Understanding consumer food choices & promotion of healthy and sustainable Mediterranean diet and lifestyle in children and adolescents through behavioural change actions: the DELICIOUS project

Figures & data

Table 1. Summary of tools used to assess potential factors associated with diet quality and adherence to the Mediterranean diet.

Tool name	Description	Reference
Mediterranean Diet Quality Index for children and adolescents (KIDMED)	This index is derived from 16 components that summarise the principles of the Mediterranean diet (positive points for at least 2 daily servings of fruit and vegetables, 3 daily servings of dairy products, daily breakfast with grains also consumed at least 5 times/week, daily use of olive oil, 2–3 weekly servings of nuts and fish, and of at least two servings for pulses; negative points for frequent intake of sweets and candies, the use of commercially baked goods and pastries in breakfast, having meals in fast-food outlets, and skipping breakfast) and provides an arithmetic score that ranges from 0 to 12, with higher scores reflecting higher adherence to the Mediterranean diet.	Serra-Majem et al. 2004
Electronic Kids Dietary Index (E-KINDEX)	The index incorporates 3 main domains of questions about (i) food groups intake (13 items), (ii) eating beliefs and behaviours (8 items), and (iii) dietary practices (9 items). The theoretical overall score ranges from 1 to 87, with higher scores indicating healthier behaviours.	Lazarou et al. 2011
Short Food Literacy Questionnaire for adults (SFLQ)	Self-rated food literacy consists of 12 questions, of which six focused on functional skills, such as understanding nutrition information and composing a balanced menu, one focused on interactive abilities such as exchanging nutrition information with family and peers, and another five asked about abilities such as critically judging nutrition information or evaluating the longer-term impact of dietary habits on health. Answers were composed of four- or five-point Likert scales answers providing points for a sum score of the 12 items (maximum score 52) indicating higher food literacy.	Gréa Krause et al. 2018
Healthy-Eating Attitudes to the Child (HEAC)	The index consisted of 8 questions with 2 possible answers (yes/no); each affirmative answer was assigned 1 point and each negative answer was assigned 0 points for a maximum score of 8 reflecting positive attitude towards healthy eating.	Romanos-Nanclares et al. 2018
Multiple constructs on health capability to retrieve health-related information	The tool comprised various constructs, including (i) Health-information functions, (ii) Health consciousness, (iii) Health-information Orientation; (iv) Health-oriented Beliefs. Answers vary, from yes/no format to five-point Likert scales, with higher scores indicating better capability to retrieve health-related information.	Dutta-Bergman 2004
Multiple constructs on barriers and enablers to adhere to a Mediterranean diet	Specific questions concerning barriers and enablers of behaviour change comprised (i) “My child’s adherence to the Mediterranean diet would provide him/her…”, (ii) Would any of the following groups of influence positively help your son/daughter to follow the Mediterranean Diet?”, and (iii) “My son/daughter’s intention to follow a Mediterranean diet would be…” with multiple answers options.	Ajzen 2011

Figure 1. Summary overview of the DELICIOUS project.

Figure 2. Articulation of the DELICIOUS project through work packages.

Table 2. Summary of tools used in the pre-post intervention phases.

Tool name	Description	Reference
Mediterranean Diet Quality Index for children and adolescents (KIDMED)	This index is derived from 16 components that summarise the principles of the Mediterranean diet (positive points for at least 2 daily servings of fruit and vegetables, 3 daily servings of dairy products, daily breakfast with grains also consumed at least 5 times/week, daily use of olive oil, 2–3 weekly servings of nuts and fish, and of at least two servings for pulses; negative points for frequent intake of sweets and candies, the use of commercially baked goods and pastries in breakfast, having meals in fast-food outlets, and skipping breakfast) and provides an arithmetic score that ranges from 0 to 12, with higher scores reflecting higher adherence to the Mediterranean diet.	Serra-Majem et al. 2004
Multiple constructs on meal habits, food choices, and nutrition knowledge	The tool includes several constructs concerning influences on meal habits, food choices, and nutrition knowledge.	Grosso et al. 2012
Attitude Scale for Healthy Nutrition (ASHN)	The tool consists of 21 items grouped in 4 constructs referring to (i) Nutrition, (ii) Emotion for Nutrition, (iii) Positive Nutrition, and (iv) and Malnutrition. Answers were provided through five-point Likert scales with overall higher scores indicating better attitudes towards healthy nutrition.	Tekkurşun Demir and Cicioğlu 2019
Depression Anxiety Stress Scales for Youth (DASS-Y)	A test comprising 21 questions exploring various aspects of interest, including ‘Anhedonia’ ‘Dysphoria,’ ‘Hopelessness,’ ‘Devaluation of life,’ ‘Self-deprecation,’ ‘Lack of interest,’ and ‘Inertia’ in 3 major constructs concerning depression, anxiety, and stress. The answers referring to how the respondent felt during the previous week consisted of 4-point Likert-type scale with higher scores indicating stronger symptoms of anxiety and related feelings.	Szabo and Lovibond 2022

Figure 3. Formal and non formal educational activities implemented in school interventions.

Serra-Majem L, Ribas L, Ngo J, Ortega RM, García A, Pérez-Rodrigo C, Aranceta J. 2004. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr. 7(7):931–935. doi:10.1079/phn2004556.

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Lazarou C, Panagiotakos DB, Spanoudis G, Matalas A-L. 2011. E-KINDEX: a dietary screening tool to assess children’s obesogenic dietary habits. J Am Coll Nutr. 30(2):100–112. doi:10.1080/07315724.2011.10719949.

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Gréa Krause C, Beer-Borst S, Sommerhalder K, Hayoz S, Abel T. 2018. A short food literacy questionnaire (SFLQ) for adults: findings from a Swiss validation study. Appetite. 120:275–280. doi:10.1016/j.appet.2017.08.039.

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Romanos-Nanclares A, Zazpe I, Santiago S, Marín L, Rico-Campà A, Martín-Calvo N. 2018. Influence of Parental Healthy-Eating Attitudes and Nutritional Knowledge on Nutritional Adequacy and Diet Quality among Preschoolers: the SENDO Project. Nutrients. 10(12):1875. doi:10.3390/nu10121875.

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Dutta-Bergman MJ. 2004. Health attitudes, health cognitions, and health behaviors among Internet health information seekers: population-based survey. J Med Internet Res. 6(2):e15. doi:10.2196/jmir.6.2.e15.

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Ajzen I. 2011. The theory of planned behaviour: reactions and reflections. Psychol Health. 26(9):1113–1127. doi:10.1080/08870446.2011.613995.

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Tekkurşun Demir G, Cicioğlu Hİ. 2019. Sağlıklı beslenmeye i̇lişkin tutum ölçeği (SBİTÖ): geçerlik ve güvenirlik çalışması. Gaziantep Üniversitesi Spor Bilimleri Dergisi. 4(2):256–274.

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Szabo M, Lovibond PF. 2022. Development and Psychometric Properties of the DASS-Youth (DASS-Y): An Extension of the Depression Anxiety Stress Scales (DASS) to Adolescents and Children. Front Psychol. 13:766890. doi:10.3389/fpsyg.2022.766890.

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