Introduction : Nutrition literacy (NL) is a recently emerged concept related to health literacy (HL). The need for an instrument to measure NL has become increasingly urgent. Our objective is to document the validation of an instrument that measures NL in Mexican adolescents. Methods : We developed an instrument based on the definition of HL proposed by the European Health Literacy Project (HLS - EU). After a dapting the HL dimensions and skills to nutrition, we built a matrix with 12 sub-dimensions and obtained 48 items for measuring the NL concept. Versions of the instrument were sequentially validated based on the judgment of experts, an evaluation with the population, a pilot trial and an analysis of the measurement model. Results : Expert judgment and evaluation corroborated the pertinence of the themes and language employed. Piloting enabled us to fine tune operational issues and establish the final version of the instrument. Lastly, an analysis of the model showed consistency and internal validity in the three model dimensions, which yielded a Cronbach alpha coefficient above 0.85. Discussion : We consider it both necessary and urgent to measure and monitor NL, contributing to the formulation of public policies grounded in evidence. Incorporating NL measurements into national surveys on health and nutrition.
AMA (1999). Health Literacy: Report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. JAMA, 281, 552-557. https://doi.org/10.1001/jama.281.6.552
Barquera, S., Hernandez-Barrera, L., Tolentino, M. L., Espinosa, J., Ng, S. W., Rivera, J. A., & Popkin, B. M. (2008). Energy Intake from Beverages Is Increasing among Mexican Adolescents and Adults. The Journal of Nutrition, 138, 2454-2461. https://doi.org/10.3945/jn.108.092163
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., Viera, A., Crotty, K., Viswanathan, M. et al. (2011). Health Literacy Interventions and Outcomes: An Updated Systematic Review. Evidence Report/Technology Assessment, No. 199, 1-941.
Bollen, K. A. (1989). Confirmatory Factor Analysis. In Structural Equations with Latent Variables (pp. 226-318). John Wiley. https://doi.org/10.1002/9781118619179
Camara dos Deputados. Senado Federal-Brasil (2017). Projeto de Lei da Camara N°102.
Carbone, E. T., & Zoellner, J. M. (2012). Nutrition and Health Literacy: A Systematic Review to Inform Nutrition Research and Practice. Journal of the Academy of Nutrition and Dietetics, 112, 254-265. https://doi.org/10.1016/j.jada.2011.08.042
Carmona, R. H. (2006, August). Health Literacy: A National Priority. Journal of General Internal Medicine, 21, 803. https://doi.org/10.1111/j.1525-1497.2006.00569.x
Cervantes, V. (2005). Interpretaciones del coeficiente alpha de Cronbach. Avances En Medición, 3, 9-28.
Colchero, M. A., Popkin, B. M., Rivera, J. A., & Ng, S. W. (2016). Beverage Purchases from Stores in Mexico under the Excise Tax on Sugar Sweetened Beverages: Observational Study. BMJ, 352, h6704. https://doi.org/10.1136/bmj.h6704
Cronbach, L. J. (1951). Coefficient Alpha and the Internal Structure of Tests. Psychometrika, 16, 297-334. https://doi.org/10.1007/BF02310555
Diamond, J. J. (2007). Development of a Reliable and Construct Valid Measure of Nutritional Literacy in Adults. Nutrition Journal, 6, 5. https://doi.org/10.1186/1475-2891-6-5
Duong, T. V., Aringazina, A., Baisunova, G., Nurjanah, Pham, T. V., Pham, K. M., Chang, P. W. et al. (2017). Measuring Health Literacy in Asia: Validation of the HLS-EU-Q47 Survey Tool in Six Asian Countries. Journal of Epidemiology, 27, 80-86. https://doi.org/10.1016/j.je.2016.09.005
El Poder del Consumidor (2019). En jornada histórica el Senado de la República aprueba el etiquetado frontal de advertencia en la Ley General de Salud. El Pode Del Consumidor. https://elpoderdelconsumidor.org/2019/10/en-jornada-historica-el-senado-de-la-republica--aprueba-el-etiquetado-frontal-de-advertencia-en-la-ley-general-de-salud
Gibbs, H., & Chapman-Novakofski, K. (2012). A Review of Health Literacy and Its Relationship to Nutrition Education. Topics in Clinical Nutrition, 27, 325-333. https://doi.org/10.1097/TIN.0b013e31826f8dc5
Gibbs, H. D., Ellerbeck, E. F., Befort, C., Gajewski, B., Kennett, A. R., Yu, Q., Sullivan, D. K. et al. (2016). Measuring Nutrition Literacy in Breast Cancer Patients: Development of a Novel Instrument. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education, 31, 493-499. https://doi.org/10.1007/s13187-015-0851-y
Gibbs, H. D., Ellerbeck, E. F., Gajewski, B., Zhang, C., & Sullivan, D. K. (2018). 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, 50, 247-257.e1. https://doi.org/10.1016/j.jneb.2017.10.008
Guttersrud, O., & Petterson, K. S. (2015). Young Adolescents’ Engagement in Dietary Behaviour—The Impact of Gender, Socio-Economic Status, Self-Efficacy and Scientific Literacy. Methodological Aspects of Constructing Measures in Nutrition Literacy Research Using the Research Model. Public Health Nutrition, 18. https://doi.org/10.1017/S1368980014003152
Huizinga, M. M., Elasy, T. A., Wallston, K. A., Cavanaugh, K., Davis, D., Gregory, R. P., Rothman, R. L. et al. (2008). Development and Validation of the Diabetes Numeracy Test (DNT). BMC Health Services Research, 8, 96. https://doi.org/10.1186/1472-6963-8-96
Jiménez-Díaz, J., Salzar, & Morera-Castro, M. (2013). Diseno y validación de un instrumento para la evaluación de patrones básicos de movimiento. Motricidad, 31, 87-97.
Joulaei, H., Keshani, P., & Kaveh, M. H. (2018). Nutrition Literacy as a Determinant for Diet Quality amongst Young Adolescents: A Cross Sectional Study. Progress in Nutrition, 20.
Kline, R. B. (2015). Principles and Practice of Structural Equation Modeling. Guildford Press.
Krause, C., Sommerhalder, K., Beer-Borst, S., & Abel, T. (2018). Just a Subtle Difference? Findings from a Systematic Review on Definitions of Nutrition Literacy and Food Literacy. Health Promotion International, 33, 378-389.
Mukamana, O., & Johri, M. (2016). What Is Known about School-Based Interventions for Health Promotion and Their Impact in Developing Countries? A Scoping Review of the Literature. Health Education Research, 31, 587-602. https://doi.org/10.1093/her/cyw040
Mussini, M., & Temporelli, K. L. (2013). Obesidad: Un desafío para las políticas públicas. Estudios Sociales (Hermosillo, Son.), 21, 165-184. http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0188-45572013000100007&nrm=iso
Naigaga, D. A., Pettersen, K. S., Henjum, S. et al. (2018). Assessing Adolescents’ Perceived Proficiency in Critically Evaluating Nutrition Information. International Journal of Behavioral Nutrition and Physical Activity, 15, 61. https://doi.org/10.1186/s12966-018-0690-4
OREALC/UNESCO Santiago, O. R. de E. para A. L. y el C. (2013). Situación educativa de América Latina y el Caribe: Hacia la eduación de calidad para todos al 2015. Santiago de Chile.
Organizacao das Nacoes Unidas (ONU) (2016). Roteiro para a Localizacao dos Objetivos de Desenvolvimento Sustentável: Implementacao e Acompanhamento no nível subnacional.
PAHO (2014). Plan of Action for the Prevention of Obesity in Children and Adolescents.
Rivera, J. A., Barquera, S., González-Cossío, T., Olaiz, G., & Sepúlveda, J. (2004). Nutrition Transition in Mexico and in Other Latin American Countries. Nutrition Reviews, 62, S149-S157. https://doi.org/10.1301/nr.2004.jul.S149-S157
Rothman, R. L., Housam, R., Weiss, H., Davis, D., Gregory, R., Gebretsadik, T., Elasy, T. A. et al. (2006). Patient Understanding of Food Labels: The Role of Literacy and Numeracy. American Journal of Preventive Medicine, 31, 391-398. https://doi.org/10.1016/j.amepre.2006.07.025
Rugani Ribeiro de Castro, I. (2017). Obesidade: Urge fazer avanASar políticas públicas para sua prevenA§Ao e controle. Cadernos de Saúede Pública, 33, e00100017. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2017000700201&nrm=iso https://doi.org/10.1590/0102-311x00100017
Secretaría de Salud (2013). Estrategia Nacional para la Prevención y el Control del Sobrepeso, la Obesidad y la Diabetes. Secretaría de Salud.
Shamah-Levy, T., Cuevas-Nasu, L., Gaona-Pineda, E. B., Gómez-Acosta, L. M., Morales-Rúan, M. D. C., Hernández-ávila, M., & Rivera-Dommarco, J. á. (2018). Sobrepeso y obesidad en ninos y adolescentes en México, actualización de la Encuesta Nacional de Salud y Nutrición de Medio Camino 2016. Salud Pública de México, 60, 244-253. https://doi.org/10.21149/8815
Silk, K. J., Sherry, J., Winn, B., Keesecker, N., Horodynski, M. A., & Sayir, A. (2008). Increasing Nutrition Literacy: Testing the Effectiveness of Print, Web Site, and Game Modalities. Journal of Nutrition Education and Behavior, 40, 3-10. https://doi.org/10.1016/j.jneb.2007.08.012
Sorensen, K., Pelikan, J. M., Rothlin, F., Ganahl, K., Slonska, Z., Doyle, G., Brand, H. et al. (2015). Health Literacy in Europe: Comparative Results of the European Health Literacy Survey (HLS-EU). European Journal of Public Health, 25, 1053-1058. https://doi.org/10.1093/eurpub/ckv043
Sorensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., European, (HLS-EU) Consortium Health Literacy Project (2012). Health Literacy and Public Health: A Systematic Review and Integration of Definitions and Models. BMC Public Health, 12, 80. https://doi.org/10.1186/1471-2458-12-80
Sorensen, K., Van den Broucke, S., Pelikan, J. M., Fullam, J., Doyle, G., Slonska, Z., Brand, H. et al. (2013). Measuring Health Literacy in Populations: Illuminating the Design and Development Process of the European Health Literacy Survey Questionnaire (HLS- EU-Q). BMC Public Health, 13, 948. https://doi.org/10.1186/1471-2458-13-948
Taylor, M. K., Sullivan, D. K., Ellerbeck, E. F., Gajewski, B. J., & Gibbs, H. D. (2019). Nutrition Literacy Predicts Adherence to Healthy/Unhealthy Diet Patterns in Adults with a Nutrition-Related Chronic Condition. Public Health Nutrition, 22. https://doi.org/10.1017/S1368980019001289
TenHave, T. R., Van Horn, B., Kumanyika, S., Askov, E., Matthews, Y., & Adams- Campbell, L. L. (1997). Literacy Assessment in a Cardiovascular Nutrition Education Setting. Patient Education and Counseling, 31, 139-150. https://doi.org/10.1016/S0738-3991(97)01003-3
van Buul, V. J., Bolman, C. A. W., Brouns, F. J. P. H., & Lechner, L. (2017). Back-of-Pack Information in Substitutive Food Choices: A Process-Tracking Study in Participants Intending to Eat Healthy. Appetite, 116, 173-183. https://doi.org/10.1016/j.appet.2017.04.036
Velardo, S. (2015). The Nuances of Health Literacy, Nutrition Literacy, and Food Literacy. Journal of Nutrition Education and Behavior, 47, 385-389.e1. https://doi.org/10.1016/j.jneb.2015.04.328
Waqa, G., Bell, C., Snowdon, W., & Moodie, M. (2017). Factors Affecting Evidence-Use in Food Policy-Making Processes in Health and Agriculture in Fiji. BMC Public Health, 17, 51. https://doi.org/10.1186/s12889-016-3944-6
Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., Hale, F. A. et al. (2005). Quick Assessment of Literacy in Primary Care: The Newest Vital Sign. Annals of Family Medicine, 3, 514-522. https://doi.org/10.1370/afm.405
WHO (2003). Regimen alimentario, nutricion y prevencion de enfermedades cronicas: Informe de una consulta mixta FAO/OMS de expertos. https://apps.who.int/iris/handle/10665/42755
WHO (2013). Global Action Plan for the Prevention and Control of Non-Communicable Diseases 2013-2020.
WHO (2015). Taxes on Sugar-Sweetened Beverages as a Public Health Strategy: The Experience of Mexico.
Worsley, A. (2002). Nutrition Knowledge and Food Consumption: Can Nutrition Knowledge Change Food Behaviour? Asia Pacific Journal of Clinical Nutrition, 11, S579-S585. https://doi.org/10.1046/j.1440-6047.11.supp3.7.x
Zoellner, J., Connell, C., Bounds, W., Crook, L., & Yadrick, K. (2009). Nutrition Literacy Status and Preferred Nutrition Communication Channels among Adults in the Lower Mississippi Delta. Preventing Chronic Disease, 6, A128.