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Development and evaluation of an intervention to improve food and nutrition literacy among Iranian Kurdish primary school children: An application of intervention mapping approach
Open accessAbstract
Background: Food and nutrition literacy (FNLIT) is a relatively new term that is used to define the knowledge, skills, and behaviors necessary to achieve a healthy diet. Improving food and nutritional literacy in children is a necessary solution to eliminate nutritional disorders in this age group. The purpose of this study was to design, implement and evaluate an intervention to improve food and nutrition literacy in children aged 10–12 years old based on an intervention mapping (IM) approach. Methods: This experimental study was performed in three phases. Through the first phase, an intervention was developed using the (IM) approach. In the second phase, the intervention was implemented for 6 months, and in the third phase, the intervention outcomes were evaluated and compared with the control group through a randomized controlled trial among 300 participants (each control and intervention group = 150). Results: Before the intervention, there was no significant difference between the control and intervention groups in all subscales of FNLIT. After the intervention, there was a significant difference between the control and intervention groups in all subscales of FNLIT ( P < 0/001). There were no differences between the two groups in terms of the FNLIT scores at baseline ( P > 0.05). However, after 6 months of intervention, a significant difference was observed between the two groups (intra-group differences) ( P < 0.001). Such a difference was not identified in the control group after 6 months also the results show the impact of socioeconomic factors and parental literacy on the average score of students' FNLIT and after the intervention, a significant difference was observed between the scores of control and intervention groups in all subscales of the FNLIT ( P < 0.001). Conclusions: The school-based intervention developed and evaluated in this study provides a basis for future programs targeting the improvement of FNLIT in children, especially in poor and deprived areas such as Kurdistan province. Clinical trial registration: Iranian Clinical Trials Registry (IRCT) Code: 32094.
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“Including food and nutrition literacy, general nutrition knowledge, and obesity-related knowledge, generally improved following intervention, although the magnitude and consistency of effects varied across studies [43–55].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Several interventions extended this content to food processing, food classification, and label-related competencies, including label literacy, nutrition label comprehension, classification of healthy and unhealthy foods, recognition of processed and ultra-processed foods, and understanding of the health and environmental implications of food choices [43, 44, 53, 54, 59, 62, 63].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Across studies, curriculum content consistently addressed foundational nutrition knowledge, including food and nutrient concepts, healthy eating, food groups, daily caloric intake, hydration, obesity-related knowledge, and balanced diet principles [43, 49, 51, 53–55, 62, 63].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Behavioral and decision-oriented components were likewise common and included food choice, planning, goal-setting, portion awareness, self-efficacy, intention formation, and family or peer reinforcement [43, 44, 46, 47, 50, 52–56, 61–63].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Nutrition education—covering definitions, food groups, and nutrient functions—was included in 20 intervention programs [43–59, 62–64].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Lessons covered choosing healthier snacks, reducing sugary drink intake, increasing fruit and vegetable consumption, and making appropriate choices across common settings, such as school, home, and when eating out [43, 53–56, 64].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“These activities aimed to help students read nutrition labels, identify foods high in fat, sugar, or salt, and use this information when making food choices [43, 49, 53, 54, 62].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Most interventions enhanced cognitive literacy, including knowledge of food groups, nutrient awareness, and label comprehension [43, 55].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Ahmadpour [43] also reported a much larger effect size than Lakshman [49] and Rosati [57].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Marked improvements in comprehensive literacy measures were observed, particularly significant gains across all subdomains of food and nutrition literacy [43].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
The cited source says what the claim attributes to it.
In the citing paper
“Practical skill practice (gardening, cooking, label reading, game-based challenges) appeared in 13 studies [43, 45, 47–50, 52, 53, 55, 58, 61, 63, 64].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
The cited source says what the claim attributes to it.
In the citing paper
“Only a minority modified access to healthier food or drink (two studies [43, 44]) or tackled media-literacy (three studies [43, 47, 58, 63]) (Supplementary files 2; Table 1 key characteristics of studies included in the review).”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
The cited source says what the claim attributes to it.
In the citing paper
“Intervention durations varied, with nine studies lasting not longer than three months [45–50, 53, 57, 62], four studies lasting 4–6 months [43, 55, 56, 58], and eight studies lasting 7–12 months [44, 51, 52, 54, 59, 61, 63, 64].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
The cited source says what the claim attributes to it.
In the citing paper
“Weekly sessions were the most common schedule (12 studies [43–46, 48, 50, 53, 55, 56, 59, 62, 63]).”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
The cited source says what the claim attributes to it.
In the citing paper
“Classroom teachers were the principal facilitators in 19 studies [43–49, 51–57, 59, 61–64], often after brief training.”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
The cited source says what the claim attributes to it.
In the citing paper
“One study explicitly incorporated media literacy by addressing resistance to food advertising as part of a broader food and nutrition literacy program [43].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
The cited source says what the claim attributes to it.
In the citing paper
“Includes studies reporting results based on nutritional knowledge (10 studies) [43, 49, 53–55, 57, 58, 61–63] and nutritional behavior (10 studies) [44, 46, 48, 50, 52, 53, 56, 59, 61, 64], as seen in Fig. 1.”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“In 18 of the 21 studies [43–59, 61–64], the stated primary outcome was improved knowledge of nutrition or obesity prevention, highlighting the field’s didactic focus.”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
Experimental — accuracy not yet measuredIn the citing paper
“Intervention components and curriculum content were delivered predominantly through school-based, classroom-oriented formats, which were reported in 18 studies [43–47, 49, 51–59, 61–63].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
In the citing paper
“Curricula consistently introduced basic food groups and their nutritional value, then built toward a clearer understanding of macronutrients, micronutrients, fiber, and water [43, 55, 59].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [43]
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Citations
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Popkin, B. M., & Gordon-Larsen, P. (2004) · International Journal of Obesity · doi:10.1038/sj.ijo.0802804 · Cited by 1,538
Intervention Mapping: A Process for Developing Theory and Evidence-Based Health Education Programs
Bartholomew, L. K., Parcel, G. S., & Kok, G. (1998) · Health Education & Behavior · doi:10.1177/109019819802500502 · Cited by 1,102 · cited 1×
“, IM comprises six steps, as follows: (1) needs assessment, (2) creating change goals matrix, (3) theory-based operational solutions, (4) program design, (5) program acceptance and implementation, and (6) program evaluation (35).”
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Cited by
Sorted by citations
Posri, S., Powwattana, A., Lagampan, S., Chongsuwat, R., Boonmanunt, S. W., & Wongkampun, S. (2026) · BMC Public Health · doi:10.1186/s12889-026-27909-w
Metadata
- Authors
- Ahmadpour, M., Omidvar, N., Shakibazadeh, E., Doustmohammadian, A., & Rahimiforoushani, A.
- Affiliations
- Maragheh University of Medical Sciences (IR)
- National Nutrition and Food Technology Research Institute (IR)
- Tehran University of Medical Sciences (IR)
- Iran University of Medical Sciences (IR)
- Corresponding author
- Omidvar, Nasrin
- ORCID
- Venue
- Frontiers in Public Health
- Publisher
- Frontiers Media SA
- Published
- 2023-01-04
- Volume
- 10
- Pages
- 1059677-1059677
- ISSN
- 2296-2565 (ISSN-L)
- PMC
- PMC9845926
- OpenAlex
- W4313588187
- Cited by
- 14
- References
- 2
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 1 · 2023: 1
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Tehran University of Medical Sciences and Health Services
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › School Health and Nursing Education
- Keywords
- food and nutrition literacy, school-based intervention, elementary school students, intervention mapping, child nutrition, healthy eating, socioeconomic factors, parental literacy, Kurdistan Province
- MeSH terms
- Child, Humans, Iran, Nutritional Status, Schools, Students, Health Literacy
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