Journal of Health Literacy

Journal of Health Literacy

Identifying the Components of Healthy Food Choice Literacy in Adolescent Girls: A Conventional Content Analysis

Articles in Press

Document Type : Original Article

Authors
Hamideh Ahangari 1
Mahdi Gholian-Aval 2
jamshid Jamali 3
Seyyedreza Sobhani 4
Mehrsadat Mahdizadeh 5
1 Department of Health Education and Health Promotion, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Department of Health Education and Health Promotion, Social Determinants of Health Research Center, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Department of Epidemiology and Biostatistics, Social Determinants of Health Research Center, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
4 Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
5 Associate Professor of Health Education and Health Promotion, Department of Public Health, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/jhl.2026.94435.1936
Abstract
Background and Objective: Healthy food choice literacy the ability to make informed dietary decisions is vital for adolescents, yet it is often limited by complex sociocultural and media influences. This conventional content analysis explores the perceptions and experiences of adolescent girls to identify the influencing components of healthy food choice literacy.

Material and Methods: To ensure depth, we employed a qualitative content analysis approach. In Iran from August to November 2025, a purposive sample of 37 participants was selected, comprising 30 adolescent girls (aged 15–18), 4 parents, and 3 key informants. Data were collected via semi-structured individual interviews and focus group discussions, then analyzed thematically following the method of Granheim and Lundman with the assistance of MAXQDA software.

Results: This qualitative analysis resulted in one main category and four key subcategories that define the determinants of healthy food choice literacy: (1) Practical knowledge and skills, where gaps in theory and cooking ability impede healthy choices; (2) Informational supports, where collaborative guidance from family and friends bolsters intrinsic motivation; (3) School educational programs, which were frequently perceived as superficial and lacking practical application; and (4) Cyberspace and social media, which emerged as a dominant yet highly unreliable source of information.

Conclusion: Various factors, including nutrition knowledge and skills, perceived support for healthy food choices, and advertising and cyberspace, can shape healthy food choice literacy. In conclusion, these findings support integrated educational interventions that, beyond raising awareness, actively foster practical skills in healthy food choices, perceived support from family and peers, and critical evaluation of digital health information, thereby fostering sustainable.
Keywords
Health literacy
Food Habits
Adolescent
Social Support

Acknowledgments: This research was conducted as part of a PhD dissertation in Health Education and Promotion at Mashhad University of Medical Sciences (Research Code: 4011787). The authors extend their sincere appreciation to all participants for their willingness to contribute, their valuable insights, and the time they devoted to sharing their experiences throughout the study.


Availability of Data and Materials: The data that support the findings of this study are available from the corresponding author upon reasonable request.


Conflicts of interest: No conflict of interest.


Consent for publication: The authors consent for publications.


Ethical Approval and consent to participate: The study was conducted in full compliance with the ethical principles outlined in the Declaration of Helsinki. Ethical clearance was obtained from the Ethics Committee of Mashhad University of Medical Sciences (Approval Code: IR.MUMS.FHMPM.REC.1402.042). Prior to data collection, all participants received detailed information about the study objectives, procedures, and confidentiality assurances. Written informed consent was obtained from every participant, as well as from parents of those under the age of 18. All transcripts were anonymized, and no identifying details were retained in the dataset. Participants were assured that their responses would remain strictly confidential and would have no effect on their academic standing or relationships with parents or school staff.


Funding: No funding was received for this study.


Authors’ Contributions: HA led the study conceptualization, managed data curation, and prepared the initial manuscript draft. MM participated in conceptualization, contributed to software coordination, and supervised the research process. MGA was involved in conceptualization, data management, formal analysis, investigation, and methodology development. SRS contributed to the study conceptualization and assisted with original draft writing. JJ was responsible for project administration and also participated in manuscript preparation. All authors reviewed, revised, and approved the final version of the 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/

1. Hübner HL, Bartelmeß T. Associations of sugar-related food parenting practices and parental feeding styles with prospective dietary behavior of children and adolescents: a systematic review of the literature from 2017 to 2023. Front Public Health. 2024;12:1382437. https://doi.org/10.3389/fpubh.2024.1382437
2. Ruiz LD, Zuelch ML, Dimitratos SM, Scherr RE. Adolescent Obesity: Diet Quality, Psychosocial Health, and Cardiometabolic Risk Factors. Nutrients. 2019;12(1). https://doi.org/10.3390/nu12010043
3. Ziegler AM, Kasprzak CM, Mansouri TH, Gregory AM, 2nd, Barich RA, Hatzinger LA, et al. An Ecological Perspective of Food Choice and Eating Autonomy Among Adolescents. Front Psychol. 2021;12:654139. https://doi.org/10.3389/fpsyg.2021.654139
4. Knight F, Kuri S, Damu C, Mejia C, Correa Guzmán N, Bergeron G, et al. Exploring the potential of meeting adolescent girls' nutrient needs in urban Colombia using food‐based recommendations. Ann N Y Acad Sci. 2023;1528(1):58-68. https://doi.org/10.1111/nyas.15050
5. Mancone S, Corrado S, Tosti B, Spica G, Di Siena F, Misiti F, et al. Enhancing nutritional knowledge and self-regulation among adolescents: efficacy of a multifaceted food literacy intervention. Front Psychol. 2024;15:1405414. https://doi.org/10.3389/fpsyg.2024.1405414
6. Silva P, Araújo R, Lopes F, Ray S. Nutrition and Food Literacy: Framing the Challenges to Health Communication. Nutrients. 2023;15(22). https://doi.org/10.3390/nu15224708
7. Krause C, Sommerhalder K, Beer-Borst S, Abel T. Just a subtle difference? Findings from a systematic review on definitions of nutrition literacy and food literacy. Health Promot Int. 2018;33(3):378-89.
8. Mohammadzadeh M, Namkhah Z, Abdolahzadeh E, Mahdizadeh M, Sobhani SR. Explanation of factors affecting food choice among Iranian young adults (18 to 24 years old): a qualitative study. BMC Public Health. 2025;25(1):1228. https://doi.org/10.1186/s12889-025-22478-w
9. Lesani A, Djafarian K, Akbarzade Z, Janbozorgi N, Shab-Bidar S. Meal-specific dietary patterns and their contribution to habitual dietary patterns in the Iranian population. Br J Nutr. 2023;129(2):262-71. https://doi.org/10.1017/S0007114521005067
10. Bastami F, Ardalan A, Zamani-Alavijeh F, Mostafavi F. Explaining the dimensions of social support for breakfast and healthy snacks in students: a qualitative study. Int J Adolesc Med Health. 2022;34(2):59-66. https://doi.org/10.1515/ijamh-2019-0249
11. Seiger E, Ouda R, Ruto N, Dianga P, Lytle L, Meyer K, et al. "We just eat this food because of hunger or because we cannot afford other foods": Drivers of Adolescent Food Choice From the Perspectives of Adolescents and Influential Adults. Curr Dev Nutr. 2022;6:603. https://doi.org/10.1093/cdn/nzac060.061
12. Gillespie B, Katageri G, Salam S, Ramadurg U, Patil S, Mhetri J, et al. Attention for and awareness of anemia in adolescents in Karnataka, India: A qualitative study. PLoS One. 2023;18(4):e0283631. https://doi.org/10.1371/journal.pone.0283631
13. Lazzaro M, Mills AM, Noble EE. Adolescent nutritional influences on the brain: implications for eating behaviors. Neuropharmacology. 2025;278:110570. https://doi.org/10.1016/j.neuropharm.2025.110570
14. Devine LD, Gallagher AM, Briggs S, Hill AJ. Factors that influence food choices in secondary school canteens: a qualitative study of pupil and staff perspectives. Front Public Health. 2023;11:1227075. https://doi.org/10.3389/fpubh.2023.1227075
15. Mingazov RN, Gureev SA, Zotov VV, Popel AE, Belisheva OA, Mingazova EN. [FEATURES OF NUTRITION OF ADOLESCENTS IN THE TWENTIES OF THE XXI CENTURY AS A HEALTH RISK FACTOR]. Probl Sots Zdravookhr Ist Med. 2022;30(s1):1078-82. https://doi.org/10.32687/0869-866X-2022-30-s1-1078-1082
16. Moore Heslin A, McNulty B. Adolescent nutrition and health: characteristics, risk factors and opportunities of an overlooked life stage. Proc Nutr Soc. 2023;82(2):142-56. https://doi.org/10.1017/S0029665123002689
17. Sahyoun GM, Do TD, Anqueira-Gonzàlez A, Hornblass A, Canetta SE. Peripuberty Is a Sensitive Period for Prefrontal Parvalbumin Interneuron Activity to Impact Adult Cognitive Flexibility. Dev Neurosci. 2025;47(2):127-38. https://doi.org/10.1159/000539584
18. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-57. https://doi.org/10.1093/intqhc/mzm042
19. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105-12. https://doi.org/10.1016/j.nedt.2003.10.001
20. Panjaitan W. Hubungan Pengetahuan Gizi Seimbang Dengan Status Gizi Remaja Di SMK SPP SNAKMA Muhammadiyah Tanjung Anom Tahun 2024. PengabdiMu. 2025;3:223-32. https://doi.org/10.62027/vitamedica.v2i3.306
21. Li S, Zhu Y, Zeng M, Li Z, Zeng H, Shi Z, et al. Association Between Nutrition Literacy and Overweight/Obesity of Adolescents: A Cross-Sectional Study in Chongqing, China. Front Nutr. 2022;9:893267. https://doi.org/10.3389/fnut.2022.893267
22. Hoteit M, Mansour R, Mohsen H, Bookari K, Hammouh F, Allehdan S, et al. Status and correlates of food and nutrition literacy among parents-adolescents' dyads: findings from 10 Arab countries. Front Nutr. 2023;10:1151498. https://doi.org/10.3389/fnut.2023.1151498
23. Bi X, Yang Y, Li H, Wang M, Zhang W, Deater-Deckard K. Parenting Styles and Parent-Adolescent Relationships: The Mediating Roles of Behavioral Autonomy and Parental Authority. Front Psychol. 2018;9:2187. https://doi.org/10.3389/fpsyg.2018.02187
24. Monroe-Lord L, Anderson A, Jones BL, Richards R, Reicks M, Gunther C, et al. Relationship between Family Racial/Ethnic Backgrounds, Parenting Practices and Styles, and Adolescent Eating Behaviors. Int J Environ Res Public Health. 2022;19(12). https://doi.org/10.3390/ijerph19127388
25. van den Broek N, Larsen JK, Verhagen M, Burk WJ, Vink JM. Is Adolescents' Food Intake Associated with Exposure to the Food Intake of Their Mothers and Best Friends? Nutrients. 2020;12(3). https://doi.org/10.3390/nu12030786
26. Kusumaningrum TAI, Madona A, Saputra OR, Seviani KF, Meyzwari FP, Widyantoro CK, et al. Penguatan Peran Orang yang Dianggap Penting dalam Penerapan Gizi Seimbang pada Remaja di Tohudan Wetan Colomadu: Strengthening the Role of People Who are Considered Important in the Implementation of Balanced Nutrition in Teenagers in Tohudan Wetan Colomadu. PengabdiMu. 2024;9(6):1064-9. https://doi.org/10.33084/pengabdianmu.v9i6.6745
27. Randby JS, Meshkovska B, Holbæk H, Lien N. An Exploration of Implementation Enablers and Barriers for Norwegian School Meal Guidelines. Glob Implement Res Appl. 2021;1(2):122-34. https://doi.org/10.1007/s43477-021-00010-7
28. Pineda E, Atanasova P, Wellappuli NT, Kusuma D, Herath H, Segal AB, et al. Policy implementation and recommended actions to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): a comparative analysis in South Asia. Lancet Reg Health Southeast Asia. 2024;26:100428. https://doi.org/10.1016/j.lansea.2024.100428
29. Brownson R, Shelton R, Geng E, Glasgow R. Revisiting concepts of evidence in implementation science. Implement Sci. 2022;17. https://doi.org/10.1186/s13012-022-01201-y
30. Sadegholvad S, Yeatman H, Omidvar N, Parrish AM, Worsley A. Gaps in Iranian School-leavers' Current Knowledge of Nutrition and Food Systems. Iran J Public Health. 2017;46(11):1589-90.
31. Ashoori M, Omidvar N, Eini-Zinab H, Shakibazadeh E, Doustmohamadian A, Abdar-Esfahani B, et al. Food and nutrition literacy status and its correlates in Iranian senior high-school students. BMC Nutr. 2021;7(1):19. https://doi.org/10.1186/s40795-021-00426-2
32. Denniss E, Lindberg R, McNaughton SA. Quality and accuracy of online nutrition-related information: a systematic review of content analysis studies. Public Health Nutr. 2023;26(7):1345-57. https://doi.org/10.1017/S1368980023000873
33. Wang Y, McKee M, Torbica A, Stuckler D. Systematic Literature Review on the Spread of Health-related Misinformation on Social Media. Soc Sci Med. 2019;240:112552 https://doi.org/10.1016/j.socscimed.2019.112552
Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 12 July 2026