Food literacy and caregivers' perceptions related to healthy eating and salt/sodium reduction in children and adolescents: A qualitative study in Costa Rica

Abstract

Background: In the home environment, the dietary caregiver, usually the mother, is responsible for food planning, purchasing, and preparation processes and, therefore, has a significant influence on the family diet. The guardians' food literacy has been recognized as a set of interrelated food skills and knowledge to support healthy dietary outcomes, but few studies have deepened into parental perceptions of these household processes. Objective: To identify parental perceptions and food literacy regarding food planning, purchasing, and preparation at home that promote and/or hinder healthy consumption and salt/sodium reduction in children and adolescents. Method: A qualitative focus group study was conducted with the parents of children and adolescents who reported being primarily responsible for food planning, purchasing, and preparation at home. Forty mothers and four fathers with at least one son or daughter aged 7 to 15 years were asked to participate in at least two of eight focus groups held in classrooms at primary schools (2) and high schools (2) in Costa Rica. Discussion guides were developed with topics and subtopics within the framework of decision/action domains related to the planning, purchasing, and preparation of healthy foods and perceived barriers for implementing eating behaviors that lead to a healthy, low-salt/low-sodium diet. The focus groups were audio-recorded and transcribed. Thematic analysis was used to analyze the transcripts, and descriptive statistics were applied to systematize the sociodemographic characteristics of the participating parents. Results: Two main categories of parenting strategies were identified: "Creativity to Save Money" (which includes taking advantage of bargains, budget planning, food recycling, and proper storage) and "Creativity to eat healthy" (which includes using household appliances, selecting simple recipes, participatory meal planning, and encouraging children's collaboration in the kitchen). However, several barriers to the adoption of healthy eating habits were recognized, such as time constraints, difficulty meeting the diverse dietary needs of household members, exposure to unhealthy foods, and the high cost of foods considered healthy. Conclusions: Household eating practices are the result of a complex interaction between economic, temporal, cultural, and social factors. Qualitative findings indicated that mothers need strategies for time management, meeting multiple family needs, managing the market exposure of food on offer, and managing food resources, rather than solely receiving education (food literacy). These findings can support future behavior-based interventions to improve family diet quality, with an emphasis on salt/sodium reduction.