Journal of Health Literacy

Journal of Health Literacy

Turkish Adaptation of the Short Nutrition Literacy Scale for Young Adults: Validity, Reliability, and Association with Mediterranean Diet Adherence

Articles in Press

Document Type : Original Article

Authors
Buse YAMAN
Hülya YILMAZ ÖNAL
Istanbul Medeniyet University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Istanbul, Türkiye.
10.22038/jhl.2026.91829.1877
Abstract
Background and Objectives: Nutrition literacy (NL) is a critical subdomain of health literacy in young adulthood, a period when lifelong dietary habits are established. This study aimed to adapt the Short Nutrition Literacy Scale for Young Adults (S-NutLit) into Turkish (S-NutLit-Tr), evaluate its psychometric properties, and examine its association with adherence to the Mediterranean diet (MEDAS).

Materials and Methods: This descriptive cross-sectional study recruited university students aged 18–25 years (n=252). Following forward–back translation and expert review, a pilot test (n=50) assessed clarity. Confirmatory factor analysis (CFA) tested the two-factor structure (Information Skills; Expert/Interaction Skills). Reliability was evaluated via Cronbach’s alpha, corrected item–total correlations (CITC), and composite reliability (CR). Convergent validity was examined using correlations with MEDAS and group comparisons by MEDAS adherence.

Results: The revised CFA model demonstrated acceptable fit: χ²(41)=82.25, χ²/df=2.01, IFI=.92, GFI=.95, CFI=.92, RMSEA=.06. Internal consistency was adequate (α=.74 total; α=.70 Factor 1; α=.62 Factor 2). Most CITC values exceeded .30; Items 7 and 9 were marginal (~.25) yet did not improve α if removed and were retained for content coverage. CR values were .71 (Factor 1) and .67 (Factor 2). S-NutLit-Tr showed significant positive, albeit weak, correlations with MEDAS (total r=.219, p<.001; Factor 1 r=.140, p=.013; Factor 2 r=.291, p<.001). S-NutLit scores differed across MEDAS adherence groups (Factor 1: F(2,249)=4.76, p=.009; Factor 2: F(2,249)=13.44, p<.001; total: F(2,249)=9.62, p<.001), with higher scores in the high-adherence group.

Conclusion: The S-NutLit-Tr is a brief, psychometrically sound instrument for assessing nutrition literacy among young adults. Its positive association with Mediterranean diet adherence supports criterion-related (convergent) validity. The scale is suitable for research and public health screening, where strengthening NL may aid healthier dietary choices.
Keywords
Health Literacy
Mediterranean Diet
Young Adult

Acknowledgements: The authors thank all students for participating in the study. We thank Dr. Mehmet Haydaroğlu for methodological advice on the statistical aspects of the study.


Availability of data and material: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.


Conflicts of Interest: The authors declare that there is no conflict of interest to disclose. 


Consent for Publication: Not applicable.


Ethics approval and consent to participate: The study was approved by the Istanbul Medeniyet University Social and Humanities Ethics Committee (Decision No. 2024/1, dated 23.01.2024). All participants were informed about the study, provided written informed consent, and the procedures conformed to the principles of the Declaration of Helsinki.


Funding: This study was supported by the Scientific and Technological Research Council of Turkey (TÜBİTAK) under the 2209-A University Students Research Projects Support Program.


Authors’ Contributions: Concept: B.S, H.Y.Ö.; Study Design: B.S., H.Y.Ö.; Data Collection/ Processing: B.S. Analysis or Interpretation: H.Y.Ö.; Literature Search: B.S., H.Y.Ö.; Writing: B.S., H.Y.Ö.; Critical Review: H.Y.Ö. Final Approval: All authors. 


Declaration of generative AI and AI-assisted technologies in the writing process: Generative AI was used only for grammar editing.

 

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 license, visit https://creativecommons.org/licenses/by/4.0/

1. Öztürk EE, Özgen L. Evaluation of the relationship between nutrition knowledge and sustainable food literacy. Journal of Contemporary Medicine. 2023;13(1):66-71. https://doi.org/10.16899/jcm.1221031
2. Silva P. Food and nutrition literacy: Exploring the divide between research and practice. Foods. 2023;12(14):2751. https://doi.org/10.3390/foods12142751 PMid:37509843 PMCid:PMC10378922
3. Organization WH. What are healthy diets? Joint statement by the Food and Agriculture Organization of the United Nations and the World Health Organization: World Health Organization; 2024.
4. Gruber M, Iwuchukwu CG, Sperr E, König J. What do people know about food, nutrition and health?-General nutrition knowledge in the Austrian population. Nutrients. 2022;14(22):4729. https://doi.org/10.3390/nu14224729 PMid:36432417 PMCid:PMC9692599
5. Organization WH. Tackling NCDs: best buys and other recommended interventions for the prevention and control of noncommunicable diseases: World Health Organization; 2024.
6. Ayer Ç, Ergin A. Status of nutritional literacy in adolescents in the semi-rural area in Turkey and related factors. Public Health Nutrition. 2021;24(12):3870-8. https://doi.org/10.1017/S1368980021002366 PMid:34047263 PMCid:PMC8369453
7. Haldeman L. Separating Fact From Fiction: Enhancing Nutrition Literacy to Navigate Healthy Eating Decisions. Journal of Nutrition Education and Behavior. 2023;55(10):698. https://doi.org/10.1016/j.jneb.2023.08.008 PMid:37806708
8. Qi Q, Sun Q, Yang L, Cui Y, Du J, Liu H. High nutrition literacy linked with low frequency of take-out food consumption in chinese college students. BMC Public Health. 2023;23(1):1132. https://doi.org/10.1186/s12889-023-16078-9 PMid:37312097 PMCid:PMC10262486
9. Mostafazadeh P, Jafari MJ, Mojebi MR, Nemati-Vakilabad R, Mirzaei A. Assessing the relationship between nutrition literacy and eating behaviors among nursing students: a cross-sectional study. BMC Public Health. 2024;24(1):18. https://doi.org/10.1186/s12889-023-17468-9 PMid:38166862 PMCid:PMC10759699
10. Aktaş N, Özdoğan Y. Gıda ve beslenme okuryazarlığı. Harran Tarım ve Gıda Bilimleri Dergisi. 2016;20(2):146-53. https://doi.org/10.29050/harranziraat.259105
11. McNamara J, Mena NZ, Neptune L, Parsons K. College students' views on functional, interactive and critical nutrition literacy: a qualitative study. International Journal of Environmental Research and Public Health. 2021;18(3):1124. https://doi.org/10.3390/ijerph18031124 PMid:33514000 PMCid:PMC7908439
12. Stok FM, Renner B, Clarys P, Lien N, Lakerveld J, Deliens T. Understanding eating behavior during the transition from adolescence to young adulthood: a literature review and perspective on future research directions. Nutrients. 2018;10(6):667.https://doi.org/10.3390/nu10060667 PMid:29794986 PMCid:PMC6024552
13. Duplaga M, Grysztar M. Nutritional behaviors, health literacy, and health locus of control of secondary schoolers in Southern Poland: a cross-sectional study. Nutrients. 2021;13(12):4323. https://doi.org/10.3390/nu13124323 PMid:34959875 PMCid:PMC8709351
14. Lai I-J, Chang L-C, Lee C-K, Liao L-L. Nutrition literacy mediates the relationships between multi-level factors and college students' healthy eating behavior: evidence from a cross-sectional study. Nutrients. 2021;13(10):3451. https://doi.org/10.3390/nu13103451 PMid:34684452 PMCid:PMC8539523
15. Wattick RA, Olfert MD, Hagedorn-Hatfield RL, Barr ML, Claydon E, Brode C. Diet quality and eating behaviors of college-attending young adults with food addiction. Eating Behaviors. 2023;49:101710. https://doi.org/10.1016/j.eatbeh.2023.101710 PMid:36863205
16. Mohsenpour MA, Karamizadeh M, Barati-Boldaji R, Ferns GA, Akbarzadeh M. Structural equation modeling of direct and indirect associations of social media addiction with eating behavior in adolescents and young adults. Scientific reports. 2023;13(1):3044. https://doi.org/10.1038/s41598-023-29961-7 PMid:36810365 PMCid:PMC9942059
17. Vrinten J, Van Royen K, Pabian S, De Backer C, Matthys C. Development and validation of a short nutrition literacy scale for young adults. Frontiers in Nutrition. 2023;10:1008971. https://doi.org/10.3389/fnut.2023.1008971 PMid:37020809 PMCid:PMC10067712
18. Filippone L, Shankland R, Hallez Q. The relationships between social media exposure, food craving, cognitive impulsivity and cognitive restraint. Journal of Eating Disorders. 2022;10(1):184. https://doi.org/10.1186/s40337-022-00698-4 PMid:36434703 PMCid:PMC9701005
19. Christoph MJ, An R. Effect of nutrition labels on dietary quality among college students: a systematic review and meta-analysis. Nutrition reviews. 2018;76(3):187-203. https://doi.org/10.1093/nutrit/nux069 PMid:29373747
20. Mengi Çelik Ö, Aytekin Şahin G, Gürel S. Do cooking and food preparation skills affect healthy eating in college students? Food Science & Nutrition. 2023;11(10):5898-907. https://doi.org/10.1002/fsn3.3591 PMid:37831736 PMCid:PMC10563711
21. Muscogiuri G, Verde L, Sulu C, Katsiki N, Hassapidou M, Frias-Toral E, et al. Mediterranean diet and obesity-related disorders: what is the evidence? Current obesity reports. 2022;11(4):287-304. https://doi.org/10.1007/s13679-022-00481-1 PMid:36178601 PMCid:PMC9729142
22. Pehlivanoğlu EFÖ, Balcıoğlu H, Ünlüoğlu İ. Akdeniz diyeti bağlılık ölçeği'nin türkçe'ye uyarlanması geçerlilik ve güvenilirliği. Osmangazi Tıp Dergisi. 2020;42(2):160-4. https://doi.org/10.20515/otd.504188
23. Koc MC, Yildirim E, Isik O, Aksen P, Talaghir L-G, Zanfir C. Turkish version of a short nutrition literacy scale for young adults: cultural adaptation and validation. Frontiers in Nutrition. 2024;11:1422738. https://doi.org/10.3389/fnut.2024.1422738 PMid:39104754 PMCid:PMC11298427
24. Erefe I. Nursing Research Principles, Process and Methods. Ankara: Odak Ofset. 2004:340-5.
25. Schröder H, Fitó M, Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, et al. A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. The Journal of nutrition. 2011;141(6):1140-5. https://doi.org/10.3945/jn.110.135566 PMid:21508208 PMCid:PMC8462571
26. Lawshe CH. A quantitative approach to content validity. Personnel psychology. 1975;28(4). https://doi.org/10.1111/j.1744-6570.1975.tb01393.x
27. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in nursing & health. 2007;30(4):459-67. https://doi.org/10.1002/nur.20199 PMid:17654487
28. Hair JF. A primer on partial least squares structural equation modeling (PLS-SEM): sage; 2014. https://doi.org/10.1108/EBR-10-2013-0128
29. Harrington D. Confirmatory factor analysis: Oxford university press; 2009. https://doi.org/10.1093/acprof:oso/9780195339888.001.0001
30. Field A. Discovering statistics using IBM SPSS statistics: Sage publications limited; 2024.
31. Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesthesia & analgesia. 2018;126(5):1763-8. https://doi.org/10.1213/ANE.0000000000002864 PMid:29481436
32. DeVellis RF, Thorpe CT. Scale development: Theory and applications: Sage publications; 2021.
33. Hooper D, Coughlan J, Mullen M. Structural equation modelling, fit indices, covariance structure modelling; reporting structural equation modelling; model fit. Electron J Bus Res Methods. 2008;6:53-60.
34. de Vet HC, Mokkink LB, Mosmuller DG, Terwee CB. Spearman-Brown prophecy formula and Cronbach's alpha: different faces of reliability and opportunities for new applications. Journal of clinical epidemiology. 2017;85:45-9. https://doi.org/10.1016/j.jclinepi.2017.01.013 PMid:28342902
35. Story M, Neumark-Sztainer D, French S. Individual and environmental influences on adolescent eating behaviors. Journal of the American Dietetic association. 2002;102(3):S40-S51. https://doi.org/10.1016/S0002-8223(02)90421-9 PMid:11902388
36. Seconda L, Egnell M, Julia C, Touvier M, Hercberg S, Pointereau P, et al. Association between sustainable dietary patterns and body weight, overweight, and obesity risk in the NutriNet-Santé prospective cohort. The American Journal of Clinical Nutrition. 2020;112(1):138-49. https://doi.org/10.1093/ajcn/nqz259 PMid:31725157
37. Cao Q, Li M, Qin G, Yan L, He J, Xu M, et al. Early adulthood weight change, midlife "Life's essential 8" health status and risk of cardiometabolic diseases: a chinese nationwide cohort study. Nutrition & Metabolism. 2023;20(1):48. https://doi.org/10.1186/s12986-023-00765-w PMid:37915057 PMCid:PMC10621175
38. Denniss E, Lindberg R, Marchese LE, McNaughton SA. # Fail: the quality and accuracy of nutrition-related information by influential Australian Instagram accounts. International Journal of Behavioral Nutrition and Physical Activity. 2024;21(1):16. https://doi.org/10.1186/s12966-024-01565-y PMid:38355567 PMCid:PMC10865719
39. 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
40. 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
41. Alpat Yavaş İ, Guney-Coskun M, Saleki N, Sezer Karataş FE, Keskin E. Nutrition literacy and its relationship with diet quality and quality of life among white-collar employees: a study from Türkiye. BMC Public Health. 2024;24(1):3478. https://doi.org/10.1186/s12889-024-21078-4 PMid:39696267 PMCid:PMC11656943
42. Rosi A, Scazzina F, Giampieri F, Álvarez-Córdova L, Abdelkarim O, Ammar A, et al. Lifestyle factors associated with children's and adolescents' adherence to the Mediterranean diet living in Mediterranean countries: the DELICIOUS project. Nutrients. 2024;17(1):26. https://doi.org/10.3390/nu17010026 PMid:39796460 PMCid:PMC11722675
43. Depboylu GY, Kaner G, Süer M, Kanyılmaz M, Alpan D. Nutrition literacy status and its association with adherence to the Mediterranean diet, anthropometric parameters and lifestyle behaviours among early adolescents. Public Health Nutrition. 2023;26(10):2108-17. https://doi.org/10.1017/S1368980023001830 PMid:37622233 PMCid:PMC10564606
44. Yılmaz M, Fırat YY, Gül FH, Kahraman TA. Sağlık okuryazarlığının diyet kalitesine etkisi. Beslenme ve Diyet Dergisi. 2021;49(2):28-37. https://doi.org/10.33076/2021.BDD.1477
45. Yıldırım M, Kızıltan G, Ok MA. Beslenme Okuryazarlığı Nedir? Başkent Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2021;6(BESLENME ÖZEL SAYISI):1-13.
46. Hawkes C, Smith TG, Jewell J, Wardle J, Hammond RA, Friel S, et al. Smart food policies for obesity prevention. The lancet. 2015;385(9985):2410-21. https://doi.org/10.1016/S0140-6736(14)61745-1 PMid:25703109 PMCid:PMC11621434
47. Sağır GŞ, Yurttagül SM, Kıratlı B. Üniversite öğrencilerinin beslenme durumlarının Akdeniz diyet kalite indeksi ile değerlendirilmesi. Zeugma Sağlık Araştırmaları Dergisi. 2020;2(3):98-106.
48. Castro-Cuesta J, Montoro-García S, Sánchez-Macarro M, Martínez MC, Marenco IE, Pérez-Camacho A, et al. Adherence to the Mediterranean diet in first-year university students and its association with lifestyle-related factors: A cross-sectional study. Hipertensión y Riesgo Vascular. 2023;40(2):65-74. https://doi.org/10.1016/j.hipert.2022.09.001 PMid:36244967
Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 28 July 2026