From Knowledge to Everyday Food Choices: A Qualitative Study of Nutrition Literacy and Eating Behaviors Among Primary School Students in Sabzevar, Iran Publisher



Mehri A ; Seyedabadi M ; Seighaldeh S S ; Bazargan M ; Rad M ; Shahrabadi R ; Jovini H ; Hashemian M ; Hassantabar B
Source: BMC Nutrition Published:2026

Abstract

Background: Nutrition literacy refers to the ability to access, understand, evaluate, and apply nutrition information to make informed dietary choices. Evidence from low- and middle-income countries (LMICs) on nutrition literacy and related behaviors among schoolchildren remains limited, particularly regarding how school, home, and community environments shape these dynamics. This study explored how primary school students in Sabzevar, Iran, understand nutrition literacy and apply it in their daily eating practices. Methods: A descriptive exploratory qualitative study was conducted in Sabzevar, Iran, between October 2021 and May 2022. Thirty-two students aged 10–12 years from three schools in different socioeconomic areas were recruited using purposive sampling, with limited snowball sampling to ensure variation in gender, BMI group, and socioeconomic status. Data were collected through semi-structured interviews guided by seven thematic sections and approximately 30 open-ended questions. Interviews lasted 45–60 min, were conducted in private school settings, and were audio-recorded with parental consent and child assent. Data saturation was reached after 28 interviews and confirmed with four additional interviews. Data were analyzed using Graneheim and Lundman’s content analysis, and trustworthiness was ensured using Lincoln and Guba’s criteria. Results: Participants included 18 girls and 14 boys (mean age: 11.06 years). Students demonstrated mainly functional nutrition literacy, identifying unhealthy foods and recognizing some health risks, particularly related to processed foods and food safety. However, knowledge rarely translated into healthy eating behaviors due to dependence on parents, simplified food classifications, taste preferences, peer norms, convenience, and irregular meal routines. Breakfast skipping and frequent consumption of processed snacks were common. Interactive and critical nutrition literacy skills were limited. Conclusion: Nutrition literacy among Iranian primary school students is largely functional, with a clear gap between knowledge and behavior. Bridging this gap requires multi-level interventions involving schools, families, and supportive food environments to strengthen interactive and critical literacy and promote lasting healthy eating habits. © The Author(s) 2026.