Table 1.

Summary characteristics of the food literacy and nutrition literacy tools for children and adolescents

Author (year), country of origin	FL or NL	Tool name	Purpose	Conceptual framework	Number of items and constructs assessed	Scoring details	Method of development	Method of administration	Sample characteristics
Khorramrouz (2021), Iran	FL and NL	Modified Food and Nutrition Literacy (M-FNLIT)	To update the previous version of the FNLIT questionnaire in upper primary schoolchildren in Mashad	Not specified, assumed to be based on the same conceptual framework as the FNLIT tool (Nutbeam’s model(37))	40 items measured under 2 domains with 6 subscales: cognitive (understanding food and nutrition information, nutrition health knowledge); skills (functional, interactive, food choice literacy, critical)	36 Likert-type items and 4 true-false questions. Scores of ‘1’ to ‘5’ were allocated to the response of items, except items 9–15 were inversely scored. True-false questions were dichotomized, whereas a score of ‘1’ for incorrect and ‘5’ for correct responses. Total raw scores range from 40 to 200 which were then proportionally transformed to a total between 0 and 100	A 4-phase process was applied: Phase 1: content and face validity of the questionnaire using Delphi consensus and interviewing; Phase 2: construct validity assessed; Phase 3: Internal consistency and reliability evaluated; Phase 4: Detect cut-off scores of the M-FNLIT scale	Self-reported survey in paper and pen format	Sampled included (n = 319) students aged 9–12 years of age where 48·9 % were girls. Majority of sample had a normal BMI z-score (boys: 59·5 %, girls: 56·4 %) where 20·9 % of boys were obese and 25 % of girls were overweight. In addition, most of the sample’s mother and father were mid-to-highly educated, only a small proportion were either illiterate or had less than or equal to 5 years of education. 64 students took part in the test–retest assessment
Liu (2021), China	FL and NL	Food and Nutrition Literacy Questionnaire for Chinese School-age Children (FNLQ-SC)	To develop and validate a questionnaire to assess the food and nutrition capacity of children and provide targets for further nutrition education and intervention	Nutbeam’s model(37): functional nutrition literacy, interactive nutrition literacy, critical nutrition literacy	50 items measured under 2 domains with 5 subscales: knowledge and understanding (knowledge and understanding of food and nutrition); skill (access to and planning for food, selecting food, preparing, eating) with 19 components	Questions included 5-point Likert type questions (e.g. “I am concerned about nutrition and health information: never, seldom, sometimes, usually, always”), choice questions (e.g. ‘Which of the following snacks is healthier?’), and fill-in-the-blank questions (e.g. ‘Fill in your height and weight.’). Each question was scored based on 2 points. Highest possible score for students of grade 7–8 is 100, while grades 5–6 is 98 (1 question skipped) and grade 3–4 is 92 (4 question skipped)	A 2-phase process was applied: Phase 1: Construction of food and nutrition literacy core components for school-aged children (including literature review and expert interview using Delphi consensus); Phase 2: Questionnaire development (evaluating appropriateness, readability and difficulty)	Self-reported, did not detail method of administration	Sample included students aged 7–17 years (n 2452) for the reliability and validity study. Most of the students were 13–15 years of age (92·6 %), and about half were female (49·6 %). Family affluence status with 13·6 % as poor, 53·3 % as medium and 32·1 % as affluent. Caregiver’s education level was mostly (49·1 %) junior high school and roughly 52·8 % have received nutrition education at school
Stjernqvist (2021), Denmark	FL	Food Literacy Instrument	To develop, test, and validate an instrument to measure food literacy in schoolchildren aged 11–15 years	Deductive approached based on Benn’s 2014(38)	37 items and 5 constructs: to know (understanding of coherence); to do (everyday life competencies, practical and technical); to sense (sensory competencies in cooking and tasting); to care (ethical considerations); and to want (citizenship, responsibility and willingness)	35 Likert-type items and 2 true/false items. Each competency has its own response options (e.g. to sense: have not tried this – very difficult – difficult – easy – very easy; or to know: correct – wrong – do not know). No information on scoring details; but higher scores indicates more food literate	A 3-phase process was applied with 8 steps: Phase 1: development by experts (content validity); Phase 2: scale testing (face validity, sampling and survey administration, item analysis); Phase 3: validation (test of dimensionality, reliability, and validity)	Self-reported questionnaires administered electronically during a single school lesson	Sample included (n 817) students in grades 6–7 where 55 % were girls. Little over two-thirds of the sample were from public schools while the latter were from a private school. About half of the sample took part in the development (n 409), and the validation (n 408) while a smaller subset (n 267) took part in retest
Ashoori (2020), Iran	FL and NL	Food and Nutrition Literacy Assessment Tool (FNLAT)	To develop and validate a FNLAT for high-school graduates and young adults in Iran	Nutbeam’s model(37): functional nutrition literacy, interactive nutrition literacy, critical nutrition literacy	60 items measured under 2 domains with 6 subscales: knowledge (food and nutrition knowledge); skills (functional, interactive, advocacy, critical analysis of the information, food label and reading skills)	Questions included binary questions (e.g. assessing food and nutrition knowledge and food label reading skills) and Likert type questions (e.g. assessing skill domain)	A 5-phase process was employed: Phase 1: Identification of FNL components for high school graduates and youth; Phase 2: Item generation and drafting the questionnaire; Phase 3 Assessment of content and face validity; Phase 4 Assessment of construct validity; and Phase 5 Assessment of reliability of the developed questionnaire	Self-reported, did not detail method of administration	Sampled included (n = 697) students aged 17–18 years of age where 51·5 % were female. The majority (52·2 %) were from high SES city districts, while others were from middle SES (24·7 %) and low SES (23·1 %) city districts. 28 students took part in the test–retest assessment
Deesamer (2020), Thailand	NL	Thai–Nutritional Literacy Assessment Tool for Adolescents (Thai–NLAT)	To develop the Thai–NLAT and test its validity and reliability	Nutbeam’s model and Velardo’s concept(37): functional nutrition literacy, interactive nutrition literacy, critical nutrition literacy	61 items assessing 5 constructs: macronutrients–micronutrients and health; nutrition and energy balance; decision–making on nutrition information; food processing; food safety	Scored out of a maximum of 61 points: 3 choices scale; incorrect responses scored as ‘0’ and correct responses scored as ‘1’ with scores summed with a higher final score indicating better nutrition literacy	A 2-phase process was employed: Phase 1 (Steps 1–5) qualitative interviews with experts to generate tool items, and preliminary item tryout (content validity, face validity, internal consistency); Phase 2 (Step 6): psychometric tests (concurrent validity, construct validity)	Self-reported, did not detail method of administration	Step 5: preliminary item tryout from (n = 275) Thai adolescents in grade 7–9 and grade 10–12 in public schools Bangkok Step 6: psychometric testing among (n 442) Thai adolescents with a mean age of 14·7 ± 1·8 years and 57·9 % were males. Majority were normal weight (76·9 %) and some were obese (13·3 %), overweight (6·1 %) and underweight (3·6 %)
Tabbachi (2020), Italy	FL	Preschool–Food Literacy Assessment Tool (Preschool–FLAT)	To assess the validity and internal consistency of the Preschool–FLAT	Vidgen’s description of FL knowledge and skills components(6)	20 items assessing 5 constructs: relationship between weight status and food/health; relationship between food quality/quantity and health, and knowing the main food categories; relationship between food and environment; traditional foods; distribution of foods at different daily meals	Scored out of a maximum of 20 points; each domain measured on a 5-point Likert scale (0–4): ‘0’ indicates no food literacy and ‘20’ indicates high food literacy	The Preschool–FLAT was previously developed by the Training-to-Health team. The following measures were assessed in this study: content validity (expert panel); internal consistency (Cronbach’s α); construct validity (structural equation modeling); discriminant validity (intervention v. control group)	Assessed by the educator in paper and pen format	Sample included (n 505) preschoolers. 53·7 % were male, most were 5–6 years (44·4 %), 4 years (39·6 %) and the remaining were 3 years (16·0 %). Half of the sample were from a low/medium school SEE (55·8 %) and medium/high school SEE (44·2 %). A majority of the children were normal weight (66·5 %) with a mean BMI of 16·3 kg/m2(sd 2·5)
Amin (2019), US	FL	Tool for Food Literacy Assessment in Children (TFLAC)	To develop and describe the content validity and reliability of a food literacy assessment tool among low-to-middle income, ethnically and racially diverse school-aged children (grades 4–5)	Not specified	25 items assessing 5 constructs: cooking skills; cooking knowledge; nutrition knowledge; food systems knowledge; and self-efficacy regarding eating	Scored out of a maximum of 40 points (details not provided): higher a score indicates more food literacy while a lower score represents less food literacy	A 3-phase process was used: Phase 1: content validity (Delphi panel with experts, content validity ratios); Phase 2: Tool Pilot study among children (feedback on each question); Phase 3: internal consistency (Cronbach’s α) and test-retest reliability (intraclass correlation coefficient) among children	Self-reported survey in paper and pen format	Phase 2: children from 2 Massachusetts elementary schools (n 38; grades 4–5) both sets were non-white (45 % and 66 %) and lower socioeconomic status (40 % and 52 %); Phase 3: children (n 706; aged 9–11) from 12 low-to-middle SES (26 %–65 %) racially and ethnically diverse elementary schools and afterschool programs
Naigaga (2018), Norway	NL	Critical Nutrition Literacy Scale (CNL–E)	To examine the psychometric properties of the CNL-E scale to measure adolescents’ perceived proficiency in ‘critically evaluation nutrition information from various sources’	Nutbeam’s model(37): functional nutrition literacy, interactive nutrition literacy, critical nutrition literacy	5 items and 2 constructs: the extent of trusting nutrition information from different sources (items 1–3); and the proficiency to establish the falsifiability of nutrition claims by judging the information against basic knowledge nutrition (items 4–5)	Scored out of a maximum of 30 points with responses scaled on a 6-point scale from ‘very difficult’ as ‘1’ to ‘very easy’ as ‘6’: higher scores represent higher perceived proficiency in critically evaluating nutrition information	The Rasch analysis approach was used to examine the psychometric properties of the CNL-E; as well as multidimensional Rasch modelling and confirmatory factor analysis	Self-reported questionnaire using an electronic survey system	Sample included (n 1622) students aged 15–16 years in grade 10 from roughly 60 schools in Norway. Students reported: gender, predominant language, place of birth, and an indicator of socioeconomic status; however, the article did not detail such information
Doustmohammadian (2017), Iran	FL and NL	Food and Nutrition Literacy (FNLIT)	To develop and test the validity and reliability of a questionnaire that assess food and nutrition literacy in elementary school children in the city of Tehran	Nutbeam’s model(37): functional nutrition literacy, interactive nutrition literacy, critical nutrition literacy	46-items measured under 2 domains with 6 subscales: cognitive (knowledge and understanding); skills (functional, food choice, interactive, and critical skills)	42 Likert-type scale and 4 true/false items. Did not mention the scoring details	A 3-phase process was applied: Phase 1: literature review and qualitative study to identify food and nutrition literacy dimensions and scale items; Phase 2: development and validation of the scale (item generation, content validity, face validity, construct validity, reliability); Phase 3: Confirmatory study	Self-reported, did not detail method of administration	Phase 2: construct validity study among (n 373) students in grade 5 (48 %) and 6 (52 %) with a mean age of 11·1 ± 0·6 years and about half were male (51 %). Phase 3: confirmatory study among (n 400) students aged 10–12 years (11·3 ± 0·6) and similarly, roughly half were male (51 %). Both studies also described their sample in terms of educational districts based on three socioeconomic levels
Williams (2017), US	NL	Menu Board Literacy (MBL) Instrument	To develop and measure the psychometric properties of an instrument that assesses menu board literacy in children	Not reported	27 items and 2 constructs: menu board literacy (20 items) and self-efficacy (7 items)	It is presumed that the menu board literacy items had one correct answer while the self-efficacy items were assessed on a 5-point Likert scale (‘Definitely cannot do this’ to ‘Extremely Confident’). However, the study did not provide details on the scoring	A 2-phase process was employed: instrument development (review, generation of items, content validity by panel of experts, cognitive interviews to students to generate final set of items) and assessment of reliability/readability (internal consistency both pretest and post-test, the Flesch Reading Ease Index)	Self-reported measure in paper and pen format; students were not able to use a calculator	Phase 1: cognitive interviews on (n 24) Black and Hispanic 4th and 5th graders Phase 2: 2 convenience samples of similarly representative students (n 32 and 141, respectively). Children were recruited from low-income New York City neighborhoods
Guttersrud (2015), Norway	NL	Engagement in Dietary Behaviour (EDB) scale and Self-Efficacy (se) in Science Scale	To assess the appropriateness of using latent scales to measure critical nutrition literacy	Nutbeam’s definition of Nutrition Literacy(37) Schwarzer and Fuchs(39) social-cognitive model of health behavior change, including self-efficacy	8-items in the engagement in dietary behaviour scale (Engagement Scale); 11-items in the critical stance towards nutrition claims (Claims Scale)	Six-point rating scale (strongly disagree, to strongly agree) for both scales	The Rasch model was used to assess item discrimination, model fit, reliability and targeting – with the purpose in constructing a valid and reliable measure	Self-reported measure using and electronic survey system	Sample included (n 740) tenth-grade students with an age range from 14–15 years where 48 % of the students were females and 9 % were minorities
Reynolds (2012), United States	NL	Food Label Literacy for Applied Nutrition Knowledge (FFLANK)	To determine the reliability and validity of a 10-item questionnaire, the FLLANK	Not specified	10-items assessing the ability to make healthful food choices based on the Nutrition Facts and ingredients lists found on food labels	Scored by the percentage of correctly identified products with response options including: ‘Label A’, ‘Label B’ or ‘Don’t Know’	The FLLANK was designed by the developers of nutrition knowledge intervention, titled Nutrition Detectives. The tool was administered 4 times: before and after the program, and then 3 months later, before and after the additional session	Self-reported measure in paper and pen format; teachers are asked to evaluate the answers with the answer sheet provided	Sample included (n 499) elementary school aged children (mean age 8·6 ± 0·9 years) from grades 2–4 where 51 % of the students were girls

FL, food literacy; NL, nutrition literacy.