Open access

Knowledge and perceptions of the 2019 Canada's Food Guide: a qualitative study with Canadian children

Publication: Applied Physiology, Nutrition, and Metabolism
1 November 2022

Abstract

To support Canadians ages 2 years and older in improving their dietary intake, Health Canada released a revised Canada's Food Guide (CFG) in 2019. This study aimed to explore the knowledge and perceptions of the 2019 CFG among children ages 9–12 years old from Southwestern Ontario. From September–November 2021, interviews were conducted with children by video conference. Thirty-five children (50% girls, 80% White; mean age 9.9 years) participated. Data were analyzed using a hybrid thematic approach with inductive and deductive analyses. Children expressed a lack of knowledge on certain foods (i.e., plant-based proteins, whole grains, and highly processed foods) that are highlighted in the CFG. Children also expressed confusion around food groups, including recommended proportions and categorization of some foods (e.g., dairy products and plant-based proteins). Children generally expressed positive perceptions regarding CFG and its eating habit recommendations, i.e., “Cook more often”, “Eat meals with others”, and “Enjoy your food”, and they suggested strategies to improve adherence to these recommendations, including providing children more responsibility and independence with food preparation tasks and minimizing family time conflicts. Children's perceptions of the CFG can help inform public health policies and programmatic strategies designed to support children's food choices and eating habits.

Résumé

Une révision par Santé Canada du Guide alimentaire canadien (GAC) a été faite en 2019 afin d’améliorer l’apport alimentaire des Canadiennes et Canadiens de deux ans et plus. Notre étude visait à explorer les connaissances et les perceptions du GAC 2019 chez les enfants âgés de 9 à 12 ans du sud-ouest de l'Ontario. De septembre à novembre 2021, des entretiens ont été menés avec des enfants par vidéoconférence. Trente-cinq enfants ont participé (50 % filles, 80 % Blancs ; âge moyen 9,9 ans). Les données ont été analysées selon une approche thématique hybride avec des analyses inductives et déductives. Les enfants ont exprimé un manque de connaissances sur certains aliments (c'est-à-dire les protéines végétales, les grains entiers, les aliments hautement transformés) qui sont mis en évidence dans le GAC. Les enfants ont également exprimé leur confusion concernant les groupes d'aliments, y compris les proportions recommandées et la catégorisation de certains aliments (p. ex., les produits laitiers, les protéines végétales). Les enfants ont généralement exprimé des perceptions positives concernant le GAC et ses recommandations en matière d'habitudes alimentaires, c'est-à-dire « Cuisiner plus souvent », « Mangez des repas avec d'autres » et « Profitez de votre nourriture » et ils ont suggéré des stratégies pour améliorer l'adhésion à ces recommandations (p. ex., attribuer aux enfants plus de responsabilité et d'indépendance dans les tâches de préparation des aliments) et pour minimiser les conflits de temps en famille. La perception qu'ont les enfants du GAC peut aider à éclairer les politiques de santé publique et les stratégies programmatiques conçues pour soutenir les choix alimentaires et les habitudes alimentaires des enfants. [Traduit par la Rédaction]

1. Introduction

A healthy diet during childhood is critical for optimal growth and development (Dudley et al. 2015) and can minimize the risk of developing non-communicable diseases, including heart disease, cancer, and diabetes (Afshin et al. 2019; World Health Organization 2020; Hack et al. 2021). However, according to dietary intake data from the 2015 Canadian Community Health Survey, a majority of children between 4–18 years of age are not meeting the minimum recommended number of servings for fruits and vegetables (Hack et al. 2021). Furthermore, intake of processed and packaged foods high in total or saturated fats, sodium, or sugar is common among Canadian children, with over half of their total daily energy coming from highly processed foods (Harrison et al. 2019; Polsky et al. 2020; Hack et al. 2021).
To support Canadians in improving their dietary habits, Health Canada released a revised CFG in 2019 (Health Canada 2019). Compared to the 2007 version, the 2019 CFG aimed to provide Canadians a more holistic approach to healthy eating through promoting both guidance for food choices to achieve a healthy dietary pattern as well as recommendations regarding eating habits, i.e., practices related to where, why, when, and how we eat. The four food groups from the 2007 version have been replaced by three groups: fruits and vegetables, whole grains, and protein foods, with an emphasis on eating more plant-based proteins (Health Canada 2019).
While previous research has examined adults’ perceptions (Vanderlee et al. 2015) and parents’ perceptions (Anderson et al. 2015; Patel and Mannion 2021; Barco Leme et al. 2022), there is a paucity of research exploring children's perceptions of the 2019 CFG and its revised recommendations. Parents play a critical role in determining children's food knowledge and practices, making it valuable to explore parental perceptions of CFG in the family or home context (Wijayaratne et al. 2020; Zarychta et al. 2021). However, interventions and policies that aim to positively influence children's diets should also integrate and reflect children's own perceptions and interpretations of the CFG. Without a clear understanding of children's ideas, the development of health programs and policies focused on improving children's dietary intake may result in the development of ineffective programs and policies.
To inform future health programs and policies, the objective of our study was to explore the perceptions and understanding of the 2019 CFG among Canadian children between 9–12 years of age using qualitative interviews. Compared to quantitative survey methodology, a qualitative approach can provide more in-depth understanding of children's perceptions of the CFG. Children aged 9–12 years are cognitively capable of developing and sharing their unique opinions and concepts (Fischer and Bullock 1983; Adler et al. 2019). Moreover, focusing on this age range can provide insight into a key period of life when children are simultaneously influenced by their home environment and by external food environments and social norms (Birch and Fisher 1998).

2. Materials and methods

2.1. Study design and population

Semi-structured interviews were conducted with children online via a video conferencing system. Eligible participants were children aged 9–12 years, who resided in Canada and spoke English. Children were primarily recruited through email invitations sent to parents participating in the Guelph Family Health Study (GFHS), a family-based trial of an obesity prevention intervention (Haines et al. 2018). One child was recruited through posts on the GFHS social media accounts. Parents completed a child eligibility screening survey via Qualtrics XM; if their child was eligible, parents provided consent for their child to participate in the study. Once parental consent was obtained, parents were emailed an assent form and a demographic survey for their child to complete.
The lead research assistant of the study (FZ) scheduled and coordinated all online child interviews via email communication with parents. Participating children were mailed a hard copy of the 2019 CFG prior to their scheduled interview time. All children confirmed verbal assent at the start of their interview. Participating children received a $20 Indigo e-gift card as a thank you for their time. This study was approved by the Research Ethics Board at the University of Guelph, Guelph, Canada (#19-07-023).

2.2. Data collection

Online interviews were conducted from September to November 2021, with interviews lasting between 16 and 33 minutes. The lead research assistant (FZ), who was trained in conducting qualitative interviews, moderated the semi-structured interviews. The interviews were audio-recorded. The lead research assistant took brief notes throughout and after the interview regarding the tone of the conversation and other details, such as parental involvement in the child's answers. The lead research assistant had no previous relationship with any participants.
The research team developed the interview guide and prompts (Table 1) to enhance discussion and reflection by children related to participants’ knowledge and perceptions of the 2019 CFG food choices and eating habit recommendations. To ensure the interview was not too long or onerous for the young participants, the research team chose to focus the interview questions on key recommendations that were either novel to the 2019 CFG, such as the eating behaviour recommendations and the term “highly processed foods” or are recommendations that Canadian children often do not meet, such as eating adequate vegetables, fruits, or whole grains. The interview guide did not include questions about recommendations to “Use food labels”, “Be aware that food marketing can influence your choices,” or “Make water your drink of choice”. The interview questions were informed by Krueger and Casey's guidelines (Krueger and Casey 2015), as well as by the content and recommendations of the 2019 CFG (Health Canada 2019).
Table 1.
Table 1. Interview questions and probes used to interview children about their perceptions of the 2019 Canada's Food Guide.
In the interview, the online version of the 2019 CFG was introduced to children via screen sharing after they were asked whether and where they had previously seen the 2019 CFG and remained in view for the remainder of the interview. The audio of the interviews was automatically transcribed by the online conferencing system. The lead research assistant (FZ) cleaned the transcriptions by reviewing each audio file and making corresponding edits to the transcripts.

2.3. Data analysis

Using the demographic survey data, children's sociodemographic characteristics were described as frequencies (percentages) for each variable: age, race, gender, and country of birth. Two researchers (FZ and AL) analyzed the interview transcripts using a hybrid thematic approach of deductive and inductive analyses (Braun and Clarke 2006). The researchers independently coded half the transcripts (= 18, = 17) (Moser and Korstjens 2018) and held a series of meetings to compare and discuss independently generated codes to ensure accuracy. Upon preliminary consensus, the researchers independently grouped the coded data into common themes. Initial themes were then reviewed and edited (i.e., renamed or collapsed) through collaborative discussion between both researchers until there was general agreement on the themes and each theme's representation of a unique aspect of the data. Theme and subtheme identification was confirmed through final discussion and consultation with the Principal Investigator (JH). This interpretive discussion enabled the development of overarching themes and corresponding subthemes that capture the varying perceptions and experiences of children.

3. Results

A total of 35 children participated in the online interviews (17 girls and 17 boys). All the children were between 9 and 12 years old, and the mean age was 9.9 years. Most participants self-identified as White (80%) and were born in Canada (91%). Six major themes were identified from the qualitative interviews. Themes and subthemes within each theme, including representative quotes, are summarized in the sections below.

3.1. General perceptions of the 2019 CFG

Overall, children reported positive perceptions of the food guide. When asked about their general thoughts on the 2019 CFG, children provided brief answers and used simple, positive terms like “good” or “healthy” to describe their thoughts on the food guide.

3.2. Lack of knowledge on certain foods included in the 2019 CFG

Overall, children demonstrated a lack of knowledge regarding certain foods promoted in the 2019 CFG, which are outlined in the following three subthemes: lack of knowledge on plant-based proteins, did not distinguish whole grains from refined grains, and lack of knowledge on highly processed foods.

3.2.1. Lack of knowledge on plant-based proteins

While most of the children reported exposure to the 2019 CFG, primarily from health-related classes at school, and sometimes from family at home, some children reported that they had never heard of or learned about plant-based proteins, or that they did not know any plant-based protein examples. As one child said: “I did not think [proteins] would come from plants.” Some children also reported that they had heard of plant-based proteins before but were unable to provide examples, either because they said they did not have knowledge of any, or because they could not recall. Children who did provide examples of plant-based proteins expressed doubt in their response and/or were incorrect in naming some examples. One child answered: “(…) Is potatoes [a plant protein] or no? I'm not sure, all I know is beans. I know stuff that comes from animals, that's the meat part, but other than that, I don't know. Is chickpea a plant?” Another child stated: “I'm pretty sure [tofu]’s not from a plant, but one from a plant could be, it could be spinach.”

3.2.2. Did not distinguish whole grains from refined grains

When the children were asked about whole grain foods, the most common examples provided were bread, pasta, rice, and noodles. In general, children did not acknowledge the whole grain options of pasta, rice, and noodles or distinguish them from their refined counterparts. Children discussed pasta, rice, and noodles as if all types of pasta, rice, and noodles are whole grain. One child reported that they think choosing whole grain foods “means a whole grain bread or maybe noodles or rice or anything.” Another child said: “Pasta, rice. That's all I can remember.”
Some children who talked about bread distinguished whole grain from white bread and acknowledged general differences between the two (i.e., health, taste): “(…) An example is bread, you don't really choose white bread as often because it's a bit unhealthy because it's been processed a lot, unlike the brown or whole grain.” However, there were some children who did not distinguish whole wheat from white bread and addressed bread as if all types of bread are part of the whole grain food group. For example, when asked what choosing whole grain foods meant, one child answered: “Choose to eat a piece of bread for breakfast.” Some children did not know how to answer this question entirely or showed uncertainty in their response: “Choose stuff that's kind of grainy and like rice and toast, kind of.”

3.2.3. Unclear definitions of highly processed food (HPF)

Children provided variable responses when discussing their understandings of HPF. Some children expressed not knowing the definition or examples of HPF, while others provided vague definitions: “[Highly processed food] is like you get meat from a cow and they go through surgery to make food and stuff.” Another child reported that HPF is not healthy “because they put stuff that's like not from plants and stuff, they just like find stuff and put it into it, so they don't check if it's like healthy or not.” When children were asked whether they thought HPF were healthy, children generally reported that HPF were unhealthy, although the rationale for their answers was mixed. Some children reported that because HPF are processed repeatedly in factories, they are automatically unhealthy. Other children reported that HPF have high sugar and fat content, making them unhealthy, and some reported that there are harmful ingredients, referred to as “bad stuff” added into the foods, making them unhealthy.

3.3. Confusion on food groups

Children demonstrated confusion with respect to the 2019 CFG recommendations. The children's confusion generally fell into three subthemes: confusion on recommendations of proportions for food groups, confusion on assignment of foods to food groups, and varying perceptions on how often to consume highly processed foods.

3.3.1. Confusion on recommendations of proportions for food groups

In discussions about how much fruits and vegetables, protein foods, and whole grain foods to consume, responses varied considerably across the children. They expressed vagueness and uncertainty, and they often reported their answers with inconsistent units. For example, one child reported: “I don't know, maybe [have] some pasta or bread each day, or some rice” when asked how much whole grains we should consume. When asked about fruits and vegetables, the same child then used whole numbers in their answer, stating that we should eat “Two, three, or more. I don't know, like two or more?.”

3.3.2. Confusion on assignment of foods to food groups

In the activity segment of the interview, wherein children were asked to assign foods from a list into the correct CFG food group (i.e., fruits and vegetables, protein foods, whole grains, and HPF), children expressed confusion about where certain foods fit. Dairy products, plant-based proteins, and HPF were the main sources of confusion. With respect to yogurt, one child reported “debating between fruits and vegetables and protein” when trying to assign yogurt its respective food group. Another child assigned yogurt to the HPF group “Because people have to make it”. Some children assigned plant-based protein sources like black beans and chickpeas to fruits and vegetables rather than protein foods. One child's rationale for assigning black beans to the fruits and vegetables food group was that “they're a different color of beans.” When asked about chickpeas, another child answered: “Fruits and vegetables. I don't even know what chickpeas are, but they're peas.” HPFs like Ritz crackers were often assigned to the whole grain food group. One child's explanation was “I don't know. I'd pick whole grainscause there's a stack of crackers at the back” (referring to the CFG 2019 snapshot).

3.3.3. Varying perceptions on how often to consume HPFs

While all the children agreed that HPFs should not be consumed too often, their interpretations of “not that often” and “once in a while” varied considerably. In the children's answers, some children interpreted “not that often” as daily, some interpreted it as every few days, and some interpreted it as every couple of weeks. One child perceived that “not that often” meant “Every maybe two or three months?

3.4. Positive perceptions of the 2019 CFG healthy eating habit recommendations

Children were asked to discuss their perceptions and understanding of the CFG eating habit recommendations, namely “Cook more often”, “Eat meals with others”, and “Enjoy your food”. In general, children positively perceived the recommendations, with the following 3 subthemes: interest in age-appropriate cooking activities, mindful eating is a form of enjoying your food, and eating with others and enjoying your food are connected.

3.4.1. Interest in age-appropriate cooking activities

Some children reported being involved in the kitchen in some way and to varying degrees. Children who mentioned helping to cook often reported engaging in cooking activities that did not require heat or complex kitchen appliances, making them relatively safe and age-appropriate (e.g., assembling ingredients, mixing, and decorating). Children reported helping with meals, including a variety of baked goods (e.g., bread and sweets), easy-to-prepare meals, like tacos and pizza, and food assembly kits (e.g., Hello Fresh, a meal kit provider across numerous countries).
Some children reported not being directly involved in any cooking activities in their homes. One of these children did, however, report helping to wash the dishes, and another reported preparing the dining table at mealtimes. Children discussed not engaging in cooking activities because of either their own or their parent's concern with kitchen tools or appliances being too dangerous. However, some of these children expressed an interest in learning and helping to cook: “I'd like if my mom just did the cooking or like the boiling water and all the hot things that children aren't allowed to touch, and then I prepare all this food that goes into it.”

3.4.2. Mindful eating is a form of enjoying your food

Some children explained their understanding of “Enjoy your food” from a mindful eating approach rather than from one that focussed on “culture and traditional foods”, as per the 2019 CFG. Children discussed slowing down, paying more attention, and savouring the food they eat as means to enjoy their food: “Savour your food. Don't just eat food 'cause it gives you energy. Eat food because you like the taste, you like eating the food. Just actually savour it, don't eat it off very quickly.” Another child mentioned how consciously reflecting on the food they eat is another representation of enjoying their food:(…) pay attention to what you're eating and think about how it tastes and things.”

3.4.3. Eating with others and enjoying your food are connected

In general, children also identified that “Eat meals with others” was important and good for you. Some children perceived the two recommendations of “Eat meals with others” and “Enjoy your food” to be related, suggesting that the practice of one recommendation can facilitate practice of the other (i.e., eating with others can facilitate the enjoyment of food, and enjoying food can be amplified by eating with others). One child said that the recommendation to “Enjoy your food” goes “hand in hand with eat meals with others, because [eating with others] also means that you're enjoying food (…) you're enjoying their company.” Another child stated: “I especially enjoy my food when I'm with my family or friends.”

3.5. Challenges and strategies to achieving the 2019 CFG healthy eating habit recommendations

In questions regarding the CFG eating habit recommendations to “Cook more often”, “Eat meals with others”, and “Enjoy your food” children were asked to discuss what makes it both harder and easier to achieve these recommendations. From the children's responses, a total of five subthemes emerged, which are organized as follows: three pairs of challenges and corresponding strategies to address the identified challenges, one subtheme that was identified as both a challenge and a strategy, and one challenge without corresponding strategies.

3.5.1. Challenge: lack of knowledge on how to cook; strategy: responsibility and a sense of autonomy supports child cooking

In discussions about the recommendation to “Cook more often”, the main challenge to following this recommendation was children's lack of cooking knowledge and skills. Children who reported not being involved in the kitchen often explained that they just “don't know how [to cook]”, with several of these children still showing interest in helping. As stated previously, some children reported not helping with cooking activities due to parents’ fear of certain kitchen appliances being too hot or dangerous for the child. This leads to the parent not involving the child in the cooking process and results in the child's lack of knowledge. When children were asked what would make it easier for them to cook more, children suggested that assigning more responsibility to the child and fostering a sense of autonomy by including children more in food decisions would encourage them to cook more often: “Choosing what to eat and being responsible for cooking it.”

3.5.2. Challenge: time conflicts and distractions; strategy: minimizing time conflicts and distractions

Overall, children reported that different sources of time conflicts or distractions hindered the children's ability to follow CFG recommendations, namely “Eat meals with others” and “Enjoy your food”. Distractions that interfered with enjoying food were often reported as screen-related: “When the TV is on, I can't like focus on eating, so sometimes I just don't even touch my food.” The often-rushed experience of getting ready for extracurricular activities, such as sports, was also reported as a source of distraction for children. Sources of time conflicts that inhibited eating with others included children's personal involvement in extracurricular activities, as well as family members’ involvement in extracurricular activities or work:
My family we do eat together a lot, but it's definitely hard with activities in the way (…) we do a lot of activities, my little sister does piano, I do gymnastics, me and my sister also go to Girl Guides. My older sister does work almost every week.”
Minimizing time conflicts and distractions was suggested to facilitate greater adherence to CFG eating habit recommendations. Children reported that removing screens (e.g., TVs and phones) during meals could encourage the enjoyment of more quality time with family while eating. One child suggested establishing a set mealtime and eating routine with family members to encourage eating more with others. Another child suggested a different approach, involving adapting to the schedules of other family members, as appropriate: “If somebody in your family had to work really late, you could try and eat another meal together, and if that wasn't possible then maybe you could move your supper a little bit later (…).”

3.5.3. Challenge: certain perceived healthy foods are disliked; strategy: lean into food and flavour preferences

For some children, their understanding of “Enjoy your food” centred around taste preference. Children reported disliking certain perceived healthy foods (primarily fruits and vegetables), which results in difficulty enjoying such foods. They described eating these foods unwillingly and often only as a result of their parent's deliberate action to include them in their meals.
When asked what would help the children to enjoy their food more, children suggested that “adding more flavour” and “trying different toppings”, such as ketchup or soy sauce, could help.
Children also advocated for choosing to eat foods they know they like and limiting foods and tastes they know they dislike. One child's response showed an understanding that encountering a food you dislike is inevitable, and they suggested a way to make such foods more enjoyable:
If there's a food that you don't really like, putting something on the side that you do like, for example, some sort of fruit that you like, or some sort of vegetable that you like. For example, I like mango and strawberries. I also like cucumbers and carrots. Putting that there would help you enjoy the food better”.

3.5.4. Challenge and strategy: emotions and feelings

A range of emotions and feelings was discussed as both challenges and strategies that hinder or support children in following the CFG eating habit recommendations. Negative feelings, such as stress experienced by the child or loved ones, were described as a hindrance to eating with others and enjoying food: “Sometimes [sister's name] and I are annoyed at the dinner table. And then sometimes my dad and mom are doing work. They come down stressed, that might make it hard to [enjoy food].” Feelings of sadness, depression, and poor mental health triggered by social conflict at school were also reported by some children as challenges to enjoying food and eating with others.
In contrast, positive feelings experienced by the child and/or loved ones were said to facilitate eating with others and enjoying food. Some children reported feeling happy as a conduit to these recommendations, and one reported feeling gratitude: “Normally every breakfast, we say something we think we're thankful for around the table and be grateful.”

3.5.5. Challenge: COVID-19 restrictions

Children understood and reported that COVID-19 limited people's ability to gather in person and eat with others who they did not live with due to public health restrictions. Given the children's general understanding of these restrictions, the majority could not report any strategies to overcome this challenge. However, one child did suggest that a gathering “outside to celebrate a birthday or to hang out” could be possible when certain restrictions were loosened or lifted.

4. Discussion

Our study objective was to explore children's perceptions and understanding of the 2019 CFG through qualitative methodology of in-depth interviews with school-aged children. Children generally reported positive perceptions of the 2019 CFG and its food choices and eating habit recommendations and identified some key challenges as well as helpful strategies for meeting these recommendations. These results can be used to develop educational material targeting children's knowledge of the 2019 CFG, as well as health programs and policies.
Children in this study reported an awareness but lack of knowledge of certain foods that are emphasized in the 2019 CFG, mainly plant-based proteins, HPF, and whole grain foods. An inconsistent understanding of HPF was also observed in an American study with children aged 9–12 years (Bleiweiss-Sande et al. 2020), wherein children's interpretations of vocabulary related to HPF (e.g., fresh, man-made, and machine-made) varied, and black-and-white interpretations of HPF as always being unhealthy were observed. In terms of whole grains, evidence from a 2018 Malaysian survey study indicated a need to increase children's whole grain knowledge, given its findings that children showed only moderate knowledge of this food group (Koo et al. 2018). The fact that children in this study showed a lack of knowledge on foods that are highlighted in the 2019 CFG despite the CFG being included in the school curriculum (Ontario Ministry of Education 2019) could indicate that these terms were not clearly defined for children or that children did not understand or retain the CFG material presented. Many studies have documented the significant influence that social institutions like schools have on children's food knowledge and dietary intake (Stewart et al. 2006; Slaughter and Ting 2010; Atik and Ertekin 2011). Thus, policy approaches to revise the content and delivery of school curricula to improve children's knowledge and understanding of foods highlighted in the 2019 CFG (e.g., plant-based proteins and whole grains) may be needed to support children in meeting the CFG recommendations.
Children showed inconsistent or incorrect responses when asked to assign foods from a list to their respective food group(s). Plant-based proteins, dairy products, and HPF were the most notable sources of confusion. Increasing children's knowledge of the protein foods group, which now includes plant-based proteins and dairy products, is particularly important because previous qualitative research indicated that some parents were unclear on which foods contain plant-based proteins (Barco Leme et al. 2022). As parents play an influential role in their children's food knowledge and diets (Hart et al. 2002; Stewart et al. 2006; Atik and Ertekin 2011; Wijayaratne et al. 2020), public health efforts should focus on increasing knowledge of healthy plant-based protein foods among both children and parents (Olfert et al. 2019; Barco Leme et al. 2022).
Lack of knowledge on how to cook was commonly reported as a challenge to achieving the CFG recommendation to “Cook more often”. Some children showed interest in helping in the kitchen but reported not acting on this interest because they or their parent was concerned about the dangers of kitchen tools. Similar findings were observed in the previous American-focussed group research (Olfert et al. 2019), wherein parents of school-aged children reported that child involvement with meal preparation was limited by parent's concern of child safety in the kitchen. Building cooking skills from a young age is important for skill retention (Lavelle et al. 2016), confidence in food practices (Hersch et al. 2014), and supporting healthy habits later in life (Utter et al. 2018). Thus, identifying effective approaches to improve children's cooking skills may help support healthy eating throughout life.
Children identified that being assigned more responsibility and feeling a stronger sense of autonomy may help to promote more cooking. This finding is corroborated by a qualitative study with older children (Amin et al. 2018) that reported increased child autonomy in meal planning as a helpful strategy to improve children's food literacy. In the qualitative study by Olfert et al. 2019, children suggested that having parents select age-appropriate cooking tasks for them to do and rewarding them for helping could effectively increase child involvement in the kitchen. Parents further suggested that children could pack their own snacks as one way to engage in age-appropriate food preparation activities. Thus, strategies to increase parental support in providing opportunities for children to engage in age-appropriate cooking activities may be helpful in increasing children's cooking behaviour. In addition, public health efforts to adequately fund, develop, and implement more family-friendly opportunities in the community to engage in experiential cooking-related activities (e.g., cooking classes and gardening classes) may increase children's cooking knowledge and skills, and inspire children to engage in more overall healthful behaviours. Food literacy supports, such as child- and family-friendly cookbooks, could be made accessible through various settings including schools or community centres.
There are limitations to this study that should be considered in the interpretation of our findings. There was a lack of sample diversity as 80% of children self-identified as White and most participants were children of parents enrolled in the GFHS, an ongoing family-based trial of an obesity prevention intervention comprising generally educated and middle- to high-income parents. The GFHS intervention focused on increasing family meals, sleep, and reducing screen time, and did not specifically address CFG. However, the food-based focus of the intervention may have resulted in self-selection bias such that families that chose to participate may have a pre-existing interest in food and health. Despite these limitations, the objective of this research was to develop a deeper understanding of children's perceptions and understanding of the 2019 CFG, which is limited in the literature. The qualitative data captured from these in-depth child interviews were informative and achieved this objective.
These findings have implications for future public health policies, including revision of the content and delivery of school curricula and programmatic strategies to support food choices and eating habits of children. Specifically, findings suggest that education regarding plant-based proteins, HPF, and whole grains (including clearly defining these terms for children) is needed to increase children's application of the CFG food choice recommendations. Increasing children's knowledge of what foods belong to specific food groups may help them to plan and build balanced meals and eating patterns. Public health efforts are needed to cultivate more opportunities for children to develop and practice their cooking skills to support efforts to have children “Cook more often”.

5. Conclusion

School-aged children generally had positive perceptions of the 2019 CFG and its recommendations but expressed a lack of knowledge on certain foods that are highlighted in the food guide. Findings of this study may be used to inform the development and implementation of public health policies and targeted health interventions that aim to improve the food literacy and eating behaviours of Canadian children.

Acknowledgements

Madeline Nixon, Research Assistant at the Guelph Family Health Study, helped with the early development of the Qualtrics XM eligibility surveys and coordination of child interviews.

References

Adler K., Salanterä S., Zumstein-Shaha M. 2019. Focus group interviews in child, youth, and parent research: an integrative literature review. Int. J. Qual. Methods, 18: 1–15.
Afshin A., Sur P.J., Fay K.A., Cornaby L., Ferrara G., Salama J.S., 2019. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet, 393: 1958–1972.
Amin S.A., Panzarella C., Lehnerd M., Cash S.B., Economos C.D., Sacheck J.M. 2018. Identifying food literacy educational opportunities for youth. Health Educ. Behav. 45: 918–925.
Anderson L.C., Mah C.L., Sellen D.W. 2015. Eating well with Canada's Food Guide? Authoritative knowledge about food and health among newcomer mothers. Appetite, 91: 357–365.
Atik D., Ertekin Z.O. 2011. Children's perception of food and healthy eating: dynamics behind their food preferences. 37: 59–65.
Barco Leme A.C., Laila A., Hou S., Fisberg R.M., Ma D.W.L., Fisberg M., Haines J. 2022. Perceptions of the 2019 Canada's Food Guide: a qualitative study with parents from Southwestern Ontario. Appl. Physiol. Nutr. Metab. 47: 34–40.
Birch L.L., Fisher J.O. 1998. Development of eating behaviors among children and adolescents. Pediatrics, 101: 539–549.
Bleiweiss-Sande R., Goldberg J., Evans E.W., Chui K., Bailey C., Sacheck J. 2020. Chemicals, cans and factories: how grade school children think about processed foods. Public Health Nutr. 23: 1735–1744.
Braun V., Clarke V. 2006. Using thematic analysis in psychology. Qual. Res. Psychol. 3: 77–101.
Dudley D.A., Cotton W.G., Peralta L.R. 2015. Teaching approaches and strategies that promote healthy eating in primary school children: a systematic review and meta-analysis. Int. J. Behav. Nutr. Phys. Act. 12: 28.
Fischer K.W., Bullock D. 1983. Development during middle childhood : the years from six to twelve. National Academies Press, Washington, DC.
Hack S., Jessri M., L'Abbé M.R. 2021. Nutritional quality of the food choices of Canadian children. BMC Nutr. 7: 16.
Haines J., Douglas S., Mirotta J.A., O'Kane C., Breau R., Walton K., 2018. Guelph family health study: pilot study of a home-based obesity prevention intervention. Can. J. Public Health, 109: 549–560.
Harrison S., Brassard D., Lemieux S., Lamarche B. 2019. Consumption and sources of saturated fatty acids according to the 2019 Canada Food Guide: data from the 2015 Canadian Community Health Survey. Nutrients, 11: 1964.
Hart K.H., Bishop J.A., Truby H. 2002. An investigation into school children's knowledge and awareness of food and nutrition. J. Hum. Nutr. Diet. 15: 129–140.
Health Canada. 2019. Canada’s dietary guidelines for health professionals and policy makers. Health Canada Ottawa Ont.
Hersch D., Perdue L., Ambroz T., Boucher J.L. 2014. The impact of cooking classes on food-related preferences, attitudes, and behaviors of school-aged children: a systematic review of the evidence, 2003-2014. Prev chronic dis 11: E193.
Koo H.C., Lee C.L., Nur Hidayah A.S., Nurain Hazwani A.R. 2018. Knowledge, attitudes and practices of schoolchildren toward whole grains and nutritional outcomes in Malaysia. Appetite, 123: 256–263.
Krueger R., Casey M.A. 2015. Focus group: a practical guide for applied research. 5th ed. Sage Publishing, Thousand Oaks, Calif.
Lavelle F., Spence M., Hollywood L., McGowan L., Surgenor R., McCloat A., 2016. Learning cooking skills at different ages: a cross-sectional study. Int J Behav Nutr Phys Act 13:119.
Moser A., Korstjens I. 2018. Series: practical guidance to qualitative research. Part 3: sampling, data collection and analysis. Eur. J. Gen. Pract.
Olfert M.D., Hagedorn R.L., Leary M.P., Eck K., Shelnutt K.P., Byrd-Bredbenner C. 2019. Parent and school-age children's food preparation cognitions and behaviors guide recommendations for future interventions. J. Nutr. Educ. Behav. 51: 684–692.
Ontario Ministry of Education. 2019. Health and physical education: the Ontario curriculum, grades 1–8. Queen's Printer for Ontario.
Patel P., Mannion C. 2021. Maternal impressions of the new 2019 Canadian Food Guide snapshot. Can. J. Diet. Pract. Res. 82: 192–195.
Polsky J.Y., Moubarac J.C., Garriguet D. 2020. Consumption of ultra-processed foods in Canada. Health Rep. 31: 3–15.
Slaughter V., Ting C. 2010. Development of ideas about food and nutrition from preschool to university. Appetite, 55: 556–564.
Stewart K., Gill P., Treasure E., Chadwick B. 2006. Understandings about food among 6–11 year olds in South Wales. Food Cult. Soc. 9: 317–336.
Utter J., Larson N., Larson M.N., Winkler M., Neumark-Sztainer D. 2018. Self-Perceived Cooking Skills in Emerging Adulthood Predict Better Dietary Behaviors and Intake 10 Years Later: A Longitudinal Study. J Nutr Educ Behav 50:494–500.
Vanderlee L., McCrory C., Hammond D. 2015. Awareness and knowledge of recommendations from Canada's Food Guide. 76: 146–149.
Wijayaratne S., Westberg K., Reid M., Worsley A. 2020. A qualitative study exploring the dietary gatekeeper's food literacy and barriers to healthy eating in the home environment. 32: 292–300.
World Health Organization. 2020. Healthy diet. Available from https://www.who.int/news-room/fact-sheets/detail/healthy-diet. [accessed 28 April 2022.]
Zarychta K., Banik A., Kulis E., Lobczowska K. 2021. Parental and child self-efficacy explaining food intake through self-regulation: a dyadic prospective study. Appl. Psychol. Health Well Being 13: 174–194.

Information & Authors

Information

Published In

cover image Applied Physiology, Nutrition, and Metabolism
Applied Physiology, Nutrition, and Metabolism
Volume 47Number 11November 2022
Pages: 1096 - 1103

History

Received: 11 July 2022
Accepted: 6 September 2022
Accepted manuscript online: 12 September 2022
Version of record online: 1 November 2022

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Key Words

  1. Canada's Food Guide
  2. children
  3. perceptions
  4. knowledge
  5. eating habits
  6. food choices
  7. healthy eating

Mots-clés

  1. Guide alimentaire canadien
  2. enfants
  3. perceptions
  4. connaissances
  5. habitudes alimentaires
  6. choix alimentaires
  7. saine alimentation

Authors

Affiliations

Flora Zhang
Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ONN1G 2W1, Canada
Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ONN1G 2W1, Canada
Ana Carolina Barco Leme
Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ONN1G 2W1, Canada
Center of Excellence in Nutrition and Feeding Difficulties, PENSI Institute/Sabará Children's Hospital, São Paulo01228-200, Brazil
Department of Human Health and Nutrition Sciences, University of Guelph, Guelph, ONN1G 2W1, Canada
Jess Haines [email protected]
Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ONN1G 2W1, Canada
on behalf of the Guelph Family Health Study

Author Contributions

JH designed the research. FZ conducted the research. FZ and AL coded the interview transcripts and analyzed and interpreted the data. JH provided mediation for interpretation of the results. FZ wrote the first draft. FZ, AL, ACBL, DWLM, and JH reviewed, commented, and provided edits to the final version. All authors have read and approved the final manuscript.

Competing Interests

The authors declare there are no competing interests.

Funding Information

This project was supported by The Helderleigh Foundation.

Metrics & Citations

Metrics

Other Metrics

Citations

Cite As

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

There are no citations for this item

View Options

View options

PDF

View PDF

Get Access

Login options

Check if you access through your login credentials or your institution to get full access on this article.

Subscribe

Click on the button below to subscribe to Applied Physiology, Nutrition, and Metabolism

Purchase options

Purchase this article to get full access to it.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

Media

Media

Other

Tables

Share Options

Share

Share the article link

Share on social media

Cookies Notification

We use cookies to improve your website experience. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy.
×