Report

Barriers to Food Literacy: A Conceptual Model to Explore

Factors Inhibiting Proficiency
D1X XEmily Truman, D2X XPhD1; D3X XCharlene Elliott, D4X XPhD2

ABSTRACT
Food literacy research typically conceptualizes food-related knowledge and skills as contributing to improved health
and nutrition; however, there is limited research examining the process that leads to this improvement. This article
reviews the literature reporting barriers to food literacy proficiency in order to examine the relationship between
food-related knowledge, attitudes, and behaviors. Informed by these barrier types, its central objective is to develop a
model of food literacy proficiency that highlights the relationship between nutrition education and health-related out-
comes. This model will help researchers, educators, and nutrition professionals implement effective interventions with
enhanced capacity to change food-related behaviors.
Key Words: food literacy, barrier, health behavior, nutrition, knowledge, attitude (J Nutr Educ Behav. 2019;
51:107−111.)
Accepted August 13, 2018. Published online September 22, 2018.

INTRODUCTION food literacy proficiency at 3 levels of through emphasis on information

adoption (individual, school, com- acquisition and application. For
Food literacy is conceptualized as a munity), and develops a model that example, Kolasa et al10 define food lit-
set of food-related skills and knowl- highlights considerations for imple- eracy as
edge that, if appropriately adopted, mentation. An improved under-
empower the individual to make standing of the range of barriers will
. . . the capacity of an individual to
informed choices about food and highlight where the efficacy of inter-
obtain, interpret, and understand
nutrition in relation to the broader ventions can be improved to pro-
basic food and nutrition informa-
food environment, contributing to mote nutrition education in schools
tion and services as well as the
improved health.1−7 Food literacy and other community programs. The
competence to use the information
has the potential to influence eating proposed model aims to help research-
and services in ways that are
patterns8 and to promote improved ers, educators, and nutrition professio-
health enhancing.10
population health.6 However, there nals design and implement effective
is limited research conceptualizing interventions with enhanced capacity
the relationship between such pro- to change food-related behaviors. Similarly, Vidgen and Gallegos5 stress
gramming and health-related out- A recent scoping review examining the importance of knowledge to con-
comes (ie, improved knowledge, definitions of food literacy found tribute to improved food intake,
attitudes, behaviors). Desired out- that a broad range of definitions of arguing that food literacy is
comes can be better understood the term exist in health and education
through an examination of the range research.9 These definitions identify a
of factors promoting and inhibiting variety of core themes, including composed of a collection of inter-
them: healthy food behaviors may be skills/behaviors, health/food choices, related knowledge, skills and
positively influenced by personal culture, knowledge, emotions, and behaviors required to plan, man-
food values, but negatively influ- the broader food system.9 Despite age, select, prepare and eat food to
enced by lack of food availability. this thematic variety, knowledge out- meet needs and determine intake.5
This article provides an overview of comes are commonly emphasized
the literature reporting barriers to across these conceptualizations These conceptualizations emphasize
the importance of knowledge acquisi-
tion in establishing behavioral
1 changes in relation to food, and also
Department of Communication, Media and Film, University of Calgary, Calgary, Alberta,
Canada inform our conception of food liter-
2 acy in 2 significant ways. First, the
Communication, Media and Film, University of Calgary, Calgary, Alberta, Canada
Conflict of Interest Disclosure: The authors have not stated any conflicts of interest. potential to achieve health-related
Address for correspondence: Emily Truman, PhD, Department of Communication, Media outcomes requires a focus on, not
and Film, Social Sciences Building, Room 320, 618 Campus Place NW, University of Cal- only knowledge (eg, what is a healthy
gary, Calgary, AB T2N 1N4; E-mail: emily.truman@ucalgary.ca food?), but also on other intermediary
Ó 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights factors such as attitudes (eg, motiva-
reserved. tion to adopt healthy eating habits)
https://doi.org/10.1016/j.jneb.2018.08.008 and behaviors (eg, cooking and eating

Journal of Nutrition Education and Behavior  Volume 51, Number 1, 2019 107
108 Truman and Elliott
healthy foods), as well as external bar-
riers (eg, home environment without
access to healthy foods). Second, a
better understanding of the relation-
ship between these intermediary fac-
tors—that is, how they connect, and
potentially influence each other—is
critical to discerning how food liter-
acy interventions can be improved in
order to contribute to health-related
outcomes.
Informed by these points, barriers
are examined here as intermediary
factors in the relationship between
food literacy and health-related out-
comes. Barriers are defined as any fac-
tor preventing the acquisition or use
of food-related knowledge, attitudes,
or skills. Their role in the process of
developing food literacy proficiency
(ie, competence in applying food
knowledge/skills to food choices/
issues) is explored through the use of
a conceptual framework adapted from
Cabana et al,11 which examines the
limiting effects of barriers on the
adoption of health care behaviors.
While the original model was devised
to evaluate factors impeding adher-
ence to information communication
practices in health care settings, its
conceptualization of the sequence of
behavior change (and role of barriers in
that process) is particularly useful for
conceptualizing desired outcomes in
literacy interventions featuring infor-
mation acquisition. In particular, it
takes a comprehensive approach to
the study of barriers in 3 categories
(skills/abilities, resources, environ-
mental conditions), as external factors
with the potential to affect the adop-
tion of improved behaviors.11 Consid-
eration of these barriers should be
central in intervention design and
implementation to optimize their
effectiveness in achieving desired out-
comes around health and nutrition
education.
DESCRIPTION OF REVIEW
A review of existing literature reporting
barriers and facilitators to food literacy
proficiency was conducted using data
from a previously performed scoping
review on food literacy definitions,9
updated to include all available litera-
ture to September 2017. The databases
used included Medline, PubMed,
Embase, CAB Abstracts, CINAHL,
Journal of Nutrition Education and Behavior  Volume 51, Number 1, 2019
Scopus, JSTOR, Web of Science, and
Google Scholar. To capture the range
of scholarship in this emergent area,
study types include published articles,
gray literature, and graduate scholar-
ship (ie, MA theses, doctoral disserta-
tions). The search located 1,407
abstracts, of which 38 were identified
for inclusion because they reported
barriers or facilitators to food literacy
development.2,4,6,9,10,12−45 In total,
133 barriers and facilitators were iden-
tified, with barriers reported almost
twice as frequently (66%) as facilitators
(34%). Barriers were chosen for further
analysis because they represented the
majority of reported factors affecting
food literacy proficiency, and because
they occur in a wide range of intercon-
nected contexts, underlining their
complexity. As evidence of their intri-
cacy, barriers were identified in rela-
tion to 3 different “levels” of food
literacy adoption: individual level (per-
sonal and interpersonal settings, such
as the home); school programs (institu-
tional setting of the middle school or
high school), and community programs
(profit/nonprofit community organi-
zations, social welfare programs). Fur-
ther, within each of these 3 levels,
different types of barriers were identi-
fied, including: knowledge, attitudes,
skills/abilities, resources, and environ-
mental conditions.
To better understand the relation-
ship between these barrier types, they
were analyzed in relation to a frame-
work developed by Cabana et al11 that
illustrates the connections between
cognitive factors (knowledge), affec-
tive factors (attitudes), and restrictions
on abilities (behaviors) in the decision-
making process, allowing for a better
understanding of how potential
behavior change takes place. The
framework maps barriers according to
3 main domains: knowledge, attitudes,
and behaviors, the last of which
includes all external limitations,
including skills/abilities, resources,
and environmental conditions. Over-
all, organizing the barriers identified
by this report according to these cate-
gories, behavioral limitations (or exter-
nal factors) are identified as the largest
group (66%), followed by knowledge
limitations at 19%, and attitudinal bar-
riers at 15%. Specified across each of
the 3 levels of food literacy adoption
(individual, school programming,
community programming), Figure 1
presents the distribution of reported
barrier types in each, with emphasis on
behavioral limitations or external fac-
tors, and its subcategories: skills/abili-
ties, resources, environmental
conditions. These subcategories are sig-
nificant as they represent the majority
of the barriers reported across each
level of food literacy adoption, and
while the lack of skills/abilities is a defi-
cit directly addressed in literacy inter-
vention programming, deficits related
to resources and environmental condi-
tions are potentially more challenging
to address. The most frequently
reported resource barriers at each level
of food literacy adoption included
lack of (learning) time for individu-
als,12,15,18,26,33,36 lack of interested/
trained teachers,4,19,34,39 and lack of
funding for community program-
ming.10,40 And the most frequently
reported barriers in relation to environ-
mental conditions across the levels of
adoption included home/living envi-
ronment,12,13,33,41 the undermining of
healthy food choices by school envi-
ronment,19,20 and community food
insecurity.6
DISCUSSION
The findings above highlight the
importance of intermediary factors in
the development of food literacy.
While knowledge and attitudes are
important in facilitating behavioral
changes, Cabana et al argue that these
2 factors
are necessary but not sufficient
for adherence . . . [an individual]
may still encounter barriers that
limit ability to perform the recom-
mended behavior due to . . . [exter-
nal] factors.11
In particular, external factors (includ-
ing resources and environmental condi-
tions), can restrict the abilities of an
individual, institution, or organiza-
tion to adopt specific behaviors.11
This points to the challenges inher-
ent in changing not only food-related
knowledge levels and attitudes, but
also food-related behaviors.
In light of these complexities, and
informed by Cabana et al’s frame-
work, a conceptual model is presented
here theorizing the relationship
Journal of Nutrition Education and Behavior  Volume 51, Number 1, 2019 Truman and Elliott 109

Figure 1. Distribution of barrier types across 3 levels of food literacy adoption, with emphasis on external factors with
potential to limit behaviors (in gray). Key examples of barriers in each category include: knowledge—lack of informa-
tion; attitudes—lack of interest; skills/abilities—lack of acquisition/application skills; resources—lack of time; and
environmental conditions—context-specific limitations of home, school, food-choice environment, and social norms.

between food literacy and health-
related outcomes, highlighting the
potential role of intermediary factors
of food knowledge, attitudes, and
behaviors (Figure 2). It is important to
note that because this model is based
upon findings from published, gray,
and emergent (graduate theses) litera-
ture, its overall validity must be con-
firmed by future research findings.
However, it provides a starting point
based on barriers identified in existing
literature (both evidence-based and
hypothesized), for theorizing
potential factors limiting intervention
outcomes. This sets it apart from
existing conceptual models of food
literacy examining key attributes,5,8
and in relation to specific contexts
such as community food security.6
Instead, this model is unique in con-
sidering where barriers are introduced
in the relationship between food liter-
acy and health-related outcomes.
In the proposed model, food liter-
acy interventions are understood as
educational programs that promote
the acquisition of knowledge (both
functional—eg, competencies—and
critical—eg, understanding9). Thus,
they contribute directly to an indi-
vidual’s level of food knowledge,
which, in turn, has the potential to
influence changes in food attitudes,
and following this, changes in food
behaviors. This progression mirrors
the “sequence of behavior change”
theorized by Cabana et al11 (eg,
knowledge to attitudes to behavior),
but as the authors point out, this
process is also impacted by external
factors (ie, skill levels, resources, and

Figure 2. Conceptual model of food literacy proficiency, highlighting potential for external factors to limit behavior
change.
110 Truman and Elliott
environmental conditions), which
not only inhibit the adoption of food
behaviors, but can also inhibit the
development of food attitudes and
knowledge acquisition. In line with
this theorization, this conceptual
model does not depict a direct con-
nection between food literacy knowl-
edge and improved health and
nutrition outcomes, as there is limited
research on this relationship. Instead,
it points toward a potential chain of
effects that includes a complex set of
external barriers acting upon the pro-
cess. This highlights the importance
of carefully considering the role of
barriers in inhibiting individual nutri-
tion-related behaviors, and raises
questions about how those barriers
may impact community- and popula-
tion-level health outcomes as well.
This report highlights the preva-
lence of external barriers in relation
to food literacy proficiency, and this
conceptual model suggests that
external barriers are key to under-
standing the relationship between
nutrition education and health-
related behaviors. However, address-
ing external barriers is challenging.
Some external barriers may be over-
come by the supply of adequate
resources.11 For example, new teach-
ing materials19,30,41 or access to
equipment26 and facilities23 can con-
tribute to the ability to offer food lit-
eracy programming. Other resource
barriers such as “lack of time” (for
both individuals to learn, and educa-
tors to instruct) are more challenging
to address because their limiting
effects are rooted in broader cultural
attitudes that undervalue the topic of
food literacy.4,16,34 Environmental
conditions are particularly complex
external barriers to address in rela-
tion to individual food literacy profi-
ciency, as they not only highlight
the importance of supportive home
and school settings, but also draw
attention to the need to consider
how the conditions of the social/psy-
chological environment (including
gender difference)13,41 and the
potential effects of the food-choice
environment (such as access to
healthy/unhealthy foods)15,22 may
limit individual proficiency despite
increased food knowledge. At the
level of school programming, for
example, such concerns are reflected
Journal of Nutrition Education and Behavior  Volume 51, Number 1, 2019
in the identification of barriers
related to food choices and food prac-
tices that represent shifts in social
norms such as the “normalization of
fast and convenience foods” and
declines in home cooking,4 which
may impact the ability to effectively
teach food literacy skills. Environ-
mental conditions pose distinct chal-
lenges to food literacy improvement
at all 3 levels of adoption because
they involve complex social relation-
ships and cultural values, and have
broad impacts in terms of food atti-
tudes and habits. That complex envi-
ronmental factors represent the
majority (66%) of barriers to food lit-
eracy proficiency suggests the need
for widespread policy support in the
areas of food education, food secu-
rity, and public health in order to
begin to address the role that envi-
ronmental conditions (or sociocul-
tural contexts) play in contributing
to unhealthy eating practices.
IMPLICATIONS FOR
RESEARCH AND PRACTICE
This report underlines the complexity
of barriers to food literacy proficiency,
and uses them to develop a concep-
tual model that highlights the rela-
tionship between nutrition education
and health-related outcomes. While
the actual impact of these barriers
must be confirmed by future research
findings, and the model tested for rel-
evance, their presence nonetheless
has implications for study design and
intervention implementation for
researchers, educators, and nutrition
professionals because it suggests the
range of barriers that can potentially
affect the planning, execution, and
evaluation stages. Further, it points to
the need to consider contextual fac-
tors in the application of food literacy
programming in order to apply it in
various settings. Given the focus on
barriers related to the environmental
conditions (including social and cul-
tural factors), this report suggests the
need for targeted interventions to
address sociocultural topics related to
food that examine its meaning and
value in everyday life, such as the
symbolic functions of foods, food
marketing and advertising, and food
availability’s impact on food choice.
Future research is needed to better
understand whether increased atten-
tion to the sociocultural dimensions
of food in relation to nutrition educa-
tion actually results in improved
health-related behaviors. However, in
considering the potential impact of a
range of external barriers on food lit-
eracy proficiency, this report, and the
conceptual model presented, support
the broader goal of producing more
effective interventions related to
nutrition education.
ACKNOWLEDGMENTS
Emily Truman and Charlene Elliott
acknowledge funding support from
the O’Brien Institute for Public
Health at the University of Calgary,
and the Canada Research Chairs Pro-
gram. Additionally, Emily Truman
acknowledges funding support from
the Canadian Institute of Health
Research’s Institute of Population &
Public Health in the form of a com-
munity support travel grant (ISU-
152135) that allowed for the presen-
tation of part of this research at the
Canadian Public Health Association’s
annual conference in Halifax, Can-
ada in June 2017.
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