Social marketing-based interventions to promote healthy nutrition behaviors: a systematic review protocol

Background: Diet-related non-communicable diseases (NCDs) are rapidly increasing worldwide and constitute one of the leading causes of mortality and morbidity. Improving population diets can play an important role in preventing and managing the diseases. Effective and efficient interventions are needed to promote healthy eating behaviors among people. The objective of this review will be to evaluate the effectiveness of social marketing-based interventions to promote healthy nutrition behaviors. Method: The following electronic databases will be searched from January 1990 onwards: PubMed/MEDLINE, EMBASE, Web of Science, and CENTRAL. We will include randomized and non-randomized trials, quasi-experimental studies, observational studies (e.g., cohort, cross-sectional, and before and after studies) evaluating the social marketing-based intervention. The primary outcomes will be nutritional behaviors. Secondary outcomes will include the quality of life, nutritional status, and weight status. Two reviewers will independently screen all citations, full-text articles, and abstract data. The study methodological quality (or bias) will be appraised using an appropriate tool. If feasible, we will conduct random-effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., age, sex, and socio-economic condition). Discussion: This study will summarize the evidence regarding the interventions� components, implementation methods, and effectiveness of interventions based on the social marketing framework to promote healthy nutrition behaviors. This review can provide policymakers with the information needed to make decisions and plan to promote healthy eating behaviors and understand the factors influencing the implementation of these programs. Systematic review registration: CRD42020163972. © 2021, The Author(s)

Nutrition labels� strengths & weaknesses and strategies for improving their use in Iran: A qualitative study

Background This study aimed to explain the strengths and weaknesses of the Traffic light label (TLL) and nutrition facts label (NFL) and the strategies for improving their use in Iran, based on the perspectives of different stakeholders, including mothers, food quality control experts (FQC), nutritionists and food industry experts. Methods We conducted 10 Focus Group Discussions (FGDs) with 63 mothers, 10 semi-structured interviews with FQCs, 1 FGD with 6 nutritionists and 1 FGD with 8 food industry experts. To clarify some of the questions that arose from the interviews, the researcher interviewed three policy makers who had sufficient information about the TLL. The discussions and interviews were transcribed verbatim and MAXQDA10 software was used for coding. Results The most important findings of this study based on different stakeholders� perspectives were as follows: mothers believed that nutrition labels reduced the consumption of high-calorie products, although they found the TLL to be easier to understand than the NFL because of its red color. However, their weaknesses were their incompatibility with culture and the lack of trust in the information provided by manufacturers. FQCs pointed out the possibility of changing formulations and the appropriateness of the traffic light for patients, but like mothers, they believed that the labels did not suit the governing culture. Further weaknesses were, misleading the consumer, problems in the colorings reported by different laboratories, and different approaches adopted by regulatory experts. The simplicity of understanding TLL for the general public has been suggested by some nutritionists. Nevertheless, the multiplicity of colors of the TLL was the most important weakness presented by nutritionists and food industry experts and the failure to implement nutrition labels was another issue raised by experts. To improve the use of nutrition labels, notification via media especially television, community education and culture building were suggested by all stakeholders. Conclusions The findings of this study underscore the importance of implementing the policy of nutrition labeling in Iran. Mothers and nutritionists believed TLL to be more appropriate for the public to understand, however, FQCs and food industry experts believed that NFL was more suitable in guiding consumers toward healthy food choices. Education and information dissemination via media on interpretive TLL may affect consumer behavior toward food purchases. © 2020 Seyedhamzeh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Relationship between household food insecurity and food and nutrition literacy among children of 9-12 years of age: a cross-sectional study in a city of Iran

Objective: The aim of this study was to assess the relationship between household food insecurity (HFI) with food and nutrition literacy (FNLIT) in a sample of Iranian children. This cross sectional study was performed on 315 children aged 9 to 12 years recruited from the primary schools throughout Mashhad, Iran. The Household Food Insecurity Access Scale (HFIAS) was used to assess the HFI. Also, overall FNLIT score and its sub-categories were evaluated using a validated 40-item questionnaire. Results: The prevalence of HFI in the total sample was about 56. Also, almost 14 of students had a low FNLIT score. Food insecure children had significantly lower levels of FNLT and some subscales including nutrition knowledge, food choice literacy, and food label literacy than the food-secure subjects, moreover, they had a higher likelihood of having low FNLIT score (OR = 2.89, CI 1.03-8.09; p = 0.04). In conclusion, there is a negative association between HFI and FNLIT in children. Further studies to confirm this finding are needed. © 2020 The Author(s)

Extent of food and nutrition literacy considerations in primary school curriculum and textbooks

Background and Objectives: The aim of this study was to analyze contents of Grades 1�6 textbooks in Iran, regarding food and nutrition literacy domains and their components. Materials & Methods: This study included content analysis of primary school textbooks (Grades 1�6) in 2019�2020 academic year. Analysis included all pages of 41 books of primary schools (4878 pages). Data collection was carried out using checklists comprised of three principal domains of food and nutrition literacy, including cognitive, skill and value-attitude as well as their components. The research tool reliability was assessed based on the agreement rate between the two coders, using Holsti method. The reliability assessment was 85.29. Results: Of all the food and nutrition literacy components in the books, 92 were related to the cognitive domain whereas 8 belonged to the skill domain of food and nutrition literacy. The value-attitude domain, including nutritional tendency, nutritional health values and cultural and social issues related to foods were mostly missing. Critical factors of food and nutrition literacy in primary school curriculum included media literacy, skills linked to food label analysis, and interactive and critical food and nutrition skills. Conclusion: In conclusion, revision of the textbook contents and curriculums is necessary to ensure that they provide acceptable levels of food and nutrition-linked skills, promoting positive attitudes of healthy eating. © 2021, National Nutrition and Food Technology Research Institute. All rights reserved

Exploring health and nutrition stakeholders' expectations and perception toward establishment of the Food and Nutrition Surveillance in Iran

Background: Food and Nutrition Surveillance (FNS) is an essential and practical tool for providing timely information at specified times for policy making. This study aimed to explore policymakers' expectations and perception on establishment of the FNS in Iran before its establishment. Materials and methods: Data in this qualitative study were gathered through documents review (23 relevant documents) and seventeen semi-structured interviews with key informants in the field of food and nutrition at the national and provincial level selected through purposive and snowball sampling. Data were content analysed using MAXQDA (2010). Findings: Most of the participants defined the FNS as a continuous monitoring system. They expected the FNS to identify and recognize food and nutrition problems; to create a common language and provide an inter-disciplinary cooperation. From the participants' point of view the most important barriers to establishing of the FNS included lack of cooperation and resistance at different levels, lack of support and partnership among the stakeholders, lack of justification and awareness of the stakeholders, mismanagement and misuse of data, inattention to infrastructure. Conclusions: Most of the stakeholders believed that the FNS was supposed to monitor food and nutrition status continuously to provide timely and accurate information for policy making. © 2021 John Wiley & Sons Ltd