The objective to explore the perspective of all stakeholders towards the definition of FANLit has been achieved with the qualitative bottom-up approach. The concept of FANLit in this study was composed of cognitive knowledge, fundamental, interactive, and critical skills related to food and nutrition. This is useful for the decision on healthy food consumption. This concept is consonant with Bloom's taxonomy which indicated that knowledge is the fundamental cognitive skill and refers to the retention of specific and discrete pieces of information, such as facts and definitions, or methodology. Using knowledge, comprehending and utilizing skills or techniques in new situations through the application in the third level of Bloom’s taxonomy of learners are a manner of practice and maintenance to behave in the timely manner [35]. The definition of FANLIt with cognitive knowledge, functional, interactive, and critical skills was consistent with the previous literatures and Nutbeam’s model of health literacy [10, 14, 16, 23]. These dimensions are essential as they might influence the health of adolescents and reduce risks of developing diseases in the future, especially non-communicable diseases.
To be specific, the first theme of FANLit was cognition of food and nutrition knowledge with food and nutrition knowledge, and understanding in food and nutrition. This theme indicates that knowledge is the initial level of cognitive behaviour [35]. It also shows that understanding is the representation of knowledge. Therefore, knowledge and understanding should be included in the definition of FANLit. This is in agreement with previous literatures indicating that health literacy had a set of knowledge and skills or a hierarchy of functions in the definition [36, 37]. In the same way, the academics agreed to have a set of knowledge and understanding in the definition of FANLit [14, 23, 24, 36,37,38,39]. This concept could be linked to translate knowledge to practice which is corresponding to procedural knowledge and judgement skills in food and nutrition [40]. The content of knowledge and understanding of food and nutrition comprises definition, types, components and sources of food, nutrition, food safety, quantity, sources, functions of nutrients, nutritional fact label and the effects of food and nutrients on health. This content is in harmony with declarative knowledge that represents understanding of factual information about food and nutrition whereas procedural knowledge represents understanding of nutrition flag that influences reasonable choices and actions of food consumption [41]. This is the fundamental knowledge to interpret various issues of food and nutrition to establish suitable food consumption practice for one's own health.
The second theme of FANLit was a set of skills of functional food and nutrition literacy with the access to food and nutrition information, food selection and food preparation skills. This theme stipulated that FANLit was a basic skill in translating knowledge and understanding to the application in accessing information, selection and preparation of food and nutrition. This result is consonant with Nutbeam [9] proposing the three-level model of functional health literacy, interactive health literacy and critical health literacy. The findings of a study by Ashoori M, et al. [23] are similar to this study in that the majority of functional skills is related to the application of basic food and nutrition knowledge, shopping and storing foods, meal preparation skill, food production, and environmental sustainability skills. In line with the previous studies, accessing food and nutrition, information, food selection [38, 42, 43], food preparation skill [24, 38, 39],and daily food and nutrition planning and management [42, 43] are included in FANLit definition.
The third theme of FANLit was a set of skills of interactive food and nutrition literacy with communication, sharing and discussion regarding health and nutrition with others (peers, family, academics, healthcare providers, and so on). This theme explained that food consumption was daily activity of people, and most students living with their parents or guardians. It is also an interaction with their peers and teachers at school. Therefore, social skills of this group to communicate and share information on food and nutrition had been developed. This result is consonant with food and nutrition [20, 24, 38], knowledge-sharing and discussion on topics related to health and nutrition with others [38]. When the interactive skill of FANLIt is achieved, the application of new information will lead to the change in their practice and behaviour. The interrelation of functional skill to interactive skill in FANLIt is the ability to combine food and nutrition information with interactive social skill to adapt ourselves to new situation.
The fourth theme of FANLit was a set of skills of critical food and nutrition literacy with information used in decision making, healthy food selection and healthy budgeting. This theme indicated that this skill is the advance of translating factual knowledge, procedural knowledge, and social skill to practice, such as preparing budget to buy healthy food. This information is shown in the reply of the participants that several social media influenced decision making on food consumption. Similar to previous studies, these components affect healthy food selection [24, 38, 39] and effective budgeting [42, 43].
In this study, there are four themes and 12 subthemes in cognitive knowledge and skills. In regards to skill domain, it is in line with Nutbeam's hierarchical model of health literacy, including functional, interactive and critical literacy [9]. The perspectives from various types of stakeholders were different due to their roles, responsibilities and perception. For example, while the students reflected understanding on the skill in food preparation, and communication with the teachers and healthcare providers, school health nurses reflected understanding on the nutrition flag, and public health practitioners on the nutrient information and the skill in food selection. This information is complementary with the others perspectives in defining FANLIt and its component from all stakeholders. These findings could be beneficial for the development on assessing instrument for FANLit in the junior secondary school students. The findings on FANLit are essential as dietary pattern relates to daily living activities. Understanding FANLit might increase the cognitive knowledge, functional, interactive, and critical skills which leads to better management on their food choice, interaction with others on food and nutrition information and critical decision making on food consumption for their own health.
The use of qualitative approach to explore and understand the issue of FANLit is considered the strength of this study. Various perspectives from national and regional levels were encompassed. Nonetheless, the specific context of the subjects of this study could be regarded as limitation. Findings from this study could be useful in underpinning further development of assessing instrument of FANLit among junior secondary school students in Thailand. In addition, the results could be used as a guideline for future programs aiming at improving food and dietary behaviour in young adults.