
  56. Camargo JT, Ramirez M, Gajewski BJ, Sullivan DK, Carlson SE, Gibbs HD. Nutrition literacy among Latina/x people during pregnancy is Associated with socioeconomic position. Journal of the Academy of Nutrition and Dietetics. 2022;122(11):2097-105. https://doi.org/10.1016/j.jand.2022.05.011 PMid:35589070

Files

Share

How to cite

Statistics