Autonomy and Health Literacy in Children’s Fruits and Vegetable Consumption

Background

Poor nutrition throughout the lifespan is implicated in several chronic diseases, yet many children do not meet dietary recommendations for fruit and vegetable (FV) consumption. Thus, prioritizing childhood nutrition and developing effective strategies for promoting healthy eating is important. Children in middle childhood may have increased opportunities to make food choices. However, these children lack the cognitive capacity for good decision-making and instead rely on previous experiences with foods to make decisions. The purpose of this study was to examine children’s health literacy (i.e., health-related reading, writing and numeracy skills) and autonomy. Specifically, we were interested in examining the relationships between autonomy, health literacy, and FV consumption.

Method

Data were collected from children 9-12-years-old (N = 57, 51% girls, 42.9% Black/African-American, 68.5% free/reduced-priced lunch) at community organizations in the Greater Boston area. Measures included health literacy (Newest Vital Signs; NVS and KidsHealth KidsPoll; KHKP), autonomy (Emotional Autonomy Scale), and dietary behaviors (Fueling Learning through Exercise; FLEX). Total correct responses on the NVS, KHKP, and total autonomy scores were computed. Daily serving of fruits and vegetables were computed from the FLEX dietary questionnaire. Preliminary analyses were conducted, including correlations between autonomy and health literacy variables. Regressions to predict daily FV consumption from autonomy and health literacy were estimated.

Results

Children had an average of 1.43 (SD = 1.47) daily servings of FV. According to the NVS, approximately 85.7% of children had limited health literacy (scores between 0 and 3) and the mean KHKP score was 29.57 (SD = 3.04). The autonomy scale mean score was 31.95 (SD = 3.99). Autonomy and health literacy variables were not significantly correlated. Autonomy accounted for 5% of the variance in, and was not significantly associated with children’s FV consumption (β = -.107, p = .108). The KHKP accounted for 18.7% of the variance in, and was positively associated with children’s FV consumption (β = .279, p = .001). The NVS accounted for less than 1% of the variance in, and was not significantly associated with children’s FV consumption (β = -.081, p = .675).

Discussion

Our findings suggest that children’s daily servings of FV are associated with their autonomy and health literacy skills. These findings support the notion that children are developing autonomy and health literacy skills which can be used for engaging in healthy decision-making simultaneously. Thus, interventions that focus on health eating and autonomy should also build in health literacy skills.