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Understanding parental health literacyand food related parenting practicesStefania Velardoa & Murray Drummonda

a School of Education, Flinders University, Adelaide, SA, AustraliaPublished online: 17 Dec 2014.

To cite this article: Stefania Velardo & Murray Drummond (2013) Understanding parental healthliteracy and food related parenting practices, Health Sociology Review, 22:2, 137-150, DOI:10.5172/hesr.2013.22.2.137

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Copyright © eContent Management Pty Ltd. Health Sociology Review (2013) 22(2): 137–150.

137Volume 22, Issue 2, June 2013 H

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The topic of children’s health has often

received much attention, given the recog-

nition that the early years of life set the foun-

dation for future wellbeing (Australian Institute

of Health and Welfare [AIHW], 2009). Good

nutrition is important for the maintenance of

physical and mental health, and is shown to sup-

port the growth and development that occurs

throughout childhood (Victora, 2009). Positive

dietary behaviours practised at an early age also

help to maintain health throughout adulthood

and reduce the risk of prevalent lifestyle diseases

such as overweight and obesity, which may pose

numerous physical and psychosocial threats to

the individual (AIHW, 2009).

The Dietary Guidelines for Children and

Adolescents in Australia provide dietary rec-

ommendations for children aged 4–18 and

encourage a nutritious diet enriched with vege-

tables, legumes, fruit and cereal (National Health

and Medical Research Council [NHMRC],

2003). Despite the recognition that nutritional

wellbeing is paramount to the overall health

and development of the child, the results of

the 2007 Australian national children’s nutri-

tion and physical activity survey indicated that

many Australian children are not meeting the

daily recommended intakes for fruits and veg-

etables (Department of Health and Ageing

[DoHA], 2008). Nowadays, Australian children

are consuming a diet that is comprised of more

high-energy, nutrient-poor foods, compared to

their predecessors (Magnus, Haby, Carter, &

Swinburn, 2009). Patterns of increased energy

consumption are commonly attributed to the

higher consumption of fast foods over time

(Popkin, Duffey, & Gordon-Larsen, 2005);

increased consumption of high-fat foods away

from the home (Drewnowski & Darmon,

2005; Stanton, 2006); increased portion sizes

for packaged foods (Kral, Roe, & Rolls, 2004;

Young & Nestle, 2002); and the increased cost

of healthy eating (John & Ziebland, 2004).

Greater exposure to Australian fast food adver-

tisements promoting foods high in fat, sugar

and salt (Chapman, Nicholas, & Supramaniam,

2006), which encourage children to repetitively

‘pester’ parents to purchase items (Marshall,

O’Donohoe, & Kline, 2007; Nicholls & Cullen,

2004) is arguably an additional factor that may

contribute towards an unhealthy diet.

In attempting to deconstruct the purported

association between social features of the mod-

ern environment and poor dietary patterns, it

is therefore necessary to gain a broader under-

standing of the interplay between the individual,

interpersonal relationships and the environ-

ment. Socio-structural factors are a fundamental

Understanding parental health literacy and food related parenting practices

STEFANIA VELARDO AND MURRAY DRUMMOND

School of Education, Flinders University, Adelaide, SA, Australia

Abstract: Health literacy, which relates to the acquisition, understanding and application of health information, has become an increasingly important public health issue, particularly where parents and children are concerned. Given that the home setting comprises a strong infl uence on children’s diets, this qualitative study explored the concept of health literacy using parents’ experiences with health information seeking and food related parenting practices. Semi-structured focus groups and in-depth interviews were conducted with parents, with children aged from birth to 12 years, in a low socio-economic region of South Australia. The results of this study indicated that there were a number of perceived barri-ers to accessing, understanding and utilising health information related to children’s nutrition. These fi ndings contribute to a broader understanding of how parents obtain and process dietary information and the channels through which they appear to be accessible.

Keywords: health literacy, sociology of children’s health, dietary behaviours, parental infl uence, intergenerational health, qualitative research

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consideration with regards to children’s health,

given that health tends to improve with higher

socio-economic status (SES) (Glover, Hetzel,

Glover, Tennant, & Page, 2006). It is not

surprising that differences in dietary patterns

across socio-economic groups are evident, with

poor behaviours more prevalent amongst chil-

dren from low SES communities (O’Dea &

Wagstaff, 2011). It may be argued that such dif-

ferences merely exist due to individual factors,

including low levels of educational attainment

and lack of health knowledge. Yet the inter-

relationship between SES and diet is complex

and it becomes imperative to also consider the

broader structural context. For example, it has

been suggested that poor dietary choices may

be pronounced in environmentally disadvan-

taged areas due to factors within the commu-

nity nutrition environment (Story, Kaphingst,

Robinson-O’Brien, & Glanz, 2008). These

may include lack of access to affordable, nutri-

tious foods (Macintyre, 2007) or mediating

factors such as increased exposure to fast food

outlets (Reidpath, Burns, Garrard, Mahoney, &

Townsend, 2002).

Lifestyle practices are complex and a multi-

tude of factors interact to shape individual dietary

patterns. Research emphasises the combined

infl uence of various agents and systems in shap-

ing children’s health related attitudes and behav-

iours, including schools (Drummond, 2010; St

Leger, 2001), peers (Drummond, 2010; Paek,

Reber, & Lariscy, 2011), the healthcare system

(Manganello, 2008) and mass media (Paek et al.,

2011). It is the role of parents, however, that

has traditionally received considerable atten-

tion within the literature, given that parents are

commonly perceived to be the agents of great-

est infl uence (Rimal, 2003). It is widely recog-

nised that parents serve important health related

roles for their children, in terms of establishing

a healthy home environment (Anzman, Rollins,

& Birch, 2010; Howard, 2007; Tucker, 2009),

making key decisions concerning diet (Golan &

Crow, 2004) and serving as role models (Ventura

& Birch, 2008). Accordingly, issues concerning

parents are important in improving child health

(Golan, 2006).

When considering parental infl uence, it is

important to acknowledge the fundamental role

of health literacy. Health literacy, defi ned as

the ‘cognitive and social skills which determine

the motivation and ability of individuals to gain

access to, understand and use information in

ways which promote and maintain good health’

(Nutbeam, 1998, p. 357), has been identifi ed

as a key public health goal within Australia.

National fi gures specify that approximately nine

million (59%) Australians lack basic health liter-

acy skills (Australian Bureau of Statistics [ABS],

2008b). Studies of health literacy have predomi-

nantly focussed on literacy and numeracy skills

in the health context. Such research is deeply

rooted in the conviction that health literacy is

shaped by people’s ability to read, write and

comprehend written and oral information in

health settings (Jordan, Buchbinder, & Osborne,

2010), given that education and literacy serve as

important determinants of health (Kickbusch,

2001). Over time, however, health literacy has

been increasingly embraced as an important life

skill that focuses on people’s ability to build self-

reliance and make decisions about health not

only in healthcare settings, but in everyday life

(Kickbusch, 2009; Peerson & Saunders, 2009;

Velardo, Elliott, Filiault, & Drummond, 2010).

This broader conceptualisation resonates

with Nutbeam’s (2000) tripartite classifi cation

of health literacy that outlines the importance

of achieving health literacy at the functional,

interactive and critical levels, thereby devel-

oping capabilities beyond the accumulation of

basic health knowledge. Progression between

degrees of health literacy, towards a critical level,

emphasises the development of broader social

skills and the promotion of actions that may

modify the underlying social determinants of

health (Nutbeam, 2008). Enhanced health liter-

acy empowers individuals to better navigate the

complex demands of the healthcare system and

comprehend health messages, which may fos-

ter confi dence in self-care and improved health

outcomes (Paasche-Orlow & Wolf, 2007).

Health literacy is infl uenced by culture and

society. Peerson and Saunders (2011) emphasise

a range of complex and interrelated factors that

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infl uence one’s motivation to access, understand

and utilise information in ways that promote

health. It becomes important to distinguish

between individuals who have simply acquired

the health related knowledge and skills neces-

sary for a healthy lifestyle, and those who are

actually motivated to exercise this knowledge.

For example, a parent may be well aware of the

benefi ts of eating fi ve serves of vegetables per

day, yet may choose to serve a nutrient-poor

meal at dinner time lacking a vegetable com-

ponent, simply because it was a more cost-

effective option. Consideration of this scenario

should not discount the importance of health

education and the transmission of health pro-

moting knowledge. Instead, it should highlight

the socially situated nature of health literacy and

the relevant socio-cultural factors that either

empower or constrain healthy choices.

Parental health literacy may impact on chil-

dren’s health through the processes of deci-

sion-making, modelling and discussions around

health. In this way, parents may provide a posi-

tive infl uence on the health knowledge, skills

and behaviours of young people (Rimal, 2003).

This pathway of intergenerational transmis-

sion, whereby parents’ health related beliefs and

behaviours are resources passed on to the subse-

quent generation of children (Modin, Koupil, &

Vågerö, 2009), not only affects the child’s short-

term physical health, but plays an integral role

in the development of the child’s own health

literacy (Paek et al., 2011). Manganello (2008)

asserts that addressing health literacy at an early

age is important, in order to shape subsequent

attitudes and behaviours that will likely endure

into adulthood.

Given the relative newness of health literacy

as a concept, research is particularly limited

where parents and children are concerned. Most

research has specifi cally focussed on parental

health literacy levels and child health outcomes in

the context of chronic illness management (e.g.,

Arnold et al., 2001; Dewalt, Dilling, Rosenthal,

& Pignone, 2007; Ross, Frier, Kelnar, & Deary,

2001; Shone, Conn, Sanders, & Halterman,

2009). Furthermore, the majority of studies to

date have used validated quantitative tools such

as the rapid estimate of adult health literacy

(REALM) or test of functional health literacy

(TOFHLA) to measure health literacy. None of

the validated tools assess parents’ skills around

attending to children’s health needs (Sanders,

Federico, Klass, Abrams, & Dreyer, 2009) and

they refl ect a narrow conceptualisation of health

literacy as a derivative of literacy, only acting to

evaluate selected aspects of individual capacity

(Baker, 2006; Nutbeam, 2008). In contrast,

data has emerged from several qualitative stud-

ies relating to the roles of health care systems

and the socio-cultural dimensions of health lit-

eracy (Briggs et al., 2010; Harrison, Mackert, &

Watkins, 2010).

There is a need for further research in this

area, particularly around broad health promoting

skills and preventative health knowledge, as

well as the interrelated forces that enhance or

undermine health literacy. Embracing a broader

conceptualisation, this study employed a quali-

tative interpretative approach to gain a descrip-

tive account of health literacy from the parental

perspective, in order to inquire into the ways

that parents access and understand health infor-

mation in a low SES region, as well as the factors

that infl uence how such information is utilised.

It must be acknowledged that this research

focussed on two dimensions of health informa-

tion seeking and health related parenting prac-

tices, relating to children’s diets and physical

activity engagement. We understand the signifi -

cance of nutritional wellbeing as well as positive

physical activity patterns in maintaining good

health during childhood, however, this paper

will solely focus on the study fi ndings that related

to nutrition. It is our contention that given the

depth and breadth of emergent themes from the

data, combining both the physical activity and

nutrition data into a paper such as this would

not do justice to both areas of research. Further

it would not accurately represent the voices of

those who participated in the study.

METHODS

ParticipantsParticipants were parents from two-parent fami-

lies with children aged from birth to 12 years.

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their own views in the context of others’ voices

and opinions. This may lead to the emergence

of viewpoints that might have otherwise been

subdued.

The focus groups followed a semi-structured,

open-ended format and the researchers utilised

an interview guide to pursue questions related to

children’s physical health, the use of community

resources, and additional modes of accessing,

synthesising and applying health information

related to children’s diets. Data that emerged

from the initial focus group interviews also

played an integral role in the development of

the subsequent interview guide for the individ-

ual interviews (Patton, 2002). Four individual

in-depth interviews, which lasted for approxi-

mately 1 hour, were then carried out with dif-

ferent participants than those interviewed in the

focus groups. The individual interviews were

conducted to pursue salient issues that emanated

from the focus groups in a more personal setting,

and they also served as a basis of methodological

triangulation (Kitto, Chesters, & Grbich, 2008),

thereby increasing internal validity.

Theoretical frameworkSocial constructionism was used as the theo-

retical framework for data analysis due to its

application to parenting and intergenerational

transmission of health. Society and culture

impact on health and infl uence the way people

view the world, in accordance to socially con-

structed assumptions and values (Burr, 2003).

For example, what it means to be ‘healthy’ or a

‘good parent’ is dependent upon cultural norms

within the socio-cultural environment. In this

way, constructionism is underpinned by the

interrogation of taken for granted knowledge

(Burr, 2003). Employing a social constructionist

approach enabled the researchers to examine the

social context within which individuals and fam-

ilies live their lives, in order to understand how

health related practices are made to mean some-

thing to people. The constructionist perspective

also enhanced the researchers’ understanding

of how social institutions are perpetuated and

maintained from one generation to the next,

through intergenerational transmission.

This particular age group was a focus of the

study, given the strength of parental infl uence

upon young children’s health behaviours and

food preferences prior to adolescence (van der

Horst et al., 2007). Most of the participants’

children did not yet attend primary school

(63%), therefore the range of children’s ages was

somewhat skewed. The research was also lim-

ited to male and female parents from two-parent

families because of the differences between sin-

gle and two-parent families, in terms of family

dynamics and child health outcomes (Gorman

& Braverman, 2008). A sample of 14 parents,

comprised of 12 mothers and two fathers, from a

low SES metropolitan local government area of

South Australia participated in the investigation.

SES was derived from the ABS SEIFA measure

(ABS, 2008a) and the South Australian Social

Atlas of Health (Glover et al., 2006). Prior to the

recruitment stage, this study was approved by

the Flinders University Social and Behavioural

Research Ethics Committee.

ProcedurePotential participants became aware of the proj-

ect through various family services agencies and

community centres within the local government

area. Information about the project and the con-

tact details of the researchers was disseminated

to clients through agency representatives. Over

a period of 8 weeks, participants indicated their

willingness to be involved in the project by con-

tacting the researcher directly, and additional

participants were then recruited by means of

snowball sampling.

Data for the study emerged from a series of

focus group discussions and in-depth individual

interviews. Prior to the individual interviews,

two focus groups were conducted to collect

data from 10 participants. The groups con-

tained six and four participants, respectively,

and lasted approximately 1 hour. Focus groups

were chosen for data collection as they facilitate

the generation of rich, descriptive data through

the exchange of ideas and comments (Freeman,

2006). Patton (2002) reinforces the strength of

the focus group methodology by outlining its

capacity to encourage participants to consider

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Given the recent shift in culture towards a

modern healthcare environment supported by

electronic processes, it is prudent to consider

online information seeking in the context of

eHealth literacy, defi ned as ‘the ability to seek,

fi nd, understand, and appraise health information

from electronic sources and apply the knowl-

edge gained to addressing or solving a health

problem’ (Norman & Skinner, 2006, p. 1). The

majority of parents expressed a number of con-

cerns in relation to the Internet, which compro-

mised their ability to access quality information

necessary to make decisions in relation to their

children’s physical health. First, online informa-

tion seeking was deemed a time consuming pro-

cess. The information-rich World Wide Web

was perceived by many as a source of ‘informa-

tion overload’, which could make parents feel

overwhelmed when trying to locate relevant

information. Contradictions lie between the

benefi ts and negative implications of being pre-

sented with a vast amount of data. On one hand,

the Internet was considered to be a useful tool,

as it provided immediate access to a wealth of

information about any topic. In contrast, many

participants described the internet as a ‘time-

sucker’ and discussed the diffi culty of knowing

‘how and where to look’. One father stated:

If you’re starting completely from scratch with no idea there’s no help. You’re on your own basically. You’ve just got to work out what to do for yourself.

In general, participants also acknowledged

that the Internet was an unregulated environ-

ment and agreed that the most diffi cult aspect

of online information seeking was their lack of

ability to critically appraise the dietary informa-

tion presented. This was commonly attributed

to a lack of opportunity to develop such skills.

Only one parent specifi cally stated that she was

confident of critically seeking and evaluating

information, however she attributed this under-

standing to skills she had developed through her

university nursing degree. Other parents stated

that they were most likely to believe information

presented by government departments, while

others expressed diffi culty with knowing what to

trust in general, as they did not have access to any

Data analysisAll of the focus group and individual discussions

were audio recorded and transcribed verbatim.

Following transcription, data were analysed using

an inductive approach (Thomas, 2006). According

to Thomas (2006), such a methodology allows

themes and patterns to emerge from raw data col-

lected, thereby refl ecting the original discussions.

The analysis consisted of several phases including

initial familiarisation with the data, followed by

thematic analysis. As outlined by Bradley, Curry,

and Devers (2007), this type of analysis involves

categorising and coding the emergent themes in

accordance to particular phrases or text segments.

Inductive analysis led to the emergence of fi ve

primary themes.

RESULTS

The following section outlines the themes iden-

tifi ed through inductive analysis, which spe-

cifi cally related to the ways that parents seek,

understand and utilise dietary information.

Accessing and understanding dietary informationOnline information seekingParents indicated almost unanimously that the

Internet was their primary source of dietary infor-

mation. This highlights a cultural transition towards

the use of the Internet as an important mode of

communicating health information, network-

ing, and consequently, health information seeking

(Berkman, Davis, & McCormack, 2010; Hesse &

Shneiderman, 2007). According to one parent:

There’s lots of stuff over the internet now which is healthy. I think if you know where to look it’s out there.

Participants predominantly sought dietary

information from the search engine Google and

several parents also accessed organisational web-

sites, such as Heinz or the Heart Foundation,

to locate information such as healthy recipes.

Participants also used the Internet to inter-

act with other parents or health professionals,

through the use of online forums and social

support networks, in order to discuss nutrition

related issues.

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specifi cally expressed concern. Parents agreed

that they would only seek dietary advice from

a doctor or dietician if they were concerned

about their child’s weight or if there was a spe-

cifi c dietary issue. One parent confi rmed this by

stating:

I’d only see the GP if I had concerns. My youngest was still at CAFS (Child and Family Services) until he was fi ve and they measured his weight and height, and so far they’ve both been fi ne. But if I did think something was wrong I would go to the doctor or a dietitian even.

Achieving nutritional wellbeing: A two-tiered conceptTwo distinct reactions can be discerned from

the question regarding how participants under-

stood children’s nutritional requirements. On

one hand, the majority of participants indicated

that knowing how to achieve and maintain a

good diet was simple and straightforward. One

parent refl ected:

But you know, everyone knows that you should eat more fresh fruit and veg and organic and all that sort of stuff. They put across that message a lot through the TV and newspapers. You hear about it all the time.

A good diet was considered an important part

of children’s health, in order to prevent certain

conditions such as obesity. Accordingly, many

participants expressed the view that modelling

healthy behaviours was an important goal. As

one parent explained:

It’s keeping them healthy with fresh fruit and veg-gies, the fi ve food groups. Children are more likely to do what they see, than what they’re told. So if they see parents living a healthy lifestyle and eating well and making the right choices they’re going to follow I think.

While all parents demonstrated an under-

standing of the basic components of a good qual-

ity diet, most experienced diffi culty with the

more complex aspects of dietary intake, includ-

ing food labels and recommended daily servings.

Deciphering food labels was perceived to be ‘time

consuming’ and ‘complicated’, and it was often

diffi cult for parents to determine whether a prod-

uct was actually healthy. Many parents expressed

guidelines that could be used to assess credibility.

For instance, one parent commented:

When you look on the Internet, you could just be someone like me, or somebody who doesn’t have a qualifi cation could write something, put their name on it, and call themselves a health professional, and you read what they’ve written. You’ve really just got to look on the Internet and hope you’re reading the right thing.

Information seeking via interpersonal and organisational networksParents consistently discussed the benefi ts of

interpersonal networks, such as relationships

with family and friends, and often felt most com-

fortable accessing these networks for nutritional

advice. Participants readily sought information

from family members or friends who had been

through the experience of becoming a parent,

as these individuals had ‘shared similar experi-

ences’. Accordingly, information was deemed

practical and related to ‘real life’, and was there-

fore extremely relevant to individual needs. One

mother enthusiastically exclaimed:

It’s just so helpful when you can talk to other parents who have been through what you’re going through.

Several parents also discussed the transmission

of information through these networks in terms

of a two-way fl ow. As one participant suggested:

A lot of it is just talking to groups of mums who are similar to me, who’ve had kids. So you know, what they do and what they suggest. I mean my girlfriend just went to a talk about preservatives at the school so then she may bring that information back to me and say ‘look, these certain biscuits have a lot of preserva-tives so don’t get those’. And then I might do the same for her.

Conversely, organisational networks, such

as interactions with general practitioners (GPs)

and dietitians, were used less frequently to access

information related to children’s diets. There

was a universal acknowledgement that health

professionals were not a source of general health

promotion information related to children’s

nutrition. Instead, their roles were associated

with the treatment of prevailing medical condi-

tions, or the provision of advice to parents who

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While most participants stated that they tried

to choose nutritious foods, several parents cau-

tiously indicated that they sometimes purchased

cheaper alternatives such as McDonalds, from

a cost and time-saving perspective. Participants

agreed that maintaining a healthy lifestyle was

more time consuming, in comparison to prac-

ticing unhealthy behaviours. Activities such as

stopping to read food labels whilst grocery shop-

ping, chopping, preparing and cooking healthy

meals, as well as ‘washing up ready for the next

day’, were perceived to be particularly laborious

and, consequently, diffi cult to factor into a busy

schedule. In contrast, takeaway meals and pre-

packaged foods appeared to save a lot of time,

in terms of preparation and cleaning. This view-

point was refl ected by one mother who stated:

I’d say, rather than making soup I’ll buy it canned because of the time factor.

Many parents also attributed lack of time to

maternal employment, which restricted their

capacity to prepare healthy meals in a timely

manner. As one participant discussed:

Well back then [in the past] they used to bake a lot because a lot of mothers didn’t work but I’m fi nding now that a lot of, like both parents have to work to pay the mortgage, so children are forced to eat unhealthy snacks because there isn’t the time.

The infl uence of the mediaAll participants felt that they were engaged in

a constant ‘battle’ against certain aspects of the

media, with regard to encouraging healthy

behaviours amongst their children. Television

advertising was deemed the most infl uential

aspect of media marketing, particularly in terms

of fast food. The majority of parents were of

the opinion that fast food restaurants, namely

McDonalds and Hungry Jacks, persuaded chil-

dren to pester parents for their products, by fre-

quently enticing the children with themed toys.

As one parent indicated:

When you’re driving around you can see the big M, you can see Red Bull, but you never drive past a bill-board with a big apple on it. Healthy eating is not promoted at all because junk food is a much bigger money grabber.

concern too for their lack of ability to calculate

the overall dietary intake from all foods consumed

in a day. One parent confi rmed such assertions

by stating:

On the food labels I try to look at those recommended daily intakes. But that’s just for that particular item, so it’s complicated because you have to work out how many things you’re going to have in the whole day.

When questioned about their understanding

of the Australian Guide to Healthy Eating (DoHA,

1998) only two participants were familiar with

the pictorial ‘food circle’ and others, in some

cases, were unaware of any dietary guidelines for

children, apart from those promoted through the

Go for 2&5 campaign. Some parents commu-

nicated that it was quite diffi cult to understand

recommended servings for different food groups.

This could consequently become a source of

confusion, particularly when trying to determine

‘how much is too much’. Indicative of other par-

ents, one participant reported:

Like you know roughly what foods they can have but sometimes it’s how often. Like how many times for carbohydrates a week? I just do a rough guide but at the end of the day, how do I know if it’s right? It’s hard and it comes down to your judgment.

Utilising dietary informationThe cost of physical healthThere was a strong consensus amongst partici-

pants that applying dietary information, in order

to maintain a healthy diet, was more costly and

time consuming than not following healthy mes-

sages. For example, ‘healthy’ foods, including

fresh fruit, vegetables and meat, were perceived

to be undeniably more expensive than ‘junk’

foods, such as processed products and takeaway

food. One mother was of the opinion that:

There is a healthy section down the supermarket aisle but the snacks are heaps more expensive. You know, healthy snacks could just be cutting up carrots, but then it’s getting them to actually eat it.

Another parent concurred by explaining:

If you weigh up what it costs to eat McDonalds every night for dinner it would be way cheaper than to buy fresh ingredients and cook yourself.

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currently plays a key role in the dissemination of

health information, the specifi c skills and capa-

bilities that form part of the eHealth literacy con-

struct have become an important component of

health literacy (Berkman et al., 2010; Kreps &

Neuhauser, 2010). Participants identifi ed a num-

ber of positive and negative factors associated

with their online information seeking. Findings

from this study support the social construction of

the Internet as a comprehensive source of health

information that provides access to a wealth of

different facts and suggestions, thus emphasis-

ing its capacity to facilitate health promotion

amongst users (Kreps & Neuhauser, 2010).

However, participants also reported navigational

diffi culties, in that it was often challenging to

locate useful information in a timely manner,

with the assurance that the data was accurate

and credible. Concerns regarding the Internet’s

information overload (Cline & Haynes, 2001)

and the integrity of health information presented

in a highly unregulated environment (Brodie

et al., 2000) are widespread. While parents

expressed a desire to be technology-savvy, this

was commonly deemed to be a diffi cult task.

Advanced technological ability in this case was

attributed to the perceived benefi ts of further

education or training, thereby providing some

insight into the social construction of technology

related attitudes amongst this group. This study

has therefore emphasised the importance of con-

sumers’ motivation and ability to achieve critical

literacy (Nutbeam, 2000) in order to critically

and effi ciently seek online health information to

distinguish accurate facts from misleading infor-

mation. Accordingly, it becomes imperative that

interventions focus on empowering parents by

developing skills in conducting Internet searches,

in order to facilitate the effective retrieval and

appraisal of online health information (Gilmour,

2007). Examples may include short demonstra-

tions of Internet use (Gilmour, 2007) or the

provision of simple resources, such as structured

guidelines, for parents to evaluate the quality of

information. These services and resources need

to be accessible to all community members. It

was also clear from participants in this study

that there is a need for the promotion of already

While some parents attempted to minimise the

effects of advertising by restricting their chil-

dren’s exposure to commercial television, their

children were still a target for marketing strat-

egies which aimed to create buying power at

supermarkets, through the appealing presen-

tation of products endorsed by well-known

companies. Most parents expressed concern in

relation to unhealthy foods which were branded

by ubiquitous cartoon and movie characters, as

children were instantly drawn to these items.

One mother described her frustration in relation

to this matter by stating:

One of the things I’ve found incredibly diffi cult is that Disney likes to slap their logo and characters over everything and that’s hard at this age because it’s on the evil, high-sugar yoghurt with very little value in it. But she sees it displayed there and she wants it, just because it’s got Disney princesses on it!

The impact of peer pressure was also a point of

discussion amongst parents. There was a mutual

understanding that peers, particularly those from

school or kindergarten, had the potential to shape

children’s food preferences to some degree. Peer

pressure was particularly challenging for parents

to overcome, considering that children would

often align themselves with friends of the same

age, as a basis for comparison. Patterns of nag-

ging or ‘pestering’ would often result, which

commonly lead to a state of parental guilt, given

that parents did not want to make their children

feel left out. Several parents admitted that they

were more likely to succumb to feelings of guilt

when they were feeling tired, rushed, or impa-

tient. One mother explained:

You can’t guard against it or protect them from it, because it’s going to happen, so you’ve got to work out a way of getting around it and explaining that, ‘in our family we don’t do this’, but that’s a really hard thing.

DISCUSSION

This qualitative study outlined a wide range of

factors that participants associated with accessing,

understanding and utilising dietary information.

Parents accessed dietary information by means of

two primary pathways; the use of the Internet and

interpersonal networks. Given that the Internet

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perspective suggests that the environment will

play a signifi cant role in shaping beliefs, norms

and constructions around food and health. Since

children continuously construct knowledge and

beliefs through their social interactions, aggres-

sive advertising strategies that are ongoing may

indeed frame certain products as desirable and

fun treats that can be consumed on a daily basis.

It is not surprising, therefore, that such active

strategies have been shown to evoke pestering

behaviours amongst children (Marshall et al.,

2007; Nicholls & Cullen, 2004). Participants also

reported that pestering was enhanced by peers,

who were therefore acknowledged as signifi cant

infl uences on children’s socialisation and food

preferences (Campbell et al., 2007). Ultimately,

the underlying socially constructed norms must

be addressed. The obvious case for change cen-

tres on the possibility for industry regulation

and the stringent restriction of unhealthy food

promotion. Additionally, initiatives to improve

children’s ability to critique food advertise-

ments may challenge already established norms.

Although the negative infl uence of friends was

reported for this study, it is also important to

acknowledge peers as potential agents for posi-

tive change, particularly within a health promot-

ing school setting (Drummond, 2010).

While the notion of physical health was

generally deemed ‘straightforward’ by the par-

ticipants within this study, most parents expe-

rienced diffi culty with more complex aspects

of children’s physical health, related to detailed

recommendations. The majority of partici-

pants were unaware that the Nutrition Australia Healthy Living Pyramid had been replaced by

the Australian Guide to Healthy Eating (DoHA,

1998) and all parents were unfamiliar with cur-

rent recommended servings for children, across

food groups. Conversely, most participants were

familiar with the recommended two serves of

fruit and fi ve serves of vegetables, promoted

through the Go for 2&5 media campaign, which

further refl ects the success reported for this

nutrition education programme in terms of dis-

seminating basic health information (Hendrie,

Coveney, & Cox, 2008). In light of these fi nd-

ings, the promotion of the Australian Guide to

established sites which are accurate, reliable and

user-friendly.

Interpersonal networks, comprised of family,

friends and other parents, served as a form of

social support for participants, as well as a source

of nutritional information. It is widely accepted

that individual networks of interpersonal rela-

tionships are often a means by which health

information is exchanged (Brashers, Goldsmith,

& Hsieh, 2002; Dutta-Bergman, 2004) so that

individuals may receive advice from others with

‘tangible experience’ (Cotten & Gupta, 2004,

p. 1796). In the case of the present study, the

transmission of information enabled parents to

exchange practical information that was rel-

evant to their needs, thereby reinforcing socially

constructed norms around diet and appropri-

ate parenting and creating a system of shared

meaning (Burr, 2003). This fi nding corroborates

research from Cotten and Gupta (2004, p. 1796)

which indicates that individuals tend to seek

general health advice from lay individuals who

are ‘approachable and amicable’ in preference

to health care providers, who do not generally

serve as the primary source of broad lifestyle

advice (Richmond, Kehoe, Heather, Wodak, &

Webster, 1996).

Another important theme that emerged

during the interviews was an apparent paradox

between a common sense view of health and a

more complex conception of nutrition. On one

hand, parents claimed that simple public mes-

sages about the consumption of fresh fruit and

vegetables were frequently conveyed through

the media and the school system, which sug-

gests that basic nutritional messages appear to be

reaching the wider community. It is interesting

to note, therefore, that parents also acknowl-

edged the negative effects of the media, in terms

of encouraging unhealthy dietary behaviours

amongst their children through television adver-

tisements and marketing strategies. This fi nding

refl ects a strong theme in the literature pertaining

to the infl uence of food advertisements aimed at

children, which promote the purchase and con-

sumption of energy-dense, nutrient-poor prod-

ucts (Campbell, Crawford, & Hesketh, 2007;

Mehta et al., 2010). A social constructionist

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peer infl uences, the factors of fi nancial burden

and time largely determined whether certain

public health messages were put into practice.

Consistent with prior research, eating foods that

were perceived to be ‘good’ and ‘healthy’ such as

fruit and vegetables (Drummond & Drummond,

2010), was associated with greater fi nancial pres-

sure (John & Ziebland, 2004; Maubach, Hoek,

& McCreanor, 2009) compared to choosing

unhealthy alternatives. Furthermore, increased

time was attributed to selecting healthy foods,

preparing and cooking nutritious meals (Jabs

et al., 2007; Tillotson, 2002) and cleaning up

(Carrigan, Szmigin, & Leek, 2006). Evidently,

the ways in which health and nutrition are socially

constructed plays a signifi cant role in the health

literacy of parents and children. The social con-

struction of a ‘fast-paced’ modern lifestyle that

incorporates maternal employment also enabled

participants to attribute unhealthy behaviours

to a general lack of time. Convenience foods,

including pre-packaged soup and fast food, were

framed as an ‘easy’ option, as opposed to the tra-

ditional ‘homemade’ baked goods that some par-

ticipants described. Given these results, one can

argue that socio-cultural infl uences, such as the

emergence of convenience foods are symbolic

of a fast-paced, contemporary lifestyle that peo-

ple mutually understand (Carrigan et al., 2006).

Although participants accepted this cultural shift

towards convenience, it is interesting to note

that the concept appeared to have a subtle nega-

tive moral connotation, in terms of the inher-

ent guilt attached to trading off health for the

benefi ts that these foods provided. Again, we are

reminded of the socially constructed notion of

the ‘healthy’ consumer who is responsible for

taking care of his/her own health by following

public messages and purchasing healthy foods

(Schneider & Davis, 2010). This extends to child

rearing, whereby there is often a moral impera-

tive for the parent or caregiver to minimise harm

and account for his/her child’s dietary intake and

health status.

Therein lies the challenge of encouraging par-

ents to navigate their way through such socio-cul-

tural infl uences, in order to build health literacy

and challenge the social constructions of health

Healthy Eating may enable parents to identify

which foods should be consumed in the great-

est proportions, across all food groups. The

consumer booklet provides valuable information

pertaining to recommended daily serves of vari-

ous food groups, as well as practical examples of

what constitutes a serve.

Participants also experienced diffi culty inter-

preting certain aspects of food labels, including

numerical information and various terms listed.

The most diffi cult aspect of comprehending

food labels was related to participants’ lack of

ability to compile information from different

food labels to conceptualise a healthy diet, in its

entirety. Similar views have also been reported

within the literature (Cowburn & Stockley,

2005; Hendrie et al., 2008). Considering that

food labels are a means by which individuals can

distinguish healthy products from less nutritious

items at the point of sale (Kelly et al., 2009) con-

sumers need to be equipped with adequate skills

to read the labels and analyse the information

presented (St Leger, 2001).

However, for these parents, understanding

the fat, sugar and salt content within a product

was mutually regarded as an expert task, and put-

ting this knowledge into practice was considered

diffi cult. This refl ects the societal tendency to

emphasise the role of the individual consumer

to self manage his/her own health (Schneider

& Davis, 2010), by reading the label and choos-

ing the healthy alternative. A consumer has a

right to understand the composition of different

foods, and the majority of participants certainly

expressed a need for more resources which could

focus on improving their comprehension of

nutrition labels. From a public health perspective,

future interventions should focus on improving

the design of Australian food labels, by promoting

a consistent form which is simple and meaningful

for the average consumer (Kelly et al., 2009).

It is also noteworthy to acknowledge the

social construction of the meaning of health and

nutrition, which became apparent throughout

the interviews. Although the participants of this

study expressed their intention to provide healthy

foods to their children, there were many elements

to the food exchange. In addition to media and

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families, across diverse communities, live their

everyday lives, one can begin to build an under-

standing of the ways in which health related atti-

tudes and behaviours are socially constructed,

maintained and perpetuated in contemporary

society. Future research should aim to develop

a deeper understanding of the ways that families

navigate their way through contemporary health

information by further examining the social and

cultural factors that infl uence health literacy.

Research efforts may therefore extend to explore

the collective health literacy of parents and chil-

dren, in order to further understand health seek-

ing behaviours amongst families.

ACKNOWLEDGMENTS

Thank you to all of the parents who shared their

stories and experiences with us. Without their con-

sent, this research would not have been possible.

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Volume 22, Issue 2, June 2013 © eContent Management Pty Ltd150

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American Journal of Public Health, 92(2), 246–249.

Received 21 June 2011 Accepted 13 February 2012

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Child and parental mental ability and glycaemic

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systematic review. Archives of Pediatrics and Adolescent Medicine, 163(2), 131–140.

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St Leger, L. (2001). Schools, health literacy and public

health: Possibilities and challenges. Health Promotion International, 16(2), 197–205.

Stanton, R. (2006). Nutrition problems in an obe-

sogenic environment. Medical Journal of Australia, 184(2), 76–79.

C A L L F O R P A P E R SExploring the human–environment connection: Rurality, ecology and social well-being

A special issue of Rural Society – Volume 23 Issue 2 – ISBN 978-1-921980-29-9 – February 2014

DEADLINE FOR PAPERS: 31ST AUGUST 2013

Guest Editors: Shelby Gull Laird (Environmental Sciences, Charles Sturt University) and Angela Wardell-Johnson (Sustainability Research Centre, University of the Sunshine Coast)

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