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‘Is there fish in fish cakes?’

An interdisciplinary inquiry into the influence of a sensory-based experiential cookingcourse on fish on children’s food literacy and fish-eating behaviorHøjer, Rikke

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- An interdisciplinary inquiry into the influence of a sensory-based experiential

theme course on fish on children’s food literacy and fish-eating behavior

‘Is there fish in fish cakes?’

PhD thesis by

Rikke Højer

This PhD thesis has been submitted to

the Faculty of Science, University of Copenhagen,

November, 2020

‘Is there fish in fish cakes?’

- An interdisciplinary inquiry into the influence of a sensory-based

experiential cooking course on fish on children’s food literacy and

fish-eating behavior

PhD thesis November 2020

Author: Rikke Højer

This thesis has been submitted to the Faculty of Science, University of Copenhagen

University of Copenhagen

Department of Food Science

Faculty of Science

Rolighedsvej 26, DK-1958 Frederiksberg C

Denmark

Title “Is there fish in fish cakes?” - An interdisciplinary inquiry into the influence of a sensory-based experiential cooking course on fish on children’s food literacy and fish-eating behavior

Author Rikke Højer

Place University of Copenhagen Faculty of Science Department of Food Science

Topic description This PhD thesis is an interdisciplinary inquiry into the influence of a sensory-based experiential cooking course on fish on children’s food literacy and fish-eating behavior.

Principal supervisor Michael Bom Frøst Associate Professor University of Copenhagen Department of Food Science

Co-supervisor Karen Wistoft Professor (MSO) Danish School of Education Department of Educational Sociology

Assessment committee

Chairman Lotte Holm Professor University of Copenhagen Department of Food and Resource Economics

External Jacob Lahne Assistant professor Virginia Polytechnic Institute and State University, Virginia, U.S.A. Department of Food Science and Technology

External Helen Coulthard Senior Lecturer De Montfort University, Leicester, UK Department of School of Applied Social Sciences

Submission date: November 3, 2020

List of papers

I. Something fishy is cooking – A survey of 11- to 13- year old Danish children’s self-evaluated food

neophobia and food behavior, knowledge, and skills in relation to fish

Højer, R. & Frøst, M.B. in (sumitted to Food Quality and Preference, October 2020)

II. Play with your food and cook it! Tactile play with fish as a way of promoting acceptance of fish in

11 to 13-year-old children in a school setting – a qualitative study

Højer, R., Wistoft, K., & Frøst, M.B. in Nutrients 2020, 12 (10), 3180;

https://doi.org/10.3390/nu12103180. (Published October 17th 2020).

III. Yes I can cook a fish; effects of a five-week sensory-based experiential theme course with fish on 11

to 13-year-old children’s food literacy and fish-eating behavior – a quasi-experimental study

Højer, R. Wistoft, K., & Frøst, M.B. in (sumitted to Food Quality and Preference, October 2020)

IV. Children’s self-reported reasons for accepting and rejecting foods.

Sick, J., Højer, R. & Olsen, A. in Nutrients 2019, 11(10), 2455; https://doi.org/10.3390/nu11102455.

(Published October 14th 2019).

List of scientific posters presented at international conferences

I. Promoting children's acceptance of fish through sensory-based experiments and experiential

learning: Breaking through the disgust barrier.

Højer, R. & Frøst, M.B.

Pangborn Sensory Science Symposium 2017, Providence, Rhode Island, USA.

II. What’s cooking? Promoting 10-13-year-old children’s acceptance of fish through experiential

learning.

Højer, R. & Frøst, M.B.

SenseAsia 2018, Asian Sensory and Consumer Research Symposium, Kuala Lumpur, Malaysia.

III. Promoting 11- to 13-year-old children’s food literacy through a community of practice – case studies

from an experiential sensory-based theme course on fish in a school setting.

Højer, R. and Frøst, M.B.

Pangborn Sensory Science Symposium 2019, Edinburgh, Scotland, United Kingdom.

i

TABLE OF CONTENT

Abbreviations v

Preface vi

Abstract viii

Resumé (Danish) x

1. INTRODUCTION 1

1.1. Child health 1

1.2. The school as setting for promoting children’s healthy food behavior 2

1.3. Research urgency and objective 3

1.4. Hypothesis and research issues addressed 3

1.5. Overview of studies 4

1.5.1. List of papers 4

1.6. Ethical approval 7

2. CHILDREN’S FISH INTAKE 8

2.1. Fish and health 8

2.2. Children’s intake of fish – perspectives from paper I 9

3. FOOD LITERACY 10

3.1. The concept of food literacy 10

3.2. Knowledge and skills; perspectives from paper I and III 13

4. CHILDREN’S ACCEPTANCE AND REJECTION OF FOOD 17

4.1. Food acceptance and rejection 17

4.1.1. Disgusting or distasteful? 19

ii

4.1.2. Food neophobia 21

4.2. Strategies for changing food behavior 23

4.2.1. Mere exposure 23

4.2.2. Evaluative conditioning 24

4.2.3. Modeling 25

4.2.4. The hands-on strategy 26

4.3. Intervention effects of applying a hands-on strategy on fish-eating behavior 27

5. COOKING COURSE MATERIALS - THEORY AND DIDACTICS 31

5.1. Presentation of materials developed 32

5.2. The subject Food Knowledge; official learning goals and expected learning 35

5.2.1. On legislation related to the subject Food Knowledge 36

5.2.2. Learning goals in teacher’s guide 37

5.3. Pedagogical theoretical foundation 38

5.4. Theme course material: didacticization 40

6. COLLECTING DATA WITH CHILDREN 43

6.1. Clarification of paradigmatic foundation 43

6.2. Children as informants 45

6.3. Research strategy & design; Mixed methods 46

6.3.1. Research strategy 46

6.3.2. Research design 47

6.4. Sampling and recruitment strategy 49

6.5. Data collection methods applied 50

6.5.1. Future workshops; exploring the field 51

6.5.2. Participant observation 53

6.5.3. Group interviews with children 54

6.5.4. Telephone interviews with teachers 56

6.5.5. Self-administrated survey questionnaire 57

iii

The Likert scale 58

Measurement of food neophobia 59

Measurement of liking to cook & fish-eating behavior 61

Measurement of opinion on Food Knowledge and individual learning conditions 62

Measurement of food literacy; knowledge & skills 62

Evaluation of theme course, main study group only 64

6.6. Analysis of results 67

6.6.1. Analysis of qualitative data 67

6.6.2. Analysis of quantitative data 68

Statistical analysis applied in paper I 68

The difference in included respondents between study I and III 69

Statistical analysis applied in paper III 70

6.7. Methods and quality criteria related to research methods 72

6.7.1. Methods applied – a look in the rearview mirror 72

6.7.2. Quality criteria 75

Quality criteria in qualitative research methods 75

Quality criteria in quantitative research methods 76

7. PERSPECTIVES ON VIDEOS, COMMENSALITY, AND SETTING 78

7.1. Self-evaluated skills and videos 78

7.2. Commensality; a community of practice 81

7.3. Food Knowledge as a setting for promoting healthy food behavior 84

8. CONCLUSIONS 86

9. THE FUTURE 89

REFERENCES 92

APPENDIX 121

iv

APPENDIX A: PAPERS & POSTERS

A1. Paper I

A2. Paper II

A3. Paper III

A4. Paper IV

A5. Scientific poster I

A6. Scientific poster II

A7. Scientific poster III

APPENDIX B: PHD ACTIVITIES

B1. Study activities

B1.1. PhD course port folio

B1.2. Teaching activities

B1.3. MSc thesis supervision activities

B1.4. Dissemination activities (scientific)

B1.5. Dissemination activities (public)

B1.6. Committee activities

B1.7. Awards

B2. Curriculum Vitae

B3. Acknowledgements

v

Abbreviations

CG1 : Control group 1

CG2 : Control group 2

G.Cph. : Greater Copenhagen

CoP : Community of Practice

GI : Group interview

FK : Food Knowledge (subject in Danish public school)

FNS : Food Neophobia Scale

FNTT : Food Neophobia Test Tool

MS : Main study group

Obs. : Participant observation

Prov. : Province of Zealand

QUAL : Qualitative method

QUAN : Quantitative method

(UNI)ANOVA : (Univariate) analysis of variance

SD : Standard deviation

vi

Preface

This thesis was submitted in fulfilment of the requirements for the PhD degree at Faculty of

Science, University of Copenhagen, Denmark. The PhD project was funded by two parties: Taste

for Life [Smag for Livet], which was a four-year research and dissemination project funded by the

Nordea Foundation, and University College Absalon, Center for Nutrition and Rehabilitation,

Nutrition and Health, Sorø, Denmark. The studies in this PhD project were conducted in

collaboration with Nordic Food Lab, Department of Food Science, University of Copenhagen, Taste

for Life, and University College Absalon, Center for Nutrition and Rehabilitation, Nutrition and

Health, Sorø, Denmark.

The thesis is based on three years of research, between June 2015 and May 2018, conducted at

public schools within the subject Food Knowledge in the Regions of Zealand and the Capitol in

Denmark with the purpose of investigating the effects of a five-week sensory-based experiential

cooking course on fish on 11- to 13-year-old children’s food literacy and fish-eating behavior.

The structure of this thesis is as follows:

Abstract: In English and Danish

Chapter 1 is an introduction and clarifies the research setting and study objective, aim, hypothesis,

and research issues addressed. It is followed by an overview of studies conducted as part of this

PhD project and a list of papers related to the results of the studies.

Chapter 2: is an introduction to children’s fish-eating behavior where the subjects of fish intake

and health, and children’s intake of fish are discussed and put into perspective by including results

from relevant papers.

Chapter 3 is a clarification and discussion of the term food literacy. Furthermore, the concept of

food literacy is put into perspective by including results from relevant papers.

Chapter 4 is a theoretical introduction to children’s food behavior in general where food choice,

acceptance and rejection, and strategies for changing food behavior are discussed and put into

perspective by including results from relevant papers.

vii

Chapter 5 is a presentation and discussion of the cooking course material developed to be included

in the intervention in the main study; a five-week sensory-based experiential cooking course on the

topic of fish. Furthermore, the pedagogical theoretic frame for the intervention is presented together

with a didactical clarification of the cooking course materials.

Chapter 6 is a presentation of paradigmatic reflections and an extended presentation and discussion

of collecting data with children, research strategy, data collection methods applied, and data

analysis methods. Finally, reflections on data collection methods applied, trustworthiness, and

strengths and limitations are clarified.

Chapter 7 presents perspectives on the papers that represent results from the PhD project and

perspectives on food literacy and development in liking after participating in the five-week sensory-

based experiential cooking course on fish.

Chapter 8 provides conclusions based on the main findings with focus on the hypothesis, research

objectives, and research issues.

Chapter 9 looks to the future with regard to future research needs and proposals for how to conduct

research in the future within the complex area of investigating and promoting children’s healthy

food behavior.

Appendixes: appendix A presents research papers and scientific posters produced during this PhD

project work. An overview is given in appendix B of relevant PhD activities carried out during the

PhD project period.

viii

Abstract

Health promotion interventions aimed at improving children’s health have been conducted for

several years. Still, worldwide, 18% of all children and adolescents between the age of 5 and 19 are

overweight or obese. In Denmark, 18% of the 9- to 13-year-old children are overweight. Childhood

and adolescence overweight and obesity are associated with, for example, an increased risk of adult

obesity, low self-esteem, and type 2 diabetes. The World Health Organization and the Danish

Health authorities both point to the importance of the educational system as a relevant setting for

promoting health. Furthermore, dietary variety is among the ten official Danish dietary

recommendations; nevertheless, Danish children aged 11- to 13- years only consume one-third of

the officially recommended amount of fish.

The objective of this study is to investigate the effect of a five-week (10 lectures of 45 minutes)

sensory-based experiential cooking course with fish on 11- to 13- year old children’s food literacy

and acceptance of fish. The aim is to promote children’s healthy food behavior.

This quasi-experimental study is based on a multi-phased mixed methods research strategy and

includes five partial studies, which were developed to support an iterative exploration and

investigation of the objective: Future workshops (n = 32), pre-test (n = 98), pilot test (n = 61),

intervention based on a quasi-experimental design (n = 268), and control study (CG1: no

intervention n = 194; CG2: oral lecture 90 min. n = 207) (part of the quasi-experimental design). A

total of 20 different schools and 48 5th

and 6th

grade classes from the geographical area of Greater

Copenhagen and the province of Zealand participated. The following research methods were

applied: Participant observation (total n = 217, intervention n = 58), group interview with children

(total n = 27, intervention n = 17), telephone interview with teachers (total n = 7, intervention n =

5), baseline and follow-up self-administrated survey questionnaire (total n = 736, intervention n =

669).

Based on the food literacy building blocks the main effects of participating in the intervention; the

five-week sensory-based experiential cooking course was 1) Plan and manage: the ability to

organize and work together, 2) Select: the ability to assess fish freshness (p = 0.007, MG > CG,

0.44 units on 5-point Likert scale), 3) Prepare: skills related to handling and cooking fish; e.g.

filleting a flatfish (p < 0.001, MG > CG, 0.89 units) and autonomy, teamwork, and development of

vocabulary. 4) Eat: no positive effects were observed for liking or assessment of fish

disgustingness; however, cooking course evaluation showed 47% had become curious on tasting

ix

other kinds of fish, and 38% stated a higher liking for fish after participation. Furthermore, Future

workshops indicated that competition was an element of interest, but also that the lack of time for

cooking in the subject Food Knowledge was of concern to the children, whereas the teachers were

more concerned with for example allocation of resources. Participant observation during pre-tests

indicated that tactile play and cooking were able to promote fish acceptance, but that rejection and

acceptance was a continuum especially moved by the degree of perceived animalness of the fish.

Furthermore, a status of Danish children’s food literacy and fish behavior revealed that Danish

children love to cook and like fish, but the liking of fish is not transformed into a concrete intake,

for example, 42% had not eaten fish within the last week. Moreover, it was observed that Danish

children had a neophilic tendency with regard to food, as liking to cook was not associated with

self-evaluated skills in food and cooking but with food neophobia, which could imply that the

enjoyment of cooking does not depend so much on self-perceived skills but rather on curiosity and

food exploration.

In conclusion, food literacy and acceptance of fish increased through participation in a five-week

sensory-based experiential cooking course with fish. Based on the output the partial studies it is

concluded that sufficient support has been collected to accept the main hypothesis: an ‘open

window’ for promoting food literacy and fish acceptance was created based on the concepts

experimentation, sensing, autonomy, knowledge and skills, and a social dimension. Furthermore, it

can be concluded that the school was a natural setting for implementation as the subject of Food

Knowledge already aims at promoting the children’s ability to make critical and reflected health and

food decisions and choices. Nevertheless, challenges could be local resources (access to educated

teachers, equipment, etc.) and subject prioritization at a local political level.

x

Resumé (Danish)

Sundhedsfremmende interventioner, der sigter mod at fremme børns sundhed, er blevet gennemført

i en lang årrække. Alligevel kan 18% af alle børn og unge mellem 5 og 19 år i Verden kategoriseres

som overvægtige eller fede. I Danmark er 18% af de 9- til 13-årige børn overvægtige. Overvægt og

fedme hos børn og unge er forbundet med for eksempel en øget risiko for fedme ind i voksenlivet,

hvilket kan medføre lav selvtillid og type 2-diabetes. Verdenssundhedsorganisationen og de danske

sundhedsmyndigheder peger begge på betydningen af uddannelsessystemet som en relevant ramme

for sundhedsfremme. Endvidere er en varieret kost en del af de ti officielle danske kostanbefalinger,

alligevel spiser danske børn i alderen 11 til 13 år kun en tredjedel af den officielt anbefalede

mængde fisk.

Målet med denne undersøgelse er at undersøge effekten af et fem ugers sansebaseret eksperimentelt

madlavningskursus med fisk (5 x 2 lektioner af 45 min.) på 11 til 13 årige børns madkundskab og

accept af fisk. Formålet er baseret på at fremme sund madadfærd hos børn.

Denne kvasi-eksperimentelle undersøgelse er baseret på en multi-fase-forskningsstrategi indenfor

mixed methods design og inkluderer fem delstudier, der blev udviklet til at understøtte en iterativ

udforskende undersøgelse af det overordnede mål: Fremtidsværksteder (n = 32), for-test (n = 98),

pilottest (n = 61), intervention baseret på et kvasi-eksperimentelt design (n = 268) og

kontrolundersøgelse (CG1: ingen intervention n = 194; CG2: mundtlig forelæsning 90 min. n =

207) (del af kvasi-eksperimentelt design). I alt deltog 20 forskellige skoler og 48 5. og 6. klasser fra

det geografiske område Storkøbenhavn og den sjællandske provins. Følgende forskningsmetoder

blev anvendt: deltagerobservation (i alt n = 217, intervention n = 58), gruppeinterview med børn (i

alt n = 27, intervention n = 17), telefoninterview med lærere (i alt n = 7, intervention n = 5),

baseline og opfølgende selvadministreret survey spørgeskema (i alt n = 736, intervention n = 669).

Ud fra elementerne i begrebet maddannelse [food literacy] er de mest fremtrædende effekter af at

deltage i interventionen; det fem ugers sensorisk-baserede eksperimentelle madlavningskursus,

følgende: 1) Planlægning og styring: evnen til at organisere og arbejde sammen, 2) Udvælge: evnen

til at vurdere fiskens friskhed (p = 0,007, MG> CG, 0,44 enheder på 5-punkts Likert skala), 3)

Tilberedning: færdigheder relateret til håndtering og madlavning af fisk; for eksempel. filetering af

en fladfisk (p <0,001, MG> CG, 0,89 enheder) og autonomi, teamarbejde og udvikling af ordforråd.

4) Spise: der blev ikke observeret positive effekter for at kunne lide fisk eller i forhold til vurdering

af fiskens ’afskyelighed’ [disgustingness]; evaluering af madlavningskurset viste imidlertid, at 47%

xi

var blevet nysgerrige efter at smage andre former for fisk, og 38% kunne bedre lide fisk efter

deltagelse i madlavningskurset sammenlignet med før. Fremtidsværkstederne indikerede, at

konkurrence var et element af interesse hos børnene, men også at manglen på tid til madlavning i

faget Madkundskab var noget, der optog børnene, mens lærerne mere var optaget af for eksempel

ressourcetildeling. Deltagerobservation under forundersøgelserne viste, at taktil leg og madlavning

var i stand til at fremme børns accept af fisk, men at afvisning og accept var et kontinuum, hvor

bevægelsen frem og tilbage især blev styret af i hvilke grad fisken blev opfattet som ’dyrisk’

[animalness]. Endvidere afslørede en status af danske børns madkundskab og adfærd i forhold til

fisk, at danske børn elsker at lave mad og at de godt kan lide fisk, men smagen af fisk omsættes

ikke til konkret indtag; for eksempel havde 42% ikke spist fisk inden for den sidste uge. Derudover

blev det observeret, at danske børn havde en neofil tendens med hensyn til mad, at det at kunne lide

at lave mad ikke var forbundet med selvevaluerede færdigheder inden for mad og madlavning, men

det var derimod forbundet med niveau af madneofobi, hvilket kunne antyde, at glæden ved at lave

mad ikke afhænger så meget af selvopfattede færdigheder, men snarere afhænger af nysgerrighed

og madudforskning.

Afslutningsvis blev maddannelse [food literacy] of accept af fisk øget gennem deltagelse i et fem

ugers sanse-baseret eksperimentelt madlavningskursus med fisk. Baseret på resultater fra de

forskellige undersøgelser kan det konkluderes, at der er indsamlet tilstrækkelig evidens, der kan

understøtte en accept af hovedhypotesen: et 'åbent vindue' til fremme af madkundskab og accept af

fisk blev oprettet baseret på begreberne eksperimentering, sansning, autonomi, viden og

færdigheder, og en social dimension. Derudover kan det konkluderes, at skolen er en naturlig

ramme for implementering, da faget madkundskab allerede sigter mod at fremme børnenes evne til

at foretage kritiske og reflekterede beslutninger og valg vedrørende sundhed og fødevarer.

Udfordringer fremadrettet kan dog være lokale ressourcer (adgang til uddannede lærere, udstyr

osv.) og prioritering af faget på et lokalt politisk niveau.

1

1. INTRODUCTION

1.1. Child health

According to World Health Organization (WHO) (2018) almost 340 million (18,4 %) children and

adolescents between the age of 5 and 19 were either overweight (BMI-for-age > 1 standard

deviation above the WHO Reference 2007 median) or obese (BMI-for-age > 2 standard deviations

above the WHO Reference 2007 median) in 2016. In Denmark, 18% of the 9- to 13-year-old

children are overweight (Sundhedsstyrelsen, 2019).

Childhood and adolescence obesity is associated with an increased risk of adult obesity, which can

lead to low self-esteem, type 2 diabetes, and premature death and disabilities as a result of, e.g.

coronary heart disease (Agirbasli, Tanrikulu, & Berenson, 2016; Reilly & Kelly, 2011; Sahoo et al.,

2015; Umer et al., 2017; World Health Organization, 2018). WHO (2018) highlights that a broad

array of health promotion actions with engagement from multiple sectors is needed to break this

tendency occurring childhood overweight and obesity. One of the sectors WHO (2018) points to is

the educational system.

Factors influencing the risk of children becoming overweight or obese are many; varying from, e.g.

genes, the mother’s health during pregnancy, and infant feeding style to the food-related

environment, socioeconomics, and activity level (Gibbs & Forste, 2014; Hendrie, Sohonpal, Lange,

& Golley, 2013; van der Klaauw & Farooqi, 2015; Rando & Simmons, 2015; Sahoo et al., 2015).

Dietary variety, which is one of the ten official Danish dietary recommendations; ‘Eat a variety of

foods, but not too much, and be physically active’ (The Danish Veterinary and Food

Administration, 2015), is related to diet quality, as a diet with greater variety is more likely to meet

nutrition recommendations (Nicklaus, 2009; Skinner, Carruth, Bounds, Ziegler, & Reidy, 2002).

Furthermore, dietary variety is also connected to the psychological dimension of a meal as it

contributes to the pleasure of eating (Rolls, 2000). Therefore, promoting diet variety through

broadening children’s food preferences for healthy foods could be a gateway to meeting the official

dietary recommendations. A food group less eaten among children in Denmark is fish as Danish

children aged 10 to 17 only consume approximately 1/3 of the recommended amount of fish per

week (Pedersen et al., 2015).

2

1.2. The school as setting for promoting children’s healthy food behavior

The core food habits are established in the home food environment (Lafraire, Rioux, Giboreau, &

Picard, 2016), but Danish children 11- to 13- years-of-age (5th

and 6th

grade; Primary Education)

spend a minimum of 33 hours per week, 40 weeks a year in the school environment (Ministry of

Children and Education, 2020). A significant part of basic life skills and experience-based life

education; bildung, is transferred from the immediate family to an expert system, which Giddens

(2013) refers to as disembedment, where the school system becomes an important part of the child’s

reference and experience core. This also concerns the child’s development of healthy food behavior

as the food environment is partly moved from the home to the expert system. According to

Colatruglio and Slater (2014) and Vileisis (2008), this shift is partly responsible for lack of informal

food literacy and kitchen literacy in young people today.

This opens an opportunity for the school setting to function as an arena for promoting healthy food

behavior through a focus on formal food literacy, which has also been suggested by, e.g. Story,

Nanney, and Schwartz (2009), Nelson, Corbin, and Nickols-Richardsson (2013), Taylor, Evers and

McKenna (2005), and the World Health Organization (2016).

According to the Public School Law of 2017 in Denmark, the aim of public school is to prepare the

child for education later in life, educate in cultural diversity, create and promote social

understanding, promote understanding for own life, opportunities, and agency, and to promote trust

and curiosity. Furthermore, it is mandatory to educate the child in the subject of health

(Bekendtgørelse af lov om folkeskolen, 2017). The setting of this study is the subject Food

Knowledge (FK).

In 2014, the subject Home Economics was replaced by the subject Food Knowledge as part of

reforming the compulsory primary and lower secondary schools in Denmark (Christensen &

Wistoft, 2016). In the Danish public school FK is a compulsory subject for one year in either 4th

,

5th

, 6th

, or 7th

grade (Bekendtgørelse af lov om folkeskolen, 2017). The subject of FK aims at

promoting the child’s ability to make critical and reflected health and food decisions and choices,

and is divided into four main competence areas: 1) Food and health, 2) Food awareness, 3) Food

preparation, and 4) The meal and food culture (Bekendtgørelse om formål, kompetencemål,

færdigheds- og vidensområder og opmærksomhedspunkter for folkeskolens fag og emner (Fælles

Mål), 2020).

3

1.3. Research urgency and objective

With the advice from WHO (2018) in mind; that the educational setting should play an active role

in promoting children’s health, and based on the aim of FK; promoting the child’s ability to make

critical and reflected health and food decisions and choices (Bekendtgørelse om formål,

kompetencemål, færdigheds- og vidensområder og opmærksomhedspunkter for folkeskolens fag og

emner (Fælles Mål), 2020), it is interesting to explore this setting as a way to promote children’s

healthy food behavior and food acceptance through the concept of food literacy.

The objective of this study is to investigate the effect of a five-week (10 lectures of 45 minutes)

sensory-based experiential cooking course with fish on 11- to 13- year old children’s food literacy

and acceptance of fish. The long term the aim is promoting healthy food behavior through an

experiential learning approach.

1.4. Hypothesis and research issues addressed

In relation to the study objective, a hypothesis was constructed. After conducting two future

workshops with students in 6th

grade and their teachers and pre-testing of experiments (see Figure

1) the hypothesis was adjusted to its present form:

Through the concepts experimentation, sensing, autonomy, knowledge and skills, and a social

dimension, an “open window” exists for promoting food literacy and acceptance related to fish.

Based on the study objective and the hypothesis the following research issues have been addressed

through submitted papers, and will be addressed and put into perspective in this PhD thesis (related

papers are listed in parenthesis, also, see section 1.5.1. for an overview):

I. A status of Danish children’s fish eating behavior and liking of fish (paper I).

II. A status of Danish children’s food literacy with regard to fish (paper I).

III. Effects of participating in a sensory-based experiment focused on tactile play and cooking as

a way of promoting 11- to 13-year-old children’s acceptance of fish (paper II).

IV. Effects of participating in a five-week sensory-based experiential, hands-on cooking course

on fish on 11- to 13- year old Danish children’s fish-eating behavior and acceptance of fish

(paper III).

V. Effects of participating in a five-week sensory-based experiential hands-on cooking course on

fish on 11- to 13- year old Danish children’s food literacy (paper III).

VI. Children’s self-evaluated reasons for accepting and rejecting foods (paper IV)

4

1.5. Overview of studies

Five studies have been carried out as a part of this PhD project. Timeline, aim and single study

information are illustrated in Figure 1.

Figure 1: Chronological overview of executed development activities and empirical studies, their

aim, and methods

1.5.1. List of papers

This PhD thesis is based on three main papers (Paper I, II, III). Paper IV will serve as a supplement

where relevant, as it is not directly a part of this study, but is inspired by its investigatory scope. In

the text they will be referred to by their roman numbers. Furthermore, with each paper the author

contributions are declared in compliance with the Vancouver Protocol (International Committee of

Medical Journal Editors, 1997). The complete papers are included in the appendix (appendix A1 -

A4).

I. Something fishy is cooking – A survey of 11- to 13- year old Danish children’s self-

evaluated food neophobia and food behavior, knowledge, and skills in relation to fish

Højer, R. & Frøst, M.B. (sumitted to Food Quality and Preference, October 2020)

5

Author contributions: Conceptualization, R.H. and M.B.F.; methodology, R.H. and M.B.F.; data collection;

R.H.; validation, R.H and M.B.F..; formal analysis, R.H.; investigation, R.H.; resources, R.H.; data curation,

M.B.F. and R.H.; writing - original draft, preparation, R.H.; writing, review and editing, R.H. and M.B.F.;

visualization, R.H.; supervision, M.B.F.; project administration, R.H. and M.B.F.; funding acquisition, R.H.

and M.B.F.

II. Play with your food and cook it! Tactile play with fish as a way of promoting acceptance of

fish in 11 to 13-year-old children in a school setting – a qualitative study

Højer, R., Wistoft, K., & Frøst, M.B. in Nutrients, 2020, 12 (10), 3180;

https://doi.org/10.3390/nu12103180 2020. (Published October 17th, 2020).

Author contributions: Conceptualization, R.H., K.W. and M.B.F.; methodology, R.H., K.W. and M.B.F.; data

collection; R.H.; validation, R.H., M.B.F.; formal analysis, R.H.; investigation, R.H.; resources, R.H.; data

curation, R.H.; writing - original draft, preparation, R.H.; writing, review and editing, R.H., K.W. and M.B.F.;

visualization, R.H.; supervision, K.W. and M.B.F.; project administration, R.H. and M.B.F.; funding

acquisition, R.H. and M.B.F.

III. Yes I can cook a fish; effects of a five-week sensory-based experiential theme course with

fish on 11 to 13-year-old children’s food literacy and fish-eating behavior – a quasi-

experimental study

Højer, R. Wistoft, K., & Frøst, M.B. (sumitted to Food Quality and Preference, October 2020)

Author contributions: Conceptualization, R.H., K.W. and M.B.F.; methodology, R.H., K.W. and M.B.F.; data

collection; R.H.; validation, R.H.; formal analysis, R.H.; investigation, R.H.; resources, R.H.; data curation,

R.H.; writing - original draft, preparation, R.H.; writing, review and editing, R.H., K.W. and M.B.F.;

visualization, R.H.; supervision, K.W. and M.B.F.; project administration, R.H. and M.B.F.; funding

acquisition, R.H. and M.B.F.

IV. Children’s self-reported reasons for accepting and rejecting foods.

Sick, J., Højer, R. & Olsen, A. in Nutrients 2019, 11(10), 2455;

https://doi.org/10.3390/nu11102455. (Published October 14th

2019).

Author contributions: Conceptualization, J.S., R.H. and A.O.; methodology, J.S. and A.O.; validation, J.S.;

formal analysis, J.S. and A.O., investigation, J.S.; resources, J.S.; data curation, J.S..; writing - original draft,

preparation, J.S.; writing, review and editing, J.S., R.H. and A.O.; visualization, J.S.; supervision, R.H. and

A.O.; project administration, A.O.; funding acquisition, A.O.

Paper I, II, and III are related through the main objective and hypothesis and are building blocks

supporting each other, moving the research inquiries towards the investigation of the main

hypothesis and conclusions. Each paper has its own objective but also provides information and

6

perspectives related to the full overview of the research issue of interest (see Figure 2 for an

illustrated overview of how the papers are related to the main hypothesis). Paper IV is based on

data not related directly to this study. Still, the results are of great interest to the perspectives in this

thesis, especially the results related to curiosity as a motivator for exploring new foods.

Figure 2: Overview of how individual papers are related to the main hypothesis

The output and outcome evaluations generated based on the studies conducted as part of the present

research could be of interest for multiple parties at different levels in society as it is intended to be

both an inquiry and an exploration of the health promotion possibilities that lies within the school

setting. As such, the output and outcome of the present research are intended to serve as a

foundation for the planning of future health promotion aimed at children. At micro-level, the

experience and results generated could be of interest for parents (public dissemination activities

have been a major part of the present research (see Appendix B)). On a meso-level, stakeholders are

7

teachers, schools, local organizations etc. At the macro-level, stakeholders are policy-makers,

educational institutions, students, and researchers in related research fields.

1.6. Ethical approval

This PhD project and all related studies were conducted in compliance with the Declaration of

Helsinki, 1964/2000 (World Health Organization, 2001) and the Respect Code of Practice (Respect

Project, Institute for Employment Studies, 2004). Ethics approval was provided by the joint

Research Ethics Committee of the Faculty of Science and Faculty of Health and Medical Sciences,

University of Copenhagen, Denmark (reference 504-0005/17-5000).

8

2. CHILDREN’S FISH INTAKE

In this chapter, child health benefits of eating fish is shortly presented,

followed by a discussion on Danish children’s fish-eating behavior in

contrast to children in comparable countries. This chapter will, in

particular, refer and relate to results presented in paper I.

2.1. Fish and health

Aside from contributing to a diverse diet, consumption of fish also contributes with valuable

nutrients of great importance for e.g. children’s cognitive development. Especially fatty fish like

salmon, mackerel, and herring are rich in marine-derived chained omega-3 (n-3) polyunsaturated

fatty acids (PUFA) (Strobel, Jahreis, & Kunth, 2012). The principal n-3 PUFA docosahexaenoic

acid (DHA, 22:6n-3) is present in the human brain and may influence neurological function and

brain development, and is important for children’s cognitive function (Dalton et al., 2009; Huss et

al., 2013; Mouritsen & Bagatolli, 2016; Weiser, Butt, & Mohajeri, 2016). Fatty fish also have a

high content of Vitamin D, which is important for e.g. calcium (Ca) absorption, bone health, and

childhood growth stages (Braegger et al., 2013; Petersen et al., 2016). Regular consumption of fish

will also have a health benefit later in life, as a regular intake of n-3 PUFA from early life reduces

the incidences of individual components of the metabolic syndrome, a combination of risk factors

including diabetes mellitus, systemic arterial hypertension, central obesity and hyperlipidemia; all

metabolic diseases associated with the development of atherosclerotic cardiovascular disease (Kelli,

Kassas, & Lattouf, 2015; Kim et al., 2016; Mouritsen & Bagatolli, 2016). Furthermore, the protein

content in fish is 15 to 20%, it contains all the essential amino acids, also the sulphur-containing

aminoacids, which are low in plant food, and fish proteins have a high degree of digestibility i.e.

85-95% (Balami, Sharma, & Karn, 2020; Tilami & Sampels, 2018). Decreased risk of developing

the metabolic syndrome and increased insulin sensitivity are some of the positive health effects

related to intake of fish protein (Aadland et al., 2016; 2015; Dort, Sirois, Leblanc, Côté, & Jacques,

2012; Tørris, Molin, & Cvancarova, 2016). Thus, broadening children’s food repertoire to include

fish as part of a healthful, diverse diet is important both short and long term to promote good health

through life.

9

2.2. Children’s intake of fish – perspectives from paper I

The Danish Veterinary and Food Administration (2015) recommends that children ≥ 3-years-of-age

eat 350 g of fish per week, nevertheless the intake of fish among children aged 10-17 is only 105 g

per week; under one-third of the national recommendations (Pedersen et al., 2015 ). For public

dissemination purposes, The Danish Veterinary and Food Administration (2015) recommends that

fish is consumed in a meal twice a week and as cold cuts several times a week.

The results presented by Pedersen et al. (2015) correlates with the findings in the survey data

presented in paper I (Appendix A1). The frequency of fish intake was relatively low (M = 0.7; scale

0-3, where 0 = no intake in the past week, 1 = one to two times in the past week): 42% had not

eaten fish in the past week, 47% had eaten fish one to two times in the past week, and only 9% had

eaten fish three to four times. Furthermore, a significant effect was observed for the geographical

area (p = 0.006), with a more frequent fish intake in Greater Copenhagen than in the province of

Zealand (MG.Cph. = 0.8; MProv. = 0.6). Most children only consumed one to two different types of fish

(47%, M = 0.7; scale 0-3, where 0 = no intake in the past week, 1 = one to two types of fish in the

past week), and boys had a significantly (p = 0.05) more varied intake of fish types than girls (Mboys

= 0.7; Mgirls = 0.6). Also, a significantly (p = 0.006) more varied intake of fish types was observed

among children from the area of Greater Copenhagen compared to children from the province of

Zealand (MG.Cph. = 0.8; MProv. = 0.6). Little research has been conducted within this specific research

area with the investigated age group. The results of Eastern-Danish children’s fish intake frequency

presented in paper I differ from results in a Swedish study, investigating adolescent’s fish intake by

being lower (Kim et al., 2010), although results similar to the Danish intake of fish was found by

Kranz, Jones, and Monsivais (2017) in United Kingdom. The higher fish intake in Swedish

adolescents compared to Danish children could be a result of Swedish schools’ obligation by law to

serve lunch making fish dishes more accessible (Osowski, Lindroos, Barbieri, & Becker, 2015).

The findings presented in paper I support the research urgency of investigating possible strategies

for promoting healthy (fish) eating behavior. However, findings presented in paper III (Appendix

A3), did not support an increase in fish intake frequency as a result of participating in the cooking

course intervention, although course evaluation showed that 47% of the children, who had

participated in the five-week cooking course had become curious on tasting other kinds of fish and

38% stated a higher liking for fish after participation. The result related to the curiosity element is in

line with the results presented in paper IV (Appendix A4); curiosity was found to be a motivator for

trying new foods.

10

3. FOOD LITERACY

In this chapter the framing concept of food literacy is presented. This

chapter will refer and relate to results primarily presented in paper I -

III with regard to knowledge and skills related to handling, preparing

and cooking fish.

The interest for formal food education has increased as a result of concerns with loss of knowledge

of food and nutrition, loss of food competences (Benn, 2014), and an increase in child obesity

(World Health Organization, 2018). Furthermore, according to Larson, Perry, Story, and Neumark-

Sztalner (2006) young people who help to cook and acquire cooking skills early in life consume a

diet more compliant with nutrition recommendations later in life. Therefore the school setting is

interesting in promoting food literacy as a strategy for promoting healthy food behavior.

3.1. The concept of food literacy

The concept of food literacy was introduced in the early ‘90s by Jones (1994) and was aimed at

specifying a functional ability of following a healthy diet without deprivation. No agreement on a

fixed definition of food literacy exists. One of the most widely applied food literacy definitions,

according to Truman, Lane, and Elliott (2017) and Rosas, Pimenta, Leal, and Schwarzer (2020), is

the definition by Vidgen and Gallegos (2014, p. 54): ‘Food literacy is the scaffolding that

empowers individuals, households, communities or nations to protect diet quality through change

and strengthen dietary resilience over time. It is composed of a collection of inter-related

knowledge, skills and behaviours required to plan, manage, select, prepare and eat food to meet

needs and determine intake. This can simply be interpreted as the tools needed for a healthy

lifelong relationship with food’.

The definition by Vidgen and Gallegos (2014) is not far from that of Jones (1994), as the primary

focus is on health promotion. Rosas et al. (2020) revisited the concept of food literacy to investigate

the main elements of the construct. They found that the main domains were very similar to that of

Vidgen and Gallegos (2014), although being more detailed. Vidgen and Gallegos (2014) identified

four main domains with eleven sub-components (see Figure 3 for details). Rosas et al. (2020) found

eight main domains: origin, safety, choice and decision, select and acquire, plan, preserve, prepare,

11

cook, and knowledge with 22 attributes; e.g. seasonal, additives, and pesticides. Comparing the 11

sub-components identified by Vidgen and Gallegos (2014) to the 22 attributes identified by Rosas

et al. (2020), the latter is more detailed but also less flexible due to the high level of specification.

Figure 3: The four competencies and eleven components encapsulating the food literacy construct,

according to Vidgen and Gallegos (2014). Figure adapted by R. Højer based on Vidgen and

Gallegos (2014, fig. 3, p. 55).

In the construct of food literacy there is also integrated functional (knowledge), interactive (skills),

and critical elements (transformation and empowerment), which relates to for example knowing

what foods to eat and why, how to read food label information and what it means, and to cook food

safely, and how and why this is done (Pendergast, Garvis, & Kanasa, 2011; Palumbo et al., 2017).

According to Pendergast et al. (2011), the mastery of these elements is achieved through the

development of self-efficacy, which, according to Bandura (1977, 1982) is the belief in one’s

capabilities to cope with, organize, and execute courses of action required to engage in and

12

overcome a given task and/or situation. With an empirically based construction of food literacy

Vidgen and Gallegos (2014) aimed at developing a health-promoting tool identifying the complex

related set of skills, knowledge and behaviors needed to protect diet quality through change and

strengthening dietary resilience over time. Although Vidgen and Gallegos’ (2014) concept of food

literacy is aimed at the individual, they also acknowledge that food literacy has a social dimension,

although it is not clearly visible in their model (Figure 3). Furthermore, according to Vidgen and

Gallegos (2014), the construct of food literacy should be seen as an investigative tool to capture a

broader perspective when investigating food choice and to conduct health-promoting interventions.

In the case of the latter, they also refer to empowerment as an important outcome of promoting

health through food literacy (Vidgen & Gallegos, 2014), which is also supported by Thomas and

Irwin (2011).

Moreover, food literacy can be understood from two perspectives; as formal food literacy, which is

linked to a formal educational setting with a learning goal perspective. This perspective has been

defined by for example Benn (2014, p. 18): ‘skills, competencies, knowledge, and self attributes

regarding a functional, interactive, and critical level […], as knowing, doing, sensing, wanting and

caring, all together as being practical prudent at a personal level but also regarding food and

meals together with others in everyday life’. The other perspective is more closely related to

informal settings, for example, the family, friends, etc., where food literacy is perceived as a part of

important life skills to lead a healthy life. The latter could be seen as a public health promotion

perspective (for example, Vidgen and Gallegos, 2014). Nevertheless, the two perspectives are not

different, as they are both related to health promotion as defined by the Ottawa Charter (1986, p 1):

‘[H]ealth promotion is the process of enabling people to increase control over, and to improve,

their health’.

The food literacy concept applied as a framework in the present study is the concept defined by

Vidgen and Gallegos (2014) as it has been applied widely as a framework for health promotion

interventions (Truman et al., 2017; Rosas et al., 2020). Furthermore, with regard to the reason for

applying Vidgen and Gallegos’ (2014) concept of food literacy, it is important to note that the

present PhD project did not have a formal learning/educational inquiry interest but is aimed at

promoting healthy food behavior by exploring the possibilities of a cooking course in a formal

school setting. As such the cooking course on fish was a research design tool in the investigation of

children’s food literacy and fish-eating behavior intended to explore a sensory-based experiential

13

approach in promoting children’s acceptance of fish, fish-eating behavior, and food literacy with the

aim of promoting healthy food behavior through life.

Furthermore, Vidgen and Gallegos’ (2014) concept of food literacy proved itself to be a solid

concept throughout the analytical work in paper I and III (Appendix A1, A3) due to its flexibility in

covering and including various aspects of capturing what happens to knowledge, practical skills,

and the social dimension when learning and exploring through food in a formal setting.

3.2. Knowledge and skills; perspectives from paper I and III

As illustrated in Figure 3, food literacy, according to Vidgen and Gallegos (2014), is based on four

primary competencies: plan and manage, select, prepare, and eat. Elements of knowledge and skills

are the foundation of these competencies.

As observed in the status survey presented in paper I, the respondents (n = 669) evaluated1

themselves positively, but just, with regard to overall knowledge on fish and cooking (M = 2.4, min.

score = -12, max. score = 12). With regard to skills the respondents (n = 669) evaluated2 themselves

positively, but again just so with a mean of 3.5 (min. score = -18, max. score = 18). Especially skills

related to filleting fish3 was evaluated negatively (M = -0.4, -0.5, min. score = -2, max. score = 2).

Furthermore, paper I presented various significant positive correlations, with the two strongest

positive correlations observed between theme 3) ‘Knowledge of fish and cooking’ and theme 4)

‘Skills in fish and cooking’ (r = 0.62, p <0.001) and theme 4) ‘Skills in fish and cooking’ and theme

6) ‘Skills in the senses’ (r = 0.61, p <0.001). The Pearson’s correlation coefficient between themes

3 and 4 indicates that knowledge is positively associated with skills: if you know it, you can do it,

and the coefficient of determinations means that 38% of the variability observed in knowledge can

be accounted for by skills. The correlation between themes 4 and 6 indicates that if skills in fish and

cooking are present, then so too is the ability to use the senses in relation to food, and 37% of the

variability observed in skills can be accounted for by the self-evaluated ability to use the senses.

These results indicate that the status of Eastern-Danish children in general functional (knowledge)

and active (skills) elements are positive, but not overwhelming, but especially the element of

1 Items based on Likert (1932) with statements evaluated on a 5-point agreement scale. Overall knowledge based on six

summed knowledge-themes items: min. score -12, max. score = 12. See section 6.5.5. for elaboration of survey

questionnaire. 2 Items based on Likert (1932) with statements evaluated on a 5-point agreement scale. Overall skills based on nine

summed skills-themes items: min. score -18, max. score = 18. See section 6.5.5. for elaboration of survey questionnaire 3 Two items measured filleting skills: item 23c.: I can fillet a flat fish; item 23d.: I can fillet a round fish.

14

preparing fish is lacking. As such, the foundation for the general hypothesis being tested in this PhD

project is warranted.

From a status on food literacy and fish (eating) behavior in paper I to the presentation of the

intervention effect in paper III: the effects of the five-week cooking course on food literacy and fish

acceptance were investigated (main study group: n = 185; control group: n = 198) based on

baseline and follow-up measurements by, among others, applying a self-administrated survey

questionnaire. Major effects were observed especially within the main study group (MS), who had

participated in the cooking course, in the areas of knowledge on fish and cooking; paired samples

Wilcoxon signed rank test showed a significant difference between scores in meta-theme

KnowFishCook (Z = 3.885, p < 0.001) between baseline and follow-up. The median score at

baseline was 2 compared to 4 at follow-up. For skills related to fish and cooking the same patterns

was observed: significant difference (Z = 8.121, p < 0.001) between scores before participating in

the five-week cooking course and after. The median score at baseline was 2 compared to 7 at

follow-up. Especially the self-evaluated ability to fillet different kinds of fish was promoted by

participation. Effects were also observed with regard to organization of work station, development

of language/vocabulary, ability to work together, the ability to work autonomous (for more

examples of effects related to food literacy see paper III, Figure 2: Key effects of participating in a

five-week experiential theme course on fish. Results from the study; Appendix A3).

To investigate the effects of participating in a five-week experiential, hands-on cooking course on

food literacy and fish acceptance Pearson’s r and r squared (r2) were computed (see Table 1) and

analyzed (data analysis not presented in papers).

15

Table 1: Pearson’s r and r2: Main study group, effect sum scores by meta-theme (data analysis not presented in papers)

1) FNTT8 2) FishBehavior 3) KnowFishCook 4) CanFishCook 5) KnowSenses 6) CanSenses

1) FNTT8 Pearson’s r/r2 1 0.19/0.04 0.15/0.02 0.19/0.04 0.09/0.01 0.24/0.06

p value* 0.010 0.036 0.009 0.22 0.001

2) FishBehavior Pearson’s r/r2 1 0.18/0.03 0.24/0.06 0.25/0.06 0.18/0.03

p value 0.013 0.001 0.001 0.016

3) KnowFishCook Pearson’s r/r2 1 0.62/0.38** 0.61/0.37 0.42/0.18

p value < 0.001 < .,001 < 0.001

4) CanFishCook Pearson’s r/r2 1 0.53/0.28 0.59/0.35

p value < 0.001 < 0.001

5) KnowSenses Pearson’s r/r2 1 0.39/0.15

p value < 0.001

6) CanSenses Pearson’r/r2 1

p value

* Correlation is significant at the 0.01 level (2-tailed).

** Bold: correlations of interest. The value of Pearson’s r was interpreted based on the definition by Dancey and Reidy (2017): weak = 0.1 - 0.3/-0.1 - -0.3; moderate =

0.4 - 0.6/-0.4 - -0.6; strong = 0.7 - 0.9/-0.7 - -0.9.

16

Four interesting positive significant correlations were observed: 3) KnowFishCook and 4)

CanFishCook (r = 0.62, p < 0.001, r2 = 0.38), 3) KnowFishCook and 5) KnowSenses (r = 0.61, p <

0.001, r2 = 0.37), 4) CanFishCook and 5) KnowSenses (r = 0.53, p < 0.001, r

2 = 0.28), and 4)

CanFishCook and 6) CanSenses (r = 0.59, p < 0.001, r2 = 0.35).

They are interesting as they provide information on how the effects of the cooking course on

knowledge and skills are interdependent, which demonstrates that the concept of food literacy is not

only about knowledge or skills, but they are intertwined and if one is positively affected the other is

likely to be positively affected too. This is also supported by, e.g. Muzaffar, Metcalfe, and Fiese

(2018), who found that school cooking programs that applied a hands-on strategy successfully

improved a number of key food-related topics: e.g. knowledge, cooking attitude and self-efficacy,

behavioral intention for cooking and eating plant foods, preferences for cooking and healthy eating,

and willingness to try new foods.

17

4. CHILDREN’S ACCEPTANCE AND REJECTION OF FOOD

In this chapter children’s food behavior is put into perspective based

on acceptance and rejection and strategies for changing food behavior.

This chapter will refer and relate to results presented in paper II- IV

with regard to tactility, food exploration, curiosity and acceptance and

rejection of food.

Healthy food habits and preferences are established early in life through the practice of the parents’,

and especially the mother’s, food habits, knowledge, skills, beliefs, and values and will be the

foundation on which the child will accept or reject food (Hendrie, Sohonpal et al., 2013; Lafraire et

al., 2016; Nicklaus, 2009; Skinner et al., 2002).

From infancy children’s food options are primarily a result of parental food practices, and social,

and environmental factors (Hursti, 1999; Lafraire et al., 2016; Scaglioni, Arrizza, Vecchi, &

Tedeschi, 2011). The infant is in its first months a univore, consuming a diet based exclusively on

milk, the only variety being breast milk or formula. With age, the child broadens its food selection

to a variety of foods, and thereby becomes, or at least has the potential to become an omnivore

(Birch & Fischer, 1998; Birch, 1999; Rozin & Vollmecke, 1986).

4.1. Food acceptance and rejection

The question is what motivates acceptance and rejection of food? Rozin and Fallon (1980, 1987)

have proposed a taxonomy of food acceptance and rejection in which they point to three prime

motivations being the foundation for acceptance and rejection causing four rejection and four

acceptance categories as presented in Table 2.

18

Table 2: The taxonomy of food rejection and acceptance. Adapted by R. Højer from Rozin and

Fallon (1986), Table 1, p. 60.

Motivation acceptance/ rejection

Categories of rejection Categories of acceptance

Distaste Danger Inappropriate Disgust Good taste Beneficial Appropriate Transvalued

Sensory Properties

+ + + +

Anticipated consequences

+ +

Ideational

?* + + ?* + +

* May be involved in response

The sensory-affective factors are related to for example the like or dislike of taste, smell etc.,

anticipated consequences: e.g. negative/positive physiological or social influences and ideational

factors are related to for example knowledge of the nature or origin of a food (Rozin & Fallon,

1986, 1987). According to Rozin and Fallon (1986), this system of motivation promoting either

rejection or acceptance is a simplification, as it only emphasizes the principal feature motivating

acceptance or rejection, and many food choices are determined by more than one of these factors.

As an example Rozin and Fallon (1986) point to acceptance of milk: it can be driven by both good

taste, which is a sensory-affective property, and by a health perspective, which is related to

anticipated consequences (Rozin & Fallon, 1986). Furthermore, factors influencing the liking and

disliking of specific foods are many, but the influence of culture is one of the predominant factors

as is the context in which the food is consumed (Rozin & Vollmecke, 1986; Lafraire et al., 2016).

Rozin and Vollmecke (1986) also point out that acquired likes can be promoted by social

encounters with people outside the family, in particular peers, which is a central assumption in the

light of the setting of this study as the school is an important scene for children’s social activity.

The social dimension of promoting food acceptance was explored in both paper II and III

(Appendix A2, A3), and the findings pointed to great potential in including this dimension in health

promotion interventions in the future. Furthermore, a rejection-acceptance continuum is presented

in paper II based on participant observational data with a focus on tactility and cooking (Højer,

Wistoft, & Frøst, 2020).

In the baseline survey questionnaire, the children (n = 669) were asked about the reasons for liking

or disliking fish (data not presented in papers). The children could freely write whatever reason(s)

19

they had for liking or not liking fish. 69% of the reasons were categorized as liking (n = 464), 16%

were categorized as not liking (n = 110), while 14% were ‘in-between/liking but…/don’t know’

reasons (n = 95). Within the categories ‘I like fish because…’ and ‘I do not like fish because...’ the

following sub-themes were identified (based on times mentioned):

I like fish because…

1) good taste (353 times)

2) healthiness (67 times)

3) make many different dishes (32 times)

4) deliciousness (23 times)

5) like texture (16 times)

6) different from meat (14 times)

I do not like fish because…

1) bad taste (77 times)

2) disgusting (14 times)

3) dislike texture (14 times)

4) dislike smell (14 times)

5) bones (8 times)

These finding are comparable to those found in paper IV (Sick, Højer, & Olsen, 2018) regarding

children’s self-evaluated reasons for accepting and rejection food. Good taste, healthiness,

deliciousness and like texture, which has also been found in other studies (e.g. Koivisto & Sjödén,

1996; Rozin & Fallon, 1986; Zampollo, Kniffin, Wansink, & Shimizu, 2012). However, two

different sub-categories were detected: that you can make many different dishes with fish, which is

an interesting observation, as this element has not been investigated before, and that fish is different

from other meats. However, Nicklaus, Boggio, Chabanet, and Issanchou (2004) found a similar

tendency, which indicated that a shift in evaluation of meat products occurs around the early

adolescent phase, especially in girls, resulting in a lower rating of meat products as the teenage

phase starts. The reasons given for not liking fish in this survey were also found by Prell, Berg, and

Jonsson (2002). Even though curiosity was not mentioned by the children regarding liking or not

liking fish, it was the most often stated reason for tasting the fish dish of the day in the evaluation of

the cooking course: 40% gave this reason, whereas the most often stated reason for not tasting was

‘I did not feel like it’ (21%).

4.1.1. Disgusting or distasteful?

Rejection based on the concepts of disgustingness and distastefulness; how is it possible to properly

distinguish between the two and determine which mechanism is at play? This is discussed in the

following section, as it is a fundamental part of the analysis presented in paper II and III. Primarily

due to findings by Angyal (1941), Rozin and Fallon (1987), Pliner and Pelchat (1991), and Martins

20

and Pliner (2006) who all found that especially foods of animal origin tend to promote the attitude

of disgust more than those of vegetable origin and that the concept of ‘animalness’ is a viable factor

in rejecting foods. Although, Pliner (1994) did not find the idea of animal to be a prime reason for

rejecting novel foods in young children, but conclude that it may simply be due to cognitive

capacity to process the concept of an idea of a food. The taxonomy of food rejection and food

acceptance developed by Rozin and collegues (1986; 1987) was based on reactions to familiar foods

(Pliner, 1994).

As Rozin and Fallon’s (1987) definition of disgust is derived from Angyal (1941), they all agree

that disgust is related to a rejection of oral consumption (Angyal, 1941; Rozin & Fallon, 1987).

According to Angyal (1941) and Rozin and Fallon (1987), a disgust reaction towards a food is

typically driven by the food being culturally learned and considered to be waste products of an

animal body (Angyal, 1941; Daniel, 2006; Rozin & Fallon, 1980; Rozin & Fallon, 1987). Angyal

(1941) argues that it is not so much the sensory quality (e.g. smell, sound, looks etc.) of the food

perceived as disgusting, but more a matter of the intimacy level of contact and thereby the risk of

being “soiled” or “contaminated” if coming into contact with the food, perceived to be disgusting,

which promotes a feeling of disgust (Angyal, 1941; Rozin & Fallon, 1987). As closeness to the food

in question determines the risk of contamination, Angyal (1941) also underlines that specific tactual

properties like softness, stickiness, and sliminess may heighten the disgustingness of the waste

products, a perspective not clear in Rozin and Fallon’s (1987) perspective on disgust. Nevertheless,

the importance of the tactile element was confirmed in paper II (Højer, Wistoft, & Frøst, 2020).

Rozin and Fallon (1987) emphasize that in terms of contamination, it is to be understood as a

psychological perception determined by the individual’s interpretation of or response to the

concrete situation. Even though Angyal (1941) and Rozin and Fallon (1987) do not directly relate

smell and disgust, Angyal (1941) argues that narrowing the nostrils and expressive movements of

the mouth as trying to avoid any penetration of smell through the nose and mouth may be a

physiological expression of disgust. Rozin and colleagues are more stringent when it comes to the

role and effect of sensory attributes on disgust and tend to pair it with distaste (Rozin, Fallon, &

Ugustoni-Ziskin, 1986; Rozin & Fallon, 1987). The category of distaste as a mean to rejection

relates to substances, which are rejected mainly as a result of an affective hedonic response of

dislike of, e.g. taste, smell, and/or texture of the food (Rozin & Fallon, 1986).

Distaste is the pre-cursor for disgust, but according to Rozin and Fallon (1986; 1987) it lacks the

dimension of contamination, ideational rejection, and inappropriateness.

21

Disgust has been recognized as one of the main core emotions, and can be identified by

characteristic facial expressions, the physiological state of nausea, and behavioral elements; e.g.

turning away or distancing of oneself from the object causing the emotion, and finally a feeling

state; e.g. revulsion (Angyal, 1941; Martins & Pliner, 2006; Rozin, Haidt, & McCauley, 2008).

Furthermore, distaste and disgust differ in the way that disgust is a guardian of the borders not only

of the bodily self but also of the social self. This means that the feeling of disgust is a protection

system, making sure that nothing perceived culturally inappropriate is incorporated into the body;

i.e. ingested (Rozin, Haidt, & McCauley, 2008). It also means that food rendered disgusting is

rarely ingested, whereas distasteful food can enter the mouth before being rejected (Rozin & Fallon,

1987; Rozin & Vollmecke, 1986).

Food rejection based on disgust starts to displays itself around the age of seven and will be

established around 12- to 13-years of age (Lafraire et al., 2016; Martins, 2006; Rozin, Fallon, &

Ugustoni-Ziskin, 1986).

One dish, in particular, was observed by the teachers to be perceived as disgusting by the children

participating in the cooking course; the fish stock and the fish soup (the fish stock was made in

module 4, and used in module 5 to prepare a kale-fish soup). In the teacher interviews, one teacher

said that some children became nauseous from the smell (one child even vomited) of the fish stock.

Another teacher said that the children had a hard time understanding that the fish head and bones

were to be used for preparing a dish, as the children, from their perspective, categorized this as

‘garbage’ (not only waste but something really disgusting), not normally eaten. In the evaluation of

the cooking course (data not presented in papers), the children evaluated ‘fun-ness’ of the modules

and experiments. In their evaluation of preparation of fish stock and fish soup the level of fun-ness

was very low: 25% and 22% respectively answered that they found it either funny or very funny

compared to for example making fried breaded dab: 41%, hake en papilotte: 33% and creating their

own recipe: 58%, and preparing their own dish with trout: 48%. Furthermore, 30% did not taste the

fish soup, which was also high compared to non-tasting of the other dishes (fried breaded dab fillet:

14%; hake en papilotte: 21%, own dish with trout: 19%. Only fried pickled herring had more non-

tasters; 36% did not taste the fried and pickled herring.

4.1.2. Food neophobia

According to Rozin and Vollmecke (1986), humans are omnivores as they can eat and digest a

broad range of foods. However, at the same time, humans are genetically pre-dispositioned to have

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an ambivalent response to potential new foods; a mixture of interest (neophilia) and fear

(neophobia). This dilemma; also known as the omnivore’s dilemma, is related to the dilemma

between the possible nutritional value of potential new food and the possibility that the new food

will be poisonous. Furthermore, Rozin and Vollmecke (1986) point out that in traditional settings,

the interest/curiosity - fear balance tends to often lean toward fear, resulting in a general

conservatism in cuisine and preferences.

The concept of food neophobia is interesting as Siegrist, Hartmann and Keller (2013) observed that

high food neophobia scores were correlated with a lower intake of vegetables, salad, poultry, and

fish compared to persons with lower food neophobia scores. Siegrist et al. (2013) found that

urbanization influenced the food neophobia score: the higher urbanization, the lower food

neophobia score. The same was observed for educational level. Similar results related to food

neophobia and food choice have been observed in children and adolescents by, e.g. Appleton et al.

(2019), Guzek, Głąbska, Lange, and Jezewska-Zychowicz,(2017), and Maiz and Balluerka (2016).

Food neophobia will stabilize with age, although there is some variance regarding at which age this

occurs. According to Nicklaus et al. (2004), it happens around adolescence (13 years), whereas

other studies state that stabilization occurs around early adulthood (Damsbo-Svendsen, Frøst &

Olsen, 2017; Koivisto & Sjoden, 1996; Lafraire et al., 2016; Rigal et al., 2006). The age-dependent

decrease in food neophobia could be explained by the fact that the child’s food experiences increase

with age, and therefore food novelty encounters are reduced over time (Dovey, Staples, Gibson &

Halford, 2008).

In this study, food neophobia was measured in the baseline, and follow-up survey as little research

has been conducted with regard to the Danish children aged 11- to 13-years. For example, Appleton

et al. (2019) included a sample of 178 Danish adolescents in the investigation of European

adolescents’ vegetable intake and liking of vegetables (total sample size: n = 736 from four

European countries).

Results from the baseline measurement of food neophobia are presented in paper I; in summary

Danish children evaluate themselves to have a neophilic tendency4 to food (MFNTT8Score = 30.3, min.

FNTT8 score: 8, max. FNTT8 score: 40). No significant effects were observed for sex (p = 0.64) or

4 Food neophobia categories inspired by Falciglia et al. (2000) and Guzek et al. (2018): neophobic (FNTT8 score of 8-

16), neophobic tendency (FNTT8 score of 17-24), neophilic tendency (FNTT8 score of 25-32) and neophilic (FNTT8

score of 33-40) (see paper I, Appendix A1).

23

area (p = 0.21) although there could be a slight tendency towards a more exploratory behavior in the

Greater Copenhagen area (FNTT8 score: 30.2) compared to the province of Zealand (FNTT8 score:

29.9). The observation of an effect of geographical area, even though not being significant,

correlates with the findings of Siegrist et al. (2013) with regard to urbanization although these

observations were based on food neophobia measured in adults.

Intervention effects related to the intervention is presented in paper III; no effect was observed in

overall food neophobia due to participation in the intervention, although single items within the

category showed significant effects (see paper III for elaboration).

4.2. Strategies for changing food behavior

Over time a number of key strategies have been identified to influence food preferences and

acceptance of novel foods (Martins, 2006; Rozin, 1988; 2010). These strategies are mere exposure

(Zajonc, 1968), evaluative conditioning (Rozin & Zellner, 1985), and modeling (Birch, 1980). A

more recent strategy applied is the hands-on or experiential learning strategy, which often includes

an underlying mix of the more traditional strategies but includes the hand-on practical element as a

primary element (e.g. Cunningham-Sabo & Lohse, 2014; Chen et al., 2014; Utter, Fay, & Denny,

2017).

The research in this PhD project is based on the hands-on strategy, specifically defined as an

experiential learning approach as defined by Kolb (2015) (see section 5.3 for an elaboration), but

also includes elements of the traditional strategies.

4.2.1. Mere exposure

In mere exposure theory novel becomes familiar with exposure, as a strategy for changing food

behavior builds on the notion that children like what they know and they eat what they like (Cooke,

2007; Wardle, Herrera, Cooke, & Gibson, 2003). According to Kalat and Rozin (1973), the

mechanism of mere exposure (repeated exposure) is based on a “learned safety” behavior. The

number of exposures needed to increase liking of a food has been found after five to six exposures

(Anzman-Frasca, Savage, Marini, Fisher, & Birch, 2012; Hausner, Olsen & Møller, 2012). Other

studies have found that eight to fourteen exposures are needed (Caton et al., 2013; Fildes, van

Jaarsveld, Wardle, & Cooke, 2014; de Wild, de Graaf, & Jager, 2014).

Hausner et al. (2012) found an increase in acceptance (measured by amount consumed) of a

vegetable purée in 2 to 3-year-old Danish children after being exposed to it five times. Zeinstra,

Vrijhof, and Kremer (2018) investigated the mere exposure strategy with Dutch children (mean age

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of 25 months), and they found a significant increase in eaten pumpkin (+15 grams; p < 0.001) and

white radish (+16 grams; p = 0.01) after being exposed to this twelve times over a five-month

period. The intake of a third vegetable, courgette, did not increase significantly as a result of mere

exposure (p = 0.54). Zeinstra et al. (2018) point out that the lesser increase in intake of courgette

may be due to familiarity with courgette or a lesser distinct taste profile of the courgette, and they

conclude that mere exposure as a strategy to increase vegetable intake might only be applicable

with unfamiliar vegetables. In a school-based intervention study with Italian children aged 6 to 9

years Laureati, Bergamaschi, and Pagliarini (2014) found that the strategy of mere exposure alone

did not increase the liking of four different pairings of fruit and vegetables to the same extent (each

pairing were served four times over a sixteen-day period), as did mere exposure combined with a

peer modeling strategy, although the effect was only observed short term. In a 6-month follow up

only liking of fruit was still stable in the mere exposure + peer modeling group. In the mere

exposure group liking of broccoli and radish had increased (the two vegetables lesser liked at

baseline), whereas liking for the remaining fruit and vegetables had decreased. Laureati et al. (2014)

conclude that mere exposure alone as a strategy for changing food behavior may be applicable with

not liked vegetables, whereas the better overall strategy is combining mere exposure with, e.g. peer

modeling (social modeling).

Mere exposure was also a part of the strategy applied in the intervention in the present study as the

children would taste fish once a week over a five-week period. Exposure to fish once a week was

deemed sufficient as fish is a food group not eaten every day. Furthermore, according to Caton et al.

(2013), five exposures are realistic when implementing exposure strategies in practice.

4.2.2. Evaluative conditioning

Evaluative conditioning is also known as Pavlovian conditioning; e.g. flavor-flavor learning/known-

unknown is paired (Rozin & Rozin, 1981; Rozin & Zellner, 1985). Evaluative conditioning in the

form of flavor-flavor learning as strategy for increasing liking for a food is interesting, as Rozin and

Zellner (1985) point out because a meal typically consists of multiple flavor components. In a

flavor-flavor pairing, a known (liked) and unknown flavor are usually presented simultaneously;

simultaneous conditioning (Rozin & Zellner, 1985). In an attempt to find a successful strategy to

increase children’s consumption of, e.g. vegetables, several studies have been conducted using the

flavor-flavor learning strategy but with mixed results. In the studies, the known and well-liked

flavor component used is often sweetness, as we humans have a predisposition for liking foods with

25

a sweet taste (Birch, 1999; Drewnowski, 1989; Ventura & Worobey, 2013). In a study with 5-year-

old children, Havermans and Jansen (2007) found that pairing vegetables (here zucchini, pumpkin,

peas, cauliflower, broccoli, and carrot cooked, mashed, diluted in water, and served in a cup

separately) with dextrose led to a significant increase in flavor preference. In a study with children

aged 3 to 5 years, Capaldi-Phillips and Wadhera (2014) paired brussel sprouts; the unknown/not

liked flavor, with a sweetened crème cheese dip; the known/liked flavor, and found, after seven

exposures hereof, that the children’s liking of plain brussel sprouts increased. In contrast, de Wild et

al. (2014) found in a study with pre-school children, that flavor-flavor learning did not have an

effect on the liking of freeze-dried red beet or parsnip. The vegetable chips were served with a

ketchup flavored dip twice a week over a seven-week period.

In this PhD project flavor-flavor learning was included in the planning and development of the

dishes and recipes for the themed cooking course, as the focus was on the dishes to be recognizable

for the children, although they were developed to challenge the children at the same time.

4.2.3. Modeling

Modeling, for example influence through peer, friend or role model (Birch, 1980; Harris, 2008;

Rozin, 2010), can also affect children’s food behavior. According to Bandura (1977), social

learning, modelling by significant others, can be influential in establishing a behavior change. After

the shift from liquid to solid food, children’s eating experiences usually take place in a social

context with other eaters involved. These eaters serve as food and eating models for the child (Birch

& Davison, 2001; Houldcroft, Haycraft, & Farrow, 2014). The food and eating models can be

divided into different categories depending on their relationship with the child, the most influential

models being parents, peers, and friends (Birch & Davison, 2001). Several studies have found an

association between especially the mother’s feeding practice and that of the child (e.g. Papaioannou

et al., 2013; Scaglioni et al., 2008; Sleddens, Kremers, De Vries, & Thijs, 2010; Wardle & Carnell,

2007). As the child starts to spend more time outside the family home environment; e.g. in

professional daycare and school settings, the more influential models seem to be peers and friends

(Houldcroft et al., 2014). Peers and friends provide a conceptually different type of relationship.

The peer relation is characterized by acceptance, but Dunn (2004) argues that this acceptance is a

one-way construct, meaning that acceptance does not have to be reciprocated by the group or

person. In contrast, a friend relationship is characterized by reciprocal affection. Birch (1980) found

that peer modeling could increase children’s consumption and preference for initially not liked

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foods. Similar findings with peer modeling have been found in other studies with children (e.g. by

Greenhalgh et al., 2009; Horne et al., 2011; Laureati et al., 2014). Friend modeling has shown to

influence food intake, food attitudes, and beliefs in children (e.g. Farrow, Haycraft, & Meyer, 2011;

Paxton, Schutz, Wertheim, & Muir, 1999; Salvy, Howard, Read, & Mele, 2009), which was also

confirmed to be the case in the intervention in this PhD project (see paper II; Højer, Wistoft, &

Frøst (2020) and paper III).

4.2.4. The hands-on strategy

The hands-on strategy often includes, as introduced at the beginning of this section, a mix of

traditional strategies, but it is also founded on a sensory-based learning approach; learning about

food (and the world) through the senses. This practice was, for example, introduced by Puisais in

France in 1974 as Les Classes du Goût; taste lessons (Leer & Wistoft, 2015; Puisais & Pierre,

1987). The Sapere method (Hagman & Algotson, 1999) is another practice founded in sensory

learning highly inspired by Puisais. Both methods have been implemented in research within the

field of promoting children’s acceptance of food through sensory learning with positive results,

although no long term effects was observed based on a single intervention period (e.g. Battjes-Fries,

Haveman-Nies, Renes, Meester & Veer, 2015; Mustonen, Ranatanen, & Tuorila, 2009; Reverdy,

Chesnel, Schlich, Köster, & Lange, 2008).

Furthermore, the interest in sensory-driven and hands-on food learning resulted in the project Taste

for Life, which is an interdisciplinary research and communication centre; ‘ without walls

established in order to foster an interdisciplinary, collaborative project with a focus on the flavour

of food as a driving force for learning, education, food literacy, and good practice. The overall

mission of the centre is to create a basis for a better and richer life for the Danish population. […]

The aim of Taste for Life is to make Danish children and adults able to use their taste consciously,

empowering them to make reasoned food choices’ (taste-for-life.org, n.d.). Taste for Life was

established in 2014 and is supported financially by Nordea-fonden.

The ‘hands-on’ learning strategy is widely applied in interventional studies aimed at increasing

acceptance of healthy foods, typically fruit and/or vegetables (Utter et al., 2017), but a theoretical

frame or definition of the concept ‘hands-on’ strategy is rarely declared or is, at best, opaque; for

example Black et al. (2018), Ehrenberg, Leone, Sharpe, Reardon, and Anzman-Frasca (2019), Zahr

and Sibesko (2017). A few interventional studies aimed at promoting healthy food behavior based

on cooking/culinary programs state to apply an experiential approach, yet no comprehensive

27

definition of the concept is provided by the authors. For example Beets, Swanger, Wilcox and

Cardinal (2007) applied an experiential learning framework, with focus on autonomy and active

participation with regard to selection, preparation, and consumption. Still, they do not elaborate

more on the concept or theoretical frame. Cunningham-Sabo and Lohse (2014) referred to their

intervention cooking program as experiential but did not define the concept, although they referred

to and measured self-efficacy. Chen et al. (2014) also applied the concept of experiential learning as

a strategy in a health promotion intervention based on cooking classes, but only referred to it as a

hands-on approach without further introduction. Jarpe-Ratner, Folkens, Sharma, Daro, and Edens

(2016) applied the concept of experiential learning without further introduction, although

hypothesizing that a hands-on approach, among other factors, would increase cooking self-efficacy.

In a systematic review of experimental research conducted with regard to changing children’s

eating behavior, DeCosta, Møller, Frøst and Olsen (2017) identified 120 experimental studies

grouped within 11 topics; parental control, reward, social facilitation, cooking programs, school

gardens, sensory education, availability and accessibility, choice architecture and nudging, branding

and food packaging, preparation and serving style, and offering a choice. After analyzing the

studies, they concluded that hands-on approaches such as gardening and cooking programs may

have a positive effect on vegetable consumption, and the effect may be larger compared to nutrition

education. Muzaffar et al. (2018) conducted a systematic review of studies conducted with children

and cooking programs based on randomized controlled trials (RCTs) or quasi-experimental trials.

They ended up with only including 6 studies in the review; nevertheless their findings support those

of DeCosta et al. (2017): The hands-on strategy increased vegetable and fibre intake.

One of the challenges withn the research of changing food behavior through the hands-on strategy -

experiential; ‘change of food behavior by doing’, is that the primary research objective up until now

has been focused on increasing intake of fruit and vegetables as part of a healthy diet. A healthy diet

is composed of variety due to micro- and macro nutrient coverage (Nordic Council of Ministers,

2014), but it is also a matter of pleasure; the perceived affective response of pleasure related to the

meal experience (Nicklaus, 2009).

4.3. Intervention effects of applying a hands-on strategy on fish-eating behavior

The intervention effects of applying a hands-on, experiential strategy to change food behavior are

presented in paper III (Appendix A3).

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In Table 3 a summary of intervention effects on self-evaluated fish-eating behavior to the liking of

fish (item 17), assessment of fish disgustingness (item 14), fish intake frequency per week (item 15)

and variety in fish types eaten within the last week (item 16) is presented (based on results

presented in paper III).

Table 3: Summary of intervention effects on self-evaluated fish-eating behavior (within main study

group data only, n = 185, paired samples Wilcoxon test, only significant effect scores reported.

Extract from paper III, Appendix A3)

Main group (n = 185)

Baseline Follow-up Paired samples

Wilcoxcon

M SD Mdn. M SD Mdn. Z p-value*

14. How disgusting do you think fish

is?** 0.6 0.6 1 0.3 1.3 0 -3.293 0.001

15. How many times have you eaten

fish within the last week?*** 0.7 1.3 1 0.7 0.8 1 -0.112 0.911

16. How many different types of fish

have you eaten within the last

week?***

0.6 0.6 1 0.7 0.6 1 0.717 0.473

17. I like fish**** 0.8 1.3 1 0.7 1.2 1 -2.098 0.036

* Significance level α 0.05

** 5-point categorical sliding bar scale: extremely, very, moderately, not very, not at all.

*** 4-point frequency scale categories applied: 1 to 2 times/types of fish, 3 to 4 times/types of fish, 5 or more

times/types of fish, and I have not eaten fish within the last week.

**** 5-point Likert scale categories applied: strongly disagree, disagree, neither agree nor disagree, agree, strongly

agree.

As presented in Table 3, no effects were observed with regard to self-evaluated intake frequency

and variety in fish types eaten within the past week, and assessment of disgustingness increased and

liking was reduced.

The lack of effect in intake frequency and fish variety could be due to family practice and home

food culture, as the children still are dependent on the family meals. Danish adults also do not

comply with the official recommendations (50 g/day) for fish intake (mean intake: 37 g/day, median

intake: 28 g/day), although the intake of fish is higher than for children aged 10- to 17 years (mean

intake: 15 g/day, median intake: 8 g/day) (Pedersen et al., 2015). One of the possible reasons for the

higher intake observed in adults could be due to the fact that, according to a market analysis from

2016, 63% of working/studying Danes had access to a lunch canteen at work/institution (n = 1059),

29

and 34% typically eat their lunch in the canteen. Furthermore, access to fish dishes as part of lunch

in the canteen was either very important or important to approx. 55% of those who typically eat in

the canteen (Landbrug og Fødevarer, 2016). If fish was eaten for lunch, it is probably less likely to

be on the family dinner table as well, which would influence the children’s intake of fish. Fish and

seafood were only represented as an ingredient in 12% of the Danish evening meals on an everyday

weekday in 2018 (Madkulturen, 2018).

The main idea in this PhD project was to focus on the children outside the family environment as a

way to broaden the children’s horizon within the world of fish dishes, hoping it would promote the

children’s curiosity on fish and trying other fish (dishes) than they typically consume, but also that

the children would ask their parents to buy fish products. Results from the follow-up survey, main

study group showed that 47% had become curious on tasting other kinds of fish (follow-up survey

item 24.a.) and 27% agreed or highly agreed with the statement regarding requesting parents to

implement fish into a dinner meal fish after participation (follow-up survey item 24.c.). The latter

was also exemplified in the following quote (from paper III), where a girl had gotten her parents to

buy a whole fresh fish, which she was to cook for the family for dinner:

’They kept correcting me: No now it is wrong, you have to cut off the head, because we

are not using that’ and stuff like that, but I just said to them: No, I have tried it before,

so now you really have to trust me’ (School MB, inf. 3) (paper III, Appendix A3).

The quote illustrates the hope for some of the effects not being the main interest in this PhD project,

but never the less of great importance in exploring new research inquires for the future: how to

create a link between the food literacy and food behavior promoted in the school setting and the

family setting.

With regard to the observed reduction in self-evaluated liking and the increased self-evaluated

assessment of fish disgustingness after participating in the fish cooking course, a possible reason

could be due to a change in the children’s understanding of what fish as a food is (see paper III for

in-depth analysis and discussion on this specific subject). A very illustrative scene and quote from a

girl (data not presented in papers) at one of the oral lectures given in control group 2 exemplifies the

lack of knowledge on food and experience with fish:

30

Lecturer: Do you eat fish? (question asked to the class in plenum). Most of the children

say yes. One girl says no, but then turns to the girl sitting next to her and asks her:

‘is there fish in fish cakes?’ The girl next to her says, yes. Then she looks at the

lecturer and says: ‘well yes, then I do eat fish’ (School CF)

The scene and quote could exemplify what Fischler (1980) refers to as gastro-anomy: a

normlessness related to food and food choice. Gastro-anomy can be a result of a lack of cultural

references; if you have never made fish cakes yourself or thought about what you are eating, how

are you really to know what you eat. A fish cake does not resemble a fish; no bones, head etc. are

visible – the degree of animalness, as Rozin and Fallon (1986, 1987) calls it, is very low as only the

name of the dish indicates that it contains fish. And from a child’s point of view: There is no dog in

dog biscuits either. Nevertheless, even though liking decreased as a result of participating in the

intervention, in the main study group evaluation of the cooking course 38% of the children stated a

higher liking for fish after participation (follow-up survey item 24.b.).

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5. COOKING COURSE MATERIALS - theory and didactics

In this chapter the theoretical and didactical foundation of the cooking

course material is presented and discussed.

The themed cooking course on fish was a research design tool in the investigation of children’s food

literacy and fish-eating behavior intended to explore a sensory-based experiential, hands-on strategy

in promoting children’s food literacy, fish-eating behavior and acceptance of fish. During the five-

week cooking course on fish, the children were presented with a variety of typical fresh Danish fish,

which they would then prepare, cook and eat together.

Initially, it is important to point out that this study was not concerned with measuring learning

output from an official educational research point of view, but rather with the children’s self-

evaluated knowledge and skills within the areas of fish and cooking and fish-eating behavior and

the potential intervention effects on food literacy related to fish and fish acceptance after

participating in an experiential sensory-based five-week theme course on fish. This study was

interested in not only the intended learning taking place but also the self-evaluated and realised

learning and individual experiences, which can be similar or different from the intended learning

(Christensen & Wistoft, 2016).

The themed cooking course on fish was based on the hands-on strategy for promoting healthy food

behavior, as presented and discussed in chapter 4, but this strategy was applied based on specific

theoretical and didactical approaches to learning and curriculum planning. Even though the present

PhD project did not have a formal learning focus or documentation aim, but was aimed at

investigating the possibilities in using the school setting to promote healthy food behavior, the

declaration of theoretical stand and didactical foundation of the material used in the intervention is

deemed of great relevance. Primarily to promote transparency in the materials used in the

intervention, but also because it is closely related to both the behavioral change strategy applied and

to the element of how and what we learn; e.g. in relation to food literacy. Secondly, it is relevant

since the cooking course material was developed to comply with the official learning goals in the

subject Food Knowledge (for 2017-2018 & 2019) set by the Danish Ministry of Children and

Education (Bekendtgørelse om formål, kompetencemål, færdigheds- og vidensområder og

32

opmærksomhedspunkter for folkeskolens fag og emner (Fælles Mål), 2020); Ministry of Children

and Education, 2019).

5.1. Presentation of materials developed

Several materials were developed to be included in the main group intervention, and a presentation

was developed for an oral presentation (2 x 45 min + 10 min. break) to be given between baseline

and follow-up survey in control group 2. See Figure 4 for a complete materials overview.

Figure 4: Overview of cooking course materials

All cooking course materials were given to the participating schools in the main study group free of

charge and financed by the PhD project without any expenses for the schools. The student booklet

lay out (88 pages) are presented in Figure 5 and a complete overview of theme course modules are

presented in Figure 6 (adapted from Paper III with minor adjustments).

33

Figure 5: Examples of student booklet content (pp. 25, 42, 43 of 88 pages in total): p 25 (left):

experiment guide with pictures of step-by-step for gyotaku experiment, p 42 (middle): experiment

guide (last page of step-by-step) for hake en papillote (in a package), p 43 (right): Talk about the

food: ‘Sensing wheel’ developed by R. Højer specifically for the student booklet.

34

Figure 6: Modules in student booklet (adapted from paper III with minor adjustments)

The student booklet also contained an appendix with pictures and description of all vegetables and

fruits included in the recipes.

The teacher’s guide (57 pages) was focused on concretizing each module and how the single

module related to the official learning goals for the subject Food Knowledge.

Every chapter in the teacher’s guide contains the following elements (see Table 4):

Table 4: Teacher’s guide content

1. Theme of the day

2. Aim

3. Experiments of the day

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4. List of materials and ingredients for the experiments of the day

5. Learning goals covered

6. Teaching activities

7. Signs of learning as evaluation tool

8. Interdisciplinary elements within development of vocabulary/language and IT and media

9. Time tips (how to save time)

For control group 2 an oral presentation was developed based on the module themes from the

student booklet (see Figure 6) to ensure similarity, and later comparability of baseline, and follow-

up survey data between the main study group (cooking course participation), control group 1 (no

interference between baseline and follow-up), and control group 2 (oral presentation between

baseline and follow-up survey).

5.2. The subject Food Knowledge; official learning goals and expected learning

The four areas of competencies and expected learning in Food Knowledge are presented in Table 5.

These are mandatory, whereas the concrete learning goals are not (not shown), but could serve as a

guidance in curriculum planning (Ministry of Children and Education, 2019).

Table 5: Areas of competences and expected learning in Food Knowledge (Ministry of Children and

Education, 2019)

Areas of competencies

Expected learning (after 4th

/5th

/6th

/7th

grade) Areas of skills and knowledge

1. Food and

Health

The student is able to make conscious food

choices related to health Health consciousness, Nutrition and energy

need, Hygiene.

2. Knowledge of

Food

The student is able to make conscious food

choices related to quality, taste, and

sustainability

Food Knowledge, Sustainability and

environment, Food declaration and food

labelling, Understanding of quality and food

consumption.

3. Cooking and

Dining

The student is able to use cooking techniques

and convert ideas in the cooking process Aim and structure of cooking, Basic

preparation methods and food techniques,

Physics and chemistry of cooking, Taste and

seasoning, Aesthetics of food,

4. Food Cultures The student is able to interpret meals with a

understanding of values, culture, and living

conditions

Meal composition, Food culture.

36

5.2.1. On legislation related to the subject Food Knowledge

The student’s booklet and teacher’s guide were developed to explicitly include the learning goals,

as the skills and knowledge-based learning goals in the legislative documents by the Danish

Ministry of Education (Bekendtgørelse om formål, kompetencemål og færdigheds- og vidensmål

for folkeskolens fag og emner (Fælles Mål), 2015) were mandatory at the time of the intervention

(January to May 2017). On May 19th, 2017, the legislation (Bekendtgørelse af lov om folkeskolen,

2017) was changed leading to increased freedom when planning the curriculum; learning goals for

skills and knowledge were now to be seen as guidance instead of being mandatory (Ministry of

Children and Education, National Agency of Education and Quality, 2019). Today (2020) the

mandatory frame for the subject Food Knowledge is as presented in Table 5.

The 2015 version of the legislation for the subject Food Knowledge (Bekendtgørelse om formål,

kompetencemål og færdigheds- og vidensmål for folkeskolens fag og emner (Fælles Mål), 2015)

including mandatory learning goals for skills and knowledge were, according to Wistoft (n.d.),

inspired by results presented by Hattie (2009) in ‘Visible learning: a synthesis of over 800 meta-

analyses relating to achievement’. Hattie (2009) relates learning goals to feedback as ‘feedback

needs to provide information specifically relating to the task or process of learning that fills a gap

between what is understood and what is aimed to be understood. […] the main purpose of feedback

is to reduce discrepancies between current understandings and performance and a learning

intention or goal (Hattie, 2009, pp. 174-175). Furthermore, Hattie (2009) underlines that clear goals

are of great importance for the feedback process, and that feedback is one of the most powerful

influences on learning. Wistoft (n.d.) points out that the continuous feedback related to the learning

goals is centred around student development, but can only be practised if the learning goals are

visible to both the student and the teacher. Among others, Christensen and Wistoft (2016) propose

that teaching in FK should include student involvement in setting learning goals. With the changes

in the legislation, the teachers now have the opportunity to practice student involvement to a higher

extend, although it requires teacher knowledge and competences within the subject’s learning

expectations. An evaluation report on the subject FK was presented in 2019, which highlights a

lower prioritizing of the teacher competence development by the school management and that the

measured competence coverage in the subject of FK is the 4th

lowest (73%, average competence

coverage in all subjects: 87%) of all subjects (Danish Evaluation Institute, 2019). To exemplify, the

following quote was given by an informant as part of the telephone interviews with the teachers (n

= 5), who participated in the cooking course on fish. They were asked about their daily work with

37

learning goals in the subject FK. Only one teacher worked with the official goals in a structured

manner. One teacher had the following comment to the question (data not presented in papers):

‘Yes, if I have to be completely honest, it is not something I spend a lot of time on…

what kind of goals there are in Home economics. I have an education in nutrition and

health [økonoma] […] and I went to the nutrition and health school and so on, so in

that way I know quite a lot about … I am not an educated Home economics teacher, but

I am able to do many things, so I just think, I am just going to teach the kids what I think

is important… and those goals – I have not spend too much time on them (T1, school MA).

5.2.2. Learning goals in teacher’s guide

All materials included in the intervention were chosen to support the official expected learning and

learning goals according to the legislation (Bekendtgørelse om formål, kompetencemål og

færdigheds- og vidensmål for folkeskolens fag og emner (Fælles Mål), 2015) (see Table 5 for

expected learning). To conceptualize how areas of competences and expected learning was

implemented in the developed cooking course material, an example of a student activity planning

sheet for one module from the teacher’s guide is presented in Table 6 (the teacher’s guide includes

seven student activity planning sheets in total).

Table 6: Example of student activity planning sheet; module 1 in teacher’s guide (translated into

English from the original Danish version, this module is coded with the colour blue in the booklet)

Student activity Student preparation Learning goals

Module 1 (chap. 3):

Gyotaku;

fish art with a

flatfish

Fish of the day:

Dab

The students work theoretical and

experimenting with flatfish:

gyotaku, filleting of flatfish, and

cooking (breaded fried fish filet)

During tasting of the dish of the

day the students have

conversations on the sensory

experience based on the ‘Sensing

Wheel’ in their groups

Experiments of the day:

X1: Gyotaku (fish print)

X2: Filleting of flatfish

X3: Dish of the day: Fried

breaded filet of dab

* Read p. 22 – 30 in

student booklet

* Watch YouTube

film: Facts on dab

* Watch YouTube

film: How to fillet a

flatfish

* Students know of the

fish dab

* Students are able to

assess fish freshness

* Students are able to

create gyotaku

* Students are able to fillet

a flatfish

* Students are able to cook

a dish with dab

38

Learning goals related to, e.g. organization, tema work and development of language/vocabulary

were not a part of the module learning goals. Nevertheless, these were prometed by the teachers in

the telephone interviews as skills learned during the cooking course (presented in paper III,

Appendix A3).

5.3. Pedagogical theoretical foundation

The theoretical, pedagogical foundation for the cooking course on fish and the included materials is

the Cycle of Learning as developed by Kolb (2015) (see Figure 7). According to Kolb (2015, p. 67)

‘learning is the process whereby knowledge is created through the transformation of experience.

Knowledge results from the combination of grasping experience and transforming it’.

Figure 7: Kolb’s Cycle of Learning. Adapted by first author R. Højer from Kolb (2015), figure 3.1.:

Structural Dimensions Underlying the Process of Experiential Learning and the Resulting Basic

Knowledge Forms.

In relation to the Cycle of Learning, Kolb’s (2015) point is that both a figurative representation of

experience; either as grasping via apprehension (feeling, emotion, and sensation) or grasping via

comprehension (thinking, conception, and judgement) and some transformation; either as

transformation via intention (reflection) or as transformation via extension (doing) are required in

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learning. Furthermore, he underlines that no mode in the cycle is superior, but all four are

equipotent contributors to the learning process (Kolb, 2015). Kolb (2015) defines learning as a

process, not a product, and refers to the learning spiral as an ongoing iterative process where prior

experiences lay the knowledge and experience foundation for taking on new assignments and

entering into new experiments. In experiential learning theory, as defined by Kolb (2015), learning

is a transaction between the person and the environment, which is also supported by Hattie (2009).

The learning space is not limited to the classroom but is understood as multidimensional, including

physical, cultural, institutional, social, and psychological aspects (Kolb, 2015). This spatial

flexibility could be one of the reasons why the experiential learning approach has become a popular

strategy for promoting healthy food choice in children: learning about healthy foods by actual

interacting and experimenting with healthy foods, not restrained to a traditional classroom setting,

also support a natural incorporation of varied learning styles. Learning styles as concept has been

defined as “a collective term for theories on how people learn best” (Boström, 2012, p. 13). Kolb’s

(2015) nine learning styles (experiencing, imagining, reflecting, analysing, thinking, deciding,

acting, initiating, and balancing) are all dynamic and dependent of learning space, but they

primarily deal with preferred learning style and the learning process in general. The learning style

model by Dunn and Dunn (Dunn et al., 2012) (see Figure 8), however, primarily focuses on

important elements when learning something new and challenging (Boström & Lassen, 2006; Dunn

et al., 2009).

Figure 8: Dunn and Dunn learning style model. Adapted by first author R. Højer from Dunn et al.

(2012), Figure 1, p 136.

40

One physiological preference element missing in the Dunn and Dunn learning style model is taste,

which is a core element in the subject of Food Knowledge. The concept of taste, however, is very

complex as it can be defined in various ways from solely related to the sensation sensed on the

tongue and processed by the taste buds to perceiving taste as a multi-sensory experience also

including past experiences and memories to a matter of communicating through taste, which is

highly social and to define taste as value and context-dependent (Christensen & Wistoft, 2016).

According to Bostöm and Lassen (2006), applying learning style considerations as part of the

didactics and pedagogical platform could increase the learner’s perceived self-efficacy and

motivation for learning.

When it comes to promoting healthy food behavior Nelson et al. (2013) argue that nutrition

knowledge alone is incomplete without the dimension of experiential learning via interactions with

food and cooking equipment. Furthermore, they point out that as students partake in culinary skills

education, based on Kolb’s (2015) experiential learning cycle, and engage in culinary concepts, a

foundation for promoting skills, technical proficiencies, and critical-thinking is laid out (Nelson et

al., 2013). Moreover, by involving children in the cooking processes, it is possible to promote the

willingness to taste novel foods and preferences for healthy foods (e.g. Allirot, da Quinta,

Chokupermal, & Urdaneta, 2016; Cunningham-Sabo and Lohse, 2014; Ehrenberg et al., 2019;

Hersch, Perdue, Ambroz, & Boucher, 2014).

5.4. Theme course material: didacticization

As the cooking course on fish was a research design tool in the investigation of children’s food

literacy and fish-eating behavior intended to explore the potential of a sensory-based experiential

approach in promoting children’s acceptance of fish, fish-eating behavior, and food literacy, a short

presentation of the didactical background is presented in the following section.

Didactically, the themed cooking course was organized and developed based on the dynamic

didactical model ‘the didactic relation model’ as described by Hiim and Hippe (2007). The model

includes the following six didactic categories: 1) learning conditions: the knowledge, experiences,

attitudes, and skills which the students already possess prior to participating in the course, 2)

setting: for example executive orders, equipment, artefacts, classroom, teacher’s resources, learning

resources, time, and place, 3) learning goals: intended learning; what should be learned from the

course/activity in terms of knowledge, skills, attitudes, and competencies, 4) content: what the

course is about, academic content selection, adjustment and presentation, 5) learning process:

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learning methods, degree of teacher/student facilitation and involvement in organization, and 6)

assessment: who should evaluate, what to evaluate and how to evaluate; course evaluation: of all

elements of the model during or after course completion are evaluated, but also student/teacher

evaluation (Hiim & Hippe, 2007).

1) Learning conditions: As part of the recruitment strategy it was ensured that no courses on fish

had been given in a school setting prior to entering this study. To ensure that the experiments

included were compatible with the grade level they were pre-tested on one 6th

grade class (n = 23),

and after extensive adjustments (some of the original experiments were too difficult and/or time

consuming; e.g. fish sausage and ravioli with fish and cheese), the complete themed cooking course

including all experiments were re-tested in a pilot study with three 6th

grade classes (n =69).

Furthermore, in the selection of fish attention was given to the importance of fish recognizability.

As such the fish selected would not be the known fish but one very similar to it; for example plaice

(Pleuronectes platessa) is a typical fish eaten in Denmark, but instead dab (Limanda limanda) was

chosen. This was done to create a link between something familiar to a less familiar/comfortable

situation (e.g. filleting and cooking fish themselves, a hypothesis confirmed in paper I), but also as a

way to introduce the children to fish less often eaten and to broaden their horizon within fish and

sensory experiences.

2) Setting: The school’s teaching kitchen. The kitchen differs from the ordinary classroom as the

environment is very different: it is filled with different sensory experiences (e.g. different surfaces,

smells, sounds etc.) compared to the everyday classroom and the layout of the room is typically

organized to accommodate practical group work (separate sections with stoves, tables, sinks etc.).

The setting also reflects that the subject and content is related to a higher degree of physical activity

(standing, moving around, using different tools) compared to the typical more stationary setting in

the everyday classroom. Therefore, the setting provides variety, also learning style-wise.

As the study was conducted in a natural setting, the theme course was run solely by the teachers but

based on the teacher’s guide.

3) Learning goals, 4) Content: These two elements were placed closely together due to the

mandatory skills and knowledge goals (Bekendtgørelse om formål, kompetencemål og færdigheds-

og vidensmål for folkeskolens fag og emner (Fælles Mål), 2015). The content in the themed

cooking course was chosen to cover specific themes of relevance regarding the expected learning

and skills- and knowledge areas (see Table 5). Furthermore, the focus was on including a wide

42

variety of materials: text, pictures, videos (including audio), tools, fish, etc. to accommodate

different learning styles.

Learning goals were constructed so they could be easily observed by the teacher, which is also

recommended by Hattie’s (2009) and included in the baseline and follow-up survey measuring self-

evaluated knowledge and skills (see paper I and III).

5) Learning process: The experiential learning approach to the learning process was based on

Kolb’s (2015) four-stage cycle. Each theme module was based on fish, which would be the basis of

the module experiments, and as such, the fish were artefacts to not only learn about but also to learn

through. From each experiment something new was experienced; through tactility; for example

experiencing how the fish feels when touching the skin, smell; for example how fresh fish smells,

taste; for example how different fish types taste, sounds; for example the sound of cutting into the

fish and hitting a bone, visual; for example seeing viscera, teeth, head and eyes. The intention was

that through concrete experience (for example sensing the fish’s specific sensory properties)

followed by reflection and thinking about what had been sensed would lead to a new perception and

evaluation of what had been sensed. Then, through experimentation and further exploration,

experience-based knowledge develops, which then could be applied in the next experiment,

resulting in a new concrete experience foundation; and so the spiral continues. Furthermore, the

intension was that the teacher would gradually include the children in the planning process and in

the last experiment; Cook off, the children would have a free choice in planning and creating a dish

with organic rainbow trout (module 4 and 5).

6) Assessment: assessment could be conducted based on the learning goals, but as a supplement the

dialogue tool ‘Sensing Wheel’ (see Figure 5, right picture) could be applied by the teacher after

each experiment to evaluate student experiences to promote student reflections. Finally, a quiz was

implemented in the student booklet, covering each module topic.

43

6. COLLECTING DATA WITH CHILDREN

In this chapter research strategy (mixed methods research strategy), study design

and data collection methods are presented. As the applied research strategy is

mixed methods, a short clarification of the paradigmatic foundation will initiate

the chapter. Furthermore, issues related to children as informants are presented.

6.1. Clarification of paradigmatic foundation

The research strategy applied in the present study was a mixed methods research strategy. This

challenges the paradigmatic foundation due to epistemological (how we know, what we know, the

relationship between the researcher and what is being researched), ontological (what is the nature of

reality), axiological (the place of values in research, what is the role of values), and methodological

(what is the process of research) traditions within different research fields (Creswell & Clark, 2011;

Shannon-Baker, 2016). The present PhD project is situated within natural and life sciences with a

tradition for researching food behavior primarily from a quantifiable point of view (see for example

the review by Decosta et al. (2017)). At the same time, specific pedagogical theory is included to

support the applied strategy in promoting a food behavioral change. Furthermore, the research

inquiries were driven by an interest in measuring quantifiable effects but also by an understanding

for what happens when children are exposed to a hands-on approach as a strategy for increasing

food literacy and influencing food behavior.

Two traditional paradigmatic stances are the post-positivistic world-view and the constructivist

world-view. The world-view associated with post-positivism is that knowledge is based on logic

and measurement of specifically selected variables, testing of theories, absolute principles and

prediction, reality can never be fully known and attempts to measure it are limited to human

comprehension (Creswell & Clark, 2011; Johnson & Gray, 2015; Weaver & Olson, 2006).

Ontologically post-positivism is focused on singular reality, for example, related to rejecting or

accepting a hypothesis and epistemologically focus is on impartiality, distance and objectivity. The

axiology-wise focus is on eliminating biases, and finally with regard to methodology deduction is

used to test existing knowledge and theory (Creswell & Clark, 2011).

44

The other paradigm; constructivism, is associated with a world-view based on how the subject

understands and constructs the world around him/her through social interaction: e.g. through words,

action, communication, materials, observation etc.; the focus is on the perspective of the subject

(Creswell & Clark, 2011; Johnson & Gray, 2015; Weaver & Olsen, 2006). The ontology of

constructivism is focused on multiple realities, which is exemplified through the use of quotes to

illustrate different perspectives, epistemologically the foundation is closeness, which for example is

operationalized through researcher’s visits to the environment in which the research subjects are

situated. Axiology-wise bias is present, but made clear in order to promote transparency, and finally

with regard to methodology researchers work inductively by building patterns and theories based on

the participants' view (Creswell & Clark, 2011).

However, when applying mixed methods as a research strategy, Johnson and Gray (2015) argue that

certain freedom and creativity should be included in designing the project, and therefore propose a

dialectical pragmatism as a partner for mixed methods strategy. Pragmatism is also suggested by

Creswell and Clark (2011), as it, among others, supports an abandonment of the forced dichotomy

between post-positivism and constructivism. Johnson and Gray (2015) define dialectical

pragmatism in the following way:

‘Dialectical pragmatism is a pragmatism tailored for mixed methods research. The base word

(pragmatism) refers to the applicability of the core tenets of philosophical and methodological

pragmatism […]. The adjective “dialectical” emphasizes that mixed methods researchers must

carefully listen to, consider, and dialogue with QUAL [qualitative research methods] and QUAN

[quantitative research methods] perspectives, and learn from the natural tensions between these

perspectives, when developing a workable solution for a mixed methods research study. Dialogue

continues at every phase of the research study. Dialectical pragmatism is most important in equal-

status mixed methods designs because in these designs the researcher or team of researchers

attempt to give equal weight to the concepts, assumptions, and practices of qualitative and

quantitative research […]. Most generally, the point is to dialectically listen to multiple standpoints

and produce an approach to research that synthesizes insights from QUAL and QUAN and any

other relevant perspectives’ (Johnson & Gray, 2015, p. 27).

Dialectical pragmatism seeks to break down a single point of view and one way of knowing in

(post-) positivism and constructivism in order to seek what is meaningful from both. Furthermore,

45

in addressing the connections between theory and data, abduction, the move back and forth between

induction and deduction, is typically the dominant way of working (Shannon-Baker, 2016).

The reasoning behind operationalizing the research inquiries through a dialectical pragmatic

paradigm is due to my belief that the studies conducted as part of this PhD project and the related

research inquiries of interest including the main hypothesis were best operationalized by letting the

research inquiries drive the paradigmatic foundation. Exploration and documentation were equally

important, and due to the exploratory need, several perspectives on the same inquiry were warranted

due to little knowledge on the subject of Danish children and fish-eating behavior. This approach is

also in line with the recommendation put forward by Hanson, Creswell, Clark, Petska & Creswell

(2005, p. 226): ‘The best paradigm is determined by the researcher and the research problem - not

by the method’.

6.2. Children as informants

Children as informants are not similar to adult informants. For example, the adults’ experience is

greater in magnitude than that of children. This means that the adult can make choices based on

prior similar experiences in many situations, whereas the child still meets many new situations.

Nevertheless, or maybe even more so, information based on children’s own experience is important,

when the research, as in this PhD project, concerns children’s behavior, knowledge, skills, and

competences. Children from the age of 11 are, according to Piaget (1929), able to engage in abstract

thinking, and Piaget (1929) calls this stage the formal logical in the child’s cognitive development,

which means that children included in this study should be able to understand and process the

various situation where they act as informants. According to Leeuw, Borgers, and Smits (2004), one

important factor in doing research with this age group is that children in the late middle childhood

(10- to 12 years of age) have begun to change with regard to their structure of self-concept. They

start to compare themselves to others making the effect of peers and friends a present issue, as is the

beginning awareness of the possibility of putting on a façade. Furthermore, in the early adolescence

phase (12- to 16-years of age), especially the conformity to peers and friends becomes very

important as social skills are developed (Leeuw et al., 2004). Moreover, it is important to

acknowledge that children’s perspective on what they experience is different than that of adults, and

that children tend to meet experiences with a higher degree of curiosity (Jirout & Klahr, 2012).

Several steps have been taken to ensure transparency and openness in relation to the participating

children. For example, if the children did not want to participate in the baseline and follow-up

46

survey, even though the parents had given written informed consent, this was honored, if the

children asked what was noted during participant observation, they were given the opportunity to

read the field notes in the field note journal, and participation in group interviews was based on

voluntary participation, the children were given the opportunity to read the interview guide before

saying yes, and a no to participation was accommodated.

6.3. Research strategy & design; Mixed methods

6.3.1. Research strategy

Creswell and Clark (2011) defines mixed methods research as a method, ’in which the researcher

collects and analyzes persuasively and rigorously both qualitative and quantitative data

(based on research questions);

mixes (or integrates or links) the two forms of data concurrently by combining them (or

emerging them), sequentially by having one build on the other, or embedding one within the

other;

gives priority to one or both forms of data (in terms of what the research emphasizes);

uses these procedures in a single study or in multiple phases of a program of study;

frames these procedures within philosophical worldviews and theoretical lenses; and

combines the procedures into specific research designs that direct the plan for conducting

the study’ (Creswell & Clark, 2011, p. 5).

The purpose of applying a mixed methods research strategy in the present PhD project was to

explore and provide insight to and a understanding of the complex research inquiries, as they are

rooted in children’s dietary intake and change of food behavior by exploring the possibilities of

sensory-based experiential learning as motivator. By collecting both quantitative and qualitative

data, it is possible to better capture this complexity than had only one research method been

applied; the collected data from the different research methods complement each other (Creswell &

Clark, 2011; Hanson et al., 2005; Shannon-Baker, 2016). An example of the relevance of applying a

mixed methods strategy became evident in paper III, where the complexity is presented with regard

to the themes related to the effects of the intervention related to the liking of fish and assessment of

fish disgustingness. The intervention effect conclusion would have been one-sided if these themes

had not been investigated by the application of several research methods: If only measured by

applying the survey questionnaire, the conclusion would have been that children’s self-evaluated

47

liking of fish and assessment of fish disgustingness was negatively influenced. However, through

teacher interviews, this was put into perspective and also supported by participant observations.

Had this been the only data, the conclusion would have been that the effect of participating in a

cooking course on fish was positive with regard to the subjects of interest. By comparing

observations from quantitative and qualitative methods, it became evident that one type of

understanding of fish was measured in the baseline survey, but it was probably a different

understanding of fish measured in the follow-up survey as a result of experience.

Furthermore, Creswell and Clark (2011) point out that the mixed methods approach is well-suited to

investigate everyday life, as everyday life is complex. In this PhD project the study is set in a

natural setting (Bryman, 2016); the subject FK in the Danish public school, in order to explore and

capture possible changes in fish-eating behavior and food literacy as a result of participating in a

sensory-based experiential cooking course on fish. The focus was to preserve the every-day school

life, and keep it as close as possible to how teaching in FK would have been conducted, had the

participants not been part of the intervention.

6.3.2. Research design

Within the mixed methods approach the framing design of the complete PhD study was a

multiphase design (Creswell & Clark, 2011), as the study combined both sequential and concurrent

strands over a 2 ½ year period as illustrated in Figure 9.

The multiphase design allows an iterative research workflow (Creswell & Clark, 2011), which was

ideal for this project, as the setting (FK and the Danish public school) was relatively unknown to me

as a research field. Phase 1 and 2 were primarily exploratory phases, phase 3 to 6 were exploratory,

and test phases, phase 7 and 8 were the main intervention phases, and finally phase 9; the data

analysis phase.

Embedded into the mixed methods multiphase design were three case studies (Yin, 2009) (phase 2:

study # 1, phase 3: study #2, and phase 5: study #3) and a quasi-experiment with case/control

design (Bryman, 2016) (phase 7 and 8; study # 4 and #5). The aims of the case studies were to serve

as preliminary explorations of the field and to gain a deeper understanding of both research setting

and segment in order to be able to make well-informed experience-based decisions moving forward

in the research process. The quasi-experiment with the case-control design was designed with one

case (main study group) and two control groups (CG1 and CG2).

48

QUAL: qualitative method, QUAN: quantitative method, obs.: participant observation, GI: group interview/children,

TI: telephone interview/teachers, CG1: control group 1, CG2: control group 2.

Figure 9: Multiphase mixed methods design. Adapted from Creswell and Clark (2011) by R. Højer.

The aim of applying a quasi-experimental design was to investigate possible effects (baseline and

follow up measurement phase: the independent variable; Y) of a five-week sensory-based

experiential theme course on fish (the intervention phase: the dependent variable; X) on

children’sfish-eating behavior and food literacy. The aim of applying two control groups was to be

able to compare the main group with 1) a matching group who had not had any intervention (CG1)

and 2) a matching group who had only had an oral lecture (2 x 45 min.) thematically reflecting the

sensory-based experiential cooking course on fish (CG2). Figure 10 illustrates the data collection

methods applied in phase 7 (main study intervention) and 8 (control study) as part of the quasi-

experiment on a timeline.

49

Figure 10: Quasi-experiment design including data collection methods; all study groups

6.4. Sampling and recruitment strategy

The sampling strategy was non-probability-sampling (Bryman, 2016), as sampling was not

conducted randomly at any phase in the mixed methods design. Nevertheless, a sampling frame was

applied: inclusion criteria were geographical location (Zealand and Falster), grade (5th

and 6th

), and

school type (public). Exclusion criteria were ‘Special needs classes’ and classes which had prior

completed a theme course on fish in Food Knowledge. Moreover, in the main study (study 4, Phase

7) an equal weight of participating classes from the Greater Copenhagen5 area and the area of

Zealand (including Falster), the latter subsequently referred to as the province, was sought.

The sampling strategy with regard to recruitment was adjusted to the different phases in the multi-

phased mixed methods design. In study 1 to 3, the sampling was based on convenience (Bryman,

2016). In study 4, the main study, recruitment was conducted by sending out invitations to

participate to public schools all over Zealand (invitations to participate in the cooking course were

5 Greater Copenhagen is defined by Statistics Denmark (2018) as covering the following geographical areas:

Copenhagen, Frederiksberg, Ballerup, Brøndby, Gentofte, Gladsaxe, Glostrup, Herlev, Albertslund, Hvidovre, Lyngby-

Taarbæk, Rødovre, Ishøj, Tårnby, Vallensbæk, Furesø, Rudersdal, Greve Strand

50

sent out to 25 randomly chosen public schools on Zealand (including Falster) and invitation to

participate in the control groups were sent out to 15 other randomly chosen public schools on

Zealand; the only criterion was geographical representativity). Allocation to control group 1 (no

intervention) or control group 2 (oral lecture) was done based on the teacher’s partition request.

Participant characteristics for children recruited for study 4 (main study) and study 5 (control study)

are presented in Table 6.

Table 6: Participant characteristics based on valid baseline survey questionnaires

Main study

group

Control group

1

Control group

2

Total

all groups

School/

class

n School/

class

n School/

class

n School/

class

n

Schools 5 268 5 194 6 207 16 669

G. CPH 2 133 3 168 2 79 7 380

Zealand 3 135 2 26 4 128 9 289

Class total 15 13 11 39

5th

grade 2 36 4 95 4 57 10 188

6th

grade 13 232 9 99 7 150 29 481

Area/class level

G. CPH, 5th

grade - - 4 94 3 40 7 134

G. CPH, 6th

grade 7 133 7 74 2 39 16 246

Zealand, 5th

grade 2 32 - - 1 17 3 49

Zealand, 6th

grade 6 103 2 26 5 111 13 240

The sample size (Israel, 1992) of children participating in the cooking course is 268 (based on data

presented in Table 6), and compared to the population (Zealand total: N = 92810; Denmark total: N

= 204767 (Statistics Denmark, 2020a,b)), the sample represents the population (both Zealand and

Denmark separately) with a 95% confidence interval with a margin error of 5.98.

A total of 860 children participated in one of the studies in this PhD project (see Figure 2 and 10), a

total of 8 teachers were formally interviewed, and 15 teachers participated through informal ‘talks’

as part of the school/class visits.

6.5. Data collection methods applied

In the following the five data collection methods applied: future workshops, participant observation,

focus group interview, telephone interview, and self-administrated questionnaire are presented

including a clarification of the aim of implementing each method as part of the mixed methods

research strategy.

51

6.5.1. Future workshops; exploring the field

Future workshop as method was first developed and applied in

Austria by Jungk in the late 50’s (Jungk & Müllert, 1998). The

main scope of future workshops is that it is based on a

participatory design where the perspective is ‘bottom-up’ and

based on inclusion and promoting democracy, empowerment,

and community feeling (Jungk & Müllert, 1998). Typically, the

method has been applied in development projects with adults

(e.g. Andersen & Bilfeldt, 2017; Hernwall, 2016), but it has

also been used with children with success (e.g. Clausen et al.,

2018; Horelli, 1998).

The future workshop consists of five phases, as illustrated in

Figure 11.

The future workshops were conducted due to an exploratory

scope; to gain insight in to and better understand relevant

possibilities and obstacles related to the research field and

target group; children. Furthermore, the future workshops were

applied as the method has a strong participatory focus with the

possibility of working within a creative frame (see Figure 12),

which was found to be an interesting approach in the

exploratory phase of the present research.

Two future workshops were carried out by a research assistant and the author:

Future workshop with one 6th

grade class, November, 2015 in Odense (n = 12) and interview

with two teachers.

Future workshop with one 6th

grade class, March, 2016 in Greater Copenhagen (n = 19) and

interview with one teacher.

The interviews with the teachers were structured like a future workshop.

Main themes identified by the children and teachers during the future workshops and interviews

were as presented in Table 7 (data not presented in papers):

Figure 11: Phases in future

workshop, adapted by R. Højer

from Jungk and Müllert(1998).

52

Table 7: Themes identified by children and teachers during future workshops

Children Teachers

1) The food cooked in Food Knowledge

good/bad (health-wise)

like/dislike

ingredients

1) Frames of Food Knowledge

time

equipment in a teaching kitchen

access to books/teaching material

décor (old)

2) Self- determination

autonomy (influence on Food Knowledge/planning,

make own recipes, compete/Master Chef)

competence (skills, easy/difficult, challenges)

togetherness (group work, ‘hygge’, the teacher’s

engagement)

2) Political

prioritizing of Food Knowledge by the

school/municipalities

economy (money pr. student)

New aims for Food Knowledge from the Ministry

Courses for teachers

3) The frames of Food Knowledge

time

equipment (knives, cutting boards etc.)

décor (old)

3) Students

student readiness

student openness to new food

The themes identified during the critique and fantasy phases (phase 2 and 3) and ideas from the

implementation phase (phase 4) were used as inspiration for the development of teaching material

(e.g. autonomy; create own recipe and Cook-off), and were included in the adjustment of the initial

working hypothesis and objectives. The following picture collage (Figure 12) is from the two future

workshops.

Figure 12: A collage of pictures from the future workshops (photos: R. Højer). Left: children’s

utopia phase; middle: Teacher’s utopia phase; right, top: ‘seafood pizza’; right, bottom: ‘not enough time’.

53

6.5.2. Participant observation

Within the method of participant observation the researcher is immersed into the research field and

group to study behavior, listen to conversations between members of the group, and ask questions

(Bernard, 2013; Bryman, 2016; Creswell, 2013).

Participant observation as a method was applied in several phases of the mixed methods research

strategy (3, 5, 7, and 8 in studies #2, 3, 4, and 5) (see Figure 9). Where participant observation was

the primary data collection method in study # 2, it was used as a complementary method in study

#3, #4, and #5. In the main study (#4) participant observation was conducted with three classes at

different schools. Participant observation was conducted during the first lessons in the theme course

(Gyotaku – Fish art) and during the last lessons (Cook-off).

The overall aim of applying the method was to explore the research field and target group, although

the degree of structuring changed between phases and studies. An observation guide was

operationalized based on the PhD project’s hypothesis and objectives, which lead to the following

main themes of interest: 1) the social/group interaction element, 2) students’ interaction with the

fish, 3) knowledge, skills, engagement, 4) development of distaste/disgust/rejection/liking/

acceptance/ willingness to taste throughout the experiment. Practical organization is presented in

paper II: Højer, Wistoft, and Frøst (2020) and paper III. Table 8 presents an overview of the aim

and the degree of the structuring of the observation guide for each application of the method.

Table 8: Participant observation: Aims and structuring

Phase/study Aim Structuring

Phase 3; study #2

Pre-test of

experiments

To explore the research field and segment to gain an insight into the

everyday life of Food Knowledge and how students work with fish.

Focus on the applicability of experiments for teaching material for the

theme course (time frame/difficulty/skills needed).

Very loose

Phase 5; study #3

Pilot test

To explore development in students’ approach to fish, skills, knowledge

and liking through the course.

To explore how the social dimension/the group influences the interaction

with the fish and cooking/eating the fish.

To explore how the students work with the developed teaching material

to make adjustments.

Loose

Phase 7; study #4

Main study

To explore development in students’ approach to fish, skills, knowledge

and liking through the course.

To explore how the social dimension/the group influences the interaction

with the fish and cooking/eating the fish.

Medium

54

Data collected from participant observation as part of study #4 was used as complementary data in

paper III. In paper II; Højer, Wistoft and Frøst (2020), participant observation during study #2 and

study #4, were presented as a qualitative explanatory multiple case study design (Yin, 2009).

Observation as research method does not appear often within the (natural or life scientific) research

field of children’s food behavior, although a few examples are Fisher and Birch (1999), Gibbs et al.

(2013), and Hendy, Williams, and Camise (2005). However, in these examples observation as

method was included as supporting method only, whereas paper II; Højer, Wistoft, and Frøst (2020)

is based solely on observations reported in an observations journal. One explanation for the absence

of observational-based studies could be, besides a lack of tradition rooted within the post-

positivistic paradigmatic approach in generating knowledge, that it is very demanding resource-

vise, and it calls for a high level of transparency in documentation and analysis of data (see Paper II

for detailed description).

6.5.3. Group interviews with children

Group interviews were applied at the end of the main study intervention. The form was a group

interview due to the higher degree of interviewer control applied compared to a focus group format

(Halkier, 2007). The aim was to interview a group of informants (children), who had been through

the same cooking course with fish, but who did not necessarily have the same individual experience

or opinion on the fish experiments or the cooking course as a whole. The intension was not that the

group of children reached a consensus through a discussion (Barbour, 2007; Halkier, 2007; Kvale,

2007), but the intention was rather that the children’s understandings and experiences were

presented from their point of view. However, the group interview (answers, building of

understandings, and meaning discussions) was also influenced by the group dynamics (Barbour,

2007; Bryman, 2016), as it was observed that the children often build on each other’s answers and

understandings, for example by finishing each other’s sentences.

Based on a funneling technique (Bryman, 2016; Kvale, 2007) a semi-structured interview guide was

constructed for the pilot test of the complete experiment (phase 5, study #3). The first questions

concerned the overall experience of participating in the theme course on fish followed by questions

related to the present research objective: Opinion on fish, fish-eating behavior, the single

experiments, skills, group work, student-fish interaction etc. If informants gave short answers

probing (Bryman, 2016; Kvale, 2007) was used to follow up; e.g. ‘Can you tell me some more

about that?’

55

The interview guide went through minor adjustments (mainly a reduction in questions) to keep the

duration of the group interview to approximately 20 min.) based on an evaluation made by two

research assistants, who conducted the pilot test (study #3) before applying it to the main study

intervention (phase 7; study #4). Data collected from group interviews after the main study

intervention (study #4) was used as complementary data in paper III.

According to Halkier (2007) the proper amount of groups depends on their function in the project.

If they serve as the sole data collection method no less than six focus groups should be conducted,

but if they serve as a complementary or follow up data collection method fewer groups will do

(Halkier, 2007), the latter was the case in this PhD project.

Informants were selected by the author after the last participant observation in the main study group

(5 to 6 informants per group). The selection criteria were as follows:

Equal division between boys and girls

Inclusion of both ‘fish-likers’ and ‘fish-dislikers’

Children who had and had not been very communicative (according to participant observation)

Willingness to participate (a no would be accommodated)

I chose to select the informants myself instead of letting the teacher appoint informants in order to

avoid bias (Bryman, 2016); the teacher would perhaps choose students, who he/she knew would be

positive or very talkative. This would go against the main aim of the group interview: To evaluate

the theme course and possible development in the informants' fish-eating behavior and food literacy

after participating in the theme course.

The group interviews were audio-recorded followed by verbatim transcription (Bryman, 2016;

Kvale, 2007).

Prior application of group interviews, although typically referred to as focus group interviews, have

been scarce as most studies within the research field of food-based health-promoting interventions

and children’s food behavior apply a quantifiable-based research method only (DeCosta et al.,

2017). Examples of studies applying interviews in some form to gain an understanding of

motivations, attitudes and practices are Condrasky, Quinn, and Cason (2008), Gibbs et al., (2013),

Hendy et al. (2005), and Lukas and Cunningham-Sabo (2011).

56

6.5.4. Telephone interviews with teachers

The interview as a data collection method is, according to Kvale (2007), concerned with knowledge

constructed between the interviewer and interviewee through interaction. Kvale (2007) underlines

that the interview is rooted in understanding experiences as told by the informant in his/her own

words and that the interview is a portrait of how the informant experiences the world based on

individual beliefs.

The interview method was applied with the purpose of serving as the teachers’ evaluation of the

theme course, but it also aimed at uncovering the teachers’ experiences with the children’s

development with regard to fish acceptance and food literacy during the theme course.

The interviews were conducted as telephone interviews because it gave way to flexibility with

regard to the teachers' time/place requirements. Furthermore, choosing to do the interviews via

telephone, I also sought to create a ‘safe space’ for the informant, as the questions also concerned

evaluation. The teachers knew that I had developed the materiel, and this knowledge might

discourage them from being completely honest or more positive than they actually were. By not

conducting the interview ‘face-to-face’ but choosing the telephone mode, the intention was to

reduce the tension, which may occur in the face-to-face situation and reduce the risk of information

bias (Bryman, 2016). Furthermore, a thorough instruction (Kvale, 2007) was given at the beginning

of each interview with regard to the aim of the interview: to evaluate the theme course with focus

on their experiences. I also underlined that the best evaluation was not merely a positive one but

one, where they told me what they really thought and had experienced as this was the best help they

could give me.

The interview guide was constructed via the funnel technique (Bryman, 2016; Kvale, 2007) and

started with an overall evaluation of the theme course before moving on to inquiries related to the

research objective. The interview guide consisted of the six themes: 1) content of theme course, 2)

working with learning goals, 3) student engagement, 4) signs of learning, 5) liking/disliking of fish

in students, and 6) teacher’s own learning. A seventh theme occurred during the interviews: how to

use the materials in the future and ideas for implementing it in the school setting after the

intervention. This theme was a result of critique of the long duration of the cooking course.

The qualitative semi-structured telephone interviews with teachers were conducted during the pilot

test (phase 5; study #3) and the main study (phase 7; study #4). In the pilot study, two interviews

57

were conducted to test the semi-structured interview guide. After minor adjustments (change in the

order of questions and reduction in questions), the interview guide was applied to teachers in the

main study. Five teachers in the main study were interviewed; one from each participating school.

The telephone interview took place after the theme course had ended, and the students had filled in

the follow-up survey questionnaire. The duration of each interview was set to 20 to 25 min. The

interviews were audio-recorded, and during the interviews, notes were taken to follow up with

questions if interesting or relevant. The interviews were transcribed verbatim (Kvale, 2007).

The inclusion of interviews with teachers as part of evaluating intervention effects of hands-on

strategies related to change of food behavior with children in a school setting is, to the knowledge

of the author, a rare practice. For example, none of the studies included in the extensive review on

changing children’s eating behavior by DeCosta et al. (2017) included this methodological

approach, although two studies not included in the review were detected to implement teacher

interview: Ensaff, Canavon, Crawford, and Barker (2015) and Lukas and Cunningham-Sabo (2011).

6.5.5. Self-administrated survey questionnaire

Highly structured questionnaires used as pre- and post- measurements (baseline and follow-up) are

typically related to the design of experiments, as is the case in this quasi-experimental case/control

design (Bryman, 2016). Data collected using structured questionnaires offers standardized and

quantifiable output from a large number of informants (Bryman, 2016).

Applying baseline and follow-up questionnaires as a method had two purposes: the baseline

survey’s main aim was to provide a status of Danish children’s liking of cooking, fish-eating

behavior, attitude towards fish, and food literacy related to fish, which is presented in paper I.

Secondly, and mainly, the purpose was to investigate possible effects (baseline and follow-up

measurement phase: the independent variable; Y) of the five-week sensory-based experiential

theme course on fish (the intervention phase: the dependent variable; X) on children’s fish-eating

behavior and food literacy in a quantifiable manner as presented in paper III. This made it possible

to look for correlations and variations through statistical analysis, which could supplement data

collected through the use of the qualitative methods (Bryman, 2016).

The questionnaire was designed and distributed using the online questionnaire tool SurveyXact by

Ramboll (version 2017). The baseline questionnaire (the same as used in the survey, presented in

paper I) contained 10 main themes subdivided in a total of 64 items. All items, but two, were close-

ended (Bryman, 2016); item 18) Why do you like/not like fish? And item 20) What is the best/worst

58

thing about Food Knowledge? The control group follow-up questionnaire was identical to the

baseline questionnaire. As for the main study group follow-up questionnaire the theme ‘opinion on

Food Knowledge and learning conditions’ was replaced by evaluative items regarding self-

evaluated fish-eating behavior after the theme course and evaluation on the theme course

experiments individually. The questionnaire themes are presented in Table 9.

Table 9: Questionnaire themes

Item # Theme

Item 1 - 4 Student information (school, class, sex, student id number)

Item 5 Liking of cooking

Item 6 - 13 Food neophobia

Item 14 - 18 Fish-eating behavior

Item 19 - 21 Opinion on the course Food Knowledge and learning conditions (baseline only)

Item 22 c-i Knowledge of fish and cooking

Item 22 a + b Knowledge of the senses

Item 23 a-f, i-l Skills in relation to fish and cooking

Item 23 g + h Skills in relation to the senses

Item 24 a - e Fish-eating behavior after the theme course (MS follow up only)

Item 25 -29 Evaluation of experiments and tasting (MS follow up only)

The Likert scale

Item 5-13, 19-20, and 22-24 were arranged as direct statements, to which a 5 point Likert scale

(Likert, 1932) (strongly disagree, disagree, neither agree nor disagree, agree, strongly agree) was

applied, indicating the level of agreement. The Likert scale measures attitude, which is understood

as behavior under a given circumstance rooted in beliefs and ideas acquired through social

interactions (Likert, 1932). Attitudes are concretized through thinking (cognition), feeling

(affective) and action (psychomotor) together in different combinations due to a specified condition

(Likert, 1932; Joshi, Kale, Chandel, & Pal, 2015). The Likert scale can be graduated response-wise

as, e.g. a 3, 5, 7, or 9 point scale. Preston and Coleman (2000) found in a test of the optimal number

of response categories in rating scales that the 5 point scale was the easiest to use (F value = 83,7)

compared to responses ranging from 2 to 10 and 101. The 5 point scale was also among the least

time consuming, but scales with 7 to 10 response categories lead to more reliable results (Preston &

Coleman, 2000). van Laerhoven, van der Zaag-Loonen, & Derkx (2004) found that children and

adolescents preferred the 5 point Likert scale over visual analogue scales (VAS), and both Preston

and Coleman (2000) and van Laerhoven et al. (2004) found the 5 point Likert scale easier to

complete than VAS, which also resulted in fewer missed answers (0,5% compared to 3% for VAS).

59

Mellor and Moore (2014) tested the 5 point Likert scale with children of different age groups to

investigate their responses to Likert scale statements, which required judgments about both physical

and abstract (e.g. emotional and behavioral) concepts. Mellor and Moore’s (2014) objective was to

evaluate the appropriateness of using the 5 point Likert scale with children. Mellor and Moore

(2014) found that in judging abstract concepts, a Likert scale with worded anchors based on a level

of agreement had the highest level of concordance with a yes/no format (the yes/no format was used

as a ‘gold standard’ to compare consistency) in the age group 10 to 13 years of age (and across age

groups): 73.20 % congruent. Still, judging the abstract concepts proved to be more difficult than

judging physical and concrete concepts; 77.71 % congruent (Mellor & Moore, 2014).

The findings by Mellor and Moore (2014) support Piaget’s (1929) theory on cognitive development

in which Piaget argues that it is not until the age of 11 that the child is able to separate physical and

concrete concepts from the abstract and thereby engage in combinatorial thinking. Furthermore,

Leeuw et al., 2004 also point out that a 5 point scale for this age group is appropriate due to

cognitive development.

The Likert scale has been applied widely within the research area of children’s self-evaluated food

behavior and self-evaluated food literacy, for example, Allirot et al. (2016), Condrasky, Williams,

Catalano, and Griffin (2011), De Bourdeaudhuij et al. (2005); Doustmohammadian et al. (2017),

and Oakley, Nelson, and Nickols-Richardson (2017).

Measurement of food neophobia

As part of the self-administrated questionnaire (both baseline and follow-up), an adjusted version of

the newly developed Food Neophobia Test Tool (FNTT) (Damsbo-Svendsen, Frøst, & Olsen, 2017)

was included; the applied version in this study is referred to as FNTT8, and presented in paper I and

III. The FNTT is a development of Pliner and Hobden’s (1992) Food Neophobia Scale (FNS),

which has been widely applied as a tool to measure food neophobia and also as a self-administrated

questionnaire for children (e.g. Guzek et al., 2017; Koivisto & Sjöden, 1996; Laureati et al., 2015;

Roßbach, Foterek, Schmidt, Hilbig, & Alexy, 2016) (see Table 10 for clarification of the different

items included in FNS, FNTT, and FNTT8).

60

Table 10: Food neophobia measurement tools: FNS, FNTT and FNTT8

Food neophobia measurement tools

Pliner & Hobden (1992) – FNS Damsbo-Svendsen, Frøst, & Olsen

(2017) – FNTT

Højer & Frøst – FNTT8*

1. I am constantly sampling new and

different foods (R)**

1. I like to try foods I have never tasted

before

6. I like to taste foods I have

never tasted

2. I don’t trust new foods. 4. I like to experience new and

different foods

7. I like to experience new and

different foods

3. If I don’t know what is in a food, I

won’t try it

8. I think it is fun to try food items I

don't know

8. I think it is fun to taste food

items I don't know

4. I like foods from different countries.

(R)

10. I will try food even though I don't

know what it is

9. I will try food even though I

don’t know what it is

5. Ethnic food looks too weird to eat. 11. I enjoy a wide variety of different

foods

12. I enjoy my food to consist of

a wide variety of different foods

and ingredients

6. At dinner parties, I will try a new

food. (R)

12. I am not afraid of eating things I

have not tasted or experienced before

10. I am not afraid of eating

things I have not tasted or

experienced before

7. I am afraid to eat things I have never

had before

13. I don't mind eating foods I am not

used to

11. I don’t mind eating foods I am

not used to

8. I am very particular about the foods I

will eat

16. I think unfamiliar food looks

unappetizing (R)

9. I will eat almost anything. (R) 17. I am not wary of trying food I have

not tasted before.

13. I am wary of trying food I

have not tasted before (R)

10. I like to try new ethnic restaurants.

(R)

18. I enjoy dining at new restaurants

* Højer and Frøst = paper I (see Appendix A1)

** (R) = reversed

The development of the FNTT by Damsbo-Svendsen, Frøst, and Olsen (2017) occurred as a result

of a need for a contemporary and comprehendible tool to measure food neophobia in 9- to 13-year

old children, whereas the original FNS developed by Pliner and Hobden (1992) was aimed at

measuring food neophobia behavior in adults. Compliance between measurement outcomes in

FNTT and FNS was evaluated by Damsbo-Svendesn, Frøst, and Olsen (2017): Pearson’s

correlations between mean scores in the FNS10 – FNTT10 and FNS6 – FNTT6 showed strong,

significant correlations (0,81 and 0,77; p < 0,05). Based on this Damsbo-Svendsen, Frøst, and

Olsen (2017) concluded that these findings indicated that the FNS and FNTT measured the same

construct.

As presented in Table 8, the differences between the FNTT developed by Damsbo-Svenden, Frøst,

and Olsen (2017) and the FNTT8 applied in the survey questionnaire in this study are the exclusion

61

of two questions (item 16 and 18 in the FNTT). Item 16 in the FNTT by Damsbo-Svenden, Frøst,

and Olsen (2017) was excluded as it showed a relatively high comprehension issue: in 58% of the

12 participating classes, one or more children had difficulties comprehending the question (based on

qualitative observation during the completion of the questionnaires). Item 18 in the FNTT was

excluded as it was focused on a dining-out setting and not relevant within the scope of this study.

This item was also removed in the FNTT9 version by Damsbo-Svendsen, Frøst, and Olsen (2017)

with the same argument. The final difference between FNTT and FNTT8 was the revision of item

11 in the FNTT8 because it showed a high comprehensive issue (75%) (Damsbo-Svenden, Frøst, &

Olsen, 2017). Moreover, Leeuw et al., (2004) and Borgers, Hox and Sikkel (2004) point out that

questions developed for children should be very careful in including questions with negations, as

this increases the complexity of the question and risk of misunderstanding increases. The 8 items

were evaluated on the 5 point Likert scale (Likert, 1932) as elaborated in the prior section.

The purpose of applying an adjusted version of the FNTT in this study was to measure food

neophobia with a tool adjusted to be used with children. Furthermore, the purpose of measuring

food neophobia was to investigate the status of food neophobia in Danish children (results presented

in paper I), and secondly to investigate how food neophobia was affected by participation in a five-

week, hands-on cooking intervention (results presented in paper III).

Measurement of liking to cook & fish-eating behavior

The students were asked to evaluate liking of cooking (baseline only); item 5, on the 5 point Likert

scale (Likert, 1932), in order to clarify the target group’s interest in cooking. According to Ryan

and Deci (2000), engagement in an activity driven by interest will result in more excitement and

confidence, enhanced performance, self-esteem, and general well-being compared to activities

externally controlled. Also, the liking of fish was evaluated on the 5 point level of agreement Likert

scale (Likert, 1932) in order to clarify the target group’s liking of fish, as liking is closely connected

with acceptance (Rozin & Fallon, 1980, 1987). Opposite to liking of fish, disgustingness of fish was

evaluated on a 5 point categorical scale (extremely, very, moderately, not very, not at all) to

investigate the target group’s opinion on fish.

A frequency scale was used in the fish-eating behavioral recall items 14 (How many times have you

eaten fish within the last week?) and 16 (How many different types of fish have you eaten within the

last week?). Both items were measured on a four point frequency scale; 1 to 2 times/types of fish, 3

to 4 times/types of fish, 5 or more times/types of fish, and I have not eaten fish within the last week.

62

The purpose of including recall items was due to an interest in measuring the frequency of food

intake, and recall based items have previously been investigated with regard to validity when

applied to children. Children younger than 8 years of age are not able to accurately recall and

conceptualize frequency of food intake, whereas older children are cognitively developed to self-

report food intake, although there is a greater margin of error when applying recall questions with

children as compared with adults (Burrows, Martin, & Collins, 2010; Leeuw et al., 2004;

Livingstone & Robson, 2000; Sharman, Skouteris, Powell, & Watson, 2016).

Measurement of opinion on Food Knowledge and individual learning conditions

Opinion on the subject Food Knowledge (item 19.a.-19.i) and individual learning conditions (21.a.-

21.m) was measured on a level of agreement 5 point Likert scale (Likert, 1932). The purpose of

measuring these variables was to gain insight into the children’s self-evaluated general opinion on

the subject of Food Knowledge and individual learning conditions. For example, Christensen and

Wistoft (2016) point out that self-reporting based on Likert scale items is a method well suited to

get the respondents to communicate about their own learning. The data is not included in any

papers.

Measurement of food literacy; knowledge & skills

To measure food literacy the children were presented with knowledge and skill statements, to which

they would assess their own knowledge or skill within a specified area related to the themes in the

theme course. Therefore, answers were based on what the students thought themselves, self-

evaluation, and not actual knowledge or skill. Self-evaluated knowledge and skills were measured

as they are integrated parts of the concept food literacy.

The statements related to food literacy were constructed based on a structure of domains,

dimensions and module and building blocks in Vidgen and Gallegos’ (2014) concept of food

literacy: 1) Plan & manage, 2) Select, 3) Prepare, and 4) Eat) (see Table 11).

63

Table 11: Domains, dimensions, and components in the measurement of food literacy

Domain Dimension Module in cooking course/

Building block in Vidgen &

Gallegos’ (2014) concept of

food literacy

Statement

Cognitive Knowledge M 1) The senses: Plan &

manage, Select, Prepare, Eat

22a. I know of the 5 basic tastes

22.b. I know of the senses' meaning for how food

tastes

M 2) Hygiene & health: Plan &

manage, Select, Prepare

22.c. I know of kitchen hygiene when I work with fish

22.gg. I know of the nutritional value of different fish

M 3) Gyotaku; Fish art: Outside

the food literacy concept

22.d. I know where gyotaku comes from

M 4) Food waste: Plan &

manage, Select

22.e. I know what food waste is

M 5) Food culture &

preservation: Plan & Manage,

Prepare, Eat

22.f. I know of the historical meaning of herring in

relation to Danish food culture

22.g. I know of vinegar/sugar as preservation method

M 6) Sustainable fish: Plan &

manage, Select

22.h. I know of sustainable fish

Fish in general: Plan & manage,

Select

22.i. I know of the fish dab, hake, herring, and trout

Skill Functional

Ability to apply preparation

methods: Prepare

23.a. I can make gyotaku

23.c. I can fillet a flatfish

23.d. I can fillet a round fish

23.e. I can debone a fish

23.f. I can cook a fish

23.i. I can follow a recipe (only baseline)

Interactive

Ability to interact with others:

Plan & manage, Eat

23.h. I can talk with others about the food's flavor

23.k. I can tell others about the food I helped to cook

23.l. I can work together with others on cooking

(only baseline)

Critical

Assessment, decision making

and planning: Plan & manage,

Select, Prepare, Eat

23.b. I can assess whether a fish is fresh

23.g. I can assess and describe the food's flavor

(only baseline)

23.j. I can create my own recipe

A similar division was applied by Doustmohammadian et al. (2017) and Palumbo et al. (2017) in

their development of tools to measure food literacy in children. The results from the self-evaluation

of skills and knowledge are reported in paper I (status of Danish children’s food literacy; baseline

data only) and paper III (effect of participating in a five-week cooking course; baseline and follow-

up data).

64

Evaluation of theme course, main study group only

In the main study's (study #4, phase 7) follow-up survey, an evaluative section was included (item

24 to 29) in the survey sent out to the main study group (not included in the control group follow-up

survey) to measure the participants’ self-evaluated fish-eating behavior after completing the hands-

on cooking course on fish (item 24.a.-e, see Table 12). Item 25 to 29 (see Table 13 and Table 14)

focused on opinion on the cooking course experiments and reasons for tasting or not tasting the fish

dish of the day.

Table 12: Statements regarding self-evaluated development in fish-eating behavior

Meta-theme Item Scale

Fish eating behavior after theme course

24.a. After the theme course I have become more curious on

tasting other fish 5 point Likert

24.b. After the theme course I like fish better than before the

theme course 5 point Likert

24. c. After the theme course I have asked my parents if we should

have fish for dinner 5 point Likert

24. d. After the theme course I have talked with my friends about

food containing fish 5 point Likert

24. e. After the theme course I have used what I have learned to

cook at home 5 point Likert

Curiosity as a variable was included based on findings by Sick, Højer, and Olsen (2018) (paper IV)

in a study on 10 to14-year-old children’s reasons for accepting and rejecting food, as this concept

was given as the most frequent reason for accepting a food (followed by good taste). Statement

24.c. was included as studies have shown that children have decision power in the family when it

comes to deciding which foods to buy. E.g. Iversen, Matthiessen, Fagt, Rosenlund, and Trolle

(2011) found that children have a major influence on the family’s decisions when it comes to

grocery shopping. The same tendency was found by O’Dougherty, Story, and Stang (2006), where

48% of the children’s requests for specific foods in the grocery store were met by the parents. Based

on this, it was interesting to investigate whether the participants had asked their parents for fish for

dinner. Based on the concept of food literacy, the interactive dimension in statement 24.d. was

included together with the critical dimension in statement 24.e.

The purpose of applying questions regarding the participants’ self-evaluated fish-eating behavior

after the theme course was to gain insight into the children’s own perspectives on

development/changes as a result of participating in the hands-on cooking course, which has also

been pointed out as an advisable method by Christensen and Wistoft (2016). The statements were

measured on a 5 point Likert scale (Likert, 1932) based on level of agreement.

65

In item 25 to 29 (see Table 13 and 14) the questions regarding opinion were constructed based on

experienced fun of the experiment (‘how did you like…’) and measured on a five-point hedonic-like

scale (Lim, 2011); A lot of fun, fun, neither, boring, very boring. Measuring children’s experienced

degree of fun was applied because, as Bisson and Luckner (1996) point out the desire to learn is

born from enjoyment, and the taste for learning is abandoned from the lack of enjoyment. Defining

the experience of fun is difficult as the term is elusive as it is based on an in-the-moment emotional

experience; nevertheless, Podilchak (1991, p. 123) has offered the following definition: ‘Fun is

defined as a social-emotional interactional process wherein persons deconstruct social-

biographical inequalities to create a with-equal-other, social-human bound’. In this Podilchak

(1991) underlines the importance of a social and emotional dimension.

Bisson and Luckner (1996) put forward four characteristics inherent to fun: Fun is relative,

situational, a voluntary experience, and inherent to our nature. The information obtained from

measuring the children’s experienced fun with each experiment helps illuminate the experiment

potential with regard to promoting food literacy and fish-eating behavior. Experience, based on

enjoyment, is more likely to be repeated, and fun can be a motivator for learners to engage in

activities without having prior experience (Bisson & Luckner, 1996). Also, according to the

‘Pollyanna Principle’, humans are more likely to remember pleasurable than non-pleasurable

experiences (Matlin & Stang, 1978), but when it comes to food memory, food aversions are more

resistant to forgetting than food preferences (Laureati & Pagliarini, 2018). Furthermore, according

to Laureati and Pagliarini (2018), emotions and food are closely tied together in a mutual

relationship.

Integrating a measurement of children’s perceived ‘fun-ness’ related to tasks and experiences has,

for example, been implemented in studies related to children’s interaction with technology, e.g.

Chu, Angello, Saenz, and Quek (2017), Read (2008), Sim, MacFarlane, and Read (2006).

After the hedonic evaluation of ‘fun-ness’, a yes/no question was asked to determine whether the

child had tasted the fish dish of the day. Depending on a yes or no answer, the child was asked to

pick one statement from a selection of six reasons, based on best fit (see Table 13 and 14).

66

Table 13: Example of module evaluation; module 3, item 25.a.- e. (item 26 - 29 are similar)

Module Item Scale

Module 3: Fish art: Gyotaku and fried fish filet (dab)

25.a. Dab: How did you like to make gyotaku? 5 point hedonic-like*

25.b. Dab: How did you like it when you filleted the dab? 5 point hedonic-like*

25.c. Dab: How did you like it when you made fried dab

fillet?

5 point hedonic-like*

25.d. Dab: Did you taste the fried dab fillet? Yes/no

25.e. Dab: Why did you/did you not taste the fried dab fillet? 10 point categorical**

* Scale categories: A lot of fun, fun, neither, boring, very boring

** See Table 12 for categories

Table 14: Stated reasons for tasting and not tasting and theme

Stated reason for tasting Stated reason for NOT tasting Theme

1. I tasted it because I was curious on

how it tasted

1. I did not taste it because I had

never tasted it before

Curiosity - Novelty

2. I tasted it because I felt like it 2. I did not taste it because I did not

feel like it

Curiosity

3. I tasted it because the others did 3. I did not taste it because the

others didn't taste it either

Peer modeling

4. I tasted it because I knew I liked it 4. I did not taste it because I knew

that I did not like it

Familiarity

5. I tasted it because it looked

delicious

5. I did not taste it because it did not

look good

Appearance

6. I don't know why I tasted 6. I don't know why I didn't taste Neutral

The stated reasons for tasting or not tasting reflected five themes of inquiry interest (six counting

‘neutral’ as presented in Table 14) as foundation for accepting or rejecting the fish dish of the day.

Curiosity (1), liking (4), and appearance (5) as variables were included based on findings from the

study by Sick et al. (2018) (paper IV). This study found that curiosity, good taste, and appearance

were the most frequent reasons given for accepting food. Among the most frequent reasons given

for rejecting food were bad taste, dislike appearance, and unfamiliarity. These findings fall in line

with results from previous studies (e.g. Holsten, Deatrick, Kumanyika, Pinto-Martin, & Compher,

2012; Murimi, Chrisman, McCollum, & Mcdonald, 2016; Pliner, Pelchat, & Grabski, 1993; Rozin

& Fallon, 1986; Wadhera & Capaldi-Phillips, 2014). However, it is the first time, to the author's

knowledge, that curiosity has been found to be so prominently declared in food acceptance.

Modeling was included as a variable (statement 3), as, e.g. Birch (1980) and Harris (2008) have

found that this element influences food behavior.

67

According to Lukas and Cunningham-Sabo (2011), there is little published research within the area

of changing children’s food behavior through a hands-on approach, which includes the children’s

perspectives on what they actually thought about the curriculum and/or cooking course elements.

An example, however, is provided by Lukas and Cunningham- Sabo (2011), who included this

perspective (based on focus groups) in their evaluation of a hands-on cooking program.

6.6. Analysis of results

6.6.1. Analysis of qualitative data

Guest, MacQueen, and Namey’s (2012) Applied Thematic Analysis (ATA) was applied to

participant observations, group interviews with the children and telephone interviews with teachers

separately to analyse patterns of meaning. ATA as an analytical tool was chosen for its flexibility

and ability to highlight similarities and differences across cases (Braun & Clark, 2006) and applied

research methods and types of texts; for example, field notes and interview transcripts (Guest et al.,

2012).

The method of analysis; ATA, due to the mix of confirmatory and exploratory construction of the

observation- and interview guides, was a hybrid approach that combined the two main contrasting

philosophical methods of reasoning: a top-down, deductive, concept-driven theoretical process and

a bottom-up, inductive, data/code-driven process (Gibbs, 2015). In the analysis process, the texts

and data, in the form of field notes and interview transcripts, were seen as proxy for experience

(Guest et al., 2012). Thematic analysis has been applied as analytical method in prior empirical

research within the research field of food choice and food behavior; for example by Ogden and

Roy-Stanley (2020), Puddephatt et al. (2020), and Romero and Francis (2020).

Field note strategy for participant observation was inscription and transcription (Gibbs, 2015), in

which descriptions of activities (inscriptions) and informants’ own words, dialogues and phrases

(transcription) were recorded in an observational journal based on the loosely constructed and pre-

thematised observational guide. After the observations, the field notes were immediately written

down by separating actual observations, phrases, and dialogues, and researcher reflections ,and pre-

coded based on concept-driven coding (Gibbs, 2015). Paper II presents results based on participant

observation data only based on observation conducted of module 3: Gyotaku; fish art (n = 132) and

focuses on acceptance and rejection of fish based on the process of working with a hands-on

approach in a timelimited context (Højer, Wistoft, & Frøst, 2020).

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For paper III, where the main objective was the investigation of the effects of the five-week cooking

course, the same procedure was followed with regard to participant observational notes, although

the final analysis included baseline and follow-up observation (n = 58). Both teacher interviews (n

= 5) and group interviews with the children (three group interviews, n = 17) were transcribed from

audio recordings followed by pre-coding based on concept-driven coding, although allowing for

data-driven codes. After re-visiting the pre-coded data sets, it was then re-analyzed by building a

data reduction matrix through segmentation, further coding, and re-coding, and ordering by

relational hierarchy, before each research method dependent data set underwent a comparison

analysis across cases; but not across research methods. To ensure credibility, themes were

discussed within the research group and finally, cross-case tables based on meta-themes (concept-

driven) (Guest et al., 2012); e.g. rejection, acceptance, craftsmanship, interaction, sub-themes; e.g.

distaste, disgust, tactility, exploration, skills, helping each other, autonomy, and sub-theme related

clusters; e.g. smell, texture, animalness, pride, us-against the fish, language, were build (see paper

III and paper II; Højer, Wistoft, and Frøst (2020) for specific meta-themes). The similarity in

themes across the three ATA’s was a result of the concept-driven coding, but as the point of view

(observer/child, child/group, and teacher) differed across the applied qualitative research methods,

so do the identified themes. For example, a predominant theme from the children’s point of view

was craftsmanship, but from the teachers’ it was dominated by a food literacy - learning point of

view.

6.6.2. Analysis of quantitative data

Statistical analysis applied in paper I

In paper I (n = 669), the dataset derived from the data corpus was the complete baseline survey data

set and consisted of 32 items. 13 schools, 39 classes with 380 respondents from the area of Greater

Copenhagen and 289 respondents from the province of Zealand participated in the study (see paper

I for complete participant characteristics).

Prior to the statistical data analysis, the items were thematised, and scores were summed within the

seven meta-themes. Cronbach’s alpha was computed to test for internal consistency within themes.

The threshold coefficient value for satisfactory scales is 0.60 - 0.70 (Cortina, 1993; Hair, Black,

Babin, & Anderson, 2014) (see Table 15, from paper I).

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Table 15: Themes, questions and Cronbach’s α values for internal consistency within themes (only

for Likert scale items, and themes with ≥ 6 items)

Meta-theme Item Cronbach’s α 1. Liking of cooking (LikeCook) 5

2. Fish intake and liking of fish (FishBehavior) 14 -17

3. Knowledge - fish and cooking (KnowFish&Cook) 22c,22e-i 0.72

4. Skills - fish and cooking (CanFish&Cook) 23b-f, 23i-l 0.85

5. Knowledge - senses (KnowSenses) 22a,b

6. Skills - senses (CanSenses) 23g,h

7. Food neophobia (FNTT8) 6-13 0.86

The statistical data analysis of the dataset was performed using the statistical software package

SPSS Statistics 25. Initially, descriptive statistics were conducted for each variable (data not

shown), followed by univariate analysis of variance (UNIANOVA) on single item level and meta-

theme level by geographical area, sex and interaction effect of area and sex. Furthermore, bivariate

correlation coefficients based on Pearson’s r (Akoglu, 2018) were computed to test for possible

significant relationships between the meta-themes (see paper I for full analysis). The value of

Pearson’s r was interpreted based on the definition by Dancey and Reidy (2017): 0 = 0; +0.1 -

+0.3/-0.1 - -0.3 = weak; +0.4 - +0.6/-0.4 - -0.6 = moderate; +0.7 - +0.9/-0.7 - -0.9 = strong; +1/-1 =

perfect.

The difference in included respondents between study I and III

In paper III, the survey data set consisted of baseline and follow-up data from 383 respondents

(main study group: n = 185; control group 1: n = 123; control group 2: n = 75) collected from 12

different schools and 32 5th

and 6th

-grade classes with 220 respondents from the area of Greater

Copenhagen and 163 respondents from the province of Zealand (see paper III for complete

participant characteristics).

A total of 750 children were reported by the teachers to enter the main study and control study.

After validation of the questionnaires, 669 completed the baseline survey questionnaire correctly

(main group: n = 268; CG1: n = 194; CG2: n = 207) and 580 completed the follow-up survey

questionnaire correctly (main group: n = 249; CG1: n = 154; CG2: n = 103. After pairing baseline

and follow-up on an individual level (based on a unique respondent id attached to each

questionnaire), 383 paired measurements were possible (main group: n = 185; CG1: n = 123; CG2:

n = 75).

70

The difference in children reported by teachers to enter the study and questionnaire start could be

due to children moving, not being present on the day for filling in the baseline questionnaire.

Furthermore, two schools (two classes) had technical problems, which resulted in a faulty

distribution of the questionnaire, which lead to only 2-3 compliant questionnaires per class (neither

of the classes completed the follow-up either).

Initially, before pairing, questionnaires were analyzed to clarify reasons for questionnaire

abandonment. All but a few was abandoned after answering the first questions on child information

leading to exclusion of the abandoned survey questionnaires to avoid skewed results. The number

of children abandoning the intervention was higher for the main study group than for the two

control groups. After communication with the participating schools, it was clarified that this was

due to internet problems at the two schools. The difference between baseline and follow-up total in

valid questionnaires is mainly due to 7 classes (n = 110) dropping out before completing the

follow-up survey questionnaire (primarily in CG1 and CG2). The reasons for not being able to pair

survey questionnaires on an individual level were a filled-in baseline but not a follow-up

questionnaire, or the other way around due to, e.g. child sickness, holiday or other.

Statistical analysis applied in paper III

Six meta-themes were constructed based on the single items: 1) Food neophobia (FNTT8), 2) Fish

attitude and behavior (FishBehavior), 3) Knowledge on fish and cooking (KnowFishCook), 4)

Skills in relation to fish and cooking (CanFishCook), 5) Knowledge on the senses (KnowSenses),

and 6) Skills in relation to the senses (CanSenses). Internal consistencies of the meta-theme

constructs were assessed by means of Cronbach’s alpha coefficient (Cortina, 1993) (only on Likert

scale items and meta-themes consisting of ≥ 6 items) by baseline and follow-up. The threshold

coefficient value for satisfactory scales is 0.60 - 0.70 (Hair et al., 2014). All Cronbach’s alpha

values were between 0.74 and 0.89 (See paper III for in-depth overview of computed values).

As part of preparing the dataset for analysis, survey scores were calculated by summation for each

theme, and an effect score was calculated by subtracting baseline score from follow-up score. An

analysis of each study group’s residuals at baseline was conducted based on skewness and kurtosis

and quantile-quantile plots (Q-Q plots) to check the assumption of normality at baseline on theme

score level. The assumption of normality was not met across all groups and themes (only within

theme 3; KnowFishCook and theme 4; CanFishCook the assumption of normality was met in all

study groups). Therefore, to test for baseline differences between study groups at baseline an

71

independent samples Kruskal-Wallis test was performed. The groups were significantly different (p

= 0.04) at baseline in meta-theme 1: FNTT8. To investigate further, an independent sample Mann-

Whitney U test and an independent sample median test were performed on all baseline meta-theme

scores between control group 1 and control group 2, which showed a significant difference between

the two groups (Mann-Whitney U p = 0.03; median test p = 0.04 ): control group 2 scored higher in

theme 1: FNTT8 (MCG1FNTT8 = 7.1, Mdn = 8) than control group 2 (MCG2FNTT8 = 5.9, Mdn = 5) with a

grand median of 7. This result is probably due to the geographical area distribution in the groups, as

control group 1 was overrepresented with regard to respondents from the area of Greater

Copenhagen, and only contained eleven children from the province (due to fall-outs). This could

influence the score in a more neophilic direction due to a greater exposure to various foodscapes as

a result of a higher degree of urbanization (Seto & Ramankutty, 2016) in Greater Copenhagen

compared to the province.

The same procedure was followed for follow-up survey scores yielding a comparative result: Only

meta-theme 1: FNTT8 was significantly different between groups (Mann-Whitney U p = 0.05 and

median test p = 0.021), control group 1 (MCG1FNTT8 = 6.4, Mdn = 7) control group 2 (MCG2FNTT8 = 5,

Mdn = 5) with a grand median of 6. As the reason for the difference between control group 1 and

control group 2 was detected, control group 1 (n = 123) and control group 2 (n = 75) were pooled

into one control group (referred to simply as control group, n = 198; Greater Cph. n = 130; Prov. n

= 68), although applying caution when interpreting results related to meta-theme 1: FNTT8.

Furthermore, an analysis of the main study group (n = 185) and pooled control group (n = 198)

effect score sum residuals was conducted based on skewness and kurtosis and quantile-quantile

plots (Q-Q plots) to check the assumption of normality. In three cases (main group KnowFishCook

and KnowSenses and control group KnowFishCook) one or two extreme outliers resulted in non-

normal distribution. Correction for these outliers resulted in a normal distribution. Nevertheless, no

respondents were removed from the data set. To test for intervention effect, univariate analysis of

variance by group (main group/MG and control group/CG), area (the province of Zealand/Prov. and

Greater Copenhagen/G.Cph.), and sex (boy and girl) was conducted on the meta-theme effect sum

and single item effect sum.

Additionally, a non-parametric paired samples Wilcoxon test (Wilcoxon signed-rank test) was

performed to test for within-group differences in medians between baseline and follow-up sums

(meta-theme level) and scores (for single items) within the main group, control group 1, and control

72

group 2 respectively. To test for effect of sex and area, univariate analysis of variance was

conducted on the effect sum.

6.7. Methods and quality criteria related to research methods

6.7.1. Methods applied – a look in the rearview mirror

Five different research methods were applied: future workshops, participant observation, group

interview with children, telephone interview with teachers, and baseline and follow-up survey

questionnaire. Looking back now; in the rearview mirror, a question must be asked: was the

inclusion of all these methods necessary in the pursuit of exploring and investigating the present

research inquiries and main hypothesis?

The first method applied was future workshops as I had no prior knowledge or experience with the

research field of either children or interventions in a school setting. From this, I learned what

children prioritize and how they like to work in the subject of Food Knowledge. One clear result

from the future workshops was the element of cooking competitions (for example Master Chef and

various baking contests on TV), and this was implemented in the cooking course material as a cook-

off, where the children got to make their own recipe and cook the dish. This was the most popular

experiment in the cooking course (only 14% of the children in the main group follow-up survey

questionnaire found it either boring or very boring, which was the lowest of all dishes made).

The initial research design did not include participant observation of the first and last cooking

course lesson in the main study group. This came about as a result of the pilot study (study 3, phase

5 in the multi-phased mixed methods research design). The pilot study was run by two bachelor

students as part of a seven-week long internship on the project Taste for Life. It was organized in

this way to have the complete cooking course, including the first draft of the student booklet and

interview guides and survey questionnaires, tested and evaluated by someone not involved in the

research in any other way; it was to pursue a relatively objective test and evaluation afterwards. As

part of the pilot test, I visited the participating classes during their last lesson of the cooking course,

and during my visit, I realized that participant observation could contribute with an insight into the

children’s understanding, opinion, attitude etc. as they were actively engaging in the cooking

course; a perspective that could not be recreated through group interview and teacher’s interview

only. A very concrete example of this is presented in paper II, which was based solely on data from

participant observation during the module Gyotaku; Fish art with dab. The result was the

73

development of a continuum of rejection and acceptance based on categorization and re-

categorization (see Figure 11) of the fish as a result of engaging in sensory-based (especially

tactility) and cooking-related activities (Højer, Wistoft, & Frøst, 2020). This was the result of

working abductively, as the observation guide primarily was concept-driven (Gibbs, 2015), but the

exploratory approach led to a model-proposal (see Figure 11) based on the observations and

became a concept included in the main study as well; especially the concept of animalness. In this

way, the abductive approach promoted an iterative development of both my own experience-base,

but also of the analysis in paper III.

Moreover, I have reflected on the necessity of the group interview, as the participant observations

also yielded an abundance of data from informal ‘talks’, but these primarily sprang from the

concrete situation the children were in at that specific point in time. The group interview gave way

to a more relaxed environment in a small group, where the children did not have to think about what

they were doing at that moment. The interviews also included narratives as a way for the children to

give examples related to the questions asked. One example was the girl, who had gotten her parents

to buy a fish, she was to prepare, but the parents kept correcting her as she filleted the fish at home

(see paper III).

The teacher’s perspectives retrieved from the telephone interviews were invaluable, as they were in

the classroom experiencing the development that occurred in the children through the cooking

course (skills in, e.g. filleting, organizing, working together, language/vocabulary development etc.;

see paper III).

The survey questionnaire was applied to measure self-evaluated effect quantifiable, and this

perspective was able to supply an insight into the children’s own opinion on a broad spectrum of

variables, which would not otherwise have been possible to collect.

So, after looking in the rearview mirror, I can answer the initial question: was inclusion of all these

methods necessary in the pursuit of exploring and investigating the present research inquiries and

main hypothesis? Yes. Table 16 presents an overview of the applied research methods and their

value and function in relation to investigating the main hypothesis.

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Table 16: Research methods and their value and function in relation to investigating the main

hypothesis

Through the concepts experimentation, sensing, autonomy, knowledge and skills, and a social dimension,

an “open window” exists for promoting food literacy and acceptance related to fish.

Research method

Aim Value (examples) Function

Future workshop (children + teachers)

Exploratory scope – gain

insight and to better

understand relevant

possibilities and obstacles

related to the research field

and target group

Ideas were used as inspiration for the

development of teaching material (e.g.

autonomy; create own recipe and Cook-

off)

The social dimension was evident and was

included in the hypothesis and as part of

the participant observation guide, group

interview guide, telephone interview guide,

and survey questionnaire

- Adjustment

of hypothesis

- Input for

teaching

material

- Adjustment

of research

methods

Participant observation (children)

To explore the field and

target group.

To explore and investigate

development in students’

approach to fish, skills,

knowledge and liking

through the cooking course.

To explore and investigate

how the social

dimension/the group

influences interaction with

the fish and cooking/eating

the fish.

Insight into the children’s understanding,

opinion, attitude etc. as they were actively

engaging in the cooking course

Discovery of the concept of ‘animal-ness’

Concrete observations of how tactility

influences rejection and acceptance

Concrete observations of learning a skill

(e.g. filleting)

Concrete observations of the ‘helping each

other’ dimension and establishment of

community of practices

- Minor

adjustments

of research

methods and

guides

- Primary data

in paper II

- Complementa

ry data in

paper III

Group interview (children)

To explore and investigate

the children’s opinion on

fish, fish eating behavior, the

single experiments, skills,

group work, student-fish

interaction

Narratives with concrete examples from

the children’s everyday lives

The children’s opinions and point of view

- Complementa

ry data in

paper III

- A validating

tool; cross-

referenced

with

observations

Telephone interview (teachers)

Teachers’ evaluation of the

theme course but it also

aimed at uncovering the

teachers’ experiences with

the children’s development

with regard to fish-eating

behavior and food literacy

during the theme course

Teachers’ evaluation of cooking course

material (didactics)

Insight into teacher s’ teaching styles

Teachers’ observations of children’s

behavior throughout the cooking course

Teachers’ observations of children’s

development in skills and acceptance of

fish – increase in skills and acceptance

were observed by teachers

- Complementa

ry data in

paper III; e.g. related to

acceptance of

fish as

teachers’

interviews

contradict

survey data on

liking and

disgustingness

(see example in

section 6.3.1.)

75

- A validating

tool; cross-

referenced

with

observations

Self-administrated survey questionnaire (children)

To provide a status of

Danish children’s liking of

cooking, fish-eating

behavior, attitude towards

fish, and food literacy

related to fish.

To investigate possible

effects of participating in a

cooking course on children’s

fish-eating behavior and

food literacy.

Investigation of status

A measure of self-evaluated effects of

participation in a quantifiable manner

Comparison of effects depending on

intervention groups (e.g. the very

positive effects on self-evaluated

skills)

- Primary data

in paper I and

III

6.7.2. Quality criteria

When conducting research based on a mixed methods research design and a dialectic pragmatic

paradigm the quality criteria to be considered reflect both research approaches: quantitative and

qualitative methods (Bryman, 2016; Creswell & Clark, 2011).

Quality criteria in qualitative research methods

Credibility (the validity of the findings) (Bryman, 2016) was sought in this study by comparing

findings with those of previous studies within similar research areas. Furthermore, children were

given the chance to read field notes taken during both participant observation and group interviews

if they asked what was written down. To reduce observer bias during participant observations,

observer assistants were present during pre-test of experiments, pilot test and at one follow-up

observation. Dependability (reliability of the findings at another time) (Bryman, 2016) was sought

via a thorough description of the study design and methods included, and by using external recruits

to run the pilot test and complete an evaluation afterwards. Even though true objectivity of the

researcher rarely exists, confirmability (Bryman, 2016) was sought through inclusion via feedback

and feedforward from both persons within the research group of Taste for Life, but also from

persons outside the research area with regard to data preparation and the analytical processes.

Furthermore, it is impossible to completely eliminate a research participation effect (McCambridge,

Witton, & Elbourne, 2014) as the presence of the research- and assistant group was an addition to

the typical setting situations.

One primary analytical approach was chosen for the qualitative data; applied thematic analysis

(ATA) (Guest et al., 2012), the reason why, has already been declared, but the analytical method is

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not without flaws. For example, Braun and Clark (2006) have pointed out that thematic analysis

loses interpretative power if not anchored within an existing theoretical framework. To

accommodate this perspective, the observation- and interview guides have all primarily been

concept driven (Gibbs, 2015) based on the acceptance and rejection taxonomy by Rozin and

collegues (1986, 1987).

Quality criteria in quantitative research methods

Internal validity is evaluated as relatively strong, for example, evaluated on high Cronbach’s alpha

values. Nevertheless, I have previously raised the question of what was measured with regard to

liking of fish and disgustingness of fish at baseline and follow-up. With regard to external validity,

this was sought by comparing findings with prior research conducted within similar research areas,

although the specific research area of the food group ‘fish’ is under-investigated. Results observed

in paper I are generalizable to the population (both Denmark and Zealand) as the sample size was

669, which also increased reliability. The generalizability and reliability of the results in paper III

are not as strong as in paper I, as the sample size was smaller due to drop-out and not being able to

pair baseline-and follow-up. Nevertheless, the observed effects still supply new knowledge to an

under-lit research area (children’s fish behavior). Furthermore, the inclusion of mixed methods

supplies strength as the data collected through the qualitative methods supported each other.

Furthermore, children were only sampled from the eastern part of Denmark (Zealand), and national

regional differences in, for example, fish-eating practices could exist from region to region.

According to Coop Analyse (2019), Danes in the eastern part of Denmark (the capital region and

Zealand) consume more fish than Danes in the northern part of Denmark (the capital region of

Denmark: index 115; Region Zealand: index 97; North Denmark region: index 86, with average

intake defined by index 100).

Self-evaluation was the main item approach, which can be a challenge in representing the actual

situation; however, the data collected represented the reality as perceived by the children in that

specific context and place in time. However, the children’s cognitive ability varies considerably

across children (Borgers et al., 2004), which lead to a ‘simplicity’ strategy in designing the survey

questionnaire. For example, a 5 point Likert scale was the primary scale applied to reduce the

complexity of the questionnaire. Mellor and Moore (2014) investigated the use of Likert scale with

children and found that reliability was increased if the scale used wordings and not numbers and

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that children can understand and use the 5 point Likert scale, although negative wording should be

avoided.

With regard to the use of Likers scale, much attention within the field of statistics concerns the

question: is Likert scale data ordinal in its construction or can it be treated as an interval scale (the

difference between categories A and B, B and C, etc. is regarded as equal). If the first answer is

correct, the appropriate statistical treatment of these data is considered to be non-parametric

analysis, but if it is the latter, parametric analysis can be applied. The issue is that parametric

statistics (for example Pearson’s correlation coefficient and analysis of variance (ANOVA)) are

generally perceived as being more statistically more powerful than non-parametric statistics (Bishop

& Herron, 2015; Knapp, 1990). The data in this PhD project has been treated primarily as interval

data, based on an assessment of normality and Q-Q plots, although a non-parametric analysis was

applied to the main study group data to test for significant effects within the study group (paper III).

Furthermore, data was summed into themes, which is an appropriate way of analyzing Likert scale

data when treating it as interval data according to Carifio and Perla (2008).

In the evaluation of the cooking course (follow-up, main study group only) the children were asked

to state their reason for tasting or not tasting the dish of the day based on ‘best fit’ choice. If I were

to adjust the survey questionnaire today, I would consider applying Check-All-That-Apply (CATA)

instead, as reasons for tasting or not tasting could be driven by several reasons. Furthermore, CATA

has previously shown to be a child-friendly tool to collect spontaneous responses to food

preferences in pre-adolescents (De Pelsmaeker, Schouteten, & Gellynck, 2013; Gallo, Swaney-

Stueve, & Chambers (2017).

The study was implemented into a natural setting, the public school in the subject Food Knowledge,

with the teachers executing the theme course as they would have any other theme or subject, and

solely based on a trust that the teachers would comply with the given guidelines. A substantial part

of the control of the activity was thereby removed. However, a natural every-day teaching situation-

setting was prioritized to investigate the ‘real’ possibility of promoting healthy food behavior

through increased food literacy in the subject, Food Knowledge. It would not have been possible if

the course had been run by, for example, a research team. Also, the focus was on whether the

teaching material would actually work in real life when used by the teachers themselves; it had to

be ‘feasible’ in a real-life school situation. This also supports the application of mixed methods

design; to view the same research question from multiple angles so that they can validate findings

with different methods.

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7. PERSPECTIVES on videos, commensality, and setting

In this chapter the three main papers (paper I, II, and III) are put into

perspective with focus on 1) the use of videos in promoting the skill-

dimension of food literacy versus the concepts of hands-on experience

and tactility, 2) Commensality; a community of practice, and 3) the

setting

The red line throughout all partial studies included in this PhD research process and the three main

papers has been the main hypothesis:

Through the concepts experimentation, sensing, autonomy, knowledge and skills, and a social

dimension, an “open window” exists for promoting food literacy and acceptance related to fish.

As illustrated in Figure 2 the papers are connected as building blocks, with paper I being the

stepping stone, a status, leading to a very specific exploration of the possibilities in applying a

tactile approach together with cooking in promoting acceptance of fresh fish in paper II (Højer,

Wistoft, & Frøst, 2020). In paper III the knowledge and experience generated from the two first

papers were put into play in the quasi-experiment to investigate the effects on food literacy and fish

related fish acceptance. This part was structured with a main study group participating in a five-

week cooking course and two separate control groups; one with no intervention (CG1) and one

which has an oral lecture based on the same themes as the booklet including the showing of two

videos (CG2).

Many observations have been presented in the papers, but especially two observations are of great

interest and have not been given the attention they deserve: 1) the effect on self-evaluated skills

with regard to assessing fish freshness and filleting a flatfish in CG 2 and 2) Commensality; the

development of a community of practice. Furthermore, a perspective on the setting is interesting as

it is an implicit part of the present research.

7.1. Self-evaluated skills and videos

The first observation of interest is shortly presented in paper III: the within-group effect on self-

evaluated skills with regard to assessing fish freshness and filleting a flatfish. As mentioned in

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chapter 5, 10 videos6 were included as part of the materials-package in the cooking course

intervention. Two of the videos were included in the oral lecture: How to assess fish freshness and

how to fillet a flatfish. During the lecture, the videos were shown to the children in plenum.

As presented in paper III, the paired samples Wilcoxon signed rank test showed significant

differences between scores at baseline and follow-up in control group 2 (oral lecture): item 23.b. I

can assess whether a fish is fresh (Z = 2.116, p = 0.034, baseline and follow-up mdn. 0, MBaseline = -

0.16, MFollow-up = 0.31) and item 23.c. I can fillet a flatfish (Z = 2.014, p = 0.044, baseline mdn. -1,

follow-up mdn. 0, MBaseline = -0.67, MFollow-up = -0.24). No significant differences were observed in

control group 1, who did not receive the lecture. This may indicate that simply by watching a video

on how to perform a task the self-evaluated skills within this area could increase, although it did not

increase as much as in the main study group, where the children worked experiential-based with the

fish. Research on the effect of videos on children’s culinary skills is, to the knowledge of the author,

non-existing, but positive effects of including videos as part of a culinary skills curriculum targeted

adults have been documented by for example Dill (2017), McKnight, Doolittle, Stitzel, Vafiadis,

and Robb (2013) and Schaeffer and Warren (2013).

The perspective of the effect on skills leads to the question ‘why not only use videos when they

apparently have an effect on skills?’ It could be argued that replacing hands-on teaching with videos

would be cost beneficiary for the school budget, but what is lost by only watching a video? In paper

II; Højer, Wistoft, & Frøst (2020) the perspective of tactility was presented: how tactile play

through making gyotaku with squid ink (Japanese fish printing technique), together with cooking,

was able to move the responses of rejection (disgust and distaste) towards acceptance as illustrated

in Figure 11 (presented in paper II).

6 The 10 videos are accessible via the YouTube channel Smag for Fisk [Taste for Fish]: URL:

https://www.youtube.com/channel/UCoFmQ8UMiMyDWrU0n8LjlCg/videos?disable_polymer=1 [06.29. 2020]

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Figure 11. A rejection-acceptance continuum based on fish categorisation with examples of

elements driving acceptance forward or backwards. Adapted from Rozin and Fallon (1987) by R.

Højer; from Højer, Wistoft, and Frøst (2020).

As illustrated in Figure 11, acceptance was not promoted by one single element, but it is reduced in

the process along the continuum. The gyotaku exercise exemplified that the first sensory experience

(smell and vision) promoted rejection, but through the tactile experiences in varies ways

collectively promoted acceptance. The development of experience would not have been possible if

only a video had been shown and the potential for promoting critical-thinking and reflection would

be reduced; an argument Nelson et al. (2013) put forward in the importance of including practical

culinary skills as part of the school curriculum.

Research into the effect of tactility on food acceptance in children is sparse and has primarily been

conducted by Coulthard, Williamson, Palfreyman, and Lyttle (2018), Coulthard and Sealy (2017),

Coulthard and Thakker (2015), Nederkoorn, Jansen, and Havermans (2015), Nederkoorn, Theiβen,

Tummers, and Roefs (2018), and Dazeley and Houston-Price (2015), and none of these studies have

focused on food of animal origin (Animalia) and were all targeted younger children.

Besides the effect on skills in CG2, the videos were also mentioned by the teachers in the telephone

interviews as part of phase 4, study #7 to be an element of great importance, as all teachers referred

to the videos as indispensable, especially to teachers not familiar with working with fish. One

teacher even said that she doubted that she would have been able to teach the cooking course

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without the filleting instruction videos, as she had no prior experience with this. Moreover, during

participant observation in the main study group at the first and the last lesson of the cooking course,

it was evident that the children had seen the videos as they kept referring to a specific phrase used

by me in the videos: ‘just let the knife do the job for you’. They would say it to each other in the

groups as help while filleting the fish.

In summary, videos alone increased the self-evaluated skills within filleting a flatfish compared to

the group which had no video shown, but the main study group with practical hands-on experience

with fish showed a higher increase in self-evaluated skills with regard to filleting a flatfish. The

latter was also supported by participant observations (paper II; Højer, Wistoft, and Frøst (2020);

paper III) and teachers’ comments in the telephone interview (paper III).

7.2. Commensality; a community of practice

The other interesting observation relates to commensality and the social dimension. As part of the

main hypothesis, I speculated, that a social dimension might be an important concept in promoting

food literacy and acceptance of fish as a gateway to promoting healthy food behavior. This concept

became evident through participant observation, interviews with the teachers and in the group

interviews with the children (perspectives included in paper II; Højer, Wistoft, and Frøst (2020);

and paper III). Furthermore, three items in the survey questionnaire measured the importance of the

social dimension in liking and learning in the subject FK quantifiable (item 19.c.: FK is fun when

we work well together in the group; item 19.f.: FK is fun when we together eat the food we have

made; 21.c. I learn better in FK when what we have a good sense of community) and one item was

constructed qualitatively (item 20: what is the best and worst thing about FK?) giving an

opportunity for the children to note their own opinion with their own words. Table 17 presents data

(not prior presented) from the survey questionnaire baseline data set (n = 669) and shows the

results from the full item 19 (FK is fun when…) and 21. (I learn better in FK when…) to illustrate

the children’s self-evaluated importance of the social dimension compared to the other included

concepts.

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Table 17: Children’s self-evaluated importance of the social dimension compared to the other

included concepts (item 19 and 21)

Item 19 Mean* ± SD Item 21 Mean ± SD

19.a. FK is fun when we do

experiments

1.2 ± 0.9 21.a. I learn better in FK when what

we do makes sense to me

1.5 ± 0.8

19.b. FK is fun when we are a part of

making decisions

1.4 ± 1 21.b. I learn better in FK when the

teacher is committed

1.3 ± 0.9

19.c. FK is fun when we work well

together in the group**

1.7 ± 0.7 21.c. I learn better in FK when we

have a good sense of community

1.6 ± 0.7

19. d. FK is fun when we make

competitions

0.7 ± 1.2 21.d. I learn better in FK when what

we do is exciting

1.6 ± 0.7

19.e. FK is fun when we are on

excursion

0.8 ± 1.2 21.e. I learn better in FK when what we

do is challenging

1.2 ± 0.9

19.f. FK is fun when we together

eat the food we have made

1.5 ± 0.8 21.f. I learn better in FK when we work

together during exercises

1.3 ± 0.9

19.g. FK is fun when we use our

senses to explore the food

0.9 ± 1 21.g. I learn better in FK when it is

clear why we do what we do during

class

1.3 ± 0.9

19.h FK is fun when our teacher is

committed

1.2 ± 1 21.h. I learn better in FK when I feel I

have influence on what we do

1.3 ± 0.9

19.i. FK is fun when I feel I have

learned something new

1.4 ± 0.9 21.i. I learn better in FK when we do

experiments and exercises with food

1.2 ± 1

19.j. FK is fun when what we do

makes sense to me

1.4 ± 0.8 21.j. I learn better in FK when we have

theoretical teaching on food

0.4 ± 1.3

19.k. FK is fun when I feel I can use

what I have learned in other courses

1.1 ± 1 21.k. I learn better in FK when I feel

we have enough time to complete a

task

1.4 ± 0.9

19.l. FK is fun when I feel I can use

what I have learned when I get home

1.5 ± 0.8 21.l. I learn better in FK when I use my

senses

0.9 ± 1

21.m. I learn better in FK when we

compete

0.7 ± 1.3

*Measured on a five point Likert scale and coded accordingly: - 2 = strongly disagree, -1 = disagree, 0 = neither agree

nor disagree, 1 = agree, 2 = strongly agree

** Items in bold relates to the social dimension

Means presented in Table 17 indicates that items related to the social dimension were evaluated by

the children to be key elements in liking the subject FK (item 19.c.: M = 1.7; 19.f.: M = 1.5.) and for

individual learning conditions in FK (item 21.c.: M = 1.6). The concept of groups was also a

pronounced theme in the qualitative item 21 (data not prior presented), where 189 (28% of 669

statements) self-formulated statements included issues related to a social and group theme; only

superseded by the theme cooking (209 statements, 31% of 669 statements). In addition, the Danish

concept ‘hygge’ [coziness] was mentioned explicitly 37 times as being important influencing the

perception of the subject FK.

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Furthermore, a sense of community was evaluated to be very important for individual learning

conditions (item 21.c., M = 1.6).

The intervention was in a school setting, and the children worked together in groups, but according

to Wenger (1998) this does not automatically promote a construction of communities of practice

(CoP), as was also not the case at the beginning of the intervention, but CoP appeared over time.

Based on observations it became clear that the groups became small learning-systems based on

peer-to-peer learning through the fish as medium (presented in paper II; Højer, Wistoft, & Frøst,

2020; and III): CoP was observed (by both research group and teachers) as what Wenger (1998)

refers to as ‘shared repertoire’: for example observed language/vocabulary used, higher confidence

in own cooking skills, development of routines and skills (filleting and use of knife), ‘mutual

engagement’: for example, in ‘helping each other’-situations (e.g. overcoming sensory-related

challenges when collecting and washing the fish), autonomy in developing own dish, exploring the

fish together, and as ‘joint enterprise’: for example individual confidence to negotiate practices (e.g.

how to fillet) and working together in reaching a common goal (see Figure 13 for more observed

examples of CoP).

Figure 13: Identified elements in the three dimensions of Community of Practice (CoP) adapted

from Wenger (1998) by R. Højer (initially presented in Højer & Frøst, 2019 at Pangborn Sensory

Science Symposium 2019, see Appendix A7).

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The role of the social dimension in promoting food literacy was also a highlight in review

conclusions by Utter et al. (2017), but they also call for more research within the area.

Furthermore, Liquori and colleagues (1998) acknowledge the importance of peers in cooking

program interventions, especially the possible effect of working in groups and having fun together

on learning and eating behavior. Lukas and Cunningham-Sabo (2011) found that teachers believed

that cooking programs encouraged students to treat each other with respect and improve their social

skills by being involved in group work. In the same way, Dougherty and Silver (2007) observed

that camaraderie was promoted by skill-building sessions, as the students met challenges and

milestones together.

7.3. Food Knowledge as a setting for promoting healthy food behavior

At the beginning of this thesis, the argumentation for FK as a research setting for promoting

children’s healthy food behavior and food acceptance through the concept of food literacy was

based on the recommendation by WHO (2018); that the educational setting should play an active

role in promoting children’s health, and the aim of FK; promoting the child’s ability to make critical

and reflected health and food decisions and choices (Bekendtgørelse om formål, kompetencemål,

færdigheds- og vidensområder og opmærksomhedspunkter for folkeskolens fag og emner (Fælles

Mål), 2020).

Data presented in Table 17 also supports the choice of setting in the present research due to its

exploratory concept. Learning about food (item 21.j. I learn better in FK when we have theoretical

teaching, M = 0.4) instead of learning with and through food (item 21.i. I learn better in FK when

we do experiments and exercises with food, M = 1.2) was clearly the preferred learning style.

Furthermore, qualitative responses given in item 20 with regard to the best and worst thing about

FK 79 responses (of 669) related directly to the learning style in FK; only one child expressed that

he did not at all like it when the activity was cooking, and it was less bad when it was theory. The

following three quotes from item 20 exemplify the responses, and support the choice of setting:

Quote 1: ‘The best about FK is the way we get to experience the food’

Quote 2: ’The best about FK is that we move around and are creative with the

food we are making’

Quote 3: ’The best about FK is that it stands out from the other subjects and that

you do not always have to sit down and read and write. And I think it is a lot of

fun and exciting to try to make new food that I have never tried to make before’

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The observations align with the argumentation by Nelson et al. (2013); when it comes to promoting

healthy food behavior nutrition knowledge alone is incomplete without the dimension of

experiential learning via interactions with food and cooking equipment. Furthermore, they point out

that as students partake in culinary skills education, based on Kolb’s (2015) experiential learning

cycle, and engage in culinary concepts, a foundation for promoting skills, technical proficiencies,

and critical-thinking is laid out (Nelson et al., 2013). Furthermore, e.g. Allirot et al. (2016),

Cunningham-Sabo and Lohse (2014), Ehrenberg et al. (2019), and Hersch et al. (2014) also argue

that by involving children in the cooking processes it is possible to promote the willingness to taste

novel foods and preferences for healthy foods.

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8. CONCLUSIONS

The main objective of this PhD project was to investigate the effects of a five-week (5 x 2 lectures

of 45 minutes) sensory-based experiential cooking course with fish on 11- to 13-year old children’s

food literacy and acceptance of fish with the aim of promoting healthy food behavior through an

experiential learning approach exemplified by a practical cooking course on the subject fresh fish.

The exploration of the main research objective was conducted based on the following hypothesis:

Through the concepts experimentation, sensing, autonomy, knowledge and skills, and a social

dimension, an “open window” exists for promoting food literacy and acceptance related to fish.

The exploration and investigation of the main hypothesis resulted in three main papers and a

supporting paper (IV). In the following, conclusions from paper I to III are presented followed by a

main conclusion.

In paper I, a status of Danish children’s food literacy and fish-eating behavior was presented aimed

at providing a current status of Danish children’s eating behavior, liking, and food literacy related to

fish to support the research urgency and relevance of the main hypothesis.

The main conclusions were that even though the children stated that they liked fish and did not find

fish disgusting, this attitude was not translated into actual fish consumption, and of most concern,

42% stated that they had not eaten any fish in the past week. From this, it could be concluded that

there was a need for promoting an increase in fish consumption. Furthermore, it could be concluded

that Danish children could be characterized as having a behavioral food neophilic tendency. It could

also be concluded that both self-evaluated knowledge of fish and cooking and self-evaluated skills

in fish and cooking were positive, although skills related directly to preparing fish were lacking.

Moreover, several interesting correlations were observed: knowledge of food and cooking had a

strong association with skills in food and cooking, as did skills in food and cooking, and skills in

the senses. Liking to cook was not associated with self-evaluated skills in food and cooking but

with FNTT8, which could imply that the enjoyment of cooking does not depend so much on self-

perceived skills but rather on curiosity and interest in food exploration.

In paper II the effects of a hands-on strategy were explored by zooming in on one single

experiment through the application of an art-based experiment (gyotaku) including preparation and

cooking of fresh fish. The main focus was to explore how children responded to handling,

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preparing, and cooking fresh fish, and how the process of the sensory-based tactile play experiment

gyotaku affected children’s acceptance of fish. Paper II served as a support and confirmation of the

main hypothesis to be tested in the main study.

The main conclusions were that by including tactile play in the form of gyotaku at the beginning of

the experiment, the fish became a creative medium, which had the potential to become an important

motivator in promoting fish acceptance. Especially because the first reactions expressed by the

children, when the fresh fish were presented, were highly driven by distaste and even disgust. This

finding was interesting, because, as presented in paper I, the children in the survey did not find fish

disgusting, which could be a reflection of the prior mentioned lack of experience with fresh fish.

Furthermore, based on the findings presented in paper II, it could be concluded that rejection and

acceptance-driven behavior moved back and forth on a continuum (a rejection-acceptance

continuum). Movement back and forth on the rejection-acceptance continuum was determined by

back loopers, for example, slimy touch, whole animal, smell, cutting through skin, texture of fish

meat in the mouth and taste. Movement forward on the rejection-acceptance continuum (forward

movers) were togetherness, helping each other, tactile play, re-categorisation of the fish,

exploration, pride, skills, and self-made (autonomy). Especially categorisation and re-categorization

of the fish (from animal to non-animal and back to animal to food) based on tactile exploration were

able to promote either rejection or acceptance-driven behavior. Based on the findings presented in

paper II, it could be concluded that tactile play combined with cooking could be a way of promoting

acceptance of fish, and as such serve as a potential strategy in promoting healthy food behavior.

In paper III, the possible effects of a five-week (5 x 2 lectures of 45 minutes) sensory-based

experiential cooking course with fish on 11- to 13-year old children’s food literacy were

investigated. The aim was to investigate the potential of promoting healthy food behavior through a

hands-on strategy based on an experiential learning approach in a school setting; exemplified by a

practical cooking course on fresh fish in the subject of Food Knowledge. As such, paper III

included knowledge and experience gathered from paper I, II and IV.

The main conclusions were that food literacy was promoted through participation in a five-week

sensory-based experiential theme course with fish. Even though it was not possible to measure an

increased liking for fish and the assessment of fish disgustingness went up after participating in the

cooking course, almost half of the children had become curious about tasting other fish types, and

38% stated that they liked fish better after participating in the cooking course. It could be concluded

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that experimentations were key elements, where the fish became something to explore and learn

from. The largest barriers were related to sensory properties of the fresh fish (e.g. smell, viscera,

and mucus on the fish), but the social dimension was important as a strategy to overcome these

barriers; they were overcome together. Knowledge increased; especially on kitchen hygiene related

to working with fish and the fish types. The effect on skills was substantial. Not only regarding the

skills related directly to handling, preparing and cooking the fish, but also, as mentioned by the

teachers, in the development of language/vocabulary; routines, setting up work stations and working

autonomously. The findings presented supported the hypothesis.

Based on the output from paper I, II, and III I conclude that sufficient support has been collected to

accept the main hypothesis: an ‘open window’ for promoting food literacy and fish acceptance was

created based on the concepts of experimentation, sensing, autonomy, knowledge and skills, and a

social dimension. It can be concluded that the school was a natural setting for implementation as the

subject of Food Knowledge already aims at promoting the children’s ability to make critical and

reflected health and food decisions and choices. Nevertheless, challenges could be local resources

(access to educated teachers, equipment, etc.).

Regarding the outcome it can be concluded that a substantial part of the children became craftsmen

through participation in the cooking course with fish. The effect of participating on skills was

remarkable, as was the curiosity on trying other fish types after participation. Still, the challenge is

to utilize this development and support and promote a spill-over to the family environment.

The impact of the intervention with regard to long term effects on fish-eating behavior is unclear,

and as such, inconclusive. Nevertheless, a lasting effect on fish cooking-efficacy could be the case.

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9. THE FUTURE

Regarding future research into how to promote children’s healthy food behavior, not only how to

increase fish acceptance, which was the focus in this PhD project, but also in a more general

perspective, several levels and perspectives are important to consider. In Figure 14, five

perspectives are presented as a lay-out for future research within the area of promoting children’s

healthy food behavior. The proposed layout is based not only on results from my research but also

on my general experience with working within the research and project milieus over the last five

years.

Figure 14: Five perspectives in future research within the area of promoting children’s healthy food

behavior.

Interdisciplinary collaboration: In 2015 the Directorate-General for Research and Innovation,

European Commission (2015) called for more interdisciplinary research as a way to conduct

research within highly complexed research areas to come up with innovative ways of conducting

research, and to add interdisciplinary perspective to challenges. This interdisciplinary collaboration

supports the application of mixed methods research strategies, and as previously pointed out the

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majority of research conducted is based primarily on quantitative data collection methods (see

DeCosta et al., 2017; Hendrie, Brindal, Baird, & Gardner, 2013). Nonetheless, for example,

O’Cathain, Thomas, Drabble, Rudolph, and Hewison (2013) point out that qualitative research is an

important, but under-utilized, element in the process of designing interventions. An example of this

interdisciplinary collaboration in research is the Taste for Life project.

Exploration of environment: research into promoting children’s healthy food behavior should

include a focus on a multi-level approach including all environments that children are engaged in,

which is also supported by, for example, Eertsman, Baeyens, and Van der Bergh (2001), Eisenmann

et al. (2008), and Karnik and Kanekar (2012).

In this PhD project the focus was on the children in the school setting, the next natural step would

be to include the family environment, and investigate if and how children can be a driver in

promoting healthy food behavior in the family (and increase fish intake), e.g. through active

involvement in cooking the family meals. As presented in paper I, Danish children enjoy cooking

(M 1.5, SD 0.8, score: min.-2/max.2), but only 7% of Danish children help to cook the evening

dinner at home, which equals once every fourteenth day (Coop Analyse, 2016). This indicates that

there is a great potential for promoting food literacy and healthy food behavior if the children were

allowed into the kitchen at home. Therefore it is important to include the ‘cooking at home’

perspective in future health promotion and to encourage parents to turn dinner preparation into a

family activity. Furthermore, it also opens up to the suggestion that children could participate in

free-time cooking activities, as 11- to 13-year-old children often are engaged in after-school

activities. This arena should also be investigated more in-depth to explore the opportunities for

health promotion through food literacy-related elements, especially, as Denmark has a strong

tradition for meeting up in associations [foreninger] to engage in all types of activities. One

example is Father’s Kitchen School [Fars Køkkenskole], where children attend cooking classes with

their father as a leisure time activity and learn to cook healthy food. The focus on food

commensality could increase food literacy through togetherness and also be a gateway to explore

food and the perspective that food is also a mutual enjoyment and something we can do together. In

Denmark, projects are currently emerging, which have a focus on reducing (young) people’s feeling

of loneliness through food commensality (e.g. Food should be eaten – together [Mad skal spises -

sammen], Food Communities with a Purpose [Madfællesskaber med Mening], Food Maker).

91

Long term effects: there is a need for more focus on long term effects within the field of changing

children’s food behavior based on food literacy-driven interventions, as the stability of the changes

seem to be questionable (Mustonen et al., 2009; Reverdy et al., 2008). Furthermore, there is also a

necessity for investigating the exposure frequency needed to ensure a stable and long term effect

and post-intervention adherence to changes introduced in interventions.

Experience-BANK: ‘Better practice’ based on knowledge and experience; there is a need for a more

structured collection of knowledge and experience generated internationally, nationally, and

regionally from research and community-based intervention programs aimed at promoting healthy

food behavior in children. The research process within the field must be iterative, so we learn from

prior knowledge and experience to ensure a ‘better practice’ in the future. The element of an

experience-BANK is tightly connected to the final proposed perspective, which I find especially

important in future research: dissemination.

Dissemination: this perspective is meant to be seen as a link between both the public and the

different stakeholders and the existing knowledge and experience within the field. If knowledge and

experience are not disseminated and shared, then it becomes an ivory tower. The main idea is that

knowledge should be accessible to everybody interested, and not just to the few. Moreover, also the

European Commission (2015, p. 4) recommends that ‘the closed shop of an academic expert

community should be transformed into an open space that engages different audiences and

communities of researchers, practitioners, users, citizens and stakeholders’. One example is the

project Taste for Life, which has a high focus on inclusion and dissemination aimed at both the

public, the political decision-makers (locally and nationally), the research environment and also the

educational institutions at all levels. Knowledge should be shared and invite to engagement; e.g.

through citizen science projects, where the public is invited to be part of generating new knowledge.

The grand prize question is, how do we get the public to engage? One place to start could be with

projects that are relevant to the majority and relates to everyday issues; like taste. In this, there is

also a potential for increased impact.

92

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APPENDIX

APPENDIX A: PAPERS & POSTERS

A1. Paper I

A2. Paper II

A3. Paper III

A4. Paper IV

A5. Scientific poster I

A6. Scientific poster II

A7. Scientific poster III

APPENDIX B: PHD ACTIVITIES

B1. Study activities

B1.1. PhD course port folio

B1.2. Teaching activities

B1.3. MSc thesis supervision activities

B1.4. Dissemination activities (scientific)

B1.5. Dissemination activities (public)

B1.6. Committee activities

B1.7. Awards

B2. Curriculum Vitae

B3. Acknowledgements

APPENDIX A: Papers and posters

I. Something fishy is cooking – A survey of 11- to 13- year old Danish children’s self-evaluated food neophobia

and food behavior, knowledge, and skills in relation to fish

Højer, R. & Frøst, M.B. in (sumitted to Food Quality and Preference, October 2020)

II. Play with your food and cook it! Tactile play with fish as a way of promoting acceptance of fish in 11 to 13-

year-old children in a school setting – a qualitative study

Højer, R., Wistoft, K., & Frøst, M.B. in Nutrients 2020, 12 (10), 3180; https://doi.org/10.3390/nu12103180

(Published October 17th

2020).

III. Yes I can cook a fish; effects of a five-week sensory-based experiential theme course with fish on 11 to 13-

year-old children’s food literacy and fish-eating behavior – a quasi-experimental study

Højer, R. Wistoft, K., & Frøst, M.B. in (sumitted to Food Quality and Preference, October 2020)

IV. Children’s self-reported reasons for accepting and rejecting foods.

Sick, J., Højer, R. & Olsen, A. in Nutrients 2019, 11(10), 2455; https://doi.org/10.3390/nu11102455.

(Published October 14th

2019).

Scientific posters presented at international conferences

I. Promoting children's acceptance of fish through sensory-based experiments and experiential learning: Breaking

through the disgust barrier.

Højer, R. & Frøst, M.B.

Pangborn Sensory Science Symposium 2017, Providence, Rhode Island, USA.

II. What’s cooking? Promoting 10-13-year-old children’s acceptance of fish through experiential learning.

Højer, R. & Frøst, M.B.

SenseAsia 2018, Asian Sensory and Consumer Research Symposium, Kuala Lumpur, Malaysia.

III. Promoting 11- to 13-year-old children’s food literacy through a community of practice – case studies from an

experiential sensory-based theme course on fish in a school setting.

Højer, R. and Frøst, M.B.

Pangborn Sensory Science Symposium 2019, Edinburgh, Scotland, United Kingdom.

A1. PAPER I

Something fishy is cooking – A survey of 11- to 13- year old Danish children’s self-evaluated

food neophobia and food behavior, knowledge, and skills in relation to fish

Højer, R. & Frøst, M.B. in (sumitted to Food Quality and Preference, October 2020)

1

TITLE 1

Something fishy is cooking – A survey of 11- to 13-year-old Danish children’s self-evaluated food 2

neophobia and food behaviour, knowledge and skills in relation to fish 3

4

AUTHORS 5

Rikke Højera,b

* & Michael Bom Frøstb 6

aUniversity College Absalon, Center for Nutrition and Rehabilitation, Nutrition and Health, 7

Slagelsevej 70-74, 4180 Sorø, Denmark. 8

bUniversity of Copenhagen, Department of Food Science, Design and Consumer Behavior, 9

Rolighedsvej 26, 1958 Frederiksberg C, Denmark. 10

11

*CORRESPONDING AUTHOR 12

E-mail addresses: rho@pha.dk (R. Højer*) and mbf@food.ku.dk (M.B. Frøst). 13

14

ABSTRACT 15

Danish children aged 10 to 17 consume only one-third of the officially recommended amount of 16

fish. Little is known about Danish children’s perception of fish, their knowledge and skills in 17

relation to preparing and cooking fish nor their status of food neophobia, or the relationship 18

between these areas. This study seeks to address this lack of knowledge. 19

The objective of this survey is to investigate 11- to 13-year-old Danes’ self-evaluated liking of 20

cooking, fish intake, liking of fish, knowledge and skills in relation to fish and cooking, and food 21

neophobia. Furthermore, the aim is to explore possible effects of sex and geographical area. 22

This cross-sectional survey targets 11- to 13-year-old children in Denmark. 669 children from the 23

eastern part of Denmark were recruited through the school subject Food Knowledge. 24

Liking of cooking was high, a general liking for fish was identified, but consumption was low, with 25

42% of respondents not having eaten fish in the past week. Self-evaluated knowledge of fish and 26

skills related to fish and cooking were generally low. Effects of sex and area were observed: boys 27

had a tendency to rate themselves higher in knowledge and skills than girls, and children from the 28

Greater Copenhagen area liked to cook more and had a more positive fish behaviour than children 29

from provincial Zealand. Furthermore, knowledge and skills related to fish and cooking were 30

strongly correlated, and liking to cook was not associated with skills in food and cooking but rather 31

with food neophobia. 32

2

KEYWORDS 33

Food behavior 34

Food literacy 35

Food skills 36

Children 37

Fish 38

Food neophobia 39

40

1. INTRODUCTION 41

Globally, in 2016, 18.4% of children and adolescents aged between five and 19 years were either 42

overweight or obese (World Health Organization, 2018). Childhood and adolescence obesity is 43

associated with an increased risk of adult obesity, which can lead to low self-esteem, type 2 diabetes 44

and premature death and disabilities resulting from, for example, coronary heart disease (Agirbasli, 45

Tanrikulu, & Berenson, 2016; Reilly & Kelly, 2011; Sahoo et al., 2015; Umer et al., 2017). 46

Therefore, promoting healthy food habits from childhood is extremely important. 47

Besides from contributing to a diverse diet, eating fish provides valuable nutrients. Fatty fish has a 48

high content of vitamin D, which is important in calcium (Ca) absorption, bone health and 49

childhood growth stages (Braegger et al., 2013; Petersen et al., 2016). Fatty fish also has a high 50

content of n-3 polyunsaturated fatty acids (PUFA), which reduce the risk of developing diabetes 51

mellitus, systemic arterial hypertension, central obesity and hyperlipidemia (Kelli, Kassas, & 52

Lattouf, 2015; Mouritsen & Bagatolli, 2016). Furthermore, fish contains 15 to 20% protein and all 53

the essential amino acids, which is favorable as the sulphur-containing amino acids: cysteine and 54

methionine, are low in plant protein sources. Moreover, fish proteins have a high degree of 55

digestibility i.e. 85-95% (Balami, Sharma, & Karn, 2020; Tilami & Sampels, 2018). Studies have 56

shown positive health effects as a result of fish protein intake; e.g. by decreasing the risk of the 57

metabolic syndrome and increasing insulin sensitivity (Aadland et al., 2016; Aadland et al., 2015; 58

Dort, Sirois, Leblanc, Côté, & Jacques, 2012; Tørris, Molin, & Cvancarova, 2016). 59

The official Danish recommendation for fish intake is 350 g per week from the age of three 60

corresponding to eating fish as a main course twice a week and several times a week as cold cuts 61

(Tetens et al., 2013). However, the intake of fish among Danish children aged 10 to 17 is only 105 62

g per week (Mdn = 56 g/week), and adults’ intake is 259 g per week (Mdn = 196 g/week). 63

Furthermore, men and boys have a slightly higher intake of fish than women and girls (Pedersen et 64

3

al., 2015). Danish adult’s intake og fish was compared to other European countries by Mertens et 65

al., (2019), and the authors found that adult Danes only consume about half the amount of fish 66

compared to their peers in France and Italy. In a study of Spanish children’s food habits the fish 67

intake was similar to that of Danish children (Madrigal et al., 2020). No studies, to the knowledge 68

of the authors, have explored the difference in fish intake between the province (Region of Zealand) 69

and the capitol area of Denmark (Greater Copenhagen); both situated in the eastern part of 70

Denmark. Woodward et al. (2000) found that food choice among adolescents residing in rural areas 71

tended to have a nutritionally less favourable pattern than food choice among individuals living in 72

urban areas whereas Samaniego-Vaesken et al. (2018) did not find that population densities were 73

associated with food choice. 74

The choice to eat fish can be affected by an array of factors. Myrland, Trondsen, Johnston, and 75

Lund (2000) found that adults’ level of education, price, fish odour, and preparation difficulty were 76

prominent barriers in choosing to eat fish. These barriers influence the children’s fish eating 77

practice, although children’s reasons for not liking fish are based on sensory attributes or the fear of 78

finding bones (Prell, Berg, & Jonsson, 2002). Furthermore, Maiz and Balluerka (2016) found a 79

significant association between regular consumption of fish (at least two to three times per week) 80

and level of food neophobia (χ² (2) = 6.739, p = 0.034) and concluded that neophobic children and 81

adolescents had a poorer diet quality than neophilic children and adolescents. Food neophobia is 82

defined as a reluctance to eat unfamiliar foods (Dovey, Staples, Gibson, & Halford, 2008). Previous 83

studies have found that individuals with high levels of food neophobia consume less vegetables, 84

fruit, and fish (Cooke, Wardle, & Gibson, 2003; Galloway, Lee, & Birch, 2003; Siegrist, Hartmann, 85

& Keller, 2013). 86

According to Larson, Story, Eisenberg, and Neumark-Sztainer (2006), young people who acquire 87

cooking skills early in life consume a diet more compliant with nutrition recommendations later in 88

life. These findings reflect a growing interest in the study of children’s and adolescents’ food 89

knowledge and skills as a gateway to promoting healthy food habits from childhood. For example, 90

Muzaffar, Metcalfe, and Fiese (2018) concluded from their literature review on interventional 91

effects that school cooking programmes that apply a hands-on strategy successfully improved a 92

number of food-related topics, for example knowledge, cooking attitude and self-efficacy, 93

behavioural intention for cooking, preferences for cooking, healthy eating and willingness to try 94

new foods. The same conclusion was made by DeCosta, Møller, Frøst, and Olsen (2017) in their 95

review of experimental research that investigated strategies to changes children’s eating behaviours. 96

4

Results from a Danish survey on Danish children’s food practices conducted by Arla Fonden (2020) 97

showed that only 26% of Danish children help to cook, set the table or help with the grocery 98

shopping at home but 82% of the children liked to cook, which point to a great potential in applying 99

the hands-on strategy as a way to promote food literacy. 100

Food behaviour, food knowledge and food skills fall within the concept of food literacy (Vidgen & 101

Gallegos, 2014). Interventions focusing on food literacy as a way to promote healthy food 102

behaviour have showed positive changes related to the intervention (e.g. Bailey, Drummond, & 103

Ward, 2019; Brooks & Begley, 2014; Vaitkeviciute, Ball, & Harris, 2015). Little is known about 104

Danish children’s food literacy in terms of skills and knowledge, and how it relates to their reported 105

behaviour. The objective of this study is to investigate 11- to 13-year-old Danes’ self-evaluated 106

liking of cooking, fish intake, liking of fish, knowledge and skills in relation to fish and cooking 107

and food neophobia. Furthermore, the aim is to explore possible effects of sex and geographical 108

area. 109

110

2. METHODS AND MATERIAL 111

2.1. Study design 112

The present study was designed as a cross-sectional survey (Bryman, 2016) to provide a snapshot 113

view of 11- to 13-year-old Danish children’s self-evaluated liking of cooking, fish intake, liking of 114

fish knowledge and skills in relation to fish and cooking and food neophobia. Data were collected 115

during the spring and autumn of 2017. 116

This study was conducted in compliance with the Declaration of Helsinki, 1964/2000 (World 117

Health Organization, 2001) and the Respect Code of Practice (Respect Project Institute for 118

Employment Studies, 2004). Ethics approval was obtained from the joint Research Ethics 119

Committee of the Faculty of Science and Faculty of Health and Medical Sciences, University of 120

Copenhagen (reference 504-0005/17-5000). 121

122

2.2. Sampling, participants and setting 123

A non-probability sampling method was applied (Bryman, 2016), although a sampling frame was 124

created which described inclusion and exclusion criteria for participating schools and classes (Table 125

1) as recruitment was done by inviting fifth and sixth grade Food Knowledge classes in the Region 126

of Zealand and Capitol Region (eastern part of Denmark) to participate. 127

128

5

Table 1 129

Sampling frame - inclusion and exclusion criteria 130

131

Invitations were sent by email to 30 randomly selected public schools covering the geographical 132

area of Zealand and Falster (the eastern part of Denmark). Sixteen public schools replied that they 133

wished to participate, but three schools were excluded because the participating classes consisted of 134

special needs children. A total of 13 schools (39 fifth and sixth grade classes (n = 669 children)) 135

were included in the study population (Table 2: participant characteristics). 136

Participating schools grouped based on geographical location in either the metropolitan area of 137

Greater Copenhagen or the remaining area of Zealand and Falster (the provinces). No participating 138

school in the Greater Copenhagen group was located more than 30 km from Copenhagen city 139

centre, whereas all participating schools in the province group were located more than 30 km from 140

Copenhagen city centre. 141

Written informed consent for participation was collected from the children’s parents. If a child 142

refused to participate in answering the survey, this was respected. 143

144

Table 2 145

Participant characteristics by area, school, class level, and sex 146

Area

The Provinces (Prov.) Greater Copenhagen* (G.Cph.)

Both areas total

(prov. + G.Cph.)

# Students

(n)

% by

area

% of

total

# Students

(n)

% by

area

% of

total

Total Students

(n)

n in

%

Schools**

8

289

43

5

380

57

13

669

# P2 78 27

Inclusion criteria Exclusion criteria

Geographical location Region of Zealand and Capitol

Region (Greater Copenhagen)

School type Public school

Class level Fifth and sixth grades

Subject Food Knowledge

Other Special needs classes

Classes that have already

completed a fish theme in the

subject Food Knowledge.

6

# P4 102 35

# P5 3 1

# P6 44 15

# P10 14 5

# P12 16 6

# P15 10 4

# P16 22 8

# C1 70 18

# C3 156 41

# C8 43 11

# C9 72 19

# C11 39 10

Classes 16 41 23 59 39

5th

grade 3 50 17 7 138 36 10 188 28

6th

grade 13 239 83 16 242 64 29 481 72

Sex

Girls ♀ 149 52 179 47 328 49

Boys ♂ 140 48 201 53 341 51

*Greater Copenhagen is defined by Statistics Denmark (2018) as covering the following geographical areas: 147 Copenhagen, Frederiksberg, Ballerup, Brøndby, Gentofte, Gladsaxe, Glostrup, Herlev, Albertslund, Hvidovre, Lyngby-148 Taarbæk, Rødovre, Ishøj, Tårnby, Vallensbæk, Furesø, Rudersdal, Greve Strand. 149 **Codes for schools were generated based on geography, identified by letter (the number identifies group placement). 150 151

The survey was conducted at the participating schools as a part of the subject Food Knowledge. The 152

survey was distributed by the teachers electronically via the schools’ intranet. 153

154

2.3. Questionnaire 155

The self-administered survey questionnaire was designed and distributed using the online 156

questionnaire tool SurveyXact developed by Ramboll (www.surveyxact.dk, n.d.). The dataset 157

consisting of 32 thematised items (student information excluded) (Table 3, 4) was selected from the 158

data corpus (excluded items concerned student evaluation of the subject Food Knowledge and 159

learning style preferences). The questionnaire was developed in Danish. For analytical purposes the 160

questionnaire was translated into English. The translation was then read and approved by the 161

research group, read by an external translator, before being translated back into Danish. Item 6-13 162

was included based on translation by Damsbo-Svendsen, Frøst, and Olsen (2017). 163

The dataset items were structured with close-ended questions. 164

165

7

Table 3 166

Themes, statements and scale 167

Theme Item # Statement/question Scale

Liking of cooking 5. I like to cook 5-point Likert*

Food neophobia 6. I like to taste foods I have never tasted. 5-point Likert

7. I like to experience new and different foods. 5-point Likert

8. I think it is fun to taste food items I don't know. 5-point Likert

9. I will try food even though I don’t know what it is. 5-point Likert

10. I am not afraid of eating things I have not tasted or

experienced before.

5-point Likert

11. I don’t mind eating foods I am not used to. 5-point Likert

12. I enjoy my food to consist of a wide variety of

different foods and ingredients.

5-point Likert

13. I am wary of trying food I have not tasted before (R) 5-point Likert

Fish intake and

liking of fish

14. How many times have you eaten fish in the past

week?

4-point

frequency **

15. How disgusting do you think fish is? 5-point categorical

sliding scale***

16. How many different types of fish have you eaten in

the past week?

4-point

frequency****

17. I like fish.

5-point Likert

Self-evaluated

knowledge in

relation to fish and

cooking

22.c. I know about kitchen hygiene when working with

fish.

5-point Likert

22.e. I know what food waste is. 5-point Likert

22.f. I know about the historical importance of herring in

Danish food culture.

5-point Likert

22.g. I know about vinegar/sugar as a preservation method. 5-point Likert

22.h. I know about organic fish. 5-point Likert

22.i. I know about these fish: dab, hake, herring and trout.

5-point Likert

Self-evaluated

skills in relation to

fish and cooking

23.b. I can assess whether a fish is fresh. 5-point Likert

23.c. I can fillet a flatfish. 5-point Likert

23.d. I can fillet a round fish. 5-point Likert

23.e. I can debone a herring. 5-point Likert

23.f. I can cook a fish. 5-point Likert

23.i. I can follow a recipe. 5-point Likert

23.j. I can make my own recipe with fish. 5-point Likert

23.k. I can tell others about the food I helped prepare. 5-point Likert

23.l. I can work together with others on cooking.

5-point Likert

Self-evaluated

knowledge in

relation to the

senses

22.a.***** I know the five basic tastes. 5-point Likert

22.b. I know how the senses affect the taste of food. 5-point Likert

Self-evaluated

skills in relation to

the senses

23.g.***** I can assess and describe how the food tastes and

feels in the mouth.

5-point Likert

23.h. I can talk with others about how the food tastes and

feels in the mouth.

5-point Likert

8

*5-point Likert scale: strongly disagree, disagree, neither agree nor disagree, agree, strongly agree (Likert, 1932). 168 **4-point frequency scale: 1-2 times, 3-4 times, 5 or more times, I have not eaten fish in the past week. 169 *** 5-point categorical sliding bar scale: extremely, very, moderately, not very, not at all. 170 ****4-point frequency scale: 1-2 types, 3-4 types, 5 or more types, I have not eaten fish in the past week. 171 ***** The question number refers to the original order in the questionnaire. Due to analytical thematisation, the original 172 order has been adapted. 173 174

Three scales were applied. A 5-point Likert scale (strongly disagree, disagree, neither agree nor 175

disagree, agree, strongly agree) was predominantly applied, indicating the respondents’ level of 176

agreement with a direct statement (Likert, 1932). To measure fish intake and fish variety (item 14 177

and 16), a 4-point frequency scale was applied. A similar frequency determination method was used 178

by Rockett and Colditz (1997) in the development of the Youth-Adolescent Questionnaire (YAQ). 179

Evaluation of fish disgustingness (item 15) was measured on a unipolar 5-point slider bar scale 180

(extremely, very, moderately, not very, not at all) to apply variety in layout and reduce respondent 181

fatigue. 182

Food neophobia was measured by applying an adjusted version of the Food Neophobia Test Tool 183

(FNTT10) (Damsbo-Svendsen et al., 2017). The FNTT10 consists of ten statements, but was adjusted 184

by the authors to consist of eight statements (FNTT8). Item 16 in the FNTT10 was not included in 185

FNTT8, since the item showed a relatively high comprehension issue (58%). Item 18 was excluded, 186

because a context question was not relevant within the scope of this study. This item was also 187

removed in the FNTT9 version by Damsbo-Svendsen et al. (2017). Item 11 in the FNTT10 was 188

revised before being included in the FNTT8 (Item 12), because it had a high comprehension issue 189

(75%). The eight statements in the FNTT8 were evaluated on the 5-point Likert scale (Likert, 1932). 190

191

2.4. Data analysis 192

Prior to the statistical data analysis, the dataset was thematised, resulting in seven themes (see Table 193

3) and Cronbach’s α values for internal consistency within themes (only for Likert scale items, and 194

themes with ≥ 6 items) was computed. Cronbach’s α for the theme Knowledge on fish and cooking 195

was 0.72, Skills related to fish and cooking 0.85, and for FNTT8 0.86. The threshold coefficient 196

value for satisfactory scales is 0.60 - 0.70 (Hair, Black, Babin, & Anderson, 2014). 197

The analytic plan was to investigate self-evaluated liking of cooking, fish intake, liking of fish, 198

knowledge and skills in relation to fish and cooking and food neophobia and to explore differences 199

between sex and geographical origin (area) of the respondents. 200

9

Data analysis was performed using the statistical software package SPSS Statistics 26. Univariate 201

analysis of variance (UNIANOVA) was conducted to explore effects of sex and area. Possible 202

relationships between variables at theme level (i.e. the theme sums) were investigated by computing 203

bivariate correlation coefficients based on Pearson’s r (Akoglu, 2018). The value of Pearson’s r was 204

interpreted based on the definition by Dancey and Reidy (2017): 0.1 - 0.3/-0.1 - -0.3 = weak; 0.4 - 205

0.6/-0.4 - -0.6 = moderate; 0.7 - 0.9/-0.7 - -0.9 = strong. 206

One food neophobia item (item 13) was a ‘negative’ statement, and during data analysis the scale 207

was reversed. To evaluate food neophobia, scores from individual items in the FNTT8 were 208

summed to a single score: a FNTT8 score ranging from 8 (high neophobia) to 40 (low neophobia). 209

Four categories were formulated inspired by Falciglia, Couch, Gribble, Pabst, and Frank (2000) and 210

Guzek et al.(2018): neophobic (score: 8-16), neophobic tendency (score: 17-24), neophilic tendency 211

(score: 25-32) and neophilic (score: 33-40). 212

213

3. RESULTS 214

General characteristics of the study sample (n = 669) are presented in Table 4. The theme sum and 215

individual items are described by mean and standard deviation (SD), and the effects of sex (girls n 216

= 328; boys n = 341) and area (province n = 289; Greater Copenhagen n = 380) are described by 217

p-value, mean and confidence interval (CI 95%). The effects of the interaction between sex and area 218

were also analysed (girls x province n= 149; girls x Greater Copenhagen n = 179; boys x province 219

n = 140; boys x Greater Copenhagen n = 201) (Figure 3). 220

10

Table 4 221

Mean and standard deviation (rounded to 0.1) reported for the seven themes and individual items. The p-value for significant effects on 222

themes and items is reported for both main factors (sex and area; Greater Copenhagen: G. Cph.; province: Prov.). 223

Overall† Effect of sex Effect of area

Theme/item Mean SD p Boy Girl CI 95% p G. Cph. Prov. CI 95%

1. 1. Liking of cooking

5. I like to cook. (-2/2)* 1.5 0.8 < 0.001 1.3 1.6 0.1 0.003 1.6 1.4 0.1

2. Fish intake & liking of fish

Sum Sum FishBehaviour (-4/12)* 3.1 2.9 0.005 3.4 2.7 0.3 0.001 3.4 2.7 0.3

14. How many times have you eaten fish in the past

week?** 0.7 0.7

0.006 0.8 0.6 0.1

15. How disgusting do you find fish? (R)***/**** 0.8 1.2 0.02 0.9 0.8 0.1 0.02 0.9 0.7 0.1

16. How many different types of fish have you eaten in

the past week?** 0.7 0.7 0.05 0.7 0.6 0.1 0.006 0.8 0.6 0.1

17. I like fish. 0.9 1.2 0.02 1 0.7 0.1 0.03 1 0.8 0.1

3. Knowledge - fish & cooking

Sum KnowFish&Cook (-12/12)* 2.4 4.7 0.028 2.8 2 0.5

22.c. I know about kitchen hygiene when working with fish. 0.8 1.1

22.e. I know what food waste is. 1.6 0.8

22.f. I know about the historical importance of herring in

Danish food culture. -0.6 1.3 0.003 -0.5 -0.8 0.1

22.g. I know about vinegar/sugar as a preservation

method. 0.2 1.3 0.004 0.3 0 0.1

22.h. I know about organic fish*****. 0.4 1.4

0.006 0.5 0.2 0.2

22.i. I know about these fish: dab, hake, herring and trout. 0.1 1.3

4. Skills – fish & cooking

Sum CanFish&Cook (-18/18)* 3.5 7.3

23.b. I can assess whether a fish is fresh. 0.1 1.3 0.01 0.3 0 0.1

23.c. I can fillet a flatfish. -0.4 1.4

23.d. I can fillet a round fish. -0.5 1.4 0.03 0 -0.7 0.2

23.e. I can debone a herring. -0.5 1.3

11

23.f. I can cook a fish. 0.3 1.4

23.i. I can follow a recipe. 1.4 0.9 < 0.001 1.3 1.6 0.1

23.j. I can create my own recipe. 0.5 1.3

23.k. I can tell others about the food I helped prepare. 1.2 1

23.l. I can work together with others on cooking. 1.4 0.9

5. Knowledge – senses

Sum KnowSenses (-4/4)* 2.2 1.8

22.a. I know the five basic tastes. 1.1 1.1

22.b. I know how the senses affect the taste of food. 1.1 0.9

6. Skills – senses

Sum CanSenses (-4/4)* 1.8 2.2

23.g. I can assess and describe the taste and texture of

food. 0.9 1.2

23.h. I can discuss the taste and texture of food with others. 0.9 1.1

7. Food neophobia

Sum FNTT8 (-16/16)* 6.3 5.8

6. I like to taste foods I have never tasted. 0.8 1

7. I like to experience new and different foods. 1 0.9

0.007 1.1 0.9 0.1

8. I think it is fun to taste food items I don't know. 0.9 1

9. I will try food even though I don’t know what it is. 0.6 1.1

10. I am not afraid of eating things I have not tasted or

experienced before. 0.8 1

11. I don’t mind eating foods I am not used to. 0.9 1

12. I enjoy my food to consist of a wide variety of

different foods and ingredients. 1 0.9

13. I am wary of trying food I have not tasted before

(R)*** 0.3 1.2

†The 5-point scale was coded accordingly: strongly disagree = -2; disagree = -1; neither agree nor disagree = 0; agree = 1; strongly agree = 2 for analytical purposes. 224 *Theme sum (min/max) 225 **Items 14 and 16 measured on a 4-point frequency scale with the following codes: 1-2 times/types of fish = 1; 3-4 times/types of fish = 2; 5 or more times/types of 226 fish = 3; I have not eaten fish in the past week = 0. 227 *** Scale reversed before analysis. The higher the score = less waryness. 228 **** Item 15 measured on a 5-point scale and coded with the following codes: extremely = -2; very = -1; moderately = 0; not very = 1; not at all = 2. A high positive 229 score = low perceived disgustingness. 230 *****Farmed fish can be organically produced, hence this item 231

12

3.1. Primary observations 232

Based on results presented in Table 4 the following observations were evaluated to be of primary 233

interest: liking of cooking was medium-high1 (see Table 4, Figure 1 and 2), fish intake frequency 234

was low but liking of fish was medium (but in the positive; 0.9) and perception of fish 235

disgustingness was low (see Table 4, Figure 3). Furthermore, self-evaluated overall knowledge on 236

fish and cooking was low, although knowledge on kitchen hygiene when working with fish was 237

rated to be medium and knowledge on food waste was rated to be high. Self-evaluated overall skills 238

related to fish and cooking was evaluated low, although skills on following a recipe, talking with 239

other about the food they helped to cook, and working together with others were rated medium-240

high. Self-evaluated overall knowledge and overall skills related to the senses were rated to be 241

medium (see Table 4). 242

Several cases of significant effect of sex and was observed: girls like to cook more than boys do 243

(see Figure 1 and 2), boys have a more frequent and diverse consumption of fish, i.e. a more 244

positive fish behaviour in general compared to girls, boys find fish less disgusting than girls and 245

boys like fish more than girls (see Figure 3). Furthermore, boys evaluate themselves to know more 246

on fish and cooking in general than girls do, boys evaluate themselves as being more capable of 247

evaluating fish freshness than girls do, but girls evaluate themselves as being more capable of 248

following a recipe than boys do. Children in G.Cph like to cook more (see Figure 1 and 2), have a 249

more positive fish behaviour in general, find fish less disgusting, and like fish more than children in 250

the province (see Figure 3). Furthermore, children in G.Cph. evaluated themselves more positive 251

with regard to knowledge about organic fish and had a higher liking of experiencing new and 252

different foods than children in the province. 253

254

1 Definition of rating: low = ≤0.5; medium = 0.6-1; medium-high = 1.1-1.5; high = ≥1.6

13

255

Figure 1: Liking of cooking; response frequency in pct. by sex and area 256

257

258

Figure 2: Item 5 ‘I like to cook’, difference between boys and girls and Greater Copenhagen and the 259

province (based on means). Error bars indicate CI95% (lowest score = -2, highest score = 2). 260

14

261

Figure 3: Intake and liking of fish: response frequency in pct. by sex and area; upper left: fish intake 262

(item 14); upper right: types of fish eaten (item 16); lower left: liking of fish (item 17); lower right: 263

fish disgustingness (item 15) 264

Furthermore, one highly significant interaction effect (sex x area) were observed: item 13: I am 265

wary of trying food I have not tasted before (R) (data not shown in Table 4) (p = 0.009, MgirlsG.Cph. = 266

0.4; MgirlsProv. = 0.1; MboysG.Cph. = 0.2; MboysProv. = 0.4) (see Figure 4). This observation indicates that 267

girls in the Greater Copenhagen area are less wary of trying food they have never tasted before 268

compared to girls in the province, whereas the opposite was observed for the boys. 269

15

270

Figure 4: Item 13: ‘I am (not) wary of trying food I have not tasted before’ (scale reversed). Effect 271

of interaction between sex and area. Error bars indicate CI95% (lowest score = -2; highest score = 272

2). 273

3.2. Food neophobia (FNTT8) 274

In general, the sample evaluated themselves as low in food neophobic behaviour (MFNTT8Score = 275

30.3; see Figure 5) and could be categorised as having a neophilic tendency based on the following 276

formulated categories: neophobic (FNTT8 score of 8-16), neophobic tendency (FNTT8 score of 17-277

24), neophilic tendency (FNTT8 score of 25-32) and neophilic (FNTT8 score of 33-40) (levels 278

inspired by Falciglia et al.(2000) and Guzek et al.(2018). No significant differences in the FNTT8 279

score were observed between groups except, although there could be a slight tendency towards a 280

more exploratory behaviour in the Greater Copenhagen area. Nevertheless, even though this 281

observation is in line with prior observations in this study with regard to the effect of area, it should 282

be explored further in future research using a larger study sample to determine whether a tendency 283

actually exists. 284

285

16

286

Figure 5: FNTT8 score means for sample total, sex and area. Differences between sex and area are 287

non-significant. 288

3.3. Correlations on theme level 289

Possible relationships between variables at theme level are presented in Table 5. 290

Table 5 291

Pearson’s correlation coefficients for themes 292 1. Like

to cook

2. Fish

behavior

3. Knowledge

- fish & cooking

4. Skills

- fish & cooking

5. Knowledge

- senses

6. Skills

- senses

7. FNTT8

1. Like to cook r 1 0.15* 0.18 0.24 0.15 0.25 0.36**

p 6.273E-05 5.114E-06 1.576E-10 1.261E-04 5.528E-11 2.55E-22

2. Fish

behaviour r 1 0.33 0.33 0.15 0.28 0.38

p 1.005E-18 2.183E-18 7.515E-05 1.490E-13 5.94E-24

3. Knowledge

- fish & cooking r 1 0.62 0.41 0.40 0.32

p 4.881E-71 2.987E-28 6.605E-27 5.325E-17

4. Skills

- fish & cooking r 1 0.29 0.61 0.38

p 5.906E-14 3.026E-69 3.661E-24

5. Knowledge

- senses r 1 0.30 0.23

p 4.819E-15 2.274E-09

6. Skills

- senses r 1 0.41

p 2.055E-28

7. FNTT8 r 1

p

30,5

30,2

30,3

30,5

29,7

30,1

30,5

29,9

30,2

29,2 29,4 29,6 29,8 30,0 30,2 30,4 30,6

G. Copenhagen

Province

Total

G. Copenhagen

Province

Total

G. Copenhagen

Province

Total

Bo

ys

Gir

lsT

ota

l

17

* Correlation is significant at the 0.001 level (2-tailed).

** Bold indicates values included in analysis based on the Pearson’s correlation coefficients value definition by Dancey

and Reidy (2017): 0.1 - 0.3/-0. 1 - -0.3 = weak; 0.4 - 0.6/-0.4 - -0.6 = moderate; 0.7 - 0.9/-0.7 - -0.9 = strong.

As presented in Table 5, all correlations between themes were significant and positive. The two 293

strongest positive correlations were observed between theme 3) ‘Knowledge of fish and cooking’ 294

and theme 4) ‘Skills in fish and cooking’ and theme 4) ‘Skills in fish and cooking’ and theme 6) 295

‘Skills in the senses’. The correlation between themes 3 and 4 indicates that knowledge is positively 296

associated with skills: if you know it, you can do it. The correlation between themes 4 and 6 297

indicates that if skills in fish and cooking are present, then so too is the ability to use the senses in 298

relation to food. 299

Six significant moderate positive correlations were observed between the following: theme 3) 300

‘Knowledge of fish and cooking’ and theme 5) ‘Knowledge about the senses’, indicating that 301

knowledge of food and cooking is, to some extent, positively related to knowledge about the senses. 302

The same moderately positive relationship is seen between theme 3) ‘Knowledge of fish and 303

cooking’ and theme 6) ‘Skills in the senses’, which indicates that knowledge of food and cooking 304

can be associated with abilities related to using the senses when working with food. 305

The following themes were observed to have a positive significant moderate association with theme 306

7) FNTT8: 1) ‘Like to cook’, 2) ‘Fish behaviour’, 4) ‘Skills in fish and cooking’, and 6) ‘Skills in 307

the senses’. These associations indicate a tendency for food exploration to be a driver for liking to 308

cook, positive fish behaviour and higher self-evaluated skills, although it is less strongly associated 309

with knowledge of the senses. 310

An interesting observation was that ‘liking to cook’ (theme 2) did not appear to have a moderate or 311

strong association with skills in fish and cooking (theme 4), which indicates that it does not matter 312

as much for the liking of cooking whether you think you can cook or not. Nevertheless, skills 313

seemed to be of greater importance than knowledge in relation to liking to cook. 314

4. DISCUSSION 315

The objectives of the present study were to investigate self-evaluated liking of cooking, fish intake, 316

liking of fish, knowledge and skills in relation to fish and cooking and food neophobia and to 317

explore differences between sex and geographical origin (area) of the respondents. 318

4.1. Liking of cooking, fish behaviour and FNTT8 319

The high liking of cooking observed in the survey (Figure 1 and 2) is supported by the findings by 320

Arla Fonden (2020), where 82% of children replied that they like to cook. The high liking of 321

18

cooking could be due to media and social media exposure of food and cooking activities. For 322

example, the television show Master Chef and the children’s version Master Chef Junior could be 323

responsible for raising the status of cooking. It could be an effect of ‘wishful identification’, which 324

is a psychological process through which a person desires or attempts to become like somebody the 325

person identifies with, for example a chef whom they perceive to be successful and admired by 326

others (Di Pietro, 2018). This effect does not explain the effect of sex in relation to liking of 327

cooking: girls liked to cook more than boys (see Figure 1), a result also identified by Cunningham-328

Sabo and Lohse (2013). 329

The effect of sex could also be a result of the reproduction of traditional gender roles. Even though 330

Holm, Ekström, Hach, and Lund (2015) found that the number of meals cooked by women 331

decreased by 20% and the number of meals cooked by men increased by 11% from 1997 to 2012, 332

50% of dinner meals were still cooked by women in Nordic households.. 333

The effect of area on liking of cooking (Greater Copenhageners had a higher liking of cooking than 334

those from the provinces) (see Figure 1, 2) could be explained by a greater exposure to various 335

foodscapes due to a higher degree of urbanisation (Seto & Ramankutty, 2016) or that leisure time 336

cooking schools are more accessible in the Greater Copenhagen area than in the provinces. 337

‘Liking to cook’ was only weakly correlated with skills (see Table 5), which is an interesting result 338

since it implies that early-phase adolescents do not have to believe that they possess cooking skills 339

in order to enjoy cooking. If the interest is there, the lack of skills will not be a barrier. Instead, food 340

exploration could be one of the drivers due to the positive moderate association between the FNTT8 341

and liking to cook (see Table 5). However, in a study conducted with adults, Hartmann, Dohle, and 342

Siegrist (2013) found that cooking enjoyment was the most important predictor of cooking skills. 343

The majority of the sample had a positive attitude towards fish; In general liking was high and the 344

rating of disgustingness of fish was low (see Figure 3). A similar result was found by Nystrand and 345

Fjørtoft (2015) when they investigated 10 to 19-year-old Norwegians’ attitude towards eating fish. 346

The positive attitude towards fish could be due to the way in which ‘fish’ as food was interpreted by 347

the sample; what was the frame of reference for ‘fish’? To put the frame of reference into 348

perspective, results from a Danish citizen science project on Danes’ fish eating habits showed that 349

the hot fish dish most frequently consumed by children was breaded fish fillet (39%), and the 350

favourite cold cuts (eaten on rye bread) were mackerel in tomato sauce (33%) and fish cakes (21%) 351

(Vuholm & Damsgaard, 2019). None of these dishes reflect that it is a fish (an animal) that is being 352

eaten (no bones, head, fish shape, etc.). As such, the degree of ‘animalness’ (Martins & Pliner, 353

19

2006; Rozin & Fallon, 1986) is greatly reduced, leaving only the name of the dish to indicate that it 354

is actually fish that is being eaten. 355

However, the positive attitude towards fish was not translated into actual intake of fish, since 42% 356

had not consumed fish in the past week, and approximately 47% had consumed fish one to two 357

times in the past week (see Figure 3). These observations are in line with the low consumption of 358

fish observed in Danish 10 to 17-year-olds (mean: 15 g/day compared with the recommended 50 359

g/day), also with regard to the gender difference: boys’ intake was slightly higher than girls (See 360

Figure 3) (Pedersen et al., 2015). The frequency of fish intake observed in the present study differs 361

from that found by Kim et al. (2010) in a study conducted with 15-year-old Swedish adolescents: 362

24% ate fish less than once a week and 57% consumed fish once a week. The higher frequency of 363

fish intake in Swedish adolescents could be due to the fact that free school meals have been 364

provided (by law) since 1946, making the choice of a fish dish more accessible (Osowski, Lindroos, 365

Barbieri, & Becker, 2015). Similarly, a comparison of adults’ fish intake in France, Italy, the Czech 366

Republic and Denmark supports the observation in the present study with regard to a low intake of 367

fish in Danish early phase adolescents, with adults in both France (M 34.3 g/day) and Italy (M 44.6 368

g/day) having a higher fish intake than their Danish peers (M 18 g/day), while adults in the Czech 369

Republic had an even lower intake (M 11.7 g/day) than Danes (Mertens et al., 2019). This illustrates 370

that low intake of fish is not a problem exclusively related to adolescents but is probably also a 371

challenge within the family. Barriers to eating fish could, for example, be a lack of skills and price; 372

the price of one kg of plaice fillets (Pleuronectes platessa), a common flatfish eaten in Denmark as 373

a fried breaded fish fillet, is approximately twice as high as that of one kg of pork chops (prices 374

compared from the same Danish online discount supermarket: www.nemlig.com, accessed 09.30. 375

2020). This perspective is also supported by Myrland et al. (2000), who found that level of 376

education, price, fish odour, and preparation difficulty were prominent barriers to eating fish. 377

Furthermore, the significant effect of both sex and area in relation to fish intake, evaluated 378

disgustingness and liking of fish were interesting observations (Table 4, Figure 3). With regard to 379

sex, boys evaluated themselves as having a more positive fish attitude and behaviour than girls. 380

Nystrand and Fjørtoft (2015) did not find a significant difference between sex and fish attitude, but 381

found a difference between boys and girls in preference for dinner fish dishes: boys had a higher 382

preference compared to girls. With regard to the effect of geographical area, Greater Copenhageners 383

had a higher self-evaluated fish intake and liked fish more than those from the provinces (Figure 3). 384

This observation cannot be explained by the higher level of education in Greater Copenhagen, since 385

20

the area is very diverse in terms of the level of education (Statistics Denmark, 2019). In a study on 386

Australian adolescents’ food habits, Woodward et al. (2000) found that food choice among 387

adolescents residing in rural areas tended to have a nutritionally less favourable pattern than food 388

choice among individuals living in urban areas. 389

Samaniego-Vaesken et al. (2018) did not find that population densities were associated with food 390

choice. However, we also observed that the FNTT8 score was slightly higher among, though not 391

significantly different from, Greater Copenhageners compared with those from the provinces, 392

possibly indicating a more pronounced food exploratory behaviour among Greater Copenhageners 393

(see Figure 5). In addition, a positive significant moderate association between fish behaviour and 394

FNTT8 was observed (Table 5). Maiz and Balluerka (2016) also found a significant association 395

between regular consumption of fish (at least two to three times per week) and level of food 396

neophobia. Furthermore, Maiz and Balluerka (2016) concluded that neophobic children and 397

adolescents had a poorer diet quality than neophilic children and adolescents, which underlines the 398

importance of focusing on this behaviour. 399

Observations in the present study on FNTT8 score resemble those found by Appleton et al. (2019) 400

in a study on European adolescents’ food neophobia: Danish adolescents score low with regard to 401

neophobic behaviour, also compared with their European peers. Appleton et al. (2019) found that 402

Danish adolescents were less neophobic (mean food neophobia scale (FNS) score: 26.6, where 10 = 403

low neophobia and 70 = high neophobia) than their European peers (UK: 36.5; France: 31.9; Italy: 404

32.7). An evaluation of German adolescents resulted in a FNS score of 31 (Roßbach, Foterek, 405

Schmidt, Hilbig, & Alexy, 2016). Koivisto Hursti and Sjödén (1997) measured the FNS score in 11- 406

to 17-year-olds as ranging from 34.1 to 32.4. However, a clear association between food habits and 407

attitude and food environment has yet to be established. 408

Furthermore, a tendency was observed indicating that FNTT8 was positively significantly associated 409

with themes based on functional action-based behaviours and skills and, to a lesser extent, the 410

knowledge-related themes (see Table 5). This could be an indication of knowledge being of less 411

importance when it comes to food neophobic behaviour. 412

4.2. Knowledge and skills 413

Overall knowledge on fish and cooking (theme 3) was observed to be low (see Table 4). At theme 414

level, boys rated themselves higher in knowledge compared to girls. The gender difference could be 415

due to a tendency for boys to over-estimate their own competencies, and could be a result of 416

cultural reproduction of gender stereotypes (Nobre & Valentini, 2019). Furthermore an effect of 417

21

area was observed related to self-evaluated knowledge of organic fish. This may be due to a higher 418

consumption of organic foods in the capital area (Copenhagen). In the capitol area, 10.3% of the 419

total food and drink expenditure is related to organic products, whereas it is only 7.1% for 420

consumers living in the region of Zealand (the provinces; the eastern part of Denmark) (Wanscher, 421

2016). 422

The overall evaluation of self-perceived skills on fish and cooking (theme 4) was observed to be 423

low (see Table 4). Observations of ratings with regard to the single items varied greatly from very 424

low to medium-high. The low ratings for skills concerned practical skills related to preparation and 425

cooking of fish (see Table 4). This could be a reflection of the generally low intake of fish and the 426

typical types of fish dishes eaten; no practical skills are needed in, for example, filleting, since fish 427

fillets are typically bought as just that – fillets. This observation could also be a reflection of only 428

26% of Danish children help to cook, set the table or help with the grocery shopping at home (Arla 429

Fonden, 2020b). Moreover, Woodruff and Kirby (2013) found that children and adolescents’ self-430

efficacy for cooking correlated positively with the frequency of participating in the preparation of 431

family meals. The conundrum is that children like to cook, but do not transfer this liking of cooking 432

to actual cooking. Arla Fonden (2020a) asked the parents why their children did not help prepare 433

meals at home and more than 60% did not specify a reason and only 15% said that it was due to 434

time. This opens a window to focus on inviting children to cook as part of the family meal 435

preparation in the future; parents have to let the children into the kitchen. Furthermore, a strong 436

positive correlation was observed between knowledge on fish and cooking and skills related to fish 437

and cooking (see Table 5), which also support the potential in promoting food literacy in the school 438

setting as part of the curriculum with the aim of both promoting food knowledge and food skills and 439

healthy food behaviour (Nelson, Corbin, & Nickols-Richardson, 2013). 440

The medium-high ratings related to self-perceived skills observed in the present study were on 441

following a recipe, talking to others about the food and working together on cooking (see Table 4), 442

which could reflect that these activities are linked to more everyday activities. Also, the social 443

dimension of working together and helping each other was found to be of great importance in the 444

process of cooking together by (Højer, Wistoft, & Frøst, 2020). 445

With regard to significant effects of sex, boys rated themselves higher than girls in their ability to 446

assess fish freshness and to fillet a round fish, albeit with a low means (see table 4). With regard to 447

the ability to follow a recipe, girls rated themselves higher than boys. With regard to sex 448

differences, Cunningham-Sabo and Lohse (2013) observed the opposite in their study on 4th

449

22

graders’ food and cooking self-efficacy (they did not differentiate between knowledge and skills): 450

girls rated themselves higher in food and cooking self-efficacy than boys. Although it is difficult to 451

make comparisons between studies due to the different uses of items, scales and coding, Woodruff 452

and Kirby (2013) did not find an effect of sex in cooking self-efficacy, although girls had a greater 453

repertoire of preparation methods (primarily with regard to the preparation of fruit and vegetables). 454

A strong positive significant correlation was observed between theme 4) ‘Skills in fish and cooking’ 455

and theme 6) ‘Skills in the senses’ (see Table 5). This indicates that the higher the self-perceived 456

cooking self-efficacy you possess, the more aware you will be of the senses, enabling you to apply 457

them to food-related practices. This finding strongly supports the importance of an experiential 458

learning approach that focuses on a hands-on approach to improving, for example, sensory 459

awareness. Nelson, Corbin, and Nickols-Richardson (2013) also support this strategy, and conclude 460

that an increase in culinary skills is a gateway to promoting healthy eating behaviour: through 461

engaging in cooking activities, exposure to healthy foods can be maximised, and through viewing, 462

smelling, handling and tasting new and less often consumed foods, it is possible to promote the 463

youth’s motivation and behavioural capacity to choose and consume healthy foods. 464

Theme 5) ‘Knowledge of the senses’ are rated higher than theme 6) ‘Skills related to using the 465

senses’ (see Table 4), and the positive correlation between the two was low, though significant (see 466

Table 5). These observations differ from knowledge and skills related to fish and cooking. This 467

could be explained by knowledge of the senses is a more tangible and factual type of knowledge, 468

whereas evaluating your own actual use of the senses is more difficult. Nevertheless, the ability to 469

use the senses had a positive significant moderate association with the FNTT8 (see Table 5). This 470

could indicate that the more food exploratory you are, the more aware you will be of using the 471

senses. This area has yet to be explored in greater depth. 472

5. LIMITATIONS 473

The validity of our findings in this study was sought by comparing the findings with those of 474

previous studies that have focused on similar research, although the specific research area of ‘fish 475

and children’ is under-investigated. Our study sample consisted solely of respondents from the 476

eastern part of Denmark, and regional differences in fish intake could exist from region to region, as 477

was found by COOP Analyse (2019), a Danish retail organisation website indexing Danish 478

consumers’ food habits. According to COOP Analyse (2019), Danes in the eastern part of Denmark 479

(the capital region and Zealand) consume more fish than Danes in the northern part of Denmark (the 480

capitol region: index 115; Zealand: index 97; Northern region: index 86, with average intake 481

23

defined by index 100). The index supports our findings with regard to fish intake (i.e. Greater 482

Copenhageners consume more fish than those from provincial Zealand), but it also indicates 483

considerable variety within Denmark, which calls for more national data in order to achieve the full 484

picture of Danish early phase children’s fish intake. 485

Furthermore, we found a liking for fish in general, although this could also partly be a result of ‘the 486

Hawthorne effect’, which refers to the impact of research participation on behaviour 487

(McCambridge, Witton, & Elbourne, 2014). 488

The use of recall questions aimed at measuring the amount or frequency of food eaten by children 489

has previously been investigated. It was acknowledged that children younger than eight years of age 490

are not capable of accurately recalling and conceptualising the frequency of food intake, whereas 491

older children are sufficiently cognitively developed to self-report their food intake. However, there 492

is a greater margin of error when applying recall questions with children compared with adults 493

(Burrows, Martin, & Collins, 2010; Livingstone & Robson, 2000; Sharman, Skouteris, Powell, & 494

Watson, 2016). Furthermore, measures were based on self-evaluation, and did not measure actual 495

behaviour, which would have produced a more accurate representing the actual situation; 496

nevertheless, our results represents the reality as perceived by the sample. 497

Finally, future research should focus on developing a unified and standardised (yet flexible to 498

situation) food literacy measurement tool, as for example attempted by Palumbo et al. (2017), 499

which would improve the possibility of comparing research results across studies. 500

501

6. CONCLUSION 502

The objective of this survey was to investigate 11- to 13-year-old Danes’ self-evaluated liking of 503

cooking, fish intake, liking of fish, knowledge and skills in relation to fish and cooking and food 504

neophobia. Furthermore, the aim was to explore possible effects of sex and geographical area. 505

We found that 11- to 13-year-old early phase adolescents in our sample very much enjoyed 506

cooking. Although we found a general liking for fish and a low perception of fish disgustingness, 507

this attitude was not translated into actual fish consumption. Of most concern was the finding that 508

42% had not eaten any fish in the past week. This underlines the importance of promoting an 509

increase in fish consumption and on how to introduce fish into the (family) meal repertoire. One 510

way of doing this could be through inviting children into the kitchen and through food exploration, 511

since we also found that Danish early phase adolescents could be characterised as having a 512

behavioural food neophilic tendency. Fish could be introduced as a theme in the school subject 513

24

Food Knowledge (compulsory subject in Danish public schools, former known as home 514

economics), which could promote a spill-over into the family meal practice in a bottom-up 515

approach. This aspect needs to be investigated further. 516

Differences between boys and girls were the most prominent effect. There were significant 517

differences in sex in three of the seven main themes: 1) ‘Liking of cooking’: girls liked to cook 518

more than boys, 2) ‘Fish behaviour’: boys had a more positive fish behaviour than girls and 3) 519

‘Knowledge of fish and cooking’: boys evaluated themselves higher than girls, although this could 520

be due to boys’ tendency to overestimate their own abilities. In comparison, there were significant 521

effects of area for two main themes: 1) ‘Liking of cooking’: Greater Copenhageners liked to cook 522

more than those from the provinces, 2) ‘Fish behaviour’: Greater Copenhageners had a more 523

positive fish behaviour than those from the provinces. 524

We found both knowledge of fish and cooking and skills in fish and cooking to be positive, 525

although skills related directly to preparing fish were lacking. Moreover, several interesting 526

correlations were observed in the study: knowledge of food and cooking had a strong association 527

with skills in food and cooking, as did skills in food and cooking and skills in the senses. In 528

conclusion, these findings underline the importance of implementing work with food literacy in, for 529

example, a school setting in order to ensure acquisition of food and cooking self-efficacy, just as 530

life skills also support healthy food choices throughout life. Liking to cook was not associated with 531

skills in food and cooking but with FNTT8, which suggests something interesting: the enjoyment of 532

cooking does not depend so much on self-perceived skills but rather on curiosity and food 533

exploration. Furthermore, the relationship between food neophobia and fish behaviour indicate that 534

the more neophilic children have a more positive fish behaviour. 535

To conclude, the findings of this study should encourage decision-makers on all community levels 536

to consider the importance of promoting food literacy and include it in a formal educational 537

perspective, as it promotes the individual’s basis for making critical and reflective healthy food 538

choices in the future, and as such could play a role in health promotion initiatives; both locally and 539

nationally. Furthermore, this research has contributed with knowledge on early phase adolescents’ 540

fish intake and fish behaviour, which, until now, has been an under-investigated research area in 541

food consumption studies; the typical subjects investigated have been fruit and vegetables, but a 542

healthy diet consists of many different food groups. 543

544

DECLARATION OF INTEREST 545

25

None. 546

AUTHOR CONTRIBUTIONS 547

R.H., M.B.F.: Conceptualization; R.H., M.B.F.: Data curation; R.H., M.B.F.: Formal analysis; R.H., 548

M.B.F.: Funding acquisition; R.H.: Investigation; R.H., M.B.F.: Methodology; R.H.: Project 549

administration; R.H., M.B.F.: Resources; R.H., M.B.F.: Software; M.B.F.: Supervision; R.H., 550

M.B.F.: Validation; R.H., M.B.F.: Visualization; R.H.: Roles/Writing - original draft; R.H., M.B.F.: 551

Writing - review & editing. 552

FUNDING SOURCES 553

This work (Smag for Fisk; Taste for Fish) is part of the research project Smag for Livet (Taste for 554

Life) and was funded by the Nordea Foundation, Denmark and University College Absalon, 555

Nutrition and Health, Sorø, Denmark. None of the funding parties had any involvement or influence 556

with regard to study design, data collection, analysis and interpretation of data, in the writing of the 557

report or in the decision to submit the article for publication. 558

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A2. PAPER II

Play with your food and cook it! Tactile play with fish as a way of promoting acceptance of

fish in 11 to 13-year-old children in a school setting – a qualitative study

Højer, R., Wistoft, K., & Frøst, M.B. in Nutrients 2020, 12 (10), 3180;

https://doi.org/10.3390/nu12103180

(Published October 17th 2020).

nutrients

Article

Play with Your Food and Cook It! Tactile Play withFish as a Way of Promoting Acceptance of Fish in 11-to 13-Year-Old Children in a School Setting—AQualitative Study

Rikke Højer 1,2,* , Karen Wistoft 3 and Michael Bom Frøst 2

1 Center for Nutrition and Rehabilitation, Nutrition and Health, University College Absalon, Slagelsevej 70-74,4180 Sorø, Denmark

2 Department of Food Science, Design and Consumer Behaviour, University of Copenhagen, Rolighedsvej 26,1958 Frederiksberg, Denmark; mbf@food.ku.dk

3 Department of Educational Sociology Emdrup, Danish School of Education, Tuborgvej 164, Building D, 143,2400 Copenhagen, Denmark; kawi@edu.au.dk

* Correspondence: rho@pha.dk; Tel.: +45-21448894

Received: 23 August 2020; Accepted: 15 October 2020; Published: 17 October 2020�����������������

Abstract: Despite a tradition of consuming fish in Denmark and despite the health benefits ofeating fish, Danish children consume only one-third of the officially recommended amount of fish.The objective of this study was to explore an experiential and sensory-based exercise in a school settingwith focus on tactile play and cooking as a way of promoting 11- to 13-year-old children’s acceptanceof fish. The design was a qualitative exploratory multiple-case design using participant observationin a school setting. Six classes were recruited from the Eastern part of Denmark (n = 132). Based onan exercise with cooking fish and gyotaku (fish print), four meta-themes were identified by applyingapplied thematic analysis: rejection, acceptance, craftsmanship, and interaction. Rejection andacceptance appeared along a rejection–acceptance continuum related to how the fish was categorised(animal, non-animal, food) in different phases of the experiment. Rejection was promoted by mucus,smell, animalness, and texture, whereas helping each other, tactile play, and craftsmanship promotedacceptance. In conclusion, this study found that tactile play combined with cooking could be a wayof promoting acceptance of fish. The findings also support a school setting as a potential gateway inpromoting healthy food behaviour.

Keywords: food acceptance; tactile play; cooking; children; fish; health promotion

1. Introduction

1.1. Background

Children aged 11 to 13 years are in the early adolescent life phase [1], a phase defined by adevelopmental plasticity [2], where lifelong habits can be established [3]. The adolescent life phase iscritical when it comes to behavioural changes in, for example, dietary habits [4]. The changes in dietaryhabits are due to, for example, an increase in autonomy and a decrease in family influence [5,6].

Consumption of fish provides valuable nutrients. Especially fatty fish have a high content ofvitamin D, which is important for e.g., calcium (Ca) absorption, bone health, and childhood growthstages [7,8]. Regular consumption of fish, especially those high in n-3 poly unsaturated fatty acids(PUFA), also reduce incidences of, for example, diabetes mellitus, systemic arterial hypertension,central obesity and hyper-lipidemia [9,10], and seem to positively influence intestinal microbiota [11].

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Furthermore, the macro nutrient content of fish with regard to protein is 15–20% and fish containsall the essential amino acids [12], which is beneficial for the diet as the sulphur-containing aminoacids, cysteine and methionine, are absent in plant protein. Furthermore, proteins from fish havea high degree of digestibility i.e., 85–95% [12,13]. Studies have shown positive health effects as aresult of fish protein intake e.g., by decreasing the risk of metabolic syndromes and increasing insulinsensitivity [14–17].

1.1.1. Acceptance and Rejection of Food

This study focuses on fish as part of a healthy diet. According to a national study, Danish childrenaged 10 to 17 years eat only 105 g of fish per week [18], one-third of the Nordic recommendations of350 g per week [19]. The intake of fish among Danish early adolescent phase children correspondswith international observations [20–22]. Furthermore, to the authors’ knowledge, little research hasbeen conducted in the area of early adolescent phase children’s acceptance of fish.

Rozin and Fallon [23,24] have developed a framework in which they have identified three principalmotivations within the taxonomy of food acceptance and rejection, which drive food acceptance andrejection: sensory-affective factors (e.g., liking/disliking taste or smell), anticipated consequences(e.g., negative/positive physiological or social), and ideational factors (e.g., knowledge of thenature or origin of a food). These motivations and attributes can lead to either rejection oracceptance: the psychological rejection categories are distaste (the concept distaste includes allsensory characteristics, real or imagined [25,26]), danger, inappropriateness, and disgust, and theacceptance categories are good taste, beneficial, appropriate, and transvalued [25,27]. Furthermore,Rozin and Vollmecke [27] point out that the influence of culture and context are predominant factorsinfluencing acceptance and rejection, and that acquired likes can be promoted by social encounterswith people outside the family, especially peers. The framework of rejection and acceptance developedby Rozin and colleagues [23,24,27] has been applied repeatedly in studies investigating food behaviour(e.g., [25,26,28,29]).

Based on the limited research conducted within and around the target group of this study, Prell,Berg, and Jonsson [30] identified a negative attitude towards the smell, the fear of finding bones,the accompaniments, and friends’ behaviour as primary barriers to eating fish. In a study focusingon foods in general, Frerichs et al. [31] found that appearance and texture were primary drivers foraccepting or rejecting food. Furthermore, Mitterer-Daltoé, Latorres, Treptow, Pastous-Madureiraa,and Queiroz [32] and Latorres, Mitterer-Daltoé, and Queiroz [33] found that young children had ahigher acceptance of fish than older children. This might be due to the older children’s cognitivematuration, leading to food-related cognitions increasing and becoming more complex [34]. The animalorigin of fish could also play a role in rejection, since foods of animal origin tend to promote anattitude of disgust more than those of vegetable origin [24,25,35,36]. Increasing acceptance of foodthrough tactility (the sense of touch by using the hands) or tactile play is a research area that has yet tobe explored in greater depth. Five recent studies have been conducted in this research area [37–42],but these studies all fall outside the age-related sample of this study. Nevertheless, the results areinteresting and relevant to this study as they point to a positive impact of tactile play on food neophobiaand/or food acceptance.

Another way of influencing food behaviour and promoting acceptance of healthy foods has beensought through a hands-on approach and cooking programmes. A review of the effect of cookingprogrammes by Utter, Fay, and Denny [43] concluded that cooking programmes may have a positiveimpact on food-related beliefs, knowledge, skills, and behaviours. Of the 20 studies included inthe review, only three were on children in the age range of the sample group in the present study.However, none of the studies included in the review focused on foods of animal origin. Furthermore,observations of children’s food behaviour and learning processes have been included in studies by,for example, Block et al. [44], Fisher and Birch [45], and Gibbs et al. [46]. The relevance of applyingobservation as a research method relates to the objective of revealing actual behaviour.

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Nelson, Corbin, and Nickols-Richardsson [47] argue that culinary skills education offers a uniqueopportunity for experiential learning, which they illustrated through the use of the Kolb Cycle ofExperiential Learning [48] combined with culinary skills education (Figure 1).

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Nelson,  Corbin,  and Nickols‐Richardsson  [47]  argue  that  culinary  skills  education  offers  a 

unique opportunity for experiential learning, which they illustrated through the use of the Kolb Cycle 

of Experiential Learning [48] combined with culinary skills education (Figure 1). 

 

Figure 1. Model of  culinary  skills education as a process  for Kolb’s  cycle of experiential  learning 

developed by Nelson, Corbin, and Nickols‐Richardsson [47]. Figure by first author R. Højer. 

According  to  Nelson  et  al.  [47],  culinary  skills  education  promotes  knowledge  through 

experience, as illustrated in Figure 1. As students move from observational to experiential learning 

stages and engage  in culinary concepts, a foundation for promoting critical thinking and  learning 

skills  and  technical  proficiencies  is  laid  out,  all  aimed  at  promoting  healthy  food  behaviour. 

Furthermore, Nelson et al. [47] conclude that nutrition knowledge alone, aimed at promoting healthy 

food behaviour, seems  incomplete without  the dimension of experiential  learning via  interactions 

with food and cooking equipment. 

1.1.2. The Subject Food Knowledge 

In 2014, the subject Food Knowledge replaced the subject Home Economics as part of a reform 

of the Danish compulsory primary and lower secondary schools. The subject is mandatory for one 

year and can be taken in 4th, 5th, or 6th grade. In the subject Food Knowledge, students focus on four 

areas  of  competencies:  Food  and Health,  Knowledge  of  Food,  Cooking  and  Dining,  and  Food 

Cultures. The purpose of the reform was to ensure that Food Knowledge provides students with an 

opportunity to work with senses and experiences. Experimentation, creation, and communication in 

relation to food and meals are also key elements, as is the development of, for example, new skills 

and knowledge through motor skills, cognition, and perception [49]. 

1.1.3. Gyotaku Explained 

Gyotaku is a traditional Japanese art form (see Figure 2); gyo is the Japanese for fish and taku 

for rubbing or printing: fish rubbing or fish printing [50]. 

Figure 1. Model of culinary skills education as a process for Kolb’s cycle of experiential learningdeveloped by Nelson, Corbin, and Nickols-Richardsson [47]. Figure by first author R. Højer.

According to Nelson et al. [47], culinary skills education promotes knowledge through experience,as illustrated in Figure 1. As students move from observational to experiential learning stagesand engage in culinary concepts, a foundation for promoting critical thinking and learningskills and technical proficiencies is laid out, all aimed at promoting healthy food behaviour.Furthermore, Nelson et al. [47] conclude that nutrition knowledge alone, aimed at promoting healthyfood behaviour, seems incomplete without the dimension of experiential learning via interactions withfood and cooking equipment.

1.1.2. The Subject Food Knowledge

In 2014, the subject Food Knowledge replaced the subject Home Economics as part of a reformof the Danish compulsory primary and lower secondary schools. The subject is mandatory for oneyear and can be taken in 4th, 5th, or 6th grade. In the subject Food Knowledge, students focus on fourareas of competencies: Food and Health, Knowledge of Food, Cooking and Dining, and Food Cultures.The purpose of the reform was to ensure that Food Knowledge provides students with an opportunityto work with senses and experiences. Experimentation, creation, and communication in relation tofood and meals are also key elements, as is the development of, for example, new skills and knowledgethrough motor skills, cognition, and perception [49].

1.1.3. Gyotaku Explained

Gyotaku is a traditional Japanese art form (see Figure 2); gyo is the Japanese for fish and taku forrubbing or printing: fish rubbing or fish printing [50].

Gyotaku was used by Japanese fishermen more than a hundred years ago [51]. To avoidmisunderstanding, the fishermen used it to replicate the correct size of the fish, whereby it became adocumentation method. During the twentieth century, the practice of gyotaku has been turned into anart form.

Nutrients 2020, 12, 3180 4 of 23

As an example of an experiential exercise, gyotaku was adapted to firstly include a tactile artexercise, which was the traditional part of the exercise to be explored in this study. Secondly, after theart part of the exercise in which the fish served as an art medium, the fish would then be included in acooking exercise. The gyotaku exercise was chosen for its novelty in a Danish context and for its tactilehands on approach to the fish.

Nutrients 2020, 12, x FOR PEER REVIEW  4 of 26 

 

Figure 2. Gyotaku of flounder (Platichthys flesus), artist: R. Højer, photo: Marilyn Koitnurm. 

Gyotaku was  used  by  Japanese  fishermen more  than  a  hundred  years  ago  [51].  To  avoid 

misunderstanding, the fishermen used it to replicate the correct size of the fish, whereby it became a 

documentation method. During the twentieth century, the practice of gyotaku has been turned into 

an art form. 

As an example of an experiential exercise, gyotaku was adapted to firstly include a tactile art 

exercise, which was the traditional part of the exercise to be explored in this study. Secondly, after 

the art part of the exercise in which the fish served as an art medium, the fish would then be included 

in a cooking exercise. The gyotaku exercise was chosen for its novelty in a Danish context and for its 

tactile hands on approach to the fish. 

1.2. Study Aim 

The aim of this study was to promote children’s acceptance of fish. Based on the hypothesis that 

through hands on experience with fish it is possible to promote acceptance of fish, the objective of 

this  study was,  through  an  intervention,  to  explore  the potential of  a  sensory‐based  experiential 

exercise in a school setting with focus on cooking and tactile play as a way of promoting 11‐ to 13‐

year‐old children’s acceptance of fish. The two main research questions to be answered were: (1) how 

do children respond to handling, preparing and cooking fresh fish? and (2) how does the process of 

the sensory‐based tactile experiment gyotaku affect children’s acceptance of fish?   

2. Materials and Methods   

2.1. Study Design 

This study was an intervention with a multiple‐case study design [52]. Six cases in six different 

classes  from  six  different  schools  were  included  in  the  intervention.  All  participating  classes 

underwent  the  experiential gyotaku  exercise one  class at a  time. The qualitative method used  to 

collect data consisted of participant observation [53].   

The gyotaku exercise was integrated into the (in Denmark) compulsory subject Food Knowledge 

(Danish: Madkundskab) [49] in the fifth and sixth grades and it meets the official learning goals (for 

2017–2018 and 2019) for the subject Food Knowledge set by the Ministry of Children and Education 

[54]. 

Ethics Approval 

Ethics approval for this study was given by the joint Research Ethics Committee of the Faculty 

of Science and  the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark 

(reference 504‐0005/17‐5000). 

Figure 2. Gyotaku of flounder (Platichthys flesus), artist: R. Højer, photo: Marilyn Koitnurm.

1.2. Study Aim

The aim of this study was to promote children’s acceptance of fish. Based on the hypothesis thatthrough hands on experience with fish it is possible to promote acceptance of fish, the objective of thisstudy was, through an intervention, to explore the potential of a sensory-based experiential exercisein a school setting with focus on cooking and tactile play as a way of promoting 11- to 13-year-oldchildren’s acceptance of fish. The two main research questions to be answered were: (1) how dochildren respond to handling, preparing and cooking fresh fish? and (2) how does the process of thesensory-based tactile experiment gyotaku affect children’s acceptance of fish?

2. Materials and Methods

2.1. Study Design

This study was an intervention with a multiple-case study design [52]. Six cases in six differentclasses from six different schools were included in the intervention. All participating classes underwentthe experiential gyotaku exercise one class at a time. The qualitative method used to collect dataconsisted of participant observation [53].

The gyotaku exercise was integrated into the (in Denmark) compulsory subject Food Knowledge(Danish: Madkundskab) [49] in the fifth and sixth grades and it meets the official learning goals(for 2017–2018 and 2019) for the subject Food Knowledge set by the Ministry of Children andEducation [54].

Ethics Approval

Ethics approval for this study was given by the joint Research Ethics Committee of theFaculty of Science and the Faculty of Health and Medical Sciences, University of Copenhagen,Denmark (reference 504-0005/17-5000).

2.2. Participants

We recruited six classes from fifth and sixth grades (11 to 13 years of age) from six different Danishpublic schools (n = 132). Four classes were from the capital region and two from the region of Zealand(see Table 1 for participant characteristics). Recruitment was geographically limited to the eastern part

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of Denmark due to convenience. The recruitment was done by sending out information letters viae-mail to schools in the eastern part of Denmark addressed to the school’s Food Knowledge teachers.For all participating children, written informed consent was given by the legally appointed caregiverparent or either parent if the parents were married or had joint custody. Children’s refusal to touch,handle, and/or taste the fish was respected by the researchers.

Table 1. Participant characteristics.

School Classes Grade n Sex (♀/♂) Teachers *

School SA ** 1 6th 32 21/11 2School SB 1 6th 24 14/10 2School SC 1 5th 18 10/8 2

School MB *** 1 6th 21 13/8 1School MC 1 5th 18 9/9 1School MD 1 6th 19 11/8 1

Total 6 132 78/54 9

* Number of teachers present during the gyotaku exercise. ** Schools SA, SB, and SC are schools from workshopsduring Science Week 2016. *** Schools MB, MC, and MD are schools from the main study 2017.

2.3. Setting and Gyotaku Exercise

School SA, SB, and SC took part in gyotaku workshops in a teaching kitchen at the Departmentof Food Science at the University of Copenhagen, Frederiksberg, Denmark, in a field trip setting.School MB, MC, and MD were in their natural educational setting, since the gyotaku exercise tookplace on three different occasions at schools in the ordinary school teaching kitchen. This differentiatedsetup was due to practical organization as the classes SA, SB and SC participated as part of ScienceWeek 2016, a yearly returning science festival in Denmark, whereas the classes MB, MC, and MD didnot participate in Science Week 2016 and data were collected during early spring 2017. All classescarried out the gyotaku exercises based on the same exercise guide.

The sensory-based experiential exercise was a four-phase exercise consisting of a) gyotaku(fish printing), which also gave its name to the complete experiment, b) filleting a fish, c) cooking thefish fillets by a commonly used Danish method, and d) tasting.

Materials for the gyotaku experiment (per group of four children): one fresh whole flatfish withhead (either dab (Limanda limanda) or flounder (Platichthys flesus)), one lemon, squid ink diluted withtap water in a cup, a small sponge, five A4 pieces of paper cut into eight equal parts, paper towels,printing paper, a cutting board, a sharp filleting knife, rye flour, salt, pepper, butter, rye bread, a fryingpan, a stove and written experimental instructions.

General organisation: all of the children worked in groups of four. Each group received one freshfish to be shared during printing, filleting, and cooking (1 fish = 4 fillets).

Phase a: Gyotaku (printing): The printing procedure was the actual gyotaku exercise. The childrenchose and picked up their group’s fish from a box containing fresh fish on ice. The fish was then cleanedby washing it under cold running water while rubbing it with a slice of fresh lemon (this dissolves thefish’s natural mucus cover). The fish was then dried with paper towels and placed on a cutting board.Paper squares were placed around the edge of the fish to avoid getting squid ink on the cutting board.Diluted squid ink was applied with a sponge to the surface of the fish until it was covered with ink.The paper squares around the fish were removed, and printing paper was placed on top of the fish.The print was transferred to the paper by stroking the fish on top of the paper. The paper was gentlypulled off the fish, and a mirrored print of the fish had been transferred to the paper (see Figure 2).

Phase b: Filleting: If they wanted to, each child in the group filleted their own fish fillet byfollowing the handout picture instructions. After the child had felt the fillet with his/her fingers toensure that no fish bones were present, the fillet was ready to be cooked.

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Phase c: Cooking: The fish fillets were turned in rye flour containing salt and pepper and werethen fried in butter on a hot pan. This is the traditional way of cooking fish fillets in Danish cuisine.

Phase d: Tasting: The fried fish fillets were served on a slice of rye bread with butter and a slice oflemon. Tasting/eating was voluntary. This is a common way of serving fish fillets in Danish cuisine.

After the experiment, the children could take the gyotaku home, or the school could use it,for example in an art exhibition.

2.4. Data Collection—Participant Observation

The participant observation was primarily concept-driven [55] and based on the framework ofRozin and Fallon’s [23] and Rozin and Vollmecke’s [27] taxonomy of food rejection and acceptance.Therefore, a loosely structured observation guide, with room for exploratory inquiry, was constructedbased on the main framework of acceptance and rejection with the following themes: (1) the social/groupinteraction element, (2) the children’s interaction with the fish, (3) the process of the exercise, and (4)development/changes in attitude throughout the experiment. Documentation methods used duringthe participant observation were in the form of written field notes and situational photos to documentthe setting, various situations, and child–fish interactions. The field note strategy was inscription andtranscription [55], in which descriptions of behaviours (inscriptions) and informants’ own words anddialogues (transcription) were recorded in an observational journal based on the loosely constructedand pre-thematised observational guide.

The same researcher participated in all gyotaku exercises by observing and interacting with thechildren through informal conversations based on the observation guide. In all cases except two(school MB and MD), observation assistants were present throughout the gyotaku exercise. At schoolsSA, SB, SC, three observation assistants were present, and at school MC one observation assistant waspresent. In all cases, the observation assistants had a semi-participatory role while also documentingthe gyotaku exercise through photos. During the participant observations, researchers and assistantsinteracted with the children through informal conversations based on the situation while the childrenwere working with the fish. Questions were based on “free narrative” [56] to promote situationalcomfort and to get and keep the conversation flowing. The questions were directed towards thechildren’s perspectives of the situational experiences; for example (to the whole group): “How is itgoing here?” and “How do you feel about filleting a fish?”. Probing [53] was used to follow up on shortanswers, for example “Can you tell me some more about that?”. The focus was on informality andconversations steered by the children and their point of view. If a child asked what had been writtendown during a conversation, he/she was given the opportunity to read it. After each observationsession, observational journals and photos were compared and evaluated. Post-intervention noteswere documented by the research group. Furthermore, the field notes in the observational journal wereimmediately after the observation separated into direct observations of behaviour, dialogues basedon children’s peer-to-peer dialogues and researcher–child dialogues, and researcher reflections.A pre-coding was conducted based on concept-driven coding [55]; for example based on the frameworkof acceptance and rejection [25,27], fish handling, sensory aspects, and group work.

2.5. Data Analytical Method

Data analysis was conducted by using Applied Thematic Analysis (ATA) developed by Guest,MacQueen, and Namey [57]. ATA was applied to identify themes and to analyse patterns of meaningin relation to the research questions under study and was chosen for its flexibility with regard to typeof texts, for example field notes [57], and its ability to highlight similarities and differences acrosscases [58].

Through a concept-driven [55] processing of data based on the research questions, four meta-themeswere identified by organizing the pre-coded text into a matrix based on the frequency of re-occurrenceof documented observed behaviours and dialogues. The identified meta-themes were rejection,acceptance, craftsmanship, and interaction. A thematic map was constructed to create a visual outline

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of possible sub-themes [57,58]. Finally, themes were re-considered to ensure accurate representation byre-reading the data set [57,58]. (See Figure 3 for presentation of the ATA data processing. This resultedin the appearance of sub-theme clusters as situational events, behaviours, etc. (see Figure 4).

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Through a concept‐driven [55] processing of data based on the research questions, four meta‐

themes were identified by organizing the pre‐coded text into a matrix based on the frequency of re‐

occurrence of documented observed behaviours and dialogues. The  identified meta‐themes were 

rejection, acceptance, craftsmanship, and  interaction. A  thematic map was constructed  to create a 

visual outline of possible sub‐themes [57,58]. Finally, themes were re‐considered to ensure accurate 

representation by  re‐reading  the data  set  [57,58].  (See Figure 3  for presentation of  the ATA data 

processing. This resulted in the appearance of sub‐theme clusters as situational events, behaviours, 

etc. (see Figure 4). 

 

Figure 3. The ATA (Applied Thematic Analysis) data processing. 

Data not relevant for the research questions were excluded from the data set and analysis after 

being  re‐read  to  ensure  lack  of  relevance.  Furthermore,  the  ATA  frame  (analysis,  results,  and 

discussion hereof) was read by and discussed with researchers within the research group, but for 

those who had not been present at the interventions the frame was read by and discussed with an 

experienced researcher outside of the research group. 

The essence of meta‐themes and sub‐themes are presented in Table 2. Data were not only sorted 

by meta‐theme and sub‐theme but also by exercise phase (see Appendix 1: Data set). 

Table 2. Essence of meta‐themes and sub‐themes. 

Meta‐Theme/Sub‐Theme  Essence 

1. Rejection: distaste 

and disgust 

The theme ‘rejection’ concerns children’s behaviour and verbal expressions 

that can be characterised as distaste or disgust as defined by Martins and 

Pliner [25], Rozin and Fallon [24], and Angyal [35]; distaste is defined as a 

sensory‐driven reaction (e.g., smell, touch, taste, appearance, texture, 

sound), and disgust as a concern with contamination or being soiled as a 

result of contact with what is perceived as animal bodily waste products. 

The latter is defined by observed body language, for example turning 

away, holding a hand in front of the mouth and/or nose, mimicking nausea 

and/or vomiting, etc. [24,35]. The theme refers to observed behaviour and 

verbal expressions motivated by any interaction with the fresh fish, which 

could promote or is a direct rejection of tasting the cooked fish at the end of 

the experiment. Rejection could also be a result of a perception of a food 

[27]. 

 

2. Acceptance: tactility, 

exploration, and 

liking 

The theme “acceptance” concerns children’s behaviour and verbal 

expressions concerning tactility, limited to include the sense of touch with 

the hands, exploration driven by curiosity, and liking, which refers to a 

positive affective response to food. Acceptance is understood as a 

willingness to taste the food, but it can then be rejected. Acceptance does 

Figure 3. The ATA (Applied Thematic Analysis) data processing.

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not depend on liking, since other motives can exist for accepting a food 

(e.g., for its health benefits) [24,27]. 

3. Craftsmanship: 

autonomy and skills 

The theme “craftsmanship” concerns observed behaviour and verbal 

expressions related to the defined activity of preparation and cooking. 

Craftsmanship is understood as a physical, bodily practice that leads to a 

tactile experience and relational understanding [59]. Craftsmanship covers 

a tacit experience‐based set of knowledge and skills within cooking – in this 

case, the fish. Even though Sennett [59] defines craftsmanship as “the skill 

of making things well”, in this case the effort and attempt matter just as 

much, and maybe more than the outcome, an approach also supported by 

Martin [60]. In craftsmanship, Martin [60] underlines the importance of 

creating an environment in which the child feels independent and thereby 

learns by making decisions. In this space of autonomy, intrinsic motivation 

may promote pride in the work, thereby increasing curiosity with regard to 

tasting the fish. 

4. Interaction: helping 

each other and peer 

influence 

The theme “interaction” refers to observed behaviour and verbal 

expressions related to social facilitation either related to the children 

helping each other or by peer influence. Through behaviour and verbal 

expressions, the children might influence each other with regard to 

accepting or rejecting the fish at the end of the experiment [27,61,62]. 

3. Results 

In Figure 4 two main categories, four meta‐themes, nine related sub‐themes, and sixteen clusters 

(italic) are presented.   

 

Figure 4. ATA frame for presentation of data: main category, meta‐themes, sub‐themes, and related 

clusters.   

Data are presented according to the ATA frame (Figure 4) by including relevant examples from 

the data set to support the ATA. Abbreviations applied in the analysis: Obs: observation, ic: informal 

conversation. Phases of the exercise: #1 = Before printing; #2 = During printing; #3 = Between printing 

and filleting; #4 = During filleting; #5 = Frying; #6 = Tasting. 

   

Figure 4. ATA frame for presentation of data: main category, meta-themes, sub-themes, and related clusters.

Data not relevant for the research questions were excluded from the data set and analysis afterbeing re-read to ensure lack of relevance. Furthermore, the ATA frame (analysis, results, and discussionhereof) was read by and discussed with researchers within the research group, but for those whohad not been present at the interventions the frame was read by and discussed with an experiencedresearcher outside of the research group.

The essence of meta-themes and sub-themes are presented in Table 2. Data were not only sortedby meta-theme and sub-theme but also by exercise phase (see Table A1: Data set).

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Table 2. Essence of meta-themes and sub-themes.

Meta-Theme/Sub-Theme Essence

1. Rejection: distaste and disgust

The theme ‘rejection’ concerns children’s behaviour and verbal expressions that can becharacterised as distaste or disgust as defined by Martins and Pliner [25], Rozin and Fallon[24], and Angyal [35]; distaste is defined as a sensory-driven reaction (e.g., smell, touch,taste, appearance, texture, sound), and disgust as a concern with contamination or beingsoiled as a result of contact with what is perceived as animal bodily waste products. Thelatter is defined by observed body language, for example turning away, holding a hand infront of the mouth and/or nose, mimicking nausea and/or vomiting, etc. [24,35]. The themerefers to observed behaviour and verbal expressions motivated by any interaction with thefresh fish, which could promote or is a direct rejection of tasting the cooked fish at the endof the experiment. Rejection could also be a result of a perception of a food [27].

2. Acceptance: tactility, exploration,and liking

The theme “acceptance” concerns children’s behaviour and verbal expressions concerningtactility, limited to include the sense of touch with the hands, exploration driven bycuriosity, and liking, which refers to a positive affective response to food. Acceptance isunderstood as a willingness to taste the food, but it can then be rejected. Acceptance doesnot depend on liking, since other motives can exist for accepting a food (e.g., for its healthbenefits) [24,27].

3. Craftsmanship: autonomy and skills

The theme “craftsmanship” concerns observed behaviour and verbal expressionsrelated to the defined activity of preparation and cooking. Craftsmanship isunderstood as a physical, bodily practice that leads to a tactile experience andrelational understanding [59]. Craftsmanship covers a tacit experience-based set ofknowledge and skills within cooking – in this case, the fish. Even though Sennett [59]defines craftsmanship as “the skill of making things well”, in this case the effort andattempt matter just as much, and maybe more than the outcome, an approach alsosupported by Martin [60]. In craftsmanship, Martin [60] underlines the importance ofcreating an environment in which the child feels independent and thereby learns bymaking decisions. In this space of autonomy, intrinsic motivation may promote pridein the work, thereby increasing curiosity with regard to tasting the fish.

4. Interaction: helping each other andpeer influence

The theme “interaction” refers to observed behaviour and verbal expressions related tosocial facilitation either related to the children helping each other or by peer influence.Through behaviour and verbal expressions, the children might influence each otherwith regard to accepting or rejecting the fish at the end of the experiment [27,61,62].

3. Results

In Figure 4 two main categories, four meta-themes, nine related sub-themes, and sixteen clusters(italic) are presented.

Data are presented according to the ATA frame (Figure 4) by including relevant examplesfrom the data set to support the ATA. Abbreviations applied in the analysis: Obs: observation, ic:informal conversation. Phases of the exercise: #1 = Before printing; #2 = During printing; #3 = Betweenprinting and filleting; #4 = During filleting; #5 = Frying; #6 = Tasting.

3.1. Meta-Theme 1: Rejection

3.1.1. Sub-Theme: Distaste

Rejection based on distaste, which includes all sensory characteristics, both real or imagined [25,26],was based on two main sensory characteristics: smell and texture. Rejection based on smell wasprimarily present in two phases of the experiment. Firstly, at the beginning of the printing phase whenthe children were presented with the fresh fish:

#1 When the lid is removed from the fish on ice, several children say: “Ugh, it smells fishy”[in a bad way] (School all, obs.)

Secondly, smell was a source of rejection based on distaste in the final experiment phase (tasting):#6 Some children do not want to taste the fish. Int.: “Why?” Response: “It smells of fish.We know we do not like fish because it feels weird in the mouth”. A girl says: “That is also why mydad does not like fish” (School MC, ic).

Furthermore, the texture of the fish in the mouth was a factor in rejecting the fish based on distaste:#6 A girl nibbles on the fried fish: “I don’t like the fish. It is kind of . . . mushy”. (School MD, obs).#6 Everyone in the class tastes the fried fish, but three boys spit it out and agree that they donot like to chew it as it is too mushy and soft in the mouth. (School MB, obs).

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3.1.2. Sub-Theme: Disgust

Apart from behaviours and verbal expressions promoting rejection based on distaste, rejection wasalso observed for the affective response of disgust.

Fear of contamination was observed primarily in two situations. Firstly, at the beginning of theexperiment (phase a) when children picked up the fresh fish using only the tips of their thumb andindex finger as shown in Figure 5. Most often the task of picking up the fish would be done by twochildren going to the fish box. One would pick up the fish (as illustrated in Figure 5) while the childnot picking up the fish would often stand in the background in order to not get too close to the fish,although still leaning forward to have a look.

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3.1. Meta‐Theme 1: Rejection 

3.1.1. Sub‐theme: Distaste 

Rejection based on distaste, which  includes all sensory characteristics, both  real or  imagined 

[25,26], was based on two main sensory characteristics: smell and texture. Rejection based on smell 

was primarily present in two phases of the experiment. Firstly, at the beginning of the printing phase 

when the children were presented with the fresh fish: 

#1 When the lid is removed from the fish on ice, several children say: “Ugh, it smells fishy” 

[in a bad way] (School all, obs.) 

Secondly, smell was a source of rejection based on distaste in the final experiment phase (tasting):   

#6 Some children do not want to taste the fish. Int.: “Why?” Response: “It smells of fish. We 

know we do not like fish because it feels weird in the mouth”. A girl says: “That is also why my dad 

does not like fish” (School MC, ic). 

Furthermore, the texture of the fish in the mouth was a factor in rejecting the fish based on distaste: 

#6 A girl nibbles on the fried fish: “I don’t like the fish. It is kind of… mushy”. (School MD, obs). 

#6 Everyone in the class tastes the fried fish, but three boys spit it out and agree that they do 

not like to chew it as it is too mushy and soft in the mouth. (School MB, obs). 

3.1.2. Sub‐theme: Disgust 

Apart from behaviours and verbal expressions promoting rejection based on distaste, rejection 

was also observed for the affective response of disgust.   

Fear of contamination was observed primarily in two situations. Firstly, at the beginning of the 

experiment (phase a) when children picked up the fresh fish using only the tips of their thumb and 

index finger as shown in Figure 5. Mo

Figure 5. A display of disgust: picking up the fish, photo: R. Højer. 

Secondly, in relation to filleting (phase b):   

#4 Several children put on latex gloves before starting filleting (School MB, obs.). 

Rejections driven by disgust  also  appeared as a  reaction  to  the  idea of “animalness”. These 

reactions were also predominant at the beginning of the experiment (phase a) and during the filleting 

phase (phase b): 

#1 Girl, when fish has been collected: “Yuck! Look, it has eyes” [pinches her nose] (School SC, 

obs). 

Figure 5. A display of disgust: picking up the fish, photo: R. Højer.

Secondly, in relation to filleting (phase b):

#4 Several children put on latex gloves before starting filleting (School MB, obs.).

Rejections driven by disgust also appeared as a reaction to the idea of “animalness”. These reactionswere also predominant at the beginning of the experiment (phase a) and during the filleting phase(phase b):

#1 Girl, when fish has been collected: “Yuck! Look, it has eyes” [pinches her nose] (School SC, obs).

#4 Int.: How is it going with filleting the fish? The girl cutting responds: “I think that sound whenyou kind of hit the bone with the knife and that sound it makes . . . ugh” [shrugs] (School MD, ic).

#4 Girl, during filleting: “Yuck, it has fish guts inside [viscera]” [she pinches her nose and turnsaway, holding her hands in front of her mouth] (School MD, obs).

3.2. Meta-Theme 2: Acceptance

3.2.1. Sub-Theme: Tactility

Acceptance through tactility was observed in two forms: “sensing a transformation” and“reduction of animalness” through the sense of touch and a re-categorisation of the fish from animal tonon-animal. The former displayed itself at the beginning of the experiment (phase a) after the fish’snatural mucus layer had been washed and removed:

#1 Boy group after washing the fish: they stroke it and agree that it is weird because it was soslimy before but now it is soft to the touch (School MD, obs).

When the children started the printing process (phase a), it seemed like the fish had beenre-categorised from animal to an art medium. Touching the fish was no longer an issue:

#2 During the printing process, great attention is given to getting the right amount of ink on theeyes, fins, and the mouth to get them onto the paper. This is done by unfolding the fins withtheir fingers and dabbing the sponge lightly on the eyes, fins, and the mouth (School all, obs.).

Nutrients 2020, 12, 3180 10 of 23

#2 Between prints, the fish is gently patted and stroked by several children; it is “tickled”between the eyes and around the mouth (School all, obs).

3.2.2. Sub-Theme: Exploration

Exploration was predominant in two main scenarios: exploring the fish before and after filleting(phase b). There were clear signs of curiosity, as shown in the following example:

#3 A girl is exploring the fish. She opens the fish’s mouth and looks into it: “I just had to lookinside. You can see its teeth . . . I just had to touch”. Another girl in the group: “Ohh yes, its mouthcan get really big”. The first girl replies: “Yes, it can eat big fish” (School MC, ic).

This exploratory scenario is also seen in Figure 6 with children putting their fingers in the fish’smouth to feel its teeth.

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#4 Int.: How is it going with filleting the fish? The girl cutting responds: “I think that sound when 

you kind of hit the bone with the knife and that sound it makes…ugh” [shrugs] (School MD, ic). 

#4 Girl, during filleting: “Yuck, it has fish guts inside [viscera]” [she pinches her nose and turns 

away, holding her hands in front of her mouth] (School MD, obs). 

3.2. Meta‐Theme 2: Acceptance 

3.2.1. Sub‐theme: Tactility 

Acceptance  through  tactility  was  observed  in  two  forms:  “sensing  a  transformation”  and 

“reduction of animalness” through the sense of touch and a re‐categorisation of the fish from animal 

to non‐animal. The former displayed itself at the beginning of the experiment (phase a) after the fish’s 

natural mucus layer had been washed and removed: 

#1 Boy group after washing the fish: they stroke it and agree that it is weird because it was 

so slimy before but now it is soft to the touch (School MD, obs). 

When the children started the printing process (phase a), it seemed  like the fish had been re‐

categorised from animal to an art medium. Touching the fish was no longer an issue: 

#2 During the printing process, great attention is given to getting the right amount of ink on 

the eyes, fins, and the mouth to get them onto the paper. This is done by unfolding the fins 

with their fingers and dabbing the sponge lightly on the eyes, fins, and the mouth (School 

all, obs.). 

#2 Between prints, the fish is gently patted and stroked by several children; it is “tickled” 

between the eyes and around the mouth (School all, obs). 

3.2.2. Sub‐theme: Exploration 

Exploration was predominant in two main scenarios: exploring the fish before and after filleting 

(phase b). There were clear signs of curiosity, as shown in the following example:   

#3 A girl is exploring the fish. She opens the fish’s mouth and looks into it: “I just had to look 

inside. You can see its teeth…I just had to touch”. Another girl in the group: “Ohh yes, its mouth 

can get really big”. The first girl replies: “Yes, it can eat big fish” (School MC, ic). 

This exploratory scenario is also seen in Figure 6 with children putting their fingers in the fish’s 

mouth to feel its teeth. 

 

Figure 6. Children exploring the fish, photo: R. Højer. Figure 6. Children exploring the fish, photo: R. Højer.

After filleting, children explored the fish:

#4 Roe in fish: at first the children do not want to touch or even look, but after a while theystart to pick at it with the knife tip, and then cut it, mash it, and study the small eggs (SchoolSA, SB, SC, obs.).

Both exploratory scenarios led to a greater child interaction with the fish.

3.2.3. Sub-Theme: Liking

Acceptance due to liking was primarily driven by the sensory characteristic “taste” (the fish tastedgood). It also seemed like taste familiarity was a factor in liking it.

#6 A girl is eating her fish fillet: “Mmm, I love fish fillet” Int.: “Why?” Girl: “It is kind of a littlebit sweet but also just good. We also get it at home” (School MD, ic).

#6 A girl tastes a little bit of roasted fish roe and says: “Mmm, it actually tastes like cod roe . . .but it is a little bit grainy and dry in the mouth” (School MD, obs).

3.3. Meta-Theme 3: Craftsmanship

3.3.1. Sub-Theme: Autonomy

Throughout the experiment, autonomy was a sub-theme, since all of the assignments werecarried out through group negotiation and decision-making; there was freedom to organise the workthemselves (no teacher involvement), for example, who should pick up the fish, who should fry thefish etc. Pride in their work was especially evident during printing (phase a) and filleting (phase b):

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#3 After the printing, children show their self-made print to teachers and other groups (Schoolall, obs).

#4 They want to try to fillet the fish themselves. The experimenter (first author) is not allowedto help too much, only to correct them if they have made a wrong cut (School all, obs).

3.3.2. Sub-Theme: Skills

Skills were developed, particularly in the filleting process (phase b). It was observed that thechildren initially had difficulties in holding the knife correctly and actually filleting the fish. During thefilleting process, they became more confident in using the knife and in how to fillet the fish (School all,obs.). During cooking (phase c), skills were developed when they were trained how to cook a fish forthe correct amount of time:

#5 While frying the fish, the children are very preoccupied with cooking it for the rightamount of time so it is not raw, but they are also focused on not cooking it for too long. Theycomment on the colour and use it as a way of telling if it is done (School all, obs).

A clear indication of the acquired skills can be seen in the following extract:

#5 After frying the fish, a girl says: “Ah, now I know how to make fish fillet. I would like to try it athome if mom will buy a fish” (School MC, ic).

3.4. Meta-Theme 4: Interaction

3.4.1. Sub-Theme: Helping Each Other

The sub-theme “helping each other” appeared primarily as “us against them/the fish” and givingadvice. A concept of “we are in this together” and “us against the fish” appeared, particularly atthe beginning of the experiment (phase a), where the children had to pick up the fish and prepare itfor printing:

#1 Two girls are washing and drying a dab before printing. They help each other by holdingthe fish at each end and carrying it together to the printing table (School MC, obs.).

Children also helped each other when washing the fish to remove the fish skin mucus prior tothe printing (phase a). For example, one child supported the fish’s tail, while another rubbed it witha lemon slice to remove mucus from the fish. Furthermore, helping each other was observed when,for example, applying the ink and giving advice on how to apply ink to the fish during printing,and giving advice on how to make a correct cut with the knife during the filleting phase (phase b):

#4 The girls give advice on how and where to cut: “You have to start with the moon-shaped cutthere”. The boys correct each other more often (School MB, obs).

3.4.2. Sub-Theme: Peer Influence

Peer influence was observed throughout the exercise and resulted in the other children in thegroup reacting either positively or negatively to the fish. The following two extracts illustrate peerinfluence leading to a positive reaction to the fish (the first extract) and a negative reaction to the fish(the second extract):

#3 After printing, two girls in a group of four are touching the fish, while the other two donot want to touch it. After observing the girls touching the fish for a little while, the othertwo girls change their mind and come over to the fish and try to touch it (School MB, obs.).

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#6 Everyone in the class tastes the fried fish, but three boys from the same group spit it outand agree that they do not like to chew it as it is too mushy and soft in the mouth (first oneboy spits it out, then the rest of the group) (School MB, obs).

The ATA is summarised visually in Figure 7, which shows meta-themes, sub-themes,and predominant clusters within identified sub-themes related to the different phases in the experiment.

Nutrients 2020, 12, x FOR PEER REVIEW  13 of 26 

 

Figure 7. Applied thematic analysis (ATA) summary visualised. 

4. Discussion 

Based on thematic analysis, we propose the following diagram to explain a rejection–acceptance 

continuum (Figure 8).   

 

Figure 7. Applied thematic analysis (ATA) summary visualised.

4. Discussion

Based on thematic analysis, we propose the following diagram to explain a rejection–acceptancecontinuum (Figure 8).

Figure 8. A rejection–acceptance continuum based on fish categorisation with examples of elementsdriving acceptance forward or backwards. Developed by first author Højer, inspired by and Rozin andFallon [24].

Nutrients 2020, 12, 3180 13 of 23

Figure 8 illustrates elements which drive either rejection or acceptance along the continuum.Our observations on the categorisation and re-categorisation of the fish as animal, non-animal, and foodwere in line with what Rozin and Fallon [63] and Martins and Pliner [25] refer to as “animalness”.This animalness can be reduced in a fish by, for example, removing the head and bones, cutting it up,cooking it, and serving it without it resembling what it is: a fish and an animal [63].

At the beginning of the exercise, the fish was categorised as an animal due to its smell, slimy texture,and visual appearance (whole animal with head, fins, blood, etc.) and thereby promoted rejection.The whole fish represented a high degree of animalness, since it did not resemble what the childrenwould typically eat (a breaded fish fillet). According to the results of a Danish citizen science projecton Danes’ fish eating habits, the hot fish dish most often eaten by children was breaded fish fillet(39%), and in the form of cold cuts (eaten on rye bread) the favourites were mackerel in tomato sauce(33%) and fish cakes (21%) [64]. According to Fischler [65], this could be categorized as gastro-anomie,because the consumer has problems in identifying food and food origin as a result of processing [65].Rejection based on animalness was also found in a Norwegian study on adolescents’ (16 to 17 yearsof age) attitudes towards meat from farm animals. Females, in particular, rejected meat due to itsassociation with, for example, blood and animal parts [66]. The study also found that participantsin regular contact with farm animals displayed no disgust reaction and had a more relaxed attitudetowards meat production [66]. In an empirical study on what motivates food disgust, Martins andPliner [25] found that animalness was not the complete explanation for a food disgust reaction,as non-animal food products were also capable of promoting disgust. According to Martins andPliner [25], an explanation could be found in the experienced texture of, for example, slime, as it couldbe related to decay. Through multidimensional scaling analysis, they were able to identify independent(i.e., unique) dimensions, suggesting that both aversive textural properties and the reminders ofanimalness are primary variables accounting for perceptions of food disgust [25,67]. Egolf, Siegrist,and Hartmann [28] also found in their study on how people’s food disgust sensitivity shapes eatingand food behaviour that surface texture of food was capable of promoting disgust.

According to our observations during the printing phase, the fish was re-categorised from animalto non-animal, because it was perceived as an art/play medium and rejection cues were not evident. Inthis phase, tactility through touching the fish, as part of the assignment of printing, appeared to promoteacceptance of the fish. This observation correlates with the findings of Coulthard and Sealy [38], whofound that pre-school children tried more fruits and vegetables after participating in a sensory playactivity with real fruits and vegetables than children in a non-food sensory play task (p < 0.001) and ina visual exposure task (p < 0.001). Similar results were also found by Nederkoorn, Theiβen, Tummers,and Roefs [41]: tactility increased the acceptance of food with the same texture.

The observed acceptance could also be promoted by the reduction in mucus on the fish afterwashing, which would reduce the texture-induced disgust as proposed by Martins and Pliner [25].Nevertheless, this does not account for the following tactile exploration of the fish, where the children,driven by curiosity about something unfamiliar, put their fingers in the fish’s mouth, touched the gills,eyes, tongue, etc., with all parts of the fish still covered by or containing mucus (see Figure 6).

At the beginning of the filleting phase of the exercise, the fish was again categorised as an animal,and rejection was promoted. A behavioural example was the observation of the children putting onlatex gloves in this phase, although this behaviour could also be a result of peer influence.

Rejection was primarily due to the cutting through of the skin of the fish and cutting close to the bones.Both sound and visual cues reminded them that they were cutting into an animal, thereby increasingthe perceived animalness. Later in the filleting phase, the fish were re-categorised from animal to food,because the fish was now fish fillets. The bones, skin, viscera, head, etc. were disposed of. What remainedwas a form of the fish that was familiar to the children: fish fillets. Applying Lévi-Strauss’ [68] concept ofnature-culture, we see that, through the filleting process, the fish had gone from a natural form to a morecultivated form, and through the frying of the fish the final step in the cultivating process had been reached.

Nutrients 2020, 12, 3180 14 of 23

Furthermore, during the filleting and cooking phase, the children started to learn technical skills,and they clearly took pride in their work, which could be an expression of what Sennett [59] calls theemotional reward for attaining a skill and doing it well, like a craftsman. This finding of promotedself-efficacy, as defined by Bandura [69], is supported by the findings of Cunningham-Sabo andLohse [70] in an interventional study with fourth-graders. Not only did they find an increase in cookingand food self-efficacy but also an increase in fruit and vegetable preference. Most notable is the findingthat non-cookers particularly benefitted from the intervention [70]. An increase in cooking efficacywas also confirmed in a similar study including an experiential approach by Jarpe-Ratner, Folkens,Sharma, Daro, and Edens [71], although no definition of the concept experiential was given.

At the end of the experiment, the fish were fried, and the re-categorisation from animal to foodwas complete. Observations showed that the majority of children chose to taste and eat the fish fillet onrye bread; the reason given was the good taste, a reason corresponding to the findings of Sick, Højer,and Olsen [29] in a study on children’s self-evaluated reasons for accepting and rejecting foods.

Rejection was promoted by, for example, the texture of the cooked fish in the mouth. Rejection offish based on texture was found by Donadini, Fumi, and Porretta [72], where fish was rejected due tosoftness, a jelly-like texture, fast melting, and tendency to fall apart easily textures. Texture was alsofound to be a key rejection characteristic by Sick, Højer, and Olsen [29]. For the children that showedreluctance throughout the experiment and ended up tasting the fish fillet, an “I filleted and cooked itmyself” effect could be a possible explanation. A similar effect of “I cooked it myself” was found byDohle, Rall, and Siegrist [73] and Allirot, da Quinta, Chokupermal, and Urdaneta [74]. Allirot et al. [74]and van der Horst, Ferrage, and Rytz [75] also point to the context or atmosphere in which the foodexposure took place and the “cooking together” factor as relevant factors impacting food likes anddislikes and thereby promoting acceptance or rejection. Since the gyotaku experiment took place in aschool(-like) setting, the “cooking together” and “helping each other” factors promoted acceptance offish. According to Lukas and Cunningham-Sabo [76], there is a difference between cooking with friendsand classmates. In a qualitative study, they found that classmates were typically associated with rules,structure, and restrictions, while friends are defined by fun and freedom [76]. Yet, when Lukas andCunningham-Sabo [76] compared data across focus groups, they found that the cooking and tastinggroup did not make a clear distinction between classmates and friends, and the children in this groupseemed to consider their classmates as friends in this “cooking together” context. This was not thecase in the two other groups. However, other studies [77,78] have not found a correlation between anexperience-based approach and positive change in acceptance, preference or liking of foods.

5. Strengths and Limitations

This section considers the credibility, transferability, dependability, and confirmability [53,79] ofthe study findings.

Credibility was sought in this study by comparing the findings with those of previous studiesthat have focused on similar research. Furthermore, to reduce observer bias, observer assistantswere present in all but two cases, and after the experiment had ended, dialogues took place betweenthe experimenter and assistant regarding what had been observed. Dependability was sought via athorough description of the study design and the gyotaku experiment itself in order to ensure that otherresearchers are able to execute a study in a similar way. Even though true objectivity of the researcherrarely exists, confirmability was sought through a sampling process, whereby the participating classesentered the study according to the rule of “first responders to the information letter” sent out via email(regional) and shared in a Food-Knowledge-specific Facebook group for teachers (national).

Geographically, the data were only collected in the eastern part of Denmark. Therefore, in termsof transferability, it could be said that this case study is not representative of the general populationof children in Denmark. Nevertheless, the findings can be seen as indications transferable to similarcontexts, since the observations seemed stable and comparable across the cases (schools and classes).Furthermore, even though the experiment varied in terms of setting, the observations across the two

Nutrients 2020, 12, 3180 15 of 23

settings seemed stable and comparable. Additionally, a research participation effect [80] cannot becompletely eliminated as the presence of the research and assistant group in the gyotaku experimentsituation is an addition to the typical setting situation. Furthermore, analysis and ATA frame wasvalidated by a researcher not part of the study, but with extensive research experience to reduce bias.

Even though more research in this area is needed, this finding opens up the possibility oftransferring the gyotaku exercise and the expected outcome to settings outside the conventionalschool setting.

We recognise that the present study holds certain limitations investigation-wise that need tobe addressed in future research. One such limitation is the aspect of how children categorise andre-categorise fish and how this is connected to the experimental context, the school arena. Furthermore,a more focused investigation of how tactile play might influence children’s acceptance of food,especially outside the area of fruit and vegetables, is warranted.

6. Conclusions

With regard to how children responded to handling, preparing, and cooking the fish and how theprocess of the gyotaku experiment affected the acceptance, we identified that response of rejection andacceptance moved back and forth on a continuum. Rejection was driven by slimy touch, whole animal,smell, cutting through skin, texture of fish meat in the mouth, and taste, and acceptance was promotedby togetherness, helping each other, tactile play, re-categorisation of the fish, exploration, pride, skills,and was self-made. Furthermore, the movement back and forth was determined by how the fishwas categorised (as animal, non-animal, or food). The study revealed that autonomy, skills, pride,and helping each other in the groups were important factors in promoting acceptance, whereas thetexture of the fish, for example, led to rejection. Furthermore, we found that using the fish as a creativemedium for tactile play became an important motivator in promoting acceptance. The findings in thisstudy highlight that cooking combined with tactile play could be a way of promoting acceptance offish, and as such serve as a potential strategy in promoting healthy food behaviour. The same exercisecould be used with other food groups as well, for example with vegetables, fruit, chicken (e.g., print offeet or wings before preparing) etc. where the squid ink is substituted with berry juice or beet rootjuice. At the same time, our findings support the importance of the school setting and the subject FoodKnowledge as a potential experiential learning gateway to promoting healthy food behaviour throughfocusing on children’s food and culinary knowledge and skills, which has also been recommended byNelson et al. [47].

Author Contributions: Conceptualization and methodology, R.H., K.W. and M.B.F.; data collection and dataanalyses, R.H., interpretation of data, R.H., K.W. and M.B.F., writing of the manuscript, R.H., review and editing,K.W. and M.B.F., supervision and funding acquisition, M.B.F. All authors have read and agreed to the publishedversion of the manuscript.

Funding: This work is part of the research project Smag for Livet (Taste for Life) and was partly funded by theNordea Foundation, Denmark, and by University College Absalon, Center for Nutrition and Rehabilitation,Nutrition and Health, Slagelsevej 70-74, 4180 Sorø, Denmark. The funding parties had no involvement in the work.

Acknowledgments: A special thank you to Margit Dall Aaslyng, University College Absalon, Center for Nutritionand Rehabilitation, Nutrition and Health, Sorø, Denmark, for invaluable comments provided in relation to theapplied thematic analysis process.

Conflicts of Interest: The authors declare no conflict of interest with regard to authorship, research, funding and/orpublication of this article.

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Appendix A

Table A1. Data set: Meta-themes, sub-themes, and data extracts from field note journal (obs: observation *, ic: informal conversation **).

Meta-Theme Sub-Theme Data Extract

1. Rejection Distaste

#1. When the lid is removed from the fish on ice, several children say “Ugh, it smells fishy” [in a bad way]. (School MB, MC, MD, SA, SB, SC, obs *).#6 Some children do not want to taste the fish.

Int.: “Why?”

Response: “It smells of fish”, “We know we do not like fish because it feels weird in the mouth”. A girl says: “That is also why my dad does not like fish” (School MC, ic**).#6 Int.: “Do you like the fish?” (asked to a girl group after frying the fish). Girl, not eating her fish fillet: “I do not like the smell of fish”. (School SB, ic).

#6 After tasting the fried fish fillet, a boy said: “Arhh, that is not for me”.

Int.: “How come?”

Boy: “It feels mushy in my mouth and tastes fishy”. (School SA, ic).#6 Two girls absolutely do not want to taste the fried fish, because they know that they do not like fish. (School SB, ic).

#6 A girl nibbles at the fried fish: “I don’t like the fish. It is kind of . . . mushy”. (School MD, obs).#6 Three boys did not want to taste the fish: “We do not like the taste and smell of fish”. (School SC, ic).

#6 Everyone in the class tastes the fried fish, but three boys spit it out and agree that they do not like to chew it as it is too mushy and soft in the mouth. (School MB, obs).#1 When the lid is removed from the fresh fish, many children react by turning away from the fish, holding their hands in front of their mouth and/or nose, pinching

their nose, mimicking vomiting, making “yuck” noises, closing their eyes, etc. (School MB, MC, MD, SA, SB, SC, obs).#1“Ugh, it is GROSS and soooo slimy . . . ”

Some children mimic vomiting (School SA, obs **.).#1 Girl, after fish has been cleaned and is placed on the cutting board: “It is not normal”. (School MD, obs.)

#1 Girl, when fish has been collected: “Yuck! Look, it has eyes” [pinches her nose]. (School SC, obs).#1 A boy does not want to touch the fish: “It is slimy”. [no special facial expression/body language]. (School MD, obs).

#1 A boy pokes the fish before washing: “Ugh, it is sticky”. (School MB, obs.)

Disgust

#1 Several children try to pick up the fish from the box using only the tips of their thumb and index finger (School MB, MC, MD, SA, SB, SC, obs).#2 A boy says that the fish is really disgusting, makes “yuck” sounds, but at the same time he cannot help himself poking it in the eye followed by big arm swings and

screeching. Then he runs over to wash his fingers and goes back and pokes the fish again. (School MD, obs).#4 A group of girls purse their lips at the sight of blood from the fish. Some close their eyes and turn away from the fish. (School MD, obs.).

#4 Int.: How is it going with filleting the fish? (Question to a girl group).The girl cutting responds: “I think that sound when you kind of hit the bone with the knife and that soundit makes . . . ugh” [shrugs] (School MD, ic).

#4 During filleting. Girl: “Yuck, it has fish guts inside [viscera]”. [she pinches her nose and turns away while holding her hands in front of her mouth]. (School MD, obs).#4 Several children put on latex gloves before starting filleting. (School MB, obs.).

#5 When the fillets have to be turned in breadcrumbs, they are moved/lifted by holding the fillet in the tail end with the tip of the thumb and index finger (to touch aslittle meat as possible). (School MB, MC, MD, SA, SB, SC, obs.).

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Table A1. Cont.

Meta-Theme Sub-Theme Data Extract

2. Acceptance

Tactility

#1 After washing the fish. Girl, stroking the fish: “It is kind of rough but now it is soft”. (School MB, obs).#1 Boy group after washing the fish: they stroke it and agree that it is weird because it was so slimy before but is now soft to the touch (School MD, obs).

#1 Int.: “What was it like to touch the fish?”

Girl: “It was fun because when you stroke it in the opposite direction, it was . . . kind of rough”. (School MC, ic).#2 During the printing process, great attention is given to getting the right amount of ink on the eyes, fins and the mouth to get them onto the paper. This is done byunfolding the fins with the fingers and dabbing the sponge lightly on the eyes, fins and the mouth (the girls are more aware of this than the boys). (School SA, SB, SC,

MB, MC, and MD, obs.).#2 Girl: “Use your fingers, it’s much easier”.

The group quickly shifts from using a spoon to using their fingers to ensure that the paper absorbs ink during the printing [stroking the fish on top of the paper].(School MD, obs.).

#2 Between prints, the fish is gently patted and stroked by several children; it is ‘tickled’ between the eyes and around the mouth. (School MB, MC, MD, SA, SB, SC, obs).#3 A girl group are stroking their fish and give it a name (School SA, obs).

#3 A girl group are gently stroking their fish, and a girl says: “I can’t eat it now” (School SB, obs.).#4 After the filleting process, they use their fingers to check for small bones in the fillets (School SA, SB, SC, MB, MC, and MD, obs.).

Exploration

#2 A boy turns the fish to its white side and asks: “Why is it white underneath?” Int.: [gives an explanation]. Boy: “Ohh, that is smart”. (School MC, ic).#3 A girl is exploring the fish. She opens the fish’s mouth and looks into it: “I just had to look inside. You can see its teeth . . . I just had to touch”.

Another girl in the group: “Ohh yes, its mouth can get really big”.

The first girl replies: “Yes, it can eat big fish”. (School MC, ic).#3 The children open the mouth of the fish and feel inside with their fingers. Feeling the teeth, in particular, makes them more curious, and they keep exploring, also by

touching the tongue. (School SA, SB, SC, MB, MC, and MD, obs.).#3 Girl: “Can you eat the squid ink?”

Int. “Yes, you can. Do you want to taste it?”

More children gather around the table, and several of them taste the ink.

“Ugh, it is very salty”. (School MC, ic).#3 After printing, a boy asks: “Can you eat the eyes . . . and may I?” (School MB, obs).

#3 Int.: “Have you ever tried to open the mouth of a fish?”

Boy group: “Nooo . . . ”. Int.: “Try it”. A boy holds the fish, while another boy opens the mouth. All: “Whoa!”. (School MB, ic).#4 A girl says: “The viscera are not disgusting but mysterious”. (School MD, obs).

#4 Boys start to explore the viscera of the fish. They ask what parts they are and whether they can be eaten. (School MB, MC, MD, SA, SB, SC, obs).#4 Boys start to pull out the intestines in their full length. (School SA, SC, obs.)

#4 Girls cutting roe out from the fish.

Int.: “Do you know what that is?”

Girl: “No . . . ”

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Table A1. Cont.

Meta-Theme Sub-Theme Data Extract

Other girl in group: “I do . . . it is roe. Can you eat it?”

Int.: “Yes”

Girl: “Let’s try and fry it and taste it”. (School SC, ic).#4 Roe in fish: first the children do not want to touch or even look, but after a while they start to pick at it with the knife tip and then cut it, mash it and study the small

eggs. (School SA, SB, SC, obs.).

Liking

#1 Girl: “It smells good and bad at the same time” (School MD, obs.).#1 Girl, when the lid is removed from the fish: “It smells fresh . . . of the sea and salt”. (School MB, obs).

#6 A girl who says that she does not like fish chooses to taste it anyway: “Ohh, but it tastes like chicken”. (School MB, obs.).#6 A girl eats fried roe: “Ohh, it tastes OK—just like the rest of the fish”. (School SB, ic).

#6 A boy fries the liver: “It tastes like chicken—not bad . . . like chicken and a little bit of blood”. (School SB, obs).#6 A girl tastes a little bit of roasted fish roe and says: “Mmm, it actually tastes like cod roe . . . but it is a little bit grainy and dry in the mouth”. (School MD, obs).

#6. After the fish has been fried, a group of boys are talking about the taste of the fish. Boy: “It actually tastes good”. Another boy replies: “Yes, much better than the ones Iget at home”. (School MC, ic).

#6 Four boys taste the fried fish: “Yes, it is good”. The other boys agree by nodding their heads. (School MD, obs.).#6 A girl is eating her fish fillet: “Mmm, I love fish fillet”

Int.: “Why?”

Girl: “It is kind of a little bit sweet but also just good. We also get it at home”. (School MD, ic).#6 Most children choose to taste the fried fish. Only a few do not eat all of it (School SA, SB, SC, obs).

3. Craftsman-ship

Autonomy

#all All assignments are carried out through group decision making and negotiation in the group (no teacher involvement), for example, who should pick up the fish, orwho should fry the fish. (School MB, MC, MD, SA, SB, SC, obs).

#2 A teacher wants to help a group with the printing, but the group says that they want to do it themselves. (School MC, obs).#3 After the printing, children show their self-made print to teachers and other groups. (School MB, MC, MD, SA, SB, SC, obs).

#4 They want to try to fillet the fish themselves. I (the experimenter) am not allowed to help too much, only to correct them if they have made a wrong cut. (School MB,MC, MD, SA, SB, SC, obs).

#4 A group asks for help with the filleting process, but the child holding the knife does not want to let it go (School MD, obs).#4 All of the children who filleted their own fish take great pride in their work; they show me their fillet and want me to praise them (prior to the filleting I made it clear

that it was difficult and nobody can do it perfectly the first time they try it). (School MB, MC, MD, SA, SB, SC, obs.).

Skills

#1 Before printing, groups evaluate the freshness of the fish based on what they remember from the theme course material (they remember the video material betterthan that from the booklet). They evaluate the freshness by smelling and agree that the fish should smell of salt and seaweed. (School MC, obs).

#2 During the printing process, great attention is given to applying the right amount of ink to the fish and getting ink on all parts of the fish—this is more pronouncedamong the girls than the boys, who are more concerned with getting it done; a lot of them call me to show me their work. (School MB, MC, MD, SA, SB, SC, obs).

#4 While filleting, several children refer to the You Tube video on filleting flatfish (a part of the theme course material): “You just have to let the knife do the work for you”becomes a phrase they repeat in the groups. (School MB, MC, MD, obs).

#4 It is evident that the children are not used to filleting fresh fish; one class has been on a cooking camp where they worked with fish, but they did not try to fillet theirown fish. (School MB, MC, MD, SA, SB, SC, obs/ic).

Nutrients 2020, 12, 3180 19 of 23

Table A1. Cont.

Meta-Theme Sub-Theme Data Extract#4 When the children start to fillet, they have great difficulty in holding the filleting knife correctly. However, when they try to fillet their own fish, they become more

confident in using the knife and hold it more correctly. (School MB, MC, MD, SA, SB, SC, obs).#5 When frying the fish, the children are very preoccupied with cooking it for the right amount of time, so it is not raw, but they are also focused on not cooking it for

too long. They comment on the colour and use that as a way of telling if it is done. (School MB, MC, MD, SA, SB, SC, obs).#5 After frying the fish, a girl says: “Ahh, now I know how to make fish fillet. I would like to try it at home if mom will buy a fish”. (School MC, ic).

4. Childinteraction

Helping each other

#all Groups are very preoccupied with justice; that all group members get to make a print, fillet and get to taste an equal amount of fish. (School MB, MC, MD, SA, SB,SC, obs).

#1 Two girls are washing and drying a dab before printing. They help each other by holding the fish at each end and carrying it together to the printing table (SchoolMC, obs.).

#1 Two boys are collecting the fish from the box. They end up picking it up together and carry it to the sink. (School SA, obs).#1 A boy and a girl are helping each other, holding the fish and washing it under running water; one of them holds the fish, while the other rubs it with lemon. (School

SB, obs).#2 During printing, the group members give advice to the child applying the ink, for example in order to get ink on the eyes, mouth and fins. Advice is also given to

avoid large ink blobs on the finished print. (School MB, MC, MD, SA, SB, SC, obs).#2 During printing, they help each other apply the paper and place it correctly on the fish; they also help each other rub the paper and lift the fish print. (School MB,

MC, MD, SA, SB, SC, obs).#2 The boys seem to correct each other, whereas the girls support each other (School MC, obs).

#4. During the filleting, the group members give advice to the child filleting, for example, on how and where to cut. (School MB, MC, MD, SA, SB, SC, obs).#4 The girls give advice on how and where to cut: “You have to start with the moon-shaped cut there”. However, the boys correct each other more often. (School MB, obs).#6 Before eating, the children help arrange the fish fillets on small platters, so it looks like a small dish, while others set the table. They all sit down and eat at two tables

laid with cutlery, glasses, water jugs and napkins. (School MD, obs).

Peer influence

#1 When the lid is removed from the box containing fish, the disgust behaviour spreads in small groups—if one person in the group reacts, the others react too. (SchoolMB, MC, MD, SA, SB, SC, obs).

#3 After printing, two girls in a group of four touch the fish, while the other two do not want to touch it. After observing the girls touching the fish for a little while, theother two girls change their mind and come over to the fish and try to touch it (School MB, obs.)

#4 While a group of boys explore the viscera and eyes of the fish, they challenge each other to touch the eye (School MC, obs).#4 During the filleting process, when children find viscera and roe in the fish, they start to react to it in the group. If one person reacts by holding a hand in front of the

mouth, other group members react in a similar way. (School MB, MC, MD, SA, SB, SC, obs).#4 A girl does not want to fillet a fish, but after observing the other girls in her group, she ends up doing it (and even eating it after it has been fried). (School MB, obs).#6 Everyone in the class tastes the fried fish, but three boys from the same group spit it out and agree that they do not like to chew it as it is too mushy and soft in the

mouth (first one boy spits it out, then the rest of the group). (School MB, obs).

Phase in the experiment: #1 = Before printing; #2 = During printing; #3 = Between printing and filleting; #4 = During filleting; #5 = Frying; #6 = Tasting; #all = All phases of the experiment.obs: observation *, ic: informal conversation **.

Nutrients 2020, 12, 3180 20 of 23

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A3. PAPER III

Yes I can cook a fish; effects of a five-week sensory-based experiential theme course with fish

on 11 to 13-year-old children’s food literacy and fish-eating behavior – a quasi-experimental

study

Højer, R. Wistoft, K., & Frøst, M.B. in (sumitted to Food Quality and Preference, October 2020)

1

TITLE 1

Yes I can cook a fish; Effects of a five week sensory-based experiential theme course with fish on 2

11- to 13- year old children’s food literacy and fish eating behaviour – a quasi-experimental study 3

4

AUTHORS 5

Rikke Højera,b

*, Karen Wistoftc, and Michael Bom Frøst

b 6

a University College Absalon, Center for Nutrition and Rehabilitation, Nutrition and Health, 7

Slagelsevej 70-74, 4180 Sorø, Denmark. 8

b University of Copenhagen, Department of Food science, Design and Consumer Behavior, 9

Rolighedsvej 26, 1958 Frederiksberg C, Denmark. 10

c Danish School of Education - Department of Educational Sociology Emdrup, Tuborgvej 164, 11

building D, 143, 2400 Copenhagen NV, Denmark 12

13

*CORRESPONDING AUTHOR 14

E-mail address: rho@pha.dk (R. Højer). 15

16

ABSTRACT 17

Danish early-phase adolescents only consume one-third of the officially recommended amount of 18

fish. The objective of this study is to investigate the effect of a five week sensory-based experiential 19

theme course with fish on 11- to 13-year old early-phased adolescents’ food literacy and acceptance 20

of fish. Study design was a quasi-experimental intervention. 32 Food Knowledge classes were 21

recruited from the eastern part of Denmark. Classes were assigned to intervention group (n = 185), 22

control group 1 (n = 123), only baseline and follow-up survey, or control group 2 (n = 75): one oral 23

lecture between baseline and follow-up survey. Mixed methods strategy was applied: baseline and 24

follow-up survey, participant observation, telephone-, and group interviews. Before between study 25

group analysis control groups were pooled. The following key effects of the intervention were 26

observed: knowledge on fish and cooking increased within specific areas, skills related to fish and 27

2

cooking increased, especially in girls. Furthermore, the social dimension and helping each other 28

were important elements. No positive effects were measured for liking or assessment of fish 29

disgustingness; however, theme course evaluation showed that 47% had become curious on tasting 30

other kinds of fish and 38% stated a higher liking for fish after participation. Furthermore, teachers 31

reported that they experienced an increase in acceptance of fish as a result of participating. In 32

conclusion food literacy and fish acceptance were increased through participation in a five week 33

sensory-based experiential theme course with fish. 34

KEYWORDS 35

Experiential learning 36

Food behaviour 37

Food literacy 38

Children 39

Fish 40

1. INTRODUCTION 41

Promoting healthy food behavior from childhood is important due to an increase in the prevalence 42

of overweight and obesity in children and adolescents (Ng et al., 2014). Globally, 18% children and 43

adolescents between 5- and 19 years of age were either overweight or obese (World Health 44

Organization, 2018). Obesity during childhood is associated with an increased risk of adult obesity, 45

resulting in an increased risk of developing low self-esteem, type 2 diabetes and disabilities 46

resulting from coronary heart disease (Agirbasli, Tanrikulu, & Berenson, 2016; Reilly & Kelly, 47

2011; Sahoo et al., 2015; Umer et al., 2017). 48

Fish provide valuable nutrients. The protein content in fish is 15 to 20% protein and contains all the 49

essential amino acids, and fish proteins have a high degree of digestibility i.e. 85-95% (Balami, 50

Sharma, & Karn, 2020; Tilami & Sampels, 2018). Positive health effects as a result of fish protein 51

intake has been identified; decreasing the risk of the metabolic syndrome and increasing insulin 52

sensitivity (Aadland et al., 2016; Aadland et al., 2015; Dort, Sirois, Leblanc, Côté, & Jacques, 2012; 53

Tørris, Molin, & Cvancarova, 2016). Furthermore, fatty fish is a good source for vitamin D, which 54

is important in calcium (Ca) absorption, bone health and childhood growth stages (Braegger et al., 55

2013; Petersen et al., 2016). Fatty fish also contains n-3 polyunsaturated fatty acids (PUFA), which 56

reduce the risk of developing diabetes mellitus, systemic arterial hypertension, central obesity and 57

hyperlipidemia (Kelli, Kassas, & Lattouf, 2015; Mouritsen & Bagatolli, 2016). 58

3

The official Danish recommendation for fish intake is 350 g per week from the age of three: eat fish 59

as a main course twice a week and several times a week as cold cuts (Tetens et al., 2013). 60

However, Danish children’s intake of fish is only 105 g per week (Mdn = 56 g/week), and adults’ 61

intake is 259 g per week (Mdn = 196 g/week). 62

According to Larson, Story, Eisenberg, and Neumark-Sztainer (2006) young people who acquire 63

cooking skills early in life consume a diet more compliant with nutrition recommendations later in 64

life. These findings reflect a growing interest in studying children’s and adolescents’ food 65

knowledge and skills; food literacy, as a gateway to promote healthy food behavior (e.g. Allirot, da 66

Quinta, Chokupermal, & Urdaneta, 2016; Cunningham-Sabo & Lohse, 2013; Jarpe-Ratner, 67

Folkens, Sharma, Daro, & Edens, 2016; Overcash et al., 2018). Furthermore, Palumbo et al. (2019) 68

found that low food literacy correlated negatively with body weight, and respondents who perceived 69

themselves to possess a higher food literacy were less prone to show long-term illnesses and 70

performance limitations in relation to every-day activities. A widely applied definition of food 71

literacy as a frame for promoting healthy food behaviour has been proposed by Vidgen and 72

Gallegos (2014) and are related to the ability to plan and manage, select, prepare, and eat food. 73

Children’s reasons for not eating fish was identified by Prell, Berg, and Jonsson (2002): a negative 74

attitude towards the smell, the fear of finding bones, and friends’ behaviour were key barriers. 75

Within the taxonomy of food acceptance and rejection Rozin and Fallon (1987) have identified 76

three prime motivations, which drive food acceptance and rejection. They are as follows: Sensory-77

affective factors (e.g. liking/disliking taste or smell), anticipated consequences (e.g. 78

negative/positive physiological or social), and ideational factors (e.g. knowledge of the nature or 79

origin of a food). These attributes can cause four psychological rejection categories: distaste, 80

danger, inappropriateness, and disgust. Foods of animal origin tend to promote the attitude of 81

disgust more than those of vegetable origin (Martins & Pliner, 2006; Pliner & Pelchat, 1991; Paul 82

Rozin & Fallon, 1987). The four psychological acceptance categories are good taste, beneficial, 83

appropriate, and transvalued (Paul Rozin & Fallon, 1987). Furthermore, Rozin and Vollmecke 84

(1986) also points out that acquired likes can be promoted by social encounters with people outside 85

the family, in particular peers. 86

A ‘hands on’ experiential learning strategy has been widely applied in interventional studies aimed 87

at increasing acceptance of healthy foods (e.g. Beets, Swanger, Wilcox, & Cardinal, 2007; Black et 88

al., 2018; Cunningham-Sabo & Lohse, 2013; Ehrenberg, Leone, Sharpe, Reardon, & Anzman-89

Frasca, 2019; Welch et al., 2002; Zahr & Sibeko, 2017). 90

4

Moreover, in promoting healthy food behaviour, Nelson, Corbin, & Nickols-Richardson (2013) 91

argue that nutrition knowledge alone is incomplete without the dimension of experiential learning 92

via interactions with food and cooking equipment. Wang and Stewart (2013) and Bailey, 93

Drummond, and Ward (2019) conclude that a school setting, for example home economics/Food 94

Knowledge, is an interesting setting for promoting and practicing food literacy and healthy food 95

behavior. Furthermore, food literacy has been the center of several interventional studies related to 96

promoting healthy food behavior (e.g. Bailey, Drummond, & Ward, 2019; Brooks & Begley, 2014; 97

Vaitkeviciute, Ball, & Harris, 2015).In addition, involving children in the cooking processes can 98

increase the willingness to taste novel foods and increase preferences for healthy foods (e.g. Allirot 99

et al., 2016; Cunningham-Sabo & Lohse, 2013; Ehrenberg et al., 2019; Hersch, Perdue, Ambroz, & 100

Boucher, 2014). 101

The objective of the present study was to investigate the effect of a five week (10 lectures of 45 102

minutes) sensory-based experiential theme course with fish on 11- to 13- year old children’s food 103

literacy and acceptance of fish. The objective was based on the following hypothesis: Through the 104

concepts experimentation, sensing, autonomy, knowledge and skills, and a social dimension an 105

“open window” exists for promoting food literacy and acceptance of fish. 106

2. METHODS AND MATERIALS 107

2.1. Study design and strategy 108

The present study was quasi-experimental (Bryman, 2016) designed with an experimental group 109

(main study group (MG); five week theme course on fish) and two independent control groups 110

(control group (CG) 1; no intervention, and CG 2; one oral lecture (2 x 45 min.) on fish and cooking 111

with fish). Assignment of participants to groups was not randomized due to school year plans and 112

teachers’ schedules. The research strategy was mixed methods with a multiphase design (Creswell 113

& Clark, 2011). The following research methods were applied: low structured participant 114

observation (at baseline and follow-up), telephone interviews with teachers after the theme course, 115

group interviews (after theme course completion), and semi-structured survey questionnaire (at 116

baseline and follow-up) (see Figure 1: timeline). 117

5

118

Figure 1: Timeline: Design and research methods by study group and application time 119

In CG 1; no intervention between baseline and follow up survey, and CG 2; oral lecture, the 120

teachers were instructed not to work with fish in the subject Food Knowledge during the five week 121

period between baseline and follow-up survey. 122

The main study (MG) ran from January 2017 to May 2017. The control group studies ran from 123

May 2017 to November 2017. The participating schools, independent of study group, had 124

individual starting times due to planning at the schools. 125

This study was conducted in compliance with the Declaration of Helsinki, 1964/2000 (World 126

Health Organization, 2001) and the Respect Code of Practice (Respect Project Institute for 127

Employment Studies, 2004). Ethics approval for this study was obtained from the joint Research 128

Ethics Committee of the Faculty of Science and Faculty of Health and Medical Sciences, University 129

of Copenhagen, Denmark (reference 504-0005/17-5000). 130

2.2. Participants and setting 131

We recruited 5th

and 6th

grade (children 11 to 13 years of age) Food Knowledge classes from 132

Danish public schools geographically located in the eastern part of Denmark (the isles of Zealand 133

and Falster). Recruitment for MG was conducted from June to August 2016, and for CG from 134

6

February to March 2017. Recruitment was done by sending out e-mail invitations to participate in 135

the research project ‘Smag for Fisk’ [Taste for Fish] to schools. As such it was a non-probability 136

sampling, but with a sampling frame (Bryman, 2016). Inclusion criteria were geographical location 137

(Zealand and Falster; the province, and the area of Greater Copenhagen), grade (5th

and 6th

), and 138

school type (public). Exclusion criteria were ‘special needs classes’ and classes which had prior 139

completed a theme course on fish in Food Knowledge. Prior to participation a written informed 140

consent was given by the participants’ parents. Children’s refusal to partake in the survey, group 141

interviews, informal interviews, and/or be photographed was respected. 142

The setting was the Danish public school and the subject Food Knowledge, which is compulsory for 143

two years. All activities took place at the participants own schools in their every-day teaching 144

environment. 145

750 children were reported by the teachers to enter the study. After validation of the questionnaires 146

669 completed the baseline survey correctly and 580 completed the follow up survey correctly. 147

After pairing responses in baseline and follow up based on a unique child id attached to each 148

questionnaire 383 paired measurements were possible. The difference between baseline and follow 149

up was mainly due to seven classes (n = 110) in CG and one class (n = 18) in MG dropping out 150

before completing the follow up survey. Reasons for not being able to pair were a filled in baseline 151

but not a follow up questionnaire, or the other way around due to e.g. child sickness or holiday (see 152

Table 1: participant characteristics). 153

7

Table 1: Participant characteristics divided by study group, geographical area (Greater Copenhagen; G.Cph. and the province), schools, 154

classes, and sex for successful pairing between baseline and follow up survey responses 155

Main study group Control group 1 Control group 2 All groups

School/

class

n children School/

class

n children School/

class

n children School/

class n children

total boys girls total boys girls total boys girls total boys girls

Schools 4 185 94 91 4 123 68 55 4 75 28 47 12 383 190 193

G.CPH 2 90 43 47 3 111 62 49 1 19 10 9 6 220 115 105

Province 2 95 54 41 1 12 6 6 3 56 18 38 6 163 78 85

Class total 13 12 7 32

5th

grade 2 28 18 10 4 67 38 29 4 30 13 17 10 125 69 56

6th

grade 11 157 79 78 8 56 30 26 3 45 15 30 22 258 124 134

Area/class level

G. CPH, 5th

grade - - - - 4 67 38 29 3 19 10 9 7 86 48 38

G. CPH, 6th

grade 7 90 43 47 7 44 24 20 - - - - 14 134 67 67

Province, 5th

grade 2 28 18 10 - - - - 1 11 3 8 3 39 21 18

Province, 6th

grade 4 67 36 31 1 12 6 6 3 45 15 30 8 124 57 67

8

2.3. Materials 156

MG received a theme course booklet containing a pre-start module and five main modules (see 157

Figure A1 for full theme course module content), a teacher’s guide booklet containing background 158

information on organization, materials and ingredients needed, and learning goals for each module, 159

access to ten videos on quality evaluation of fresh fish, facts on fish and filleting instruction videos, 160

knives, tweezers, preservation jaws, fresh squid ink and Wenzhou paper (for gyotaku). Furthermore, 161

fresh fish was delivered prior to each module; dab (Limanda limanda), hake (Merluccius 162

merluccius), herring (Clupea harengus), and organic sea farmed rainbow trout (Oncorhynchus 163

mykiss). Didactically, the theme course was developed based on two future works (Jungk & 164

Müllert, 1998) and pre-testing with children in the target group and organized based on the didactic 165

relation model (Hiim & Hippe, 2007). 166

In CG 2 participating classes would receive an oral lecture (2 x 45 min.) after completion of the 167

baseline survey. During the lecture participants would not engage in any practical experiments but 168

would be shown two short videos; one on how to evaluate freshness of fish and one on how to fillet 169

a flat fish. After completing the follow up survey CG 1 and CG 2 would receive a box with fresh 170

flat fish including exercise guides and recipes. 171

All fish delivered to participants were payed for by the research project Taste for Fish. 172

2.4. Methods applied 173

2.4.1. Participant observation 174

Participant observations were conducted with three classes (n = 58) in MG during the first and last 175

lessons with fish (module 1; Fish art; flat fish; module 5; Cook off), with the aim of collecting first-176

hand data, which could serve as supplement data to both group interviews and teacher interviews. 177

The participant observation guide was primarily concept driven (Gibbs, 2008) based on the 178

framework of Rozin and Fallon's (1987) taxonomy of food rejection and acceptance. The 179

observation guide contained the following themes: 1) the social/group interaction element, 2) the 180

children’s interaction with the fish, 3) the process of the exercise and 4) development/changes in 181

attitude throughout the experiment. Documentation methods were written field notes and situational 182

photos to document the setting, various situations and child-fish interactions. The field note strategy 183

was inscription and transcription (Gibbs, 2008): descriptions of behaviours (inscriptions) and 184

informants’ own words and dialogues (transcription) were recorded in an observational journal. 185

If a child asked what had been written down during an observation or conversation, he/she was 186

given the opportunity to read it. A research assistant not part of the research group assisted at one 187

9

school in order to validate observations. Furthermore, after each session observations, dialogues and 188

photos were compared, and evaluation and round-up notes were discussed within the research group 189

and with a research assistant not part of the research group. 190

2.4.2. Group interviews 191

Group interviews (Halkier, 2008, 2010) was conducted with three groups of children (n = 17; girls: 192

n = 9, boys: n = 8) from MG after the last theme, but before completing the follow up survey. A 193

confirmatory pre-thematised semi-structured interview guide was constructed by using a funneling 194

technique (Bryman, 2016). Themes were based on previous research (e.g. Birch, 1980; Nederkoorn, 195

Theiβen, Tummers, & Roefs, 2018; Prell et al., 2002), existing theory (Rozin & Fallon, 1987; 196

Sennett, 2009) and the present study aim. Initial dialogue focused on overall experience of 197

participating in the theme course on fish, followed by dialogues on fish eating behavior, the 198

exercises/recipes, skills, team work, student-fish interaction etc. 199

Children selected to participate in group interviews was selected randomly by the research group to 200

avoid that the teacher would select children they knew would be more positive. If a child invited to 201

participate did not wish to, this was respected. The group interviews were conducted in a quiet area 202

at the school and organized by sitting in a circle. Documentation method was audio recording, 203

which was transcribed verbatim. 204

2.4.3. Teacher telephone interviews 205

Five teachers from MG were interviewed after completion of the theme course. The interview aim 206

was to provide information on the teachers’ evaluation of the theme course and experiences with the 207

children’s fish behavior and food literacy during the theme course. The interviews were conducted 208

as a telephone interviews due to flexibility and to create a ‘safe space’ for the informant, as the 209

questions concerned evaluation (Bryman, 2016). The semi-structured interview guide was based on 210

a confirmatory approach with pre-constructed themes based on previous research (see section 2.4.2) 211

and the present study aim, and structured according to the funnel technique (Bryman, 2016; Kvale, 212

2007). The interview guide consisted of the following themes: 1) content of theme course, 2) 213

participants’ engagement, 3) observed signs of learning, 4) liking/disliking of fish observed in 214

children, and 5) teacher’s own learning. 215

2.4.4. Survey questionnaire 216

The survey questionnaire was designed and distributed to all participating study groups using the 217

online questionnaire tool SurveyXact By Ramboll. 218

10

The baseline and follow-up dataset consisted of 15 items with a total of 28 questions (student 219

information excluded) (see Appendix: Table A.1). Excluded items from the data corpus concerned 220

liking of cooking (only measured in baseline), student evaluation of the subject Food Knowledge, 221

and learning style preferences. In the MG follow-up survey two items were included (item 24: Fish 222

eating behavior after the theme course and 25-29: Evaluation of experiments and tasting) to serve as 223

evaluation of participation in the theme course. 224

The dataset items were structured with close-ended questions. The primary scale applied was a 5-225

point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, strongly agree) 226

(Likert, 1932). For item 14 and 16 a 4-point frequency scale was applied in order to measure the 227

frequency of fish intake (1 to 2 times/types of fish, 3 to 4 times/types of fish, 5 or more times/types 228

of fish, and I have not eaten fish within the last week). Item 15 was an evaluation of how disgusting 229

the respondents found fish and it was constructed as a 5-point scale (extremely, very, moderately, 230

not very, not at all) on a sliding bar. This was done to reduce respondent fatigue and to apply 231

variety in the questionnaire layout. Food neophobia was measured by applying an adjusted version 232

of the Food Neophobia Test Tool (FNTT10) (Damsbo-Svendsen, Frøst, & Olsen, 2017). FNTT10 233

originally consisted of 10 items but in the present study, the FNTT applied consisted of 8 items 234

(FNTT8) due to evaluation of comprehension-issues in FNTT10. 235

The questionnaire was developed in Danish and for analytical purposes it was translated into 236

English. The translation was read and approved by the research group and read by an external 237

translator. Finally it was translated back into Danish. Translation of item 6-13 was based on 238

translation by Damsbo-Svendsen, Frøst, and Olsen (2017). 239

2.5. Data analysis 240

2.5.1. Qualitative data analysis 241

Applied Thematic Analysis (ATA), as developed by Guest, MacQueen, and Namey (2012) was 242

applied to participant observation, group interviews and telephone interviews with teachers 243

separately to analyse patterns of meaning. It was chosen for its flexibility and ability to highlight 244

similarities and differences across cases (Braun & Clarke, 2006) and applied research methods and 245

types of texts; for example field notes and interview transcripts (Guest et al., 2012). Data analysis 246

was primarily concept driven although data driven analysis was included to give way to exploration 247

of new themes (Gibbs, 2008). Thematic analysis has been applied in prior empirical research within 248

the research field of food choice and food behavior (Højer, Wistoft, & Frøst, 2020; Romero & 249

Francis, 2020; Ogden & Roy-Stanley, 2020; Puddephatt et al., 2020). 250

11

Each dataset was pre-coded, re-read and codes were discussed in the research group. Analysis 251

continued by building a data reduction matrix based on segmentation, further coding and re-coding 252

and ordering by relational hierarchy before each research method dependent data set underwent a 253

comparison analysis across cases; not across research methods (Guest et al., 2012). Cross-case 254

tables based on meta-themes (concept-driven) and data driven sub-themes and clusters were 255

constructed (see Appendix: Table A.2.). 256

2.5.2. Quantitative data analysis 257

Statistical data analysis of the data set was conducted using the statistical software SPSS Statistics 258

version 26. Meta-themes were constructed based on the single items (see Appendix: Table A.1.) and 259

scores were calculated by summation for each meta-theme, and an effect score was calculated by 260

subtracting baseline score from follow-up score. Internal consistencies of the meta-theme constructs 261

were assessed by means of Cronbach’s alpha coefficient (Likert scale items and meta-themes 262

consisting of ≥ 6 items only) by baseline and follow. The threshold coefficient value for satisfactory 263

scales is 0.60 - 0.70 (Hair, Black, Babin, & Anderson, 2014). All Cronbach’s alpha values were 264

between 0.74 and 0.89 (see Appendix: Table A1). 265

An independent samples Mann-Whitney U test and an independent samples median test were 266

performed on baseline meta-theme scores for CG 1 (n = 123) and CG 2 (n = 75). A significant 267

difference (Mann-Whitney U p = 0.03; median test p = 0.04) between the two groups was observed 268

in meta-theme 1: FNTT8: CG 1 scored higher (MCG1FNTT8 = 7.1, Mdn = 8) than CG 2 (MCG2FNTT8 = 269

5.9, Mdn = 5) with a grand median of 7. This observation could be due to geographical area 270

distribution, as CG 1 was over represented with regard to respondents from the area of Greater 271

Copenhagen, and only contained eleven children from the province (due to fall outs). The same 272

procedure was followed for follow-up survey scores yielding a comparative result. As a possible 273

reason for the difference between CG 1 and CG 2 was detected and plausible, control groups were 274

pooled into one control group (CG, n = 198), although applying caution when interpreting results 275

related to meta-theme 1: FNTT8. 276

To test for intervention effect univariate analysis of variance by group (MG/CG), area 277

(province/G.Cph.), and sex (boy/girl) was conducted on the meta-theme effect sum and single item 278

effect sum (significant results are presented in Table 2, 3, and 4). Non-parametric paired samples 279

Wilcoxon test (Wilcoxon signed-rank test) was performed to test for within-group differences in 280

medians between baseline and follow-up sums (meta-theme level) and scores (for single items) 281

within MG, CG 1, and CG2 respectively (Table 5; only significant scores presented). 282

12

3. RESULTS 283

The objective of this study was to investigate the effect of a five week sensory-based experiential 284

theme course with fish on 11- to 13- year old early phased adolescents’ food literacy and acceptance 285

of fish. In the following results are presented by between study group effects (MG and CG) and 286

within study group effects (all three study groups separately). Results from the ATA are presented 287

to add additional perspectives to survey results. 288

289

13

Table 2: Between study group effects of intervention (rounded to 0.1). Only significant effects are listed (significance level α 0.05) 290

Mean difference: follow-up - baseline Effect of intervention (MG: n = 185; CG: n = 198)

Main group Control group

M SD M SD p MG (SE) CI95% CG (SE) CI95%

2. FishBehaviour

14. How disgusting do you think fish is? -0.3 1.3 0 0.7 0.002 -0.3 (0.1) -0.5, -0.2 0 (0.1) -0.1, 0.2

3. KnowFishCook

22.c. I know of kitchen hygiene when I work

with fish 0.5 1.3 0.1 1.2 0.001 0.5 (0.1) 0.3, 0.7 0.1 (0.1) -0.1, 0.3

4. CanFish&Cook 5 7.4 0.7 6 < 0.001 5.1 (0.5) 4.2, 6.1 0.4 (0.5) -0.6, 1.4

23.b. I can assess whether a fish is fresh 0.5 1.5 0.1 1.5 0.007 0.6 (0.1) 0.3, 0.8 0.1 (0.1) -0.1, 0.3 23.c. I can fillet a flat fish 1.1 1.6 0.3 1.4 < 0.001 1.1 (0.1) 0.9, 1.3 0.2 (0.1) 0, 0.5

23.d. I can fillet a round fish 1.2 1.6 0.1 1.5 < 0.001 1.2 (0.1) 1, 1.4 0 (0.1) -0.2, 0.2

23.e. I can debone a fish 1 1.5 0.2 1.4 < 0.001 1 (0.1) 0.8, 1.2 0.1 (0.1) -0.1, 0.4 23.f. I can cook a fish 0.7 1.5 -0.1 1.3 < 0.001 0.8 (0.1) 0.6, 1 -0.1 (0.1) -0.3, 0.1 23.j. I can create my own recipe 0.5 1.4 0.2 1.3 0.015 0.5 (0.1) 0.3, 0.7 0.1 (0.1) -0.1, 0.3

5. KnowSenses -0.2 2 0.3 1.9 0.025 -0.1 (0.1) -0.4, 0.1 0.3 (0.2) 0, 0.6

22.a. I know of the 5 basic tastes 0 1.2 0.3 1.2 0.04 0 (0.1) -0.1, 0.2 0.3 (0.1) 0.1, 0.5

291 292

293

294

295

296

297

298

299

14

Table 3: Between study group effects of intervention: interaction effect of group x sex (rounded to 0.1). Only significant effects are listed 300

(significance level α 0.05) 301

Mean difference: follow-up - baseline Interaction effects (group x sex)

MG CG

M SD

M SD p MG x

Boys (SE) CI95% MG x

Girls (SE) CI95% CG x Boys

(SE) CI95% CG x Girls

(SE) CI95%

1. FNTT8 -0.2 4.2 -0.8 4.4 0.016 -0.8 (0.5) -1.7, 0.1 0.3 (0.5) -0.6, 1.2 -0.1 (0.5) -1.1, 0.9 -1.2 (0.4) -2.1, -0.4

6. I like to taste food I have

never tasted before -0.1 0.9 -0.1 1 0.003 -0.2 (0.1) -0.4, 0 0 (0.1) -0.2, 0.2 0.2 (0.1) -0.1, 0.4 -0.2 (0.1) -0.4, -0.0

7. I like to experience new

and different foods 0 0.9 -0.2 0.9 0.001 -0.2 (0.1) -0.4, 0 0.1 (0.1) -0.1, 0.3 0 (0.1) -0.2, 0.2 -0.3 (0.2) -0.5, -0.1

9.I will try food even

though I don’t know what it

is

0 1 0.1 0.9 0.006 -0.2 (0.1) -0.4, 0 -0.2 (0.1) -0.1, 0.3 0.2 (0.1) 0, 0.4 0 (0.1) -0.2, 0.2

2. FishBehaviour

14. How disgusting do you

think fish is? -0.3 1.3 0 0.7 < 0.001 0 (0.1) -0.3, 0.2 -0.6 (0.1) -0.8, -0.4 -0.1 (0.1) -0.3, 0.2 0.1 (0.1) -0.1, 0.3

16. How many different

types of fish have you eaten

within the last week?

0 0.7 0 0.7 0.025 0 (0.1) -0.1, 0.2 0 (0.1) -0.2, 0.2 -0.2 (0.1) -0.4, 0 0.1 (0.1) 0, 0.2

4. CanFishCook 5 7.4 0.7 6 0.022 3.7 (0.7) 2.4, 5.1 6.5 (0.7) 5.2, 7.9 0.6 (0.8) -0.9, 2.2 0.2 (0.7) -1.1, 1.5

5. KnowSenses -0.2 2 0.3 1.9 0.004 -0.4 (0.2) -0.8, -0.1 0.2 (0.2) -0.2, 0.6 0.6 (0.2) 0.2, 1.1 0 (0.2) -0.4, 0.4

22.a. I know of the 5 basic

tastes 0 1.2 0.3 1.2 0.014 -0.2 (0.1) -0.4, 0.1 0.2 (0.1) -0.2, 0.5 0.4 (0.1) 0.2, 0.7 0.2 (0.1) -0.1, 0.4

22.b. I know of the senses'

meaning for how food tastes -0.2 1.2 0 1 0.018 -0.3 (0.1) -0.5, -0.1 -0.1 (0.1) -0.3, 0.2 0.2 (0.1) -0.1, 0.5 -0.1 (0.1) -0.4, 0.1

302

303

304

305

306

307

308

15

Table 4: Between study group effects of intervention: interaction effect of group x area (rounded to 0.1). Only significant effects are listed 309

(significance level α 0.05) 310

Mean difference: follow-up - baseline

Interaction effects (group x area) MG

CG

M SD

M SD P MG x Prov**

(SE) CI95% MG x G.Cph.

(SE) CI95% CG x Prov.

(SE) CI95% CG x G.Cph.

(SE) CI95%

3. KnowFishCook 1.3 5.6

1 4.4 0.004 0.1 (0.5) -0.9, 1.1 2.6 (0.5) 1.6, 3.6 1.4 (0.6) 0.2, 2.6 0.8 (0.4) -0.1, 1.6

22.f. I know of the historical

meaning of herring in relation

to Danish food culture

0.3 1.6 0.4 1.5 0.004 -0.1 (0.2) -0.4, 0.2 0.7 (0.2) 0.3, 1 0.6 (0.2) 0.2, 0.9 0.3 (0.1) 0, 0.6

22.g. I know of vinegar/sugar

as preservation method 0.2 1.6 0.2 1.4 0.011 -0.1 (0.2) -0.3, 0.2 0.5 (0.2) 0.2, 0.8 0.4 (0.2) 0, 0.7 0.1 (0.1) -0.1, 0.4

22.i. I know of the fish dab,

hake, herring, and trout 0.4 1.5 0.2 1.2 0.005 0.1 (0.1) -0.2, 0.4 0.7 (0.2) 0.4, 1 0.4 (0.2) 0.1, 0.8 0.2 (0.1) -0.1, 0.4

4. CanFishCook

23.j. I can create my own

recipe 0.5 1.4 0.2 1.3 0.037 0.2 (0.1) -0.1, 0.4 0.8 (0.1) 0.6, 1 0.1 (0.2) -0.2, 0.5 0.1 (0.1) -0.1, 0.4

16

Table 5: Paired samples Wilcoxon test; within group differences in baseline and follow-up scores 311

(rounded to 0.1). Only significant effects are listed (significance level α 0.05). 312

Main group (n = 185)

Baseline Follow-up Paired samples

Wilcoxcon

M SD Mdn. M SD Mdn. Z p

1. FNTT8* 5.8 5.7 6

5.6 6.2 6

11. I don't mind eating foods I am not

used to** 0.9 1 1 0.7 1 1 -2.259 0.024

2. FishBehaviour 2.8 2.9 3 2.4 3 2 -2.406 0.016

14. How disgusting do you think fish

is?*** 0.6 0.6 1 0.3 1.3 0 -3.293 0.001

17. I like fish 0.8 1.3 1 0.7 1.2 1 -2.098 0.036

3. KnowFishCook 2.5 4.9 2 3.8 4.9 4 3.885 < 0.001

22.c. I know of kitchen hygiene when I

work with fish

0.7 1.1 1 1.2 1 1 4.793 < 0.001

22.f. I know of the historical meaning

of herring in relation to Danish food

culture

-0.5 1.3 0 -0.3 1.3 0 2.291 0.022

22.i I know of the fish dab, hake,

herring, and trout

0.1 1.3 0 0.5 1.2 1 3.138 0.002

4. CanFishCook 1 6.6 2

6 6.4 7

8.121 < 0.001

23.b. I can assess whether a fish is fresh 0.2 1.2 0

0.7 1.1 1

4.517 < 0.001

23.c. I can fillet a flat fish -0.2 1.4 0

0.9 1.2 1

7.702 < 0.001

23.d. I can fillet a round fish -0.5 1.3 0

0.7 1.3 1

7.968 < 0.001

23.e. I can debone a fish -0.4 1.3 0

0.6 1.3 1

7.460 < 0.001

23.f. I can cook a fish 0.3 1.3 0

1 1 1

6.248 < 0.001

23.j. I can create my own recipe 0.5 1.3 1

1 1.2 1

4.231 < 0.001

5. KnowSenses 2.3 1.7 3

2.2 1.9 3

22.b. I know of the senses' meaning for

how food tastes

1.2 0.9 1 1 1 1 -2.124 0.034

6. CanSenses 0.9 1.2 1 0.77 1.15 1

Control group 1 (n = 123)

1. FNTT8 7.1 5.6 8

6.4 5.6 7

-2 0.045

2. FishBehaviour 3.4 2.9 4

3.4 3 4

3. KnowFishCook 2.5 4.1 2

3.2 5 3

2.288 0.022

22.c. I know of kitchen hygiene when I

work with fish

0.8 1.1 1 1 1 1 2.448 0.014

22.i I know of the fish dab, hake,

herring, and trout

0 1.2 0 0.2 1.2 0 2.522 0.012

4. CanFishCook 1.2 5.9 1

1.7 5.9 1

5. KnowSenses 2 1.9 2

2.2 1.8 3

6. CanSenses 1.1 1 1 1 1 1

Control group 2 (n = 75)

1. FNTT8 5.9 4.8 5

5 5.8 5

9. I like to experience new and different 0.5 0.9 0 0.6 1 1 -2.809 0.005

17

food

2. FishBehaviour 3.1 2.9 4

3 3.3 4

3. KnowFishCook 2.3 4.5 2

3.8 4.8 4

3.036 0.002

22.f. I know of the historical meaning

of herring in relation to Danish food

culture

-0.8 1.4 -1 -0.2 1.4 0 3.081 0.002

22.g. I know of vinegar/sugar as

preservation method

-0.1 1.3 0 0.3 1.2 0 2.004 0.045

4. CanFishCook -0.1 6.2 0

1.2 6.7 1

23.b. I can assess whether a fish is fresh -0.2 1.2 0

0.3 1.4 0

2.116 0.034

23.c. I can fillet a flat fish -0.7 1.3 -1

-0.2 1.4 0

2.014 0.044

5. KnowSenses 2 1.7 2

2.4 1.7 2

2.118 0.034

22.a. I know of the 5 basic tastes 0.8 1.1 1

1.2 0.9 1

2.627 0.009

6. CanSenses 1 1 1 0.9 1.2 1

*Based on meta-theme sums: Min./max. sum: meta-theme 1: -16/16; meta-theme 2: -4/12; meta-theme 3: -12/12; meta-313 theme 4: -14/14; meta-theme 5: -4/4; meta-theme 6: -2/2 314 **Italic: single items, only significant differences included. 5 point Likert scale (-2 = strongly disagree to 2 = strongly 315 agree) except for item 14 (see next) 316 ***Item 14: Scale: 5-point categorical sliding bar scale: -2 = extremely, very, moderately, not very, 2 = not at all. The 317 lower the value, the higher perception of disgustingness 318

319

3.1. Presentation of intervention effects 320

Based on results presented in Table 2, 3, 4, and 5 the following observations were evaluated to be of 321

primary interest. Perceived disgustingness increased in MG compared to CG indicating a negative 322

effect of participating in the intervention (Table 2), and especially the girls in MG, were negatively 323

affected by participating in the intervention (Table 3). Also, within the MG the paired samples 324

Wilcoxon signed rank test (Table 5) showed a significant difference (p = 0.016) between scores at 325

baseline and follow-up within the theme FishBehaviour, indicating a negative development in 326

overall fish behaviour after participating in the intervention. Also liking of fish decreased. However, 327

MG was asked whether they had become curious on tasting other types of fish after participating in 328

the theme course, and 47% agreed or strongly agreed to the statement. Furthermore, 38% either 329

agreed or strongly agreed to the statement ‘after the theme course I like fish better, than I did 330

before’. Results from the teacher telephone interviews put the observations into perspective, as they 331

reported great development in the attitude towards fish from beginning to end: where the beginning 332

of the theme course was characterized by children commenting on and reacting to the bad smell, 333

slimy texture, and fish bones, eyes, etc. and at the end preparing the fish as it was any other food 334

without any comments. One teacher expressed the development in the following way: 335

18

‘From seeing them the first time with pointing little fingers and till now, where it is like 336

now we just go and start, while we talk about the cartilage or the fish anatomy and stuff 337

like that. It is a HUGE leap from where they started, from never having touched a fish 338

and thinking that a fish is a breaded thing in a bag in the freezer’ (School MC, T3). 339

The same development was also observed during participant observation at baseline and follow-up, 340

but here it also became very clear that working in groups helped overcome challenges. For example 341

in the beginning of the theme course it was observed that when the children had to pick up the fish 342

from the ice box, they went together, and helped each other carrying it back to their working station. 343

Whereas in the end of the theme course it was observed that they would still go together to pick up 344

the fish, but only one carried it back to the working station. 345

An increase in self-evaluated knowledge on kitchen hygiene when working with fish in MG was 346

observed as an effect of participating in the intervention compared to CG (Table 2). Furthermore, a 347

significant difference in effect mean on meta-theme level for KnowFishCook was observed in the 348

interaction effect between group and area (p = 0.004) (Table 4) indicating a positive effect on 349

knowledge within fish and cooking by participating in the five week theme course compared to the 350

control group, especially for main group children in the area of Greater Copenhagen. Within MG 351

the paired samples Wilcoxon signed rank test (Table 5) showed a significant difference between 352

scores in meta-theme KnowFishCook (p < 0.001) between baseline and follow-up. The median 353

score at baseline was 2 compared to 4 at follow-up indicating a within group increase in knowledge. 354

For the meta-theme CanFishCook a significant difference in effect mean between study groups was 355

observed (p = < 0.001) (Table 2), which indicates an evident positive effect on skills from 356

participating in the five week theme course compared to CG. The same pattern was observed for all 357

the single items within this theme with the most visible effect on filleting skills. The same was 358

observed within MG in the paired samples Wilcoxon signed rank test (Table 5). 359

Acquiring filleting skills were also one of the most pronounced topics in the group interviews. A 360

girl shared an experience from home, as she had gotten her parents to buy a whole fresh fish, which 361

she would then fillet because she had learned it during the theme course, but the kept correcting her: 362

’They kept correcting me: No now it is wrong, you have to cut of the head, because we 363

are not using that’ and stuff like that, but I just said to them: No, I have tried it before, 364

so now you really have to trust me’ (School MB, inf. 3). 365

19

This narrative also supports the find that girls in MG rated themselves higher in skill in general 366

compared to both boys in MG but also with regard to CG (Table 3). Also the teachers all pointed to 367

the filleting as a skill learned during the theme course. They also mentioned that even though the 368

children were insecure while filleting, they did not want actual help, just an acknowledgement that 369

they were not doing it wrong. The same was observed through participant observation, but here it 370

was also evident that helping each other in the group was of great importance: while one child was 371

filleting the other group members would give advice on where to cut and how to hold the knife. The 372

teachers also referred to other skills that were not measured in the survey. For example the ability to 373

set up a work station, to make a routine within the group, to plan who does what and when, and to 374

make decisions, especially in the last module with the cook-off, where the children had to create 375

their own recipe and cook the dish. A development in language was also observed during 376

participant observation: in the beginning the children were not able to use the correct terms when 377

referring to filleting the fish; they called it cutting up the fish. During observation at follow-up the 378

language used was now filleting and deboning. This was also an issue in the group interviews where 379

the children put a lot of effort into using the words filleting and deboning, as they would correct 380

themselves if they got it wrong. Finally, an interaction effect og group and area was observed: the 381

effect of participating in the intervention was higher for MG G.Cph. compared to the province and 382

CG with regard to skills related to fish and cooking (Table 4). 383

No significant differences within CG 1 or 2 were detected on meta-theme level for CanFishCook in 384

the paired samples Wilcoxon signed rank test (Table 5). However, in CG 2 (oral lecture) two 385

interesting significant differences between scores at baseline and follow-up were observed: item 386

23.b. I can assess whether a fish is fresh (p = 0.034) and item 23.c. I can fillet a flat fish (p = 0.044). 387

These are interesting because as part of the oral lecture 2 short videos were shown to the children: 388

one on how to assess the freshness of fish and one on how to fillet a flat fish. No significant 389

differences were observed in control group 1. 390

A significant difference in effect was observed between MG and CG with regard to the meta-theme 391

KnowSenses (p = 0.025) and the single item 22.a. I know of the 5 basic tastes (p = 0.04) (Table 2). 392

Furthermore, on knowledge on the five basic tastes girls in MG and boys in CG were both 393

positively affected compared to their group counterparts and especially boys in CG were positively 394

affected compared to boys in MG, who were negatively affected. On knowledge on the senses' 395

meaning for how food tastes boys in CG were most affected compared to all other participants 396

(Table 3). Within CG 2 in the paired samples Wilcoxon signed rank test a significant difference (p 397

20

= 0.034) between baseline and follow-up scores was observed on meta-theme level for KnowSenses 398

and on knowledge on the five basic tastes (p = 0.009) (Table 5). 399

Finally, with regard to food neophobia a significant interaction effect of study group and sex (p = 400

0.016) was observed. Girls in MG had a higher mean effect score than girls in CG, while boys in 401

MG had a lower (and negative) mean effect score than boys in CG (Table 3). Furthermore, for three 402

single items (item 6, 7, and 9) significant interaction effects of group and sex (p = 0.003, p = 0.001, 403

p = 0.006 respectively) (Table 3) were observed, which all centers around a liking of trying and/or 404

tasting unfamiliar food. For all three items the same pattern was observed: boys in MG were 405

negatively affected by participation, whereas boys in CG were positively affected. For girls the 406

effect was the opposite compared to that of boys, except for item 9, where girls in MG also were 407

negatively affected, but not as much as the boys in MG. This could indicate that girls in MG were 408

more positively affected by participating in the theme course than boys, but at the same time boys in 409

CG were positively affected and girls in CG negatively affected by simply participating in the 410

study. This tendency was also evident during the group interview as two different girls talk about 411

the development in how touching the fish were experienced: 412

‘I did not like touching the fish very much in the beginning, but now I feel much better, 413

when I touch it’ (School MC, inf. 4). 414

’In the beginning I did not even dare to touch a fish, but now I dare touching it with my 415

fingers in its’ mouth’ (School MD, inf. 4). 416

3.2. Key effects of experiential theme course on fish and the concept of food literacy 417

Food literacy was a framing concept in this study; hence the key effects of participating in the five 418

week theme course on fish are portrayed in Figure 2. Figure 2 was build based on Vidgen and 419

Gallegos' (2014) four building blocks of food literacy; plan and manage, select, prepare, and eat. 420

However, the element of a social dimension was included to the figure as well, as the social 421

dimension was identified to be of great importance in the present study. 422

21

423

Figure 2: Key effects of participating in a five week experiential theme course on fish. Results from 424

the study configured to Vidgen and Gallegos' (2014) figure of the food literacy concept (Figure 3, p 425

55) by first author R. Højer. 426

4. DISCUSSION 427

In this study we investigated the effect of a five week sensory-based experiential theme course with 428

fish on 11- to 13- year old children’s food literacy and acceptance of fish. The food literacy concept 429

frame was that of Vidgen and Gallegos (2014), who identified four building blocks in the food 430

literacy construct: plan and manage, select, prepare, and eat. 431

As part of our hypothesis we speculated that knowledge and skills, as part of the concept of food 432

literacy, could be increased through the experiential hands-on learning approach in the practical 433

cooking theme course on fish. We found that knowledge was predominately related to ‘plan and 434

manage’ and ‘select’ in the food literacy concept frame (but not exclusively) (see Figure 2). No 435

intervention effect of group was observed on KnowFishCook (Table 2), although a within group 436

22

difference was observed but for all groups with the highest difference between baseline and follow-437

up in MG and CG2. CG 2 had an oral lecture, and this could be the reason as to why a difference 438

was detected. The smaller difference found in CG 1 could be explained by an increase in interest as 439

a result of participating in the survey (see Table 5). An effect of group was observed in self-440

evaluated knowledge on kitchen hygiene when working with fish (Table 2), which could be due to 441

its tight relation to a practical element; handling and preparing fish. An interesting observation was 442

that the girls generally rated themselves lower at baseline in both knowledge and skills compared to 443

the boys. This could be a reflection of what Nobre and Valentini (2019) refers to as a result of 444

cultural reproduction of gender stereotypes, as boys have a tendency to over-estimate their own 445

competencies. 446

The intervention effect on self-evaluated skills was a key observation. Skills were highly related to 447

the ‘prepare’ building block of food literacy (but not exclusively) (see Figure 2), and even though 448

there was differences between boys and girls (girls in MG were more positively affected by the 449

intervention compared to the boys), both girls and boys were highly affected by participating in the 450

theme course (Table 2, 3). Cunningham-Sabo and Lohse (2013) observed the same tendency in their 451

study on 4th

graders’ food and cooking self-efficacy: girls rated themselves higher in food and 452

cooking self-efficacy than boys. An increase in cooking skills and cooking efficacy in general after 453

participating in a hands-on intervention has been demonstrated in prior studies (Chen et al., 2014; 454

Jarpe-Ratner et al., 2016; Utter, Denny, Lucassen, & Dyson, 2016; Zahr & Sibeko, 2017). 455

Furthermore, the within group results in CG 2 (oral lecture) that showed a difference between 456

baseline and follow-up related to evaluation of fish freshness and the ability to fillet a flat fish 457

(Table 5) was very interesting. These findings are interesting because as part of the oral lecture two 458

short videos were shown in class: one on how to assess the freshness of fish and one on how to fillet 459

a flat fish. No significant differences were observed in CG 1. This find indicates that simply by 460

watching a video of how to perform a task could increase the self-evaluated skills within this area, 461

although it does not increase as much as in MG, where the children had the fish between their 462

hands. Videos as a way of learning food skills has also been tested with positive outcome by 463

Bramston, Rouf, and Allman-Farinelli (2020) and Schaeffer and Warren (2013). 464

With regard to the final building block of food literacy; eat, we hypothesized that it would be 465

possible to increase fish acceptance through practical experience with fresh fish. This development 466

had been documented in prior reviews within the area of interventional effects of (school) cooking 467

23

programs (Muzaffar, Metcalfe, & Fiese, 2018; Utter, Fay, & Denny, 2017), however, these reviews 468

only included hands-on strategies related to increasing fruit and/or vegetable intake. In the present 469

study we observed the direct opposite effect of the intervention: assessment of disgustingness 470

increased and liking decreased; especially among the girls in MG (Table 2, 3). Although teachers 471

stated that most of the children tasted the fish dishes, this was not reflected in the measured attitude 472

or in the consumption frequency of fish after participation in the theme course. A perspective that is 473

relevant to take into account is how the fish was perceived at baseline, and how did this perception 474

change due to participation in the theme course? According to the teachers, the children had very 475

little experience with actually handling fresh fish before participation. Furthermore, results from a 476

Danish citizen science project on Danes’ fish eating habits showed that the hot fish dish most 477

frequently consumed by children was breaded fish fillet, and the favourite cold cuts were mackerel 478

in tomato sauce and fish cakes (Vuholm & Damsgaard, 2019). These fish dishes do not reflect that 479

it is a fish (an animal) being eaten (no bones, head, fish shape, etc.), and so it could be argued that 480

the degree of ‘animalness’ is greatly reduced in these dishes, leaving only the name of the dish to 481

indicate that it is actually fish being eaten. As such, the perception of fish before participation was 482

based on references to the few fish dishes and products they were used to prior to the theme course, 483

whereas at follow-up, the perception was based on actual experience with a variety of fresh fish. 484

This scenario is supported by Martins and Pliner (2006) and Rozin and Fallon (1987) with regard to 485

the perception of ’animalness’. Prell et al. (2002) found that the key promoters of negative attitude 486

towards fish were the smell and the fear of finding bones, which is highly related the fish as an 487

animal. Furthermore, Pliner and Pelchat (1991) found that the rejection of novel foods of animal 488

origin often was motivated by disgust. 489

However, in contrast, after participation in the theme course 47% of the MG children had become 490

curious on tasting other types of fish, and 38% stated that they liked fish better after participating in 491

the theme course. These results indicate that fish attitude and liking of fish are complex themes to 492

measure. The find of a curiosity on tasting other fish types is interesting as it is directed at tasting. A 493

similar result was found by Nystrand and Fjørtoft (2015) in their investigation of adolescents’ 494

attitude towards fish, and they concluded that taste experience of fish dishes can contribute to a 495

positive attitude change. Also, Sick, Højer, and Olsen (2019) found that curiosity was a main driver 496

in tasting foods. 497

24

Finally, we speculated that a social dimension and autonomy would be important elements in 498

promoting food literacy and acceptance of fish, and these became evident through participant 499

observation, interviews with the teachers and in the group interviews with the children. Especially 500

helping each other was evident during participant observation, where the groups was observed to be 501

small learning-systems based on peer-to-peer learning through the fish as a medium. Utter et al. 502

(2017) also point to the importance and potential of the social dimension in promoting food literacy 503

as do Højer et al. (2020). Furthermore, Liquori, Koch, Contento, and Castle (1998) acknowledged 504

the importance of peers in cooking program interventions, particularly the possible effects that 505

working in groups and having fun together has on both learning and eating behaviour. 506

5. LIMITATIONS 507

Validity in was sought by comparing findings from the present study with prior studies within the 508

similar research area, although the specific research area of the food group ‘fish’ is under-509

investigated. We only recruited for the sample from the eastern part of Denmark, and national 510

regional differences in, for example, fish eating practices could exist from region to region. 511

According to COOP Analyse (2019) Danes in the eastern part of Denmark (the capitol region and 512

region of Zealand) consume more fish than Danes in the northern region of Denmark (the capital 513

region: index 115; region of Zealand: index 97; Northern region: index 86, with average intake 514

defined by index 100). Furthermore, we are also aware of the ‘the Hawthorne effect’, which refers 515

to the impact of research participation on behaviour (McCambridge, Witton, & Elbourne, 2014), 516

which could explain the effect observed in CG 1 with regard to knowledge, but also in MG, 517

especially during participant observation and interviews. 518

Furthermore, the survey was based on self-evaluation, which does not necessarily represent the 519

actual situation. Nevertheless, it represents the reality as perceived by the children in that specific 520

context and place in time. 521

Participant observations, teacher interviews, and group interviews were found to support the survey 522

results, but were also able to add further perspectives and shed light on areas not being measured 523

quantifiably; especially elements related to the importance of the social dimension and development 524

of skills not included in the survey. As of such, the mixed methods research strategy (Creswell & 525

Clark, 2011) was the correct strategy. 526

Finally, the present study was based on a teacher-led intervention in a natural setting, the public 527

school in the subject Food Knowledge, based on a trust that the teachers would comply with theme 528

course instructions and guides. This intervention set-up meant a lesser degree of research control, 529

25

however, a natural every-day teaching situation-setting was prioritized in order to investigate an 530

actual possibility of promoting food literacy and acceptance of fish. 531

6. CONCLUSION 532

Based on our findings we conclude that food literacy and acceptance of fish were promoted through 533

participation in a five week sensory-based experiential theme course with fish. Even though we 534

were not able to measure an increase in liking for fish and the assessment of fish disgustingness 535

increased as a result of participating in the theme course, we still found that almost half of the 536

children had become curious on tasting other fish types and 38% liked fish better after participation 537

in the theme course. We found that barriers for accepting fish were fish smell and mucus on the 538

fish, but experience and the social dimension helped to overcome this. 539

Knowledge increased; especially on kitchen hygiene related to working with fish and the fish types. 540

The intervention effect on skills was high, and were not limited to handling, preparing and cooking 541

the fish, but also in the development of language/vocabulary; routines, setting up working stations, 542

and working autonomously. We also found that girls’ skills in particular were positively affected by 543

participation in the theme course. 544

Finally, within CG 2, we found that a 2 x 45 min. oral lecture, where two specific videos, one on 545

assessment of fish freshness and one on how to fillet a flat fish, actually were able to significantly 546

positively affect the children’s self-evaluated skills within the two areas. 547

The present study findings support the hypothesis, that an ‘open window’ was created based on the 548

concepts experimentation, sensing, autonomy, knowledge and skills, and a social dimension for 549

promoting food literacy. 550

Future research should focus on long-term effects of interventions based on food literacy as a 551

strategy for promoting healthy food behavior, as this is inadequately studied. Also, more research 552

within the area of food acceptance should include a broader variety of foods, and focus on fish as its 553

own food group. Lastly, as it is evident that the social dimension facilitates learning and change, we 554

call for more studies to investigate it in a long-term everyday perspective. 555

DECLARATION OF CONFLICT OF INTEREST 556

None. 557

AUTHOR CONTRIBUTIONS 558

R.H..: Conceptualization; R.H.: Data curation; R.H., M.B.F., K.W.: Formal analysis; R.H., M.B.F.: 559

Funding acquisition; R.H.: Investigation; R.H., M.B.F.: Methodology; R.H.: Project administration; 560

26

R.H., M.B.F.: Resources; R.H.: Software; M.B.F., KW: Supervision; R.H., M.B.F., K.W.: 561

Validation; R.H.: Visualization; R.H.: Roles/Writing - original draft; R.H., M.B.F., K.W.: Writing - 562

review & editing. 563

FUNDING SOURCES 564

This work is part of the research project Smag for Livet (Taste for Life) and was funded by the 565

Nordea Foundation, Denmark and University College Absalon, Nutrition and Health, Sorø, 566

Denmark. None of the funding parties had any involvement or influence with regard to study 567

design, data collection, analysis and interpretation of data, in the writing of the report or in the 568

decision to submit the article for publication. 569

570

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790

791

792

793

794

795

796

797

798

799

800

801

802

803

804

805

806

807

808

34

APPENDIX 809

810

Figure A1: Fish theme course modules and content in theme course booklet 811

812

813

814

815

816

817

818

819

820

35

Table A.1: Themes for comparison between main study group and control group including single 821

items, scale applied and Cronbach’s α 822

Meta-theme Item Scale Cronbach’s α 1) Self-evaluated food

neophobia

(FNTT8)

6, 7, 8, 9, 10, 11, 12, 13 Baseline: 0.86

Follow-up: 0.89

6. I like to taste foods I have never tasted before 5-point Likert*

7. I like to experience new and different foods 5-point Likert

8. I think it is fun to taste food items I don't

know

5-point Likert

9. I will try food even though I don’t know what

it is

5-point Likert

10. I am not afraid of eating things I have not

tasted or experienced before

5-point Likert

11. I don’t mind eating foods I am not used to 5-point Likert

12. I enjoy my food to consist of a wide variety

of different foods and ingredients

5-point Likert

13. I am wary of trying food I have not tasted

before (R)

5-point Likert

2) Self-evaluated fish

attitude & behavior:

Liking of fish & fish

intake

(FishBehaviour)

14, 15, 16, 17

14. How disgusting do you think fish is? 5-point

categorical

sliding scale**

15. How many times have you eaten fish within

the last week?

4-point

frequency***

16. How many different types of fish have you

eaten within the last week?

4-point

frequency***

17. I like fish 5-point Likert

3) Self-evaluated

knowledge on fish and

cooking

(KnowFishCook)

22.c, e, f, g, h, i Baseline: 0.74

Follow-up: 0.83

22.c. I know of kitchen hygiene when I work

with fish

5-point Likert

22.e. I know what food waste is 5-point Likert

22.f. I know of the historical meaning of herring

in relation to Danish food culture

5-point Likert

22.g. I know of vinegar/sugar as preservation

method

5-point Likert

22.h. I know of sustainable fish 5-point Likert

22.i. I know of the fish dab, hake, herring, and

trout

5-point Likert

4) Self-evaluated skills

related to fish and

cooking

(CanFishCook)

23.b, c, d, e, f, j, k Baseline: 0.85

Follow-up: 0.88

23.b. I can assess whether a fish is fresh 5-point Likert

23.c. I can fillet a flat fish 5-point Likert

23.d. I can fillet a round fish 5-point Likert

23.e. I can debone a fish 5-point Likert

23.f. I can cook a fish 5-point Likert

23.j. I can create my own recipe 5-point Likert

23.k. I can tell others about the food I helped to

cook

5-point Likert

5) Self-evaluated

knowledge on the senses

(KnowSenses)

22.a,b

22.a. I know of the 5 basic tastes 5-point Likert

36

22.b. I know the meaning of the senses for how

food tastes

5-point Likert

6) Self-evaluated skills in

relation to the senses

23.h

(CanSenses) 23.h. I can talk with others about how the food

tastes and feels in the mouth

5-point Likert

* 5-point Likert scale categories applied: strongly disagree, disagree, neither agree nor disagree, agree, strongly agree. 823

** 5-point categorical sliding bar scale: extremely, very, moderately, not very, not at all. 824

*** 4-point frequency scale categories applied: 1 to 2 times/types of fish, 3 to 4 times/types of fish, 5 or more 825

times/types of fish, and I have not eaten fish within the last week. 826

827

828

829

830

831

832

833

834

835

836

837

838

839

840

841

842

843

37

Table A.2: Meta-themes, sub-themes and clusters identified by ATA; participant observation, group 844

interviews with children, and telephone interviews with teachers 845

Meta-themes Sub-themes Clusters

Participant observation (n = 58)

1. Rejection Distaste Smell, texture

Disgust Fear of contamination, animalness

2. Acceptance Tactility Sensing a transformation, re-categorization

Exploration Curiosity

Liking Good taste, familiarity

3. Craftsmanship Autonomy Freedom to organize, pride

Skills Experience, confidence

4. Interaction Helping each other Us against the fish, giving advice

Peer influence Positive, negative

Group interviews (n = 17)

1. Rejection Distaste Smell, texture, visual

Disgust Fear of contamination, animalness

2. Acceptance Tactility Touching the fish

Exploration Curiosity

Liking Taste

3. Craftsmanship Autonomy Freedom to organize

Skills Experience, confidence, doing it ‘right’

4. Interaction Organization New groups, active/not sitting

Togetherness Supporting each other, eating together

5. Fish eating behavior Fish eating behavior at home Frequency, fish dishes eaten

Fish eating behavior after course Change in liking & consumption

Telephone interviews; teachers (n = 5)

1. Rejection Distaste Smell, touch

2. Acceptance Liking Tactility/touch, visual, taste, curiosity

3. Food literacy Knowledge Food – not food, language

Skills Fish handling, organization

Behavior Autonomy, curiosity, pride, confidence,

ownership

4. Interaction Togetherness Working together, helping each other, peer

influence, eating together

846

A4. PAPER IV

Children’s self-reported reasons for accepting and rejecting foods.

Sick, J., Højer, R. & Olsen, A. in Nutrients 2019, 11(10), 2455;

https://doi.org/10.3390/nu11102455. (Published October 14th 2019).

nutrients

Article

Children’s Self-Reported Reasons for Accepting andRejecting Foods

Julia Sick 1,2,† , Rikke Højer 2,3 and Annemarie Olsen 2,*1 Department of Agriculture, Food, Environment and Forestry, University of Florence, Via Donizetti 6,

50144 Florence, Italy; julia.sick@unifi.it2 Department of Food Science, Faculty of Science, Section for Design and Consumer Behaviour,

University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark; rikke.h@food.ku.dk3 University College Absalon, Center for Nutrition & Rehabilitation, Nutrition & Health, Slagelsevej 72,

4180 Sorø, Denmark* Correspondence: ano@food.ku.dk; Tel.: +45-35331018† This work was part of Julia Sick’s master’s thesis.

Received: 30 August 2019; Accepted: 3 October 2019; Published: 14 October 2019�����������������

Abstract: Children’s eating behavior does not necessarily align with dietary recommendations, andthere is a need for better understanding the factors underlying their food choices. The aim of this studywas to investigate children’s self-reported reasons for accepting and rejecting foods. A questionnairewas developed with reasons based on prior research and in-depth interviews. A set of variousfood stimuli covering different types was evaluated by 106 girls and 99 boys aged 10–13 years bychecking all reasons that apply (CATA) for either accepting or rejecting them. Results showed genderdifferences among reasons for both food acceptance and rejection, but also in liking and willingnessto re-taste the stimuli. The most common reason for food acceptance was good taste in boys andcuriosity in girls; for food rejection they were bad taste, bad smell and dislike of appearance in boysand bad taste, bad smell, dislike of appearance and texture in girls. Overall, boys liked the foodstimuli more than girls and were more willing to re-taste them. Future research should focus moreon the role of sensory properties in both acceptance and rejection, and the potential of children’scuriosity as a driver in tasting foods should be further explored.

Keywords: food choice; acceptance; rejection; children; eating behavior; food; CATA

1. Introduction

Dietary variety has been linked to nutritional status and is therefore important for health [1].However, a recent Danish cross-sectional study showed that school children consumed insufficientamounts of fruits and vegetables, fish and dietary fiber, but an excess consumption of red meat,saturated fats and sugars [2]. Insufficient dietary variety is often linked to picky eating and foodneophobia [3], but to promote healthy food habits, more knowledge is required about factors thatdetermine food choice. Fallon and coworkers have proposed four main reasons for rejection includingdistaste, danger, disgust and inappropriateness and four main reasons for acceptance of foods includinggood taste, benefit, appropriateness and transvalue [4,5], whereof some of the factors already appearduring childhood [6].

Koivisto and Sjödén (1996) investigated reasons for liking and disliking foods in 2–17-year-oldchildren and discovered that distaste was the main reason for disliking and good taste the mainreason for liking specific foods. Other important reasons children stated for dislike were “texture”and “negative consequences” or they were not able to indicate the reason and responded with“don’t know”. The importance of taste and texture has also been highlighted in other studies [7–9],

Nutrients 2019, 11, 2455; doi:10.3390/nu11102455 www.mdpi.com/journal/nutrients

Nutrients 2019, 11, 2455 2 of 14

although a review on children’s exposure to healthy foods concluded that liking and familiarity are themost important factors determining children’s food choice. The importance of sensory properties washighlighted as one of the most influential factors determining eating behavior [9–13] and within these,good taste, smell and appearance [7,14,15] and texture [15] were shown as the basic requirements offood consumption and indicators of whether a food is eaten or not.

Currently, there is some inconsistency to which factors mostly determine children’s acceptanceor rejection of food and there is also a lack of knowledge about children’s self-reported reasons.Most research in this field has examined children’s reasons indirectly, where factors influencingfood choice were described by academic professionals or by asking parents [8,16,17]. In fact,research conducted by asking children directly seems to be limited, although recently childrenhave been recognized as an important consumer group that are able to conduct consumer tests bydescribing different food products [18–20]. Asking children directly through questionnaires could givea better understanding to why they accept some foods while rejecting others. Especially, as childrengrow older, they gain more autonomy when it comes to choosing food and following take their owndecisions about what foods they want or don’t want to eat. Additionally, the direct exposure to foodcan evoke various reactions (i.e., physical or physiological) and stimulate the senses from personto person differently leading to individual differences in taste perception [21]. Hence, a parent orcaregiver usually responds very subjectively and might not reflect the child’s own food experience verywell. Therefore, it is important to examine children’s direct responses, although there might be indirectfactors (i.e., biological, contextual, environmental, experiential, emotional) they are not aware of whenaccepting or rejecting food [20,22,23]. Both direct and indirect factors are needed to better understandchildren’s food choices. In addition, many studies focus on the rejection of food [16,22,24,25], but alsoknowledge about food acceptance is essential for a more complete comprehension of food choice [26].There are several interesting health implications of such research, as such knowledge could be used byparents, health care practitioners, and school canteens alike to facilitate and support healthy eatingbehavior and encourage children to eat a wide range of foods.

Moreover, there seem to be differences between genders in relation to children’s selection offood. It was detected that girls liked vegetables [10,11,27,28] and fruits [27,28] more than boys andthat boys liked fatty and sugary foods, eggs [27], meat [12,27], fish and poultry [12] more thangirls. Furthermore, it was demonstrated that males and females differed in comfort food preferences,where females showed a higher preference for snack foods, whereas males preferred foods that weredescribed as hearty, warm and comfort foods related to meals [13]. However, this is in contrastwith some research that could not show any or only minor gender differences in food preferencesfor specific food groups [10,25,29]. Women were shown to be more disgust sensitive than men [25],but when investigating food-related personality traits in children, boys were shown to be more foodneophobic compared to girls [30,31]. Another study revealed gender-specific differences concerningfood packaging influences. Children were more likely to choose gender-consistent packaging ofa snack, even if a snack was offered that was tastier and did not have gender-consistent packaging [32].As gender differences have been shown in relation to different aspects of food choice [27], it is alsocrucial to investigate gender differences in reasons for accepting and rejecting food. For instance, foodprovided in e.g., school canteens, is usually the same for both genders, but if different parametersdrive acceptance and rejection among boys and girls, this is important to know in order to implementapproaches—gender-neutral or gender-specific—that will contribute to increase acceptance of healthyfoods among both genders.

Based on previous research we hypothesized that children base their food choices mainly onsensory attributes and that there are gender-specific differences in the reasons given for acceptingor rejecting specific foods. Accordingly, the aim of the present study was to examine children’sself-reported reasons for accepting and rejecting food and to investigate possible gender differencesrelated to these.

Nutrients 2019, 11, 2455 3 of 14

2. Materials and Methods

2.1. Participants

The study comprised 106 girls and 99 boys aged 10–13 years and the average age was 11.0 ± 0.1(mean ± standard error of the mean (SEM)) for both genders. Recruitment was done by sendinginvitation letters to public schools in Copenhagen, Denmark, whereof 10 school classes from five publicsecondary schools agreed to participate. Parents were asked to give written consent and to state iftheir child had any food allergies. It was voluntary for the children to participate. The procedureswere in accordance with the Helsinki declaration. In Denmark this type of research does not requireformal ethical approval, and it is thus not possible to obtain it.

Previously, a pilot study was run to test the study procedure with 15 girls and 6 boys both aged9–10 years attending a public school in Copenhagen that followed the same participation criteria asmentioned above.

2.2. Selection of Stimuli

A broad spectrum of food groups was included, as previously conducted studies showed that boysand girls have different preferences for various food groups [12,27] and consequently would facilitatea range of reasons for liking or disliking these. One-on-one interviews (60 min) were conducted withfour children aged 9–10 years, which were presented with different food stimuli presented as foodimages to explore, to assess which foods would elicit the highest number and diversity of reasons foracceptance and/or rejection. Each child was shown 28 food images including a set of fruit, vegetable,meat-based, fish-based and dairy products. Consequently, 14 food images were selected from theinterviews and tested as real food stimuli in a piloted tasting session. All products were requiredto be easily available in local supermarkets, have affordable prices and be suitable for handling andserving whole classes simultaneously. Additionally, potentially allergenic foods to children wereconsidered [33]. As most of the stimuli were accepted in the pilot study, some of the stimuli wereexcluded or replaced with stimuli that are usually disliked and rejected by children to increase thenumber of reasons for rejected stimuli [24]. It was also observed that with the serving of the 10th foodstimulus, children started to lose concentration. Consequently, the stimuli used in the main studyincluded nine food stimuli: pumpkin (pickled and cubed; Samsø Syltefabrik), kale (raw and sliced;Coop), seaweed (dried dulse; Palmaria palmata; Dietz Seaweed), physalis (served as whole fruit; Coop),caviar (lumpfish roe from Cyclopterus lumpus; Vores®), herring (pickled and sliced in small pieces;Princip), anchovy (pickled and sliced in pieces; Lykkeberg), blue cheese (cut in cubes; Castello®) anddeer salami (sliced in quarters; Deli del Toro, Copenhagen). Prior to study execution, the stimuli werecut into equal bite-sized pieces that were distributed and presented in tasting cups (30 mL).

2.3. Selection of Reasons for Acceptance and Rejection

Another part of the one-on-one interviews on the selection of food stimuli was also to interviewthe same children about their reasons for accepting or rejecting food based on their most liked andmost disliked foods. The aim was to open a discussion about children’s most liked and disliked foodstimuli and their reasons for them. First, children were asked to draw these foods on a provided sheetto make them feel at ease. All interviews were audio recorded and transcribed verbatim. The childrenreported 70 reasons for acceptance and 38 reasons for rejection. The reasons were categorized intothemes following thematic analysis and summarized, if shown similar (i.e., “good taste” and “Ilike the taste”) [34], whereas duplicates were excluded by the researcher. Following categorization,10 reasons for acceptance (health, familiarity, good taste, positive sensory properties, appropriateness,special person, special occasions, good association with other food, culture, curiosity) and 6 reasonsfor rejection (danger, negative sensory properties, distaste, disgust, bad association with other foods,inappropriateness) resulted that were used in the main study. The obtained reasons were aligned with

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reasons that were found through reviewing literature about factors determining children’s food choicesand preferences.

The databases Web of Science and PubMed were screened for relevant literature using thefollowing key words: “children”, “food behavior”, “food choice”, “dietary choice”, “food acceptance”,“food rejection”, “food selection”, “food preferences”, “eating behavior”, “disliking”, “liking”, “reasons”and “factors”. The resulting literature was checked for relevance and references cited in each article,which were examined for further related studies. Only literature with full access and written in Englishwere included, but no constraints were set in terms of date of publication. Studies that were consideredeligible focused on factors and reasons in food choice in children and adults.

A total of 52 articles were found to be eligible according to the above criteria, which were scannedfor children’s reasons to accept or reject food (see Table S1). As some reasons from the literature searchoverlapped with reasons from the interviews, the most common reasons were selected by a researcher.The final stimuli are listed in the following section, “Questionnaire”.

2.4. Questionnaire

A questionnaire was developed to gain insight into reasons for accepting or rejecting foodstimuli in children. These reasons were collected via a check-all-that-apply (CATA), which has beenpreviously shown to be an easy, quick and child-friendly tool to collect spontaneous responses tofood preferences in pre-adolescents [18,19,35]. A number of 10 reasons for each acceptance andrejection was aimed to be included in the final questionnaire, which is an appropriate number ofitems to use for a CATA questionnaire [36]. Reasons for acceptance included good taste, good smell,like of texture, like of appearance, healthy, familiar, special occasion, curious, culture, and parents;while reasons for rejection included bad taste, bad smell, dislike of texture, dislike of appearance,unhealthy, disgust, unfamiliar, bad experience, inedible, religion. Reasons were formulated as fullsentences and formulated appropriately for children in this age group (pre-adolescents) to understand.As the literature on reasons for food acceptance and rejection was in English language, reasons weretranslated into Danish language by a native speaker. In case children had other or additional reasonsfor accepting or rejecting that were not stated, they were able to state these in an open-ended text box.

Additionally, familiarity of each stimulus was assessed by checking one of the response categories:I know it and tasted it before/I know it, but never tasted it before / I don’t know it. Children whotasted the food were asked to indicate their overall liking of the stimuli on a 7-point facial hedonicscale (response options: Super bad/Bad/Slightly bad/OK/Slightly good/Good/Super good) [37] andtheir willingness to re-taste it (yes/no).

2.5. Study Procedure

At first, an instructor briefed the children that they were about to taste several food stimuli andthat they would be asked about their self-reported reasons for accepting or rejecting these. It wasemphasized that it was completely voluntary to participate. They were presented the questionnaireand asked to evaluate nine food stimuli by repeatedly going through the following steps: (a) tastinga sample (the children had the option not to taste the stimulus and had to note this accordingly);(b) giving reasons for accepting or rejecting it; (c) assessing the liking and willingness to re-taste,if tasted. The tasting sessions were conducted during school time at forenoon between 10:00–12:00taking 45–60 min to complete. All necessary material was set up in the children’s habitual classrooms,where they normally eat. The children were allowed to sit at their ordinary seats and were notsegregated by gender. The children were provided with a questionnaire, a plate, some forks andspoons, a napkin, a water cup for palate cleansing and a spitting cup. After tasting each food stimulus,children were asked to clean their palate with a water and dry bread crackers. The instructor guidedthe children through each stimulus assisted by two further assistants. The responsible teacher waspresent during the tasting session to keep the children as calm as possible. To minimize peer influenceand stimulus boredom, two different serving orders were used (the other group received the same

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stimuli in the opposite serving order), so children sitting next to each other were served differentfoods [38,39].

2.6. Data Analysis

The CATA questionnaire was analyzed by calculating the frequencies of reported reasons foracceptance of all food stimuli. The same procedure was done for food rejection. Reasons that werechecked by ≥50% of children were regarded as an important reason to choose the food stimuli. Genderdifferences were analyzed via Fisher’s exact test for all food stimuli comparing the counts of girls andboys for each reason. Additional reasons for acceptance and rejection stated through the open-endedtext format were analyzed via thematic analysis, which is appropriate for analyzing qualitative data inthis context [34].

For analyzing liking data of the 7-point facial hedonic scale, the mean liking (±SEM) was calculated.Gender differences were obtained comparing the means for liking via two-sample Student’s t-test.The willingness to re-taste was expressed as the proportions of girls and boys who were willingto re-taste the stimuli using Fisher’s exact test. The familiarity of the stimuli was expressed as thefrequency of children who had tasted and not tasted the stimuli previously/who did not know thestimuli. Food stimuli were regarded as familiar if tasted previously by ≥50% of children. χ2-testwas used to test if there was a difference in serving order of the stimuli between the two groupscomparing the frequencies of the totals of acceptance and rejection of the stimuli from each servinggroup. The comparison was conducted for each stimulus and conducted separately for acceptance andrejection. The level of significance was set to p ≤ 0.05.

Statistical analyzes were conducted via XLSTAT (Addinsoft 2019; XLSTAT 2019.2.3; Boston, USA) andvisualized via Microsoft® Excel® (for Office 365 MSO (16.9.11); Version 1902, Redmond, WA 98052 USA).

3. Results

In total, boys gave 2270 reasons and girls gave 1832 reasons for accepting foods, while boysgave 704 reasons and girls gave 585 reasons for rejecting foods. There were 13 cases across severalfood stimuli with no responses arising from children with allergy and/or intolerances, who could nottaste specific foods and were therefore excluded from the analyzes. There were no differences whencomparing children with the two different serving orders (p = 0.72), so in the following all data aremerged together.

Most stimuli were rather unfamiliar as most of the food stimuli had been previously tasted by<50% of the children (see Figure 1). Pumpkin, anchovy, seaweed and blue cheese were the leastpreviously tasted and most unknown food stimuli, while herring, physalis and caviar were a bit morefamiliar to the children. The most previously tasted food stimuli were deer salami and kale whichwere familiar to approximately half of the children.

Figure 1. Familiarity of food stimuli from the least previously tasted and most unknown (left) to themost tasted food stimuli (right); n = 201–205 children.

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3.1. Children’s Reasons to Accept and Reject Foods

Children’s reasons for acceptance are given in Figure 2. The reason of good taste (61%) was mostimportant for boys and curiosity (66%) was most important for girls, which both were selected by ≥50%of children, respectively. The other reasons followed the same order of importance for both genders,which are listed from greatest to least (girls, boys): like of appearance (32%, 43%); healthy (30%, 43%);good smell (24%, 40%); like of texture (17%, 27%); familiar (13%, 15%); parents (12%, 15%); culture(10%, 11%); and special occasion (5%, 6%). As these reasons were stated by <50% of children they weretherefore regarded as less important.

Figure 2. Reasons for accepting the food stimuli for girls and boys (pumpkin n = 79/80; kale n = 94/100;seaweed n = 92/89; physalis n = 93/94; caviar n = 86/80; herring n = 69/72; anchovy n = 53/66; blue cheesen = 69/62; deer salami n = 89/94); n = number of girls/boys accepting a food stimulus; the particularfrequencies correspond to the lines below them and 0% corresponds to the center of the spider chart.Level of significance: * p ≤ 0.05, ** p ≤ 0.01, *** p ≤ 0.001.

There were gender differences for several of the reasons given. Good smell (p ≤ 0.01) and like oftexture (p ≤ 0.05) were more important in boys, whereas curiosity (p ≤ 0.001) was more important ingirls for accepting the food stimuli.

Reasons for rejection are given in Figure 3. The reasons are listed from greatest to least (girls, boys)as follows: bad taste (79%, 71%); bad smell (70%, 67%); dislike of appearance (60%, 55%). These reasonswere selected by >50% among both genders and dislike of texture (55%, 37%) was selected by themajority of girls. Significant gender differences were seen for dislike of texture (p < 0.05), which wasmore important in girls when rejecting the food stimuli.

Figure 3. Reasons for rejecting the food stimuli for girls and boys (pumpkin n = 17/19; kale n = 4/4;seaweed n = 6/16; physalis n = 4/10; caviar n = 11/23; herring n = 29/30; anchovy n = 45/32; blue cheesen = 27/40; deer salami n = 9/10); n = number of girls/boys rejecting a food stimulus; the particularfrequencies correspond to the lines below them and 0% corresponds to the center of the spider chart.Level of significance: * p ≤ 0.05.

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3.2. Results from Open-End Response for Reasons to Accept or Reject Food

Children mentioned several other reasons for food acceptance and rejection. If children statedvery similar reasons, these were merged into one category by the author. Other reasons for acceptanceresulted in additional categories: grandparents, good association with other food, liking, challenge,good experience in childhood, ideals and price/value and other reasons for rejection resulted inprocessing of food, dislike and fear.

3.3. Liking and Willingness to Re-Taste

Food stimuli showed differences in mean liking, but differences between genders were shown(see Figure 4). In general, all food stimuli were more liked by boys, but this was only significant forpumpkin (p = 0.004), seaweed (p ≤ 0.001), caviar (p ≤ 0.001) and herring (p = 0.004).

Figure 4. Mean liking (±SEM) of stimuli for boys and girls. Level of significance: ** p ≤ 0.01, *** p ≤ 0.001.

Children’s willingness to re-taste the food stimuli was rather low, but it varied somewhatbetween stimuli (see Figure 5). In general, boys showed a higher willingness to re-taste the stimuli,but a significant gender difference was only shown for blue cheese (p ≤ 0.05).

Figure 5. Children’s willingness to re-taste the food stimuli for boys and girls. Level of significance: * p ≤0.05.

4. Discussion

The present study investigated children’s self-reported reasons for accepting and rejecting specificfood stimuli and if there were gender differences for these. We could only partly confirm that sensoryattributes are children’s main drivers in food acceptance and rejection, as hypothesized, but we wereable to show some gender differences in reasons for accepting and rejecting specific food stimuli,which confirmed our hypothesis. The results will be discussed more in detail in the following sections.

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4.1. Children’s Reasons for Accepting Foods

Curiosity was the most important reason in girls (66%) and was shown to be significantly moreimportant in girls than boys. This suggests that girls may be more influenced by curiosity than boyswhen deciding to try rather novel food or they may just be more aware of this influence than boys maybe. Although, curiosity was selected by 48% of boys, it was the second most important reason and a keycontributing factor. Interestingly, the study showed a very high importance for curiosity for the foodstimuli that were mainly unfamiliar in the current study. It seems like the children were very interestedto taste the novel foods, which could result from their natural drive to explore and discover [40–42].Children’s curiosity emerges from birth and seems to decrease in adulthood [43]. In accordance withour study, it was previously shown that unfamiliar foods were accepted because of an interest evokedat the thought of consuming them [44], and that children’s food choice was influenced by a combinationof curiosity and hesitancy when tasting new foods [45]. The fact that curiosity was so important maybe used by researchers, schools and parents when trying to motivate children to try tasting novelfoods [39,41,46]. Also, it remains to be determined what stimulates curiosity the most (e.g., the fooditself, the eating situation or something else). A factor could be that the children regarded our tastingsas a special event outside of the regular teaching class, which may have triggered the children to bemore curious in trying the foods. However, studies examining children’s curiosity in connection tofood choice are still rare but could be an interesting area to explore more in the future.

Good taste was the most frequently stated reason in boys (61%) and the second most frequentlystated reason among girls (45%). We could not show a direct difference between genders, suggestinggood taste is almost equally important in girls and boys. The high frequency of good taste is inaccordance with a study on 6–14-year-old children, where 41%–59% of the reasons for liking specificfoods resulted to be good taste [16]. Likewise, Fallon and co-workers suggested that good taste is oneof the most influential factors in children’s and adult’s food acceptance [4,5,47].

Children selected appearance as the third most important reason (43% in boys and 32% in girls).The role of appearance in food choice has previously been demonstrated, where the serving style/shapeof snack vegetables [48] and food plate presentation [49] clearly influenced children’s preferences forthem. The literature on children’s preferred appearance of food is still relatively sparse, but it certainlyseems to be an area worth further investigation. Interestingly, boys showed higher frequencies forall sensory properties, but these were only significant for good smell and liked texture. However,good smell and liked texture were selected by <50% of girls and boys and might therefore requiremore investigation to draw further conclusions.

Health and familiarity did not play a key role in this study, which aligns with previous findings,where familiarity was chosen less when choosing what to eat [50]. This contradicts research showingthat familiarity influences children’s food choices and preferences to a considerable degree [51]. The factthat familiarity was primarily selected in connection with food rejection in this study, might be explainedby the low familiarity of the food stimuli considered. A higher frequency for familiarity in boys (15%)than girls (6%) could be observed, which was also demonstrated previously, where familiar foods weremore preferred by school-aged boys compared to girls [12]. Still, this study could not demonstratea significant gender difference. Although environmental and social factors such as culture [52] andparents [53,54] are known to play great roles when choosing food, these reasons seemed less importantfor most children in accepting and rejecting food in the current study. Culture and parents maybe more indirect influences and children may not pay attention to them directly. Additionally, byobserving the children it was seen that—despite instructions not to interact—children challengedeach other a few times to taste the foods (like the anchovy) they, e.g., felt disgusted by. Accordingly,some children—mainly boys—stated in the other reason category that they felt challenged to tryingthe foods.

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4.2. Children’s Reasons for Rejecting Foods

In the present study, food rejection was shown to be more dominant in girls than in boys, which wasalso demonstrated previously, where women rejected more foods than men [25]. Women also appearedto be more sensitive to disgust than men, which might explain the slightly higher frequency of thereason disgust in girls (28%) than boys (24%) in the current study. The most important reasons forfood rejection were within sensory attributes including bad taste, bad smell, disliking appearanceand disliking texture, which were selected by >50% of both girls and boys. This highlights the roleof sensory attributes in children’s food rejection. The reason of bad taste occurred most frequently,which is in accordance with Koivisto and Sjödén (1996), who investigated reasons for food rejectionin children. The high relevance of the reasons of bad smell and dislike of appearance could beexplained by the fact that they act as a “warning signal” to reject foods that are considered offensiveor even disgusting because they could be potentially dangerous [47]. Texture is a strong influence inchildren [9,55] and the current study identified that dislike of texture was more important in girlscompared to boys. Although it could not support a significant difference between genders for anyother sensory properties [25,56], a recent study showed that females tended to give more responses fortexture [57], which underpins the results of the current study.

The reasons of unfamiliarity, inedible, disgust, unhealthy, bad experience and religion were not veryimportant compared to the sensory properties in the rejection of the food stimuli. However, unfamiliaritywas demonstrated to be the second most important reason after the sensory attributes, which conforms withfindings that taste and familiarity affect children’s food choices greatly [58]. Research has also establisheda connection between dislike and the rejection of unfamiliar food [14,59,60]. Unhealthy was the third leaststated reason, which contrasts previously conducted research finding that health was one of the mostimportant determinants in adult’s food choices [50]. Children are probably too young to understand whateffects the consumption of food or its nutritional value may have [61].

The same seems to apply to bad consequences in children’s rejection of foods. In addition to that,many children did not know and had not tried the stimuli before, which could be an explanation as towhy this reason was not relevant for the children. Inappropriateness and disgust were only of veryminor importance, which contrasts former research stating that these are one of the main reasons forfood rejection in children and adults [5,47]. An explanation could be that the selection of stimuli wasconsidered “appropriate” to most of the children in the present study. Interestingly, disgust was mostlyselected for blue cheese and foods from fish-origin (i.e., anchovy, caviar and herring) suggesting thatchildren could be more disgust-sensitive towards these foods.

4.3. Liking and Willingness to Re-Taste Specific Foods

The current study showed that boys liked most of the stimuli more than girls, which alignswith previous research, where men tended to give more likes than dislikes compared to women andvice versa [62]. Furthermore, boys liked most of the fish products of this study (caviar and herring)more, which was also shown previously in children [12]. However, the current study could notconfirm a significant higher preference for meat products, as opposed to Caine-Bish and Scheule (2009),who investigated gender differences in children’s food preferences [12].

The most liked food stimuli—like deer salami, physalis and kale—were also demonstrated tobe the food stimuli the children would like to re-taste the most. This can be explained by the theorythat positive food experiences can elevate its liking [63]. The remaining stimuli showed a rather lowinclination to be re-tasted, which is attended by the low means of liking.

There was no significant gender difference in regard to re-tasting the food products, except forblue cheese, which boys were more willing to re-taste. These results propose that both genders maybe similar in terms of re-tasting foods. Since boys generally liked the foods more than girls, it isremarkable that their absolute level of willingness to re-taste was almost the same.

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4.4. Strengths and Limitations

The food stimuli can be explained as rather unfamiliar to the children. Still, the number ofaccepted stimuli was very high, which contrasts research showing that familiar foods are more likelyto be accepted compared to unfamiliar foods [44]. One explanation for this phenomenon could bethat children often seem to eat more foods away from home, which they would refuse at home [64].Food choices are often influenced by the social and physical environment and its various contexts [65].This observation could explain the high percentage of accepted stimuli in this study.

Additionally, the food stimuli covered several of foods groups including vegetables, fruits, fish andmeat-based products and dairy. However, the food stimuli might be quite particular and therefore notreflect an entire food category, especially considering that both the products within a food categoryand their preparation methods can vary a lot. Therefore, the results of the current study may be uniqueto these foods as opposed to these types of foods or foods in general. Consequently, future researchshould focus on a broader range of stimuli to be able to generalize. The preparation of the stimuli(pre-cutting into bite-sized pieces) may have increased the number of accepted stimuli, as it was shownin a previous research [48,66]. Hence, this knowledge can be used to make food more appealing forchildren by using appropriate serving styles, i.e., schools should pre-cut fruits and vegetables.

Although it was a strength that the schools were located in various areas of Copenhagen,which represented children from different socio-economic backgrounds, the study might be limitedto children living in the city as food choices of children from the city and rural areas can vary [52].Additionally, age can be a factor in children’s food choices [27], but in the current study the ageinvestigated was limited to 10–13-year-old children and was not discussed due to the small differencein age.

4.5. Implications for Health Behavior

Previous studies showed that unfamiliar foods are often rejected [22,24], which was however herenot the case; it was shown that unfamiliar foods had a rather high acceptance. The fact that our researchteam came from outside the school could have provoked a natural interest in the children to try novelfoods. Therefore, it could be relevant to have more projects in schools, where children are exposed tonew and healthy foods. To be effective, teachers should be advised to implement health professionalsor organizations disseminating taste and healthy foods in their curriculum. When children are exposedto food, this should be conducted as interestingly as possible by, e.g., creating tasting experimentsand games with food, challenging the children to taste, letting them explore and teaching them aboutinteresting food facts [46]. The fact that curiosity seems promising may be integrated better intofuture interventions.

Additionally, the study provides support for the importance of sensory properties of foods in bothacceptance and rejection. Previously conducted sensory education programs have shown positiveeffects on encouraging children to try novel foods and reducing food neophobia [40,67]. The sensorylessons can be used to make children well-informed consumers through activities that focus on theiruse of senses when tasting food and appeal to their interest and curiosity. Additionally, the knowledgeabout gender differences in reasons for accepting and rejecting food can be used, e.g., in school cantinas,to make healthy foods more interesting, adjusted for both girls and boys in terms of appearance, smell,taste and texture. A better understanding of children’s reasons for accepting and rejecting foods willprovide parents and practitioners alike with knowledge about how to best support the development ofhealthy eating behavior without disregarding the role of gender in children’s food preferences.

In this respect, our findings provide suggestions for practical implications and a scope for furtherresearch on sensory education and food exposure programs, which have potential to motivate childrento try new foods: children’s curiosity seems to be the optimal precondition to taste foods they have nevertasted before. Exposure to novel healthy food products can help to increase children’s food acceptanceand thereby broaden the variety of their diet [40]. To promote dietary variety from very early on isessential as food preferences formed in early childhood do show some tracking into adulthood and may

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contribute to build the basis for food habits later in life [68]. Poor dietary choices in adulthood can leadto the development of chronic diseases like heart disease, stroke, cancer, chronic respiratory diseasesand diabetes, which are the major causes of mortality worldwide [69]. Consequently, as a varied dietincluding healthy foods is assumed to be beneficial for health and part of a healthy lifestyle, suchapproaches could contribute to healthier children [70].

5. Conclusions

The results suggest promising insights into children’s reasons to accept or reject foods and thatgender differences should be considered when investigating children’s food choices and preferences.More focus should be on the role of sensory attributes in food acceptance and rejection and theimportance of children’s curiosity as a driver to accept novel foods. This knowledge can be used toincrease the dietary variety of healthy foods.

Supplementary Materials: The following are available online at http://www.mdpi.com/2072-6643/11/10/2455/s1,Table S1: List of references and reasons in food choice and food preferences in children and adults.

Author Contributions: Conceptualization, J.S., R.H.N. and A.O.; methodology, J.S. and A.O.; validation, J.S.;formal analysis, J.S. and A.O., investigation, J.S.; resources, J.S.; data curation, J.S..; writing—original draftpreparation, J.S.; writing—review and editing, J.S., R.H.N. and A.O.; visualization, J.S.; supervision, R.H.N. andA.O.; project administration, A.O.; funding acquisition, A.O.

Funding: This research was funded by Nordea-fonden as part of the project “Taste for Life” (http://www.taste-for-life.org/). The foundation had no involvement in the work.

Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design of thestudy; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision topublish the results.

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A5. SCIENTIFIC POSTER I

Pangborn 2017

Promoting children's acceptance of fish through sensory-based experiments and experiential

learning: Breaking through the disgust barrier.

Højer, R. & Frøst, M.B.

Pangborn Sensory Science Symposium 2017, Providence, Rhode Island, USA.

Methods and Materials

Intervention design The gyotaku experiment is the first experiment in a 5 week theme

course on fish developed for FCS in 5th – 6th grade (5 x 3 lessons of 45

min.). This experiment is suitable for 2-3 lessons of 45 min. As part of

the 5 week theme course the pupils will learn how to evaluate

freshness, gut, fillet, cook, and make a recipe. Furthermore, they will

learn about the senses, nutrition, food waste, preservation techniques,

food culture, and sustainable fishing. The 5 week theme course on fish

was developed for the main intervention, that was conducted in the

spring 2017 with 16 classes on Zealand (n=321).

In the gyotaku experiment the pupils work together in groups. They

pick up the fresh fish, followed by washing it under cold water to

remove the slime. Here after they dry the fish and place it on a cutting

board. Squid ink is applied by using a sponge. A piece of paper is

placed over the fish, and by stroking the paper an image of the fish

appears. The paper is removed and the gyotaku is done.

Afterwards the fish is filleted, breaded, fried in butter, and served on

rye bread with lemon. Tasting is voluntary.

Study design and procedure The observational study was conducted during spring 2016 and 2017,

as a part of the main intervention based on mixed methods research

strategy16. Observations were conducted as participant observation,

where the observer is an active part of the situation16. Field notes was

written down during and after the experiments, followed by

categorization in a theme matrix. During observation special focus was

on pupils’ first reaction when seeing the fresh fish, and how this

reaction developed or changed during the sensory-based interaction.

Study population Pupils age 11-13 years from 5th - 6th grade. The pupils came from six

different public schools on Zealand (n = 125).

Promoting children's acceptance of fish through sensory-based experiments and

experiential learning: Breaking through the disgust barrier

Introduction

Danes eat less fish than recommended by health authorities. Children

in the age range 10-17 years only eat 105 g fish per week; one third of

to the recommended 350 grams per week1. Considering that Denmark

has over 8.500 km of costal line2, it is not the lack of access to good

fishing waters. Eating fish, especially fatty fish, contributes with the

polyunsaturated fatty acid Ω3 to the diet, which has a positive effect on

cognitive function and reduces the risk of cardiovascular diseases3,4.

Exposure to unfamiliar or novel healthy foods like fish, vegetables, fruit

etc. can increase children’s diet variety5,8,9,11. A varied diet including

healthy foods is assumed to be beneficial for health and part of a

healthy lifestyle, also later in life6,7,10. As humans we evaluate food

based on sensory properties, anticipated consequences of ingestion,

and ideas about its nature or origin13. In order to accept a novel food, it

has to be categorized as “safe”12,14. Furthermore acceptance is also

influenced by the child’s habitus, the context and social setting in which

the food item is meet15,9.

Højer, Rikke*1, 2 & Frøst, Michael Bom2

*Presenting and corresponding author (rikke.h@food.ku.dk) 1University College Absalon, Center for Nutrition and Rehabilitation, Health and Nutrition, Slagelsevej 70-74, DK-4180 Sorø, Denmark 2Nordic Food Lab, Design and Consumer Behaviour Section, Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 26, DK-1958 Frederiksberg C, Denmark

U N I V E R S I T Y O F C O P E N H A G E N

F A C U LT Y O F S C I E N C E , N O R D I C F O O D L A B

U N I V E R S I T Y C O L L E G E A B S A L O N

C E N T E R F O R N U T R I T I O N A N D R E H A B I L I T AT I O N

Results and Discussion

Typical initial reactions were disgust. This was expressed both verbally

(looked disgusting, smelled “fishy” and felt “slimy”) and with mimics

and sounds indicating disgust. The fist barrier was to pick up the fish.

This pupils handled this by supporting each other: They typically were

two to pick up the fish and wash it. It was a “us-against-them”(the fish),

which Sennett (2013) calls a win-win exchange strategy, when working

together on experiments17.

Even though disgust signs seemed to reappear in the filleting process,

this was quickly converted to a “this is how it is” approach. Also even

though the pupils frequently asked for advise in the process, they were

very explicit about not wanting practical help. They wanted to do it

theme selves; an expression of autonomy, which Ryan and Deci (2000)

has identified, in the theory of self determination, as one of the main

factors in promoting motivation and engagement together with

competences, and relatedness21. This could also be an expression of

what Sennett (2009) calls the emotional reward for attaining a skill:

Pride in their work20.

The majority of pupils chose to taste their fried fish fillet; also pupils that

showed intense disgust in the beginning. This observation is supported

by Birch (1999), that preferences for food are learned via practical

experience with food22. Furthermore, by findings done by Mustonen

and Turorila (2010) in Finland5, Allirot and colleagues (2016) in Spain23,

and Jarpe-Ratner and colleagues (2016) in USA24. Nevertheless

studies on experiential sensory-based education in schools have yet to

demonstrate a time stable change in food preferences and liking for

novel food25,26.

Conclusions

This observational study showed that by using the fish as a creative

and sensory-based medium facilitated curiosity and thereby exploration

of other aspects of the fish, e.g. the anatomy of the fish. Furthermore,

this experiential teaching method was observed to deeply engage the

pupils in their class work. The observations also revealed that the

pupils’ disgust, as a result of the visual, olfactory and tactile challenges

from working with fresh whole fish, can be overcome through

craftsmanship, autonomy and working together in groups.

Finally, observations indicated that disgust - liking is fluent back and

forth on a continuum, where barriers like picking up the slimy fish is a

point of disgust, then the disgust declines during the printing process,

but takes a small loop back starting the filleting. In the end, when the

fillets are fried, observations showed that liking is predominant.

Probably because it now looks like something the pupils know, and

categorize “safe” to eat.

Acknowledgements

This study is part of Smag for Livet (www.taste-for-life.org), Supported by Nordea-fonden.

Image 3: Pupils with their gyotaku print. Photo credit: Nordic Food Lab (Marilyn Koitnurm)

Image 5: Pupils filleting and eating their fish. Photo credit: Nordic Food Lab (Rikke Højer) Image 4: Pupils experimenting with

fish. Photo credit: Nordic Food Lab (Rikke Højer)

Image 1: Flounder (Platichthys flesus) and gyotaku print of it. Photo credit: Nordic Food Lab

(Marilyn Koitnurm)

Fresh whole fish still have all their organs, have a particular smell and

natural slime-cover. Visual, olfactory, and touch perceptions are all

tough barriers to overcome in the acceptance process; before even

getting to the tasting part9.

In Danish schools, the course Family and Consumer Sciences (FCS)

is mandatory for one year in 4th, 5th or 6th grade, which makes it an

unique arena for learning and promoting diverse and healthy food

habits.

Image 2: Picking up the fresh fish. Photo credit: Nordic Food Lab (Rikke Højer)

Over the Gyotaku process steps, the

disgust reaction started to change to

curiosity and exploration. Studies

combining tactile play as a way of

promoting food acceptance for the

age group of this study population

could not be identified, but

Nederkoorn, Jansen, and

Havermans (2015)18 and Coulthard

and Thakker (2015)19 found a

tendency of reduced neophobia in

relation to fruit and vegetables as a

result of tactile play in pre-school

children. This is supported by

Sennett (2009): “play is a school for

learning to increase complexity”20.

The objective of this study is

to investigate the experien-

tial and sensory-based

experiment: Gyotaku (a

traditional Japanese fish

printing technique) as a way

of breaking through the

disgust barrier when it

comes to children accepting

fish.

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A6. SCIENTIFIC POSTER II

SenseAsia 2018

What’s cooking? Promoting 10-13-year-old children’s acceptance of fish through experiential

learning.

Højer, R. & Frøst, M.B.

SenseAsia 2018, Asian Sensory and Consumer Research Symposium, Kuala Lumpur, Malaysia.

The main group participated in a five week theme course on

fish developed for FCS in 5th – 6th grade (5 x 3 lessons of 45

min.). Control group 2 had an oral lecture (2 x 45 min.)

based on the same themes: The senses, quality of fresh

fish, tactility, filleting, cooking, food history, preservation,

food waste, sustainability, nutrition etc.

Results and Discussion

Differences between MG and both control groups at

baseline were analyzed, no significant differences were

found (p > 0,05). Hence, the groups were considered similar

at baseline. Control subgroup 1 and 2 were pooled, as no

differences between them were found (p > 0,05) (data not

illustrated).

Compared to CG a significant increase in self-evaluated fish

cooking skills (table 1, p < 0,0005, mean: illustration 2, top)

for participants in the fish cooking course (MG), was

demonstrated. In liking of fish, means revealed a tendency

to decreased liking compared to baseline, especially in MG

(table 1, p = 0,144, mean: illustration 2, bottom).

What’s cooking? Promoting 10-13 year old children’s acceptance of fish

through experiential learning

Introduction

Danish children aged 10-17 years only eat 1/3 of the 350

grams of fish per week recommended by health authorities1.

Eating fish, especially fatty fish, as a part of a various diet

ensures a contribution of the polyunsaturated fatty acid Ω3

which is important to ensure children’s positive cognitive

development and function, and over the life span reduces

the risk of developing cardiovascular diseases2, 3, 4.

In Danish public schools Family and consumer sciences (lit:

Madkundskab, similar to Home economics) is mandatory for

one year in either 4th, 5th, or 6th grade, which makes the

school arena an unique setting for learning about and

promoting healthy diverse food habits. Furthermore,

according to Larson et al. (2006) young people who help to

cook and there by acquire cooking skills early in life tend to

consume a healthier diet according to the nutrition

recommendations later in life9

The aim of this study is to examine if practical experience,

e.g. cooking, in a school setting affects 10-13 year old

children’s acceptance of fish.

Methods and Materials

Study population Students age 10-13 years from 5th - 6th grade. The students

in both the main group and the control group came from

different public schools on Zealand: The main group from

five schools and the control group from ten schools

respectively.

Study design This study is a interdisciplinary, quasi-experimental

intervention with a main group (MG, n = 270) and a control

group (CG, n = 299). Furthermore, the control group was

randomly divided into two sub-groups: Control group 1 and

2 (CG1: n = 159; CG2: n = 140).

A mixed methods strategy was applied6. The students filled

in a baseline and effect questionnaire primarily based on a

five point Likert scale7. Also participant observation of the

first and last theme and focus groups with students in three

randomly selected classes were conducted in MG.

Højer, Rikke*1, 2 & Frøst, Michael Bom2

*Presenting and corresponding author (rikke.h@food.ku.dk) 1University College Absalon, Center for Nutrition and Rehabilitation, Health and Nutrition, Slagelsevej 70-74, DK-4180 Sorø, Denmark 2Nordic Food Lab, Design and Consumer Behaviour Section, Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 26, DK-1958 Frederiksberg C, Denmark

U N I V E R S I T Y O F C O P E N H A G E N

F A C U LT Y O F S C I E N C E , N O R D I C F O O D L A B

U N I V E R S I T Y C O L L E G E A B S A L O N

C E N T E R F O R N U T R I T I O N A N D R E H A B I L I T AT I O N

The lack of increase in liking of fish in the main group after

participating in the five week experiential sensory-based

theme course on fish could be due to the fact that being

faced with fresh whole fish with slime, blood, and internal

organs is very different from the fish accessible in the

supermarket, which typically is already cleaned and filleted.

Wherefore it could be due to either distaste or disgust and

the fear of contamination cf. the theory of disgust as laid out

by Rozin and Fallon (1986)8, or a case of what Fischler

(1980)9 calls gastro-anomia; a loss of the ability to identify

foods as a result of industrial purification.

Although no significant increase in liking of fish was

demonstrated in the main study after participation in the five

week theme course an evaluative question detected that

approximately 44% of the students in this group had

become more curious on tasting other fish (illustration

3), which is a significant difference from before (p = 0,013,

CI: 0,04, 0,38).

Acknowledgements

This study is part of Smag for Livet (www.taste-for-life.org),

Supported by Nordea-fonden.

References

1. Pedersen, A. N.; Christensen, T.; Matthiessen, J.; Knudsen, V. K.; Rosenlund-Sørensen, M.;

Biltoft-Jensen, A.; Hinsch, H.; Ygil, K. H.; Kørup, K.; Saxholt, E.; Trolle, E.; Søndergaard, A. B.

& Fagt, S. (2015). Danskernes kostvaner 2011-2013. Hovedresultater. 1. udgave,

februar 2015. DTU Fødevareinstituttet. ISBN: 978-87-93109-39-1.

2. Mouritsen, O.G. & Bagatolli, L.A. (2016). Life – as a matter of fat. Lipids in a Membrane

Biophysics Perspective. The Frontiers Collection. Springer, Cham. ISBN: 978-3-319-22614-9.

3. Nordic Counsil of Ministers (2014). Nordic Nutrition Recommendations 2012. Integrating

nutrition and physical activity. Nord 2014:002. Norden. ISBN 978–92–893–2670–4.

4. Schuchardt, J. P.; Huss, M.; Stauss-Grabo, M. & Hahn, A. (2010). Significance of long-chain

polyunsaturated fatty acids (PUFAs) for the development and behaviour of children. European

Journal of Pediatrics, 169, (2), 149–164. https://doi-org.ep.fjernadgang.kb.dk/10.1007/s00431-

009-1035-8.

5. Larson, N.I.; Perry, C.L.; Story, M., & Neumark-Sztalner, D. (2006). Food preparation by

young adults is associated with better diet quality. Journal of the American Dietetic

Association, 106, (12), 2001-2007. DOI: 10.1016/j.jada.2006.09.008.

6. Bryman, A. (2016). Social Research Methods. 5th edition Oxford University Press 2016.

ISBN: 978-0-19-968945-3

7. Likert, R. (1932). A technique for the measurement of attitudes. Archives of psychology, 140.

5 – 55. New York.

8. Rozin, P. & Fallon, A. (1986). The Acquisition of Likes and Dislikes for Foods. In Food and

Nutrition Board, National Research Council (1986). What Is America Eating?: Proceedings

of a Symposium. pp 58-70. ISBN 0-309-56401-8.

9. Fischler, C. (1980). Food habits, social change and the nature/culture dilemma. Social

Science Information, 19, (6), 937-953. DOI: 10.1177/053901848001900603.

Tabel 1: P values from unpaired and paired t-tests for the following

statements in the study at baseline (B) and after (E): Q: I can cook a fish

and Q: I like fish

Image 1 & 2: Students filleting dab. Photo: R. Højer, 2017.

Illustration 2:

Top: Mean values by groups – Q: I can cook a fish incl. 95% CI

Bottom: Mean values by groups – Q: I like fish incl. 95% CI

(Scale: min. -2, = Strongly disagree, max. 2 = Strongly agree)

Illustration 1: Study design

Illustration 3: Percentage distribution on a five-point Likert scale from

main study effect questionnaire - statement listed above

Conclusions

In conclusion practical experience increases the

students’ self-evaluated skills, but even though no

increase in liking was observed in the

questionnaire, there was an increase in curiosity

for trying other fish, for those students that

participated in the five week experiential sensory-

based theme course. Thus, practical sensory-

based experience with fish and gaining a practical

skill increase positive views toward eating fish,

which can set a direction for future motivation and

curiosity to try fish.

A7. SCIENTIFIC POSTER III

Pangborn 2019*

Promoting 11- to 13-year-old children’s food literacy through a community of practice – case

studies from an experiential sensory-based theme course on fish in a school setting.

Højer, R. and Frøst, M.B.

Pangborn Sensory Science Symposium 2019, Edinburgh, Scotland, United Kingdom.

*’Scientific Committee Recommended’ poster

U N I V E R S I T Y O F C O P E N H A G E N

F A C U L T Y O F S C I E N C E

U N I V E R S I T Y C O L L E G E A B S A L O N

C E N T E R F O R N U T R I T I O N A N D R E H A B I L I T AT I O N

Introduction

32% of the Danes spend less than 15 minutes on cooking the evening meal, 47% use conven-ience products as a part of the food preparation, and 18% judge themselves lacking cooking competencies

1.

The interest in children’s formal food education has increased as a result of concerns with loss of knowledge of food and nutrition, loss of food competences, and an in-crease in child obesity

2, 3.

In Danish public schools Family and consum-er sciences (FCS) is mandatory for one year in either 4th, 5th, or 6th grade, which makes the school an unique setting for pro-moting food literacy.

The aim of this study was to explore the construction of community of practice in a school cooking class setting (FCS) as a way of promoting 11-13 year old children’s food literacy.

Methods Study population

Students age 11-13 years from 5th - 6

th

grade. The students came from differ-ent public schools on Zealand, Den-mark.

Study design

The case studies were part of an in-terdisciplinary quasi-experimental inter-vention with a main group (MG) and a control group (CG). A mixed methods re-search strategy

4 was applied in the form of

baseline and follow up participant observations (3 schools, 3 classes from MG, n = 58), questionnaires from MG and CG total respectively, and teacher interviews at follow up (5 schools, n = 5).

Figure 1:Study design

Main group: 4 schools, 13 classes, n = 185

Control group: 8 schools, 19 classes, n = 198

Results & Discussion

The school is a social setting and FCS is founded on experiential learning and group activities

but this does not automatically lead to the construction of communities of practice (CoP)5.

Observations and interviews conducted during this study indicated that com-munity of practice was not evident in the beginning of the cooking pro-

gram but appeared over time:

▪ Students started exploring together driven by curiosity

▪ Students gained a mutual language, developed routines, and

skills.

▪ Students started to negotiate how to fillet the fish and how to

use the knife

▪ Students took mutual responsibility in reaching a goal (see figure 2

for more themes).

In MG at follow up a significant increase in cooking skill was found (p < 0,001), no significant difference was found in the ability to talk

about sensory properties (table 1), but a significant dif-ference between genders (p = 0,02;) (table 2) was

detected in the ability to talk about food;

▪ Girls rated themselves higher than

boys.

This finding might be due to a greater difference in self-evaluation of cook-ing skills from baseline to follow up in the girls group; girls mean jumps from 0,1 to 1,09, where as boys mean

only moves from 0,45 to 0,95, indicat-ing a higher self evaluated cooking skill

at baseline than girls, but they are overtak-en at follow up by the girls.

Benn (2014) stresses that the learning dimension of food literacy is accomplished by learning through the food.

In the community of practice food literacy and self-efficacy6 was promoted; in working with the

fish peer-to-peer learning occurred; evident in the shared repertoire, e.g. observed language used, and in mutual engagement, e.g. in ‘helping each other’-situations. An increase in self-efficacy, was observed e.g. through joint enterprise, e.g. individual confidence to negotiate practices, but also in shared repertoire, e.g. higher confidence in own cooking skills (p < 0,001) (table 1).

Conclusions

▪ Participation in the FCS cooking program increased food literacy through the con-

struction of communities of practice.

▪ Learning is both social; e.g. peer-to-peer learning situations, and individual; e.g.

through increase in skills and self-efficacy.

▪ Not all development was quantifiably measurable in children’s questionnaire re-

sponses. Some were detected through observations and teachers’ statements.

This underlines the importance of applying mixed methods strategy to research within the field of food literacy.

References 1. Hoff, H., Westergaard, K., & Jakobsen, G. S. (2018). Madkultur18. Sådan spiser danskerne. Madkulturens årlige befolkningsundersøgelse af danskernes mad- og måltidsvaner, 2018. Madkulturen, 2. udgave, 2018. 2. Benn, J. (2014). Food, nutrition or cooking literacy - a review of concepts and competencies regarding food education. International Journal of Home Economics, 7, 1, 13-35. 3. World Health Organization (2018). World health statistics 2018: monitoring health for the SDGs, sustainable development goals. World Health Organization. 4. Bryman, A. (2016). Social Research Methods. 5th edition Oxford University Press 2016. 5. Wenger, E. (1998). Communities of Practice. Learning, Meaning, and Identity. Cambridge University Press. 6. Bandura, A. (1977). Self-efficacy: Toward a Unifying Theory of Behavioral Change. Psychological Review, 84, (2), 191-215.

Acknowledgements The study was supported by Nordea-fonden under the Taste for Life project and University College Absalon, Centre for Nutrition and Rehabilitation, Nutrition and Health, Sorø, Denmark. Neither had any involvement in the work.

Food literacy: “skills, compe-

tencies, knowledge, and self at-

tributes regarding a functional,

interactive, and critical level

[…], knowing, doing, sensing,

wanting and caring, all together

as being practical prudent at a

personal level but also regard-

ing food and meals together

with others in everyday life” 2

Organization of cooking program in FCS

MG participated in a 5 week cooking program with fish meeting the official curriculum and learning goal requirements for FCS in 5th – 6th grade (5 x 3 lessons of 45 min.).

Themes: the senses, quality of fresh fish, tactility, fillet-ing, cooking, food history, preservation, sustainability, nutrition etc.

▪ The students were organized in groups of 3-4.

▪ They worked with 4 species of fresh fish

▪ The first 4 blocks were pre-planed with activities, rec-

ipes, and picture-based guides.

▪ The last block was organized as a “cook off”: The

recipe for a dish was to be constructed by the stu-dents, and the dish would be presented by the groups “Master chef– style”.

Image 1: Students during ”cook off”. Photo: R. Højer, 2017

MG: Descriptive statistics MG: Paired t-test for difference in means; baseline & follow up

B/F* n Mean** Mean/CI 95% p value***

Q 23.f. I can cook a fish B 185 0,28 -0,74 (-0,953, -0,528) < 0,001

F 185 1,02

Q. 23.h. I can talk with others about the food's flavor

B 185 0,87 0,1 (-0,098, 0,293) 0,327

F 185 0,77

Q. 23.k. I can tell others about the food I helped to cook

B 185 1,16 -0,03 (-0,214, 0,160) 0,776

F 185 1,18

MG: Descriptive statistics MG: Unpaired t-test for difference in means; baseline & follow up

B/F* n Mean** Mean/CI 95% p value***

Q. 23.k. I can tell others about the food I helped to cook

B. Boys 94 1,19 0,07 (-0,219, 0,360) 0,631

B. Girls 91 1,12

F. Boys 94 1,01 -0,35 (-0,651, -0,053) 0,021

F. Girls 91 1,36

Figure 2: Identified elements in the three dimensions of CoP

Table 1: Effects of cooking program. Paired t-tests for difference in means at baseline & follow up

Table 2: Gender differences in effect of cooking program. Unpaired t-tests for difference in means at baseline & follow up

*B: Baseline; F: Follow up

**Five point Likert scale: Strongly disagree: -2; strongly agree: 2

***2-tailed p-value > 0,05 = no significant difference in mean; the groups can be concluded to be similar in mean

APPENDIX B: PHD ACTIVITIES

B1. Study activities

B1.1. PhD course port folio

Time Course name Institution Course type ECTS

June 2015

Introduction Course for New

PhD Students

SCIENCE, Department of

Science Education, University

of Copenhagen

Type 1 - Complementary

skills course, e.g. Project

Management, Scientific

Writing

3

December 2015 Writing for Scientific Staff Global Denmark A/S,

Department of Science

Education, University of

Copenhagen

Type 1 - Complementary

skills course, e.g. Project

Management, Scientific

Writing

2.5

February 2016 Open Innovation: An emerging

perspective on science-based

innovation and entrepreneurship

SCIENCE, University of

Copenhagen

Type 2 - Scientific PhD

course

2

June 2016 Practice Theory and Social

Theories of Learning

Department of Learning and

Philosophy, Aalborg

University

Type 2 - Scientific PhD

course

4

November 2016 Basic Statistics for Health

Researchers

Faculty of Health and Medical

Sciences, University of

Copenhagen

Type 2 - Scientific PhD

course

11

February 2017 Focus groups as research

method

Faculty of Social Sciences,

Sociology, University of

Copenhagen

Type 2 - Scientific PhD

course

2

August 2017 12th Pangborn Sensory Science

Symposium 2017

Providence, Rhode Island,

U.S.A

Type 4 - Other course

activity: e.g. journal club, ad

hoc course, conference

2

November 2017 Cultural Analysis – A PhD

Workshop for Developing

Insights Into Everyday Life

Department of Culture and

Global Studies, Aalborg

University

Type 2 - Scientific PhD

course

1

Merit Introduction to University

Pedagogy

3

ECTS total 30,5

B1.2. Teaching activities

Time Course Assignments H Exp.

Fall

2015

Food in practice, UC Absalon Plan curriculum, give lectures 24

Fall

2015

Philosophy of Science & research

methodology, UC Absalon

Plan curriculum, give lectures, examination of

students (written report + oral exam)

24

Fall

2015

Research design, UC Absalon Plan curriculum, give lectures, supervision 42

Winter/spring

2016

Food in practice, UC Absalon Plan curriculum, give lectures 12

Winter/spring

2016

Philosophy of Science & research

methodology, UC Absalon

Plan curriculum, give lectures, supervision,

examination of students (written report + oral

exam)

64

Winter

2016

Assistant supervisor – 2 groups – Food

innovation and Health theme course,

UCPH

Supervision of master student on methodology,

research design.

10

Spring

2016

Food Science, UC Absalon Plan curriculum, give lectures, supervision,

examination of students (written report + oral

exam)

48

Spring

2016

Children’s acceptance of fish, UC

Absalon

Presentation of own research incl. theory and

research methods as case example

10

Summer

2016

Examiner at oral re-exam Examination of written assignment and oral

presentation

6

Fall

2016

Intern supervision, UC Absalon/ Smag

for Livet

Coordination of intern work plan and supervision

of interns

25

Spring

2017

Food Science, UC Absalon Plan curriculum, give lectures, supervision,

examination of students (written - extern), post-

course administration

84

B1.3. MSc thesis supervision activities

Winter

2016

Co-Supervision of master student, UCPH

Julia Sick: Children’s reasons for accepting and rejecting

food

Supervision of master student on

methodology, research design etc.

Spring

2017

Co-Supervision of master student, UCPH

Claus Frantzen: Taste and Gamification

Supervision of master student on

methodology, research design etc.

B1.4. Dissemination activities (scientific)

Winter

2017

Stop Making Sense, Philadelphia, PA, USA

Oral presentation

Promoting children’s acceptance of fish

through experiential learning

Summer

2017

Pangborn Sensory Science Symposium, Providence, RI,

USA

Oral snap shot presentation and poster presentation

Co-author: M.B. Frøst

Promoting children's acceptance of fish

through sensory-based experiments and

experiential learning: Breaking through

the disgust barrier

Spring

2018

SenseAsia 2018, Kuala Lumpur, Malaysia

Poster presentation

Co-author: M.B. Frøst

What’s cooking? Promoting 10-13 year

old children’s acceptance of fish through

experiential learning

Summer

2019

Pangborn Sensory Science Symposium, Edinburgh,

Scotland, UK.

Oral presentation (Early career research seminar) and

poster presentation

Co-author: M.B. Frøst

Promoting 11- to 13- year old children’s

food literacy through a community of

practice – case studies from an

experiential sensory-based theme course

on fish in a school setting.

B1.5. Dissemination activities (public)

Summer

2015

Kulinarisk Sydfyn, Svendborg, DK, Smag for Livet/UCPH

Culinary event and food fair/farmers market

Dissemination, Workshops, qualitative

data collection

Summer

2015

Pometet, UCPH: Dehydration of plums

Fruit and berry festival at UCPH research station

Dissemination, workshops, qualitative

and quantitative data collection

Spring

2016

Danish Science Week 2016, Smag for livet/UCPH

Gyotaku experiment with 5th

and 6th

grade school children

Dissemination, workshops, qualitative

data collection

Summer

2016

Kulinarisk Sydfyn, Svendborg, DK, Smag for Livet/UCPH

Gyotaku experiment with children

Dissemination, workshops, qualitative

data collection

Fall

2016

Kulturnatten, (Culture night) Smag for Livet/UCPH

Taste as a multimodal sensation

Dissemination

B1.6. Committee activities

Winter 2014 – winter 2016 UC Absalon teacher representative in educational committee

Summer 2015 – fall 2016 Nordic Food Lab representative in FOOD work environment committee

B1.7. Awards

2017 Travel award: 12th Pangborn Sensory Science Symposium, Providence, Rhode Island, USA,

20th – 24th Aug. 2017

2019 Travel award: 13th Pangborn Sensory Science Symposium, Edinburgh, Scotland, UK., 28th

of July – 1st of Aug. 2019

B2. Curriculum Vitae

Rikke Højer, 12.12. 1977

Education May 1th 2015 -

Nordic Food Lab, Faculty of Food Science, (May 2015 – June 2018) Design and Consumer Behavior, Faculty of Food Science (June 2018 -) University of Copenhagen, Denmark Ph.D. student September 2009 – October 2011

Faculty of Science, University of Copenhagen, Denmark: MSc. in Gastronomy & Health (cand.scient.) January 2006 – June 2009

University College Zealand Ankerhus, Soroe, DK: Bachelor in Nutrition & Health specializing in Human Nutrition

August 2001 – June 2003

University College North Jutland, Aalborg, Denmark: AP Degree in Service, Hospitality & Tourism Management specializing in Hotel Management.

January 2001

Food College, Aalborg, Denmark: Passed exam and apprenticeship as a chef with the distinction ”Bronze Medal” August 1996 – January 1997

Cleveland Community College, College of Arts and Sciences, Cleveland, Tennessee, USA: Courses: Associate of Science: German, American History, Anthropology, World Religion.

I was born and grew up in Vendsyssel, the Northern part of Denmark. For over 20 years my parents had a small catering business making Danish Smørrebrød. So food was an integrated part of my upbringing. In 2001 I finished my education as a chef and went on to become executive head chef two months later. I thought my life path was laid out for me; but I got wiser. After a car accident in 2004, I went back to school. After followed a move to Copenhagen in 2009, and today I am an associate professor at UCA and food is still the main theme song professionally. How lucky am I?

Funny enough I never liked fish that much. I loved to cook it, but not eat it; a mushy texture and a fishy flavor. Today I eat more fish than I did before I started my PhD. Conclusion: Mere exposure + playing with food = A new food world to explore

Topic: Children’s food literacy and eating behavior

Master’s Thesis (45 ECT, grade: 12/A):

Topic: Acceptance of New Nordic Diet among Men in the province (the municipality of Hjørring, DK). A pilot study under the project OPUS

Bachelor Paper (grade: 12/A)

Topic: Men & Health – a health campaign strategy

Main Paper:

Analysis of Skallerup Sea Side Resort´s concept and service package

B3. Acknowledgements

Thank you to University College Absalon, Nutrition and Health and Ida Husby for seeing and

believing in my potential – I DID IT! Finally… The support and encouragement from the World’s

most fantastic co-workers at Ankerhus, University College Absalon (Nutrition and Health) gave me

the energy to keep going – even during the darkest of times. A special thank you to Helle K. and

Margit for your help and support.

Thank you to the Nordea Foundation for partly funding this study, and Smag for Livet (Taste for

Life). It has been truly inspiring to be part of the exploration.

At a superior level – no one above in my professional life – BOM! Thank you for preventing me

from committing unspeakable things (even though you know I have the words for it, as I have ‘a

very foul mouth’) at too many occasions. Look at the bright side… we made it out - but sadly the

rope was much too long and so much potential was lost in the process. Thank you for your

‘nerdiness’, for correcting me, when I did not pronounce it correctly (Reine Claude is a fantastic

plum), for the fantastic and inspiring discussions on research, science, and of course on everything

food. Most of all thank you for putting up with my stubbornness and for laughing with me, when I

recognized that I was wrong. I will always admire and appreciate your curiosity and open-

mindedness with regard to exploring new research fields and methods. THANK YOU – you never

stopped believing in me… NOW YOU ARE FREE…but admit it… you will miss when I

challenge you and want to discuss everything… juuust a little bit… just you wait…

This PhD would not have been possible without the support from my parents and for the help they

provide. So Thank you, I will never be able to repay you, but I try every day.

Of course last but not least: she is my rock and knows me too well. Thank you Sanne for being you

and for all our fantastic discussions on philosophy of science, research methods, and PhD project

challenges. Also, thank you for making Tobias’ car available when a trip to a deep dark forest was

on the table, and for offering your shoveling expertise. You held me up through the darkest period

of my life when I felt I was drowning. So this PhD was also possible because of you being you (and

offcourse thank you Tobias for lending me your girlfriend).

I never thought it would take me this long, but I never doubted that I would get it done… all good

things + a bucket-full of stubbornness. The final moments of this written thesis I give to a song

that got me through and still reminds me not to linger on past insignificant elements and

experiences.

Nashville: ‘Don't Put Dirt On My Grave’ by Hayden Panettiere ‘… So to all of you out there, who want me to beg for forgiveness, want to burn my records and cancel my concerts and want to put my carrier in the ground… this one is for you …’

I thought things couldn't get much worse But guess what they did

You hit my heart upside with a wrecking ball Oh but that's what I get

But I'm not going no where I can live on my prayers

'Cause I'm done playin' nice I'm done running for life

'Cause you think that you got me scared

This time it's goodbye trouble I feel the light at the end of this tunnel

I get stronger with every step

Come Hell, come high water You push on me I'm going to push back harder

I got a whole lot more than a little bit left Oh, so don't put dirt on my grave just yet

Oh, don't put dirt on my grave just yet

Everyone can save their breath They can spare me the change

You can point your finger somewhere else If you're looking to blame

I'll give you something to believe Nothing on me says defeat

No I'll never look back So you better think fast

If you think you can cut me deep

This time it's goodbye trouble I feel the light at the end of this tunnel

I get stronger with every step

Come Hell, come high water You push on me I'm going to push back harder

I got a whole lot more than a little bit left Hey, so don't put dirt on my grave just yet

Oh, don't put dirt on my grave just yet Song writers: Caitlyn Elizabeth Smith & Trenton Kelly Dabbs Don't Put Dirt on My Grave Just Yet © BMG Rights Management US, LLC https://www.youtube.com/watch?v=zp3tYO7mIUE

Co-author statements & Supervisor report

P H D S C H O O L O F S C I E N C E U N I V E R S I T Y O F C O P E N H A G E N

Revised March 2016

1. PhD student Name: Rikke Højer UCPH user id:

Or date of birth SDT845

Department: Food Science 2. Paper/Manuscript This co-authorship declaration applies to the following:

Title: Something fishy is cooking – A survey of 11- to 13- year old Danish children’s self-evaluated

food neophobia and food behavior, knowledge, and skills in relation to fish

Authors(s): Rikke Højer and Michal Bom Frøst Journal: Submitted to Food Quality and Preference (October 25th 2020) Vol/page: DOI: 3. Contributions to the paper/manuscript made by the PhD student

What was the role of the PhD student in designing the study?

Conceptualization; Methodology; Design and strategy; Validation; Visualization;.

How did the PhD student participate in data collection and/or development of theory?

Data curation; Formal analysis; Investigation

Which part of the manuscript did the PhD student write or contribute to?

Writing - original draft; Writing - review & editing

Did the PhD student read and comment on the final manuscript?

Yes

3A. Co-authorship statement All papers/manuscripts with multiple authors which is part of a PhD thesis should contain a co-author statement, stating the PhD student’s contribution to the paper

PAGE 2 OF 2

Revised March 2016

4. Material in the paper from another degree / thesis Data collected and preliminary work carried out as part of another degree/thesis may be part of the PhD thesis if further research, analysis and writing are carried out as part of the PhD study.

Does the paper contain data material, which has also formed part of a previous degree / thesis (e.g. your master’s degree)?

Yes

Please indicate which degree/thesis:

Please indicate which specific part(-s) of the paper that has been produced as part of the PhD study:

The entire paper.

Signatures The co-author statement should always be signed by the first author, the corresponding-/senior author and the PhD student. If there are two or three authors the statement must always be signed by them all

Date: 10.26. 2020 Name: Rikke Højer Signature:

Date: 10.26. 2020 Name: Michael Bom Frøst Signature:

Date: Name: Signature:

The co-authorship statement must be handed in to the PhD secretary at your department at the same time as the PhD thesis, but not included in the PhD thesis. You can find your PhD secretary here: www.science.ku.dk/phd/

P H D S C H O O L O F S C I E N C E

U N I V E R S I T Y O F C O P E N H A G E N

Revised March 2016

1. PhD student

Name: Rikke Højer UCPH user id:

Or date of birth SDT845

Department: Food Science

2. Paper/Manuscript This co-authorship declaration applies to the following:

Title:

Children’s Self-Reported Reasons for Accepting and Rejecting Foods

Authors(s): Julia Sick, Rikke Højer and Annemarie Olsen

Journal: Nutrients

Vol/page: 11, 2455 (1-14)

DOI: 10.3390/nu11102455

3. Contributions to the paper/manuscript made by the PhD student

What was the role of the PhD student in designing the study?

Contribution to conceptualization, choice of stimuli and study design

How did the PhD student participate in data collection and/or development of theory?

Through co-supervision

Which part of the manuscript did the PhD student write or contribute to?

Contributed to reviewing and editing of complete manuscript

Did the PhD student read and comment on the final manuscript?

Yes

3A. Co-authorship statement All papers/manuscripts with multiple authors which is part of a PhD thesis should contain a co-author statement, stating the PhD student’s contribution to the paper

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Revised March 2016

4. Material in the paper from another degree / thesis Data collected and preliminary work carried out as part of another degree/thesis may be part of the PhD thesis if further research, analysis and writing are carried out as part of the PhD study.

Does the paper contain data material, which has also formed part of a previous degree / thesis (e.g. your master’s degree)?

Yes

Please indicate which degree/thesis: MSc thesis for Julia Sick

Please indicate which specific part(-s) of the paper that has been produced as part of the PhD study:

The entire paper.

Signatures The co-author statement should always be signed by the first author, the corresponding-/senior author and the PhD student.

If there are two or three authors the statement must always be signed by them all

Date: 09.28.2020 Name: Julia Sick Signature:

Date: 09.24. 2020 Name: Rikke Højer Signature:

Date: 29/9-2020 Name: Annemarie Olsen Signature:

The co-authorship statement must be handed in to the PhD secretary at your department at the same time as the

PhD thesis, but not included in the PhD thesis. You can find your PhD secretary here: www.science.ku.dk/phd/

The description must contain an opinion on the progress of the PhD programme as a whole, incl. the

individual study elements i.e. teaching and knowledge dissemination, collaboration with other research

environments, courses etc.

Main supervisor’s statement for Rikke Højer Nielsen

The PhD-thesis as a whole is centred around testing if and how a sensory-based experiential

intervention carried out as teaching program in the school topic Food Knowledge (Madkundskab) affects

children’s food literacy and reported behaviour in relation to fish.

The following main hypothesis was investigated:

Through the concepts experimentation, sensing, autonomy and influence, knowledge and skills, and a

community of practice/a social dimension an “open window” for increasing the acceptance of fish, food

literacy, and finally, food exploration will open. The hypothesis was investigated in a school setting in

the compulsory subject Madkundskab in 5th and 6th grade (11-13-year old children).

During the five week teaching program (2 modules of 45 minutes/week) on the topic of fish the children

were presented with a variety of typical fresh Danish fish, which they would then prepare, cook and eat

together. The teaching program was a research design tool in the investigation of children’s food literacy

and fish eating behaviour intended to explore a sensory-based experiential approach in promoting

children’s acceptance of fish, fish eating behavior, and food literacy.

The study had a main experiment group and 2 separate control groups. 669 children from the east

Denmark (Capitol region and Region of Zeeland) entered the study. The following research methods

were applied during the complete data collection phase:

1. Future workshops with children in the target group to develop the content of the teaching program

2. Observations: Participant observation during some of the course modules (intervention activities) in

the main group. Rikke was one of the observers, supported by research assistants in some others.

Rikke lead the analysis of the outcome.

3. Interviews: Group interviews, informal individual interviews, telephone interviews with participating

teachers. Rikke carried out the majority of the interviews and lead the analysis of the outcome.

4. Surveys: baseline and follow-up survey questionnaires investigating aspects of the participants’

background, attitude and behaviour in relation to the intervention and to fish. Rikke developed and

tested parts of the questionnaire and relied on tested survey methodology (Food Neophobia) for

other parts, adapting it to the present purpose. Rikke lead the analysis of the outcome with support

from the main supervisor.

The PhD thesis is based on three main papers (paper I, II, III) Paper IV serves as supplement as it is not a

central part of this study, but is inspired by its investigatory scope. The papers and their status listed

below:

I. Something fishy is cooking – A survey of 11- to 13- year old Danish children’s self-evaluated food

neophobia and food behaviour, knowledge, and skills in relation to fish

Højer, R. & Frøst, M.B. submitted to Food Quality and Preference (2020-10- 25)

II. Play with your food and cook it! Tactile play with fish as a way of promoting acceptance of fish in

11- to 13- year old children in a school setting – a qualitative study

Højer, R., Wistoft, K., & Frøst, M.B. (2020) Nutrients 12(10)3180. Published 2020-10-17

III. Yes I can cook a fish; effects of a five week sensory-based experiential theme course with fish on

11- to 13- year old children’s food literacy and fish eating behavior – a control study

Højer, R. Wistoft, K., & Frøst, M.B. under submission for Food Quality and Preference. Expected

submission 2020-10-31

IV. Children’s self-reported reasons for accepting and rejecting foods.

Sick, J., Højer, R. & Olsen, A. (2019) Nutrients 11(10)2455. Published 2019-10-14

The main findings of the thesis is a very brief summary:

Based on the output from paper I, II, and III the author conclude that sufficient support has been

collected to accept the main hypothesis: an ‘open window’ for promoting food literacy and fish

acceptance was created based on the concepts of experimentation, sensing, autonomy, knowledge and

skills, and a social dimension. Furthermore, it can be concluded that the school was a natural setting for

implementation as the subject of Food Knowledge already aims at promoting the children’s ability to

make critical and reflected health and food decisions and choices. Nevertheless, challenges could be

local resources (access to educated teachers, equipment etc.).

With regard to outcome it can be concluded that a substantial part of the children became craftsmen

through participation in the cooking course with fish. The effect of participating on skills was

remarkable, as was the curiosity on trying other fish types after participation, but the challenge is to

utilize this development and support and promote a spill-over to the family environment.

The impact of the intervention with regard to long term effects on fish eating behavior is unclear, and as

such no conclusions can be made. Nevertheless, a lasting effect on fish cooking-efficacy could be the

case.

In the opinion of the main supervisor it is a substantial work of high research quality, based on sound

methodology. The interdisciplinary nature of the experiments positions it as a unique scientific work.

The PhD has taken substantially longer to complete than projected. However, there are good reasons for this.

Together we have overcome them and all is done now. In the periods where Rikke has worked on the thesis good

progress has been not.

Course work

Rikke has completed the necessary ECTS points for completion of the PhD

International research environment

Is completed with one month at Institiute Paul Bocuse in Lyon France. Here she carried out fieldwork to learn

about taste education in the French school system

Teaching and student supervision

Rikke’s main work as a lecturer at Professionshøjskolen Absalon (University College Absalon) has meant that a

large part of her teaching has been carried out there. In addition to that she has served as co-supervisor for two

MSc-theses at UCPH, and contributed a supervisor for students in the Thematic Course in Food Innovation and

Health during once instalment of the course. Her teaching load has been more than sufficient.

Below I have copied in her registered teaching activities during the first three years PhD-period

Time Course Assignments H Exp.

Fall 2015

Food in practice, UC Absalon Plan curriculum, give lectures 24

Fall 2015

Philosophy of Science & research methodology, UC Absalon

Plan curriculum, give lectures, examination of students (written report + oral exam)

24

Fall 2015

Research design, UC Absalon Plan curriculum, give lectures, supervision 42

Winter/spring 2016

Food in practice, UC Absalon Plan curriculum, give lectures 12

Winter/spring 2016

Philosophy of Science & research methodology, UC Absalon

Plan curriculum, give lectures, supervision, examination of students (written report + oral exam)

64

Winter 2016

Assistant supervisor – 2 groups – Food innovation and Health theme course, UCPH

Supervision of master student on methodology, research design.

10

Spring 2016

Food Science, UC Absalon Plan curriculum, give lectures, supervision, examination of students (written report + oral exam)

48

Spring 2016

Children’s acceptance of fish, UC Absalon

Presentation of own research incl. theory and research methods as case example

10

Summer 2016

Examiner at oral re-exam Examination of written assignment and oral presentation

6

Fall 2016

Intern supervision, UC Absalon/ Smag for Livet

Coordination of intern work plan and supervision of interns

25

Spring 2017

Food Science, UC Absalon Plan curriculum, give lectures, supervision, examination of students (written - extern), post-course administration

84

It total to 349 hours of work.

Popular dissemination

The nature of the Smag for Livet project has meant that all researchers have an extra obligation for public

dissemination. Rikke has fully lived up to that, with many appearances at culinary festivals of one of the activities

developed for the teaching program – the Gyatako workshop.

Here the acitvities are listed

Summer 2015

Kulinarisk Sydfyn, Svendborg, DK, Smag for Livet/UCPH Culinary event and food fair/farmers market

Dissemination, Workshops, qualitative data collection

Summer 2015

Pometet, UCPH: Dehydration of plums Fruit and berry festival at UCPH research station

Dissemination, workshops, qualitative and quantitative data collection

Spring 2016

Danish Science Week 2016, Smag for livet/UCPH Gyotaku experiment with 5

th and 6

th grade school children

Dissemination, workshops, qualitative data collection

Summer 2016

Kulinarisk Sydfyn, Svendborg, DK, Smag for Livet/UCPH Gyotaku experiment with children

Dissemination, workshops, qualitative data collection

Fall 2016

Kulturnatten, (Culture night) Smag for Livet/UCPH Taste as a multimodal sensation

Dissemination

Scientific dissemination

Rikke has contributed to international scientific conferences. She has presented her work at 4 different

conferences. It amounts to two oral presentation, one snap oral presentation and one only as poster. They are

listed below.

Winter 2017

Stop Making Sense, Philadelphia, PA, USA Oral presentation

Promoting children’s acceptance of fish through experiential learning

Summer 2017

Pangborn Sensory Science Symposium, Providence, RI, USA Oral snap shot presentation and poster presentation *Co-author: M.B. Frøst

Promoting children's acceptance of fish through sensory-based experiments and experiential learning: Breaking through the disgust barrier

Spring 2018

SenseAsia 2018, Kuala Lumpur, Malaysia Poster presentation *Co-author: M.B. Frøst

What’s cooking? Promoting 10-13 year old children’s acceptance of fish through experiential learning

Summer 2019

Pangborn Sensory Science Symposium, Edinburgh, Scotland, UK. Oral presentation (Early career research seminar) and poster presentation *Co-author: M.B. Frøst

Promoting 11- to 13- year old children’s food literacy through a community of practice – case studies from an experiential sensory-based theme course on fish in a school setting.

‘Yes…’

‘well yes, then I do eat fish’