Understanding Australian Adolescents’ Perceptions of Healthy and Sustainable Diets, and Perceptions and Consumption of Pulses

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for submitting the manuscript “Understanding Australian Adolescents’ Perceptions of Healthy and Sustainable Diets, and Perceptions and Consumption of Pulses” to Nutrients. The article addresses healthy eating, sustainability, and legume consumption among adolescents—topics aligned with public health and environmental agendas. However, I have some questions:

- A major limitation of the work is the number of participants, even considering the referral sampling. This limitation needs to be thoroughly discussed as it interferes with the generalizability of the results, since it disregards ethical, socioeconomic, gender, etc. factors.

- Another problematic issue in this study is that the number of focus groups was determined by school availability, and not by the saturation typical of qualitative studies. This may have restricted the depth of the analytical categories.

- An interesting point is that the title suggests that the studies conducted are related only to pulses, but in fact the research was broader than that, and pulse consumption was actually an outcome.

- In general, the abstract brings up several contexts: health, consumer perception, food choices, pulses, and at the end it even mentions the need for more cooking classes. It needs to be more dynamic and a single text that, by itself, conveys an understanding of the manuscript as a whole. My suggestion is to rewrite it.
- Line #21: this project or this study?

- Line #62: how low?

- Was pulse consumption measured only by self-report? No other measures such as food diaries or 24-hour recalls were performed. Together, all these tools would favor this answer, since self-reporting may have been induced by the focus group conducted prior to the questionnaire.

- As some of the participants speak another language at home, the study needs to delve deeper into how culture influences legume consumption—a relevant factor.
- I believe the conclusion ends up being modest due to the limitations, as indicating that "more education" will lead to behavioral changes seems quite superficial considering the different aspects of behavior.

Author Response

Comment 1: A major limitation of the work is the number of participants, even considering the referral sampling. This limitation needs to be thoroughly discussed as it interferes with the generalizability of the results, since it disregards ethical, socioeconomic, gender, etc. factors.

• Response 1: Thank you for this point. We have clarified the need for future research with greater sample sizes and representation of the broader population in line 606-611: “This study was conducted with student leaders attending a government operated high school in a metropolitan area of Australia characterised by easy access to a variety of fast food outlets and mid to lower socioeconomic advantage, and therefore findings may have varied should the study have been conducted in schools with different socioeconomic, cultural and geographical characteristics, or even amongst the wider school population within the same sample school’ and line 634-638: ‘Future studies investigating adolescents’ perceptions of healthy and sustainable diets, and pulses, and quantitative consumption data of pulses should be undertaken with different socio-economic and cultural groups, and larger sample sizes to provide more generaliseable results for the Australian adolescent population and guide future scalable interventions.”

Comment 2: Another problematic issue in this study is that the number of focus groups was determined by school availability, and not by the saturation typical of qualitative studies. This may have restricted the depth of the analytical categories.

• Response 2: Thank you for your comment. We have added text stating the implications of this limitation to line 626. “The sample size and amount of data collected from the focus groups was limited by school and student availability, rather than data collection ceasing at the point of data saturation, as is common in qualitative studies [58], which may have limited the variety and depth of themes identified.” We also have made recommendations for future research to mitigate challenges associated with data collection in the high school setting in lines 638-645: ‘In the preliminary stages of this study, several challenges were experienced in the ethical approval processes and recruitment of schools to conduct research across multiple jurisdictions and locations, which had been the original goal. Therefore future studies with Australian adolescents should develop and nurture relationship with schools and plan the research resources needed for broader, more representative data collection efforts. Alternatively, future research could consider alternate setting such as recreational or sporting facilities, or digital platforms for data collection or delivery of interventions, however sample bias must be considered in these settings’

Comment 3: An interesting point is that the title suggests that the studies conducted are related only to pulses, but in fact the research was broader than that, and pulse consumption was actually an outcome.

• Response 3: Thank you for your comment. The title aims to convey the two main focuses of this study; 1) perceptions of healthy and sustainable diets, and 2) perceptions and consumption of pulses (hence the repeated use of the word ‘perception(s)’ in the manuscript title and the use of a comma to separate these two areas of focus). Most broadly this study investigates perceptions of healthy and sustainable diets. More specifically but still within the context of a healthy and sustainable diet, this study also investigates perceptions and consumption of pulses.
• In designing the study, the research team were initially and primarily interested in perceptions and consumption of pulses by Australian adolescents. Existing literature indicated that consumption of pulses was likely to be poor, and familiarity with the concept of pulses may also be very low and therefore there was a risk that narrowing the study to only pulses only result in limited meaningful data and difficulty in drawing conclusions and implications. From the literature, we also found that understanding of healthy sustainable diets was likely to be poor and perceptions were unclear. For this reason, we also focused on gathering perceptions of healthy and sustainable diets (more broadly) with the hope that the depth of meaningful data may be greater than that for perceptions of pulses only, and that the findings may be of relevance to a broader audience. Pulse consumption was not intended to be interpreted as an indicator of a healthy and sustainable diet. We hope this further clarifies the choice of wording and grammar of our title as a reflection of the focuses of the study.

Comment 4: In general, the abstract brings up several contexts: health, consumer perception, food choices, pulses, and at the end it even mentions the need for more cooking classes. It needs to be more dynamic and a single text that, by itself, conveys an understanding of the manuscript as a whole. My suggestion is to rewrite it.

• Response 4: Thank you for your suggestion to improve the readability of the abstract to ensure it conveys an understanding of the manuscript. We have simplified the background section and improved cohesion by removing a statement. We have added a summary statement in the conclusions section to give a broad concluding remark summarising the results, separate to the implications, in lines 32-34: Perceptions of sustainable diets and pulses were very limited, and a lack of knowledge, skills and limited availability were identified as barriers to their consumption. The words ‘knowledge and skills’ and ‘accessibility and availability of appealing’ have been replaced with ‘capability’ and ‘opportunity to access’ in line 31 for consistency with theoretical framework of the study: “Consumption of pulses was below recommendations in national and international dietary guidelines. The main factors influencing pulse consumption related to students’ lack of capability to prepare pulses, and the reduced opportunity to access pulse-based foods.” Minor changes in wording have also been made to convey that results were derived from self-reported data from adolescents, rather than objective measures.

Comment 5: Line #21: this project or this study?

• Response 5: Thank you for this correction. The word ‘project’ in line 20 has been replaced with ‘study’.

Comment 6: Line #62: how low?

• Response 6: We have specified the level of consumption of pulses with the most recent Australian dietary intake data released in 2025. Line 66-68 now states, … with the average Australian consuming 12g of legumes per day, short of the national guidelines of 150-300g legumes per week and international guidelines of 75g per day [9,16,17]

Comment 7: Was pulse consumption measured only by self-report? No other measures such as food diaries or 24-hour recalls were performed. Together, all these tools would favor this answer, since self-reporting may have been induced by the focus group conducted prior to the questionnaire.

• Response 7: We have clarified that pulse consumption was measured by self-report only as part of the survey in line 631, “Quantification of dietary pulse intake was measured by self-reported short questions regarding frequency of consumption only, not by a systematic total dietary assessment methods, thus the extent to which dietary guidelines for pulses were met may be subject to over- or under- reporting” The implications of this are stated in lines 621-62, and other relevant limitations to this data collection from adolescents stated in lines 615-620 and 638-645.

Comment 8: As some of the participants speak another language at home, the study needs to delve deeper into how culture influences legume consumption—a relevant factor.

• Response 8: Thank you for this comment. We agree that culture is likely to have a strong influence on pulse consumption. Due to the small sample size discussed above, we do not feel it is appropriate to draw conclusions from our data about variability in pulse consumption patterns based on cultural background. However, we agree this is an important factor and it has been more clearly described in the discussion section in lines 618-620: Pulses are most commonly consumed in African, Asian and South American cuisines – particularly in Indian, Turkish and Middle Eastern dishes, and therefore familiarity and consumption of pulses are likely to be strongly influenced by cultural background [60]. A recommendation to investigate the influence of culture on pulse consumption has been specified in line 636: “Future studies investigating adolescents’ perceptions of healthy and sustainable diets, and pulses, and quantitative consumption data of pulses should be undertaken with different socio-economic and cultural groups and larger sample sizes…”

Comment 9: I believe the conclusion ends up being modest due to the limitations, as indicating that "more education" will lead to behavioral changes seems quite superficial considering the different aspects of behavior.

• Response 9: We agree that education alone will have little impact on changing dietary behaviour, yet when delivered in conjunction with training/practical skills and changes to the food environmental, education can address knowledge gaps and changes in dietary behaviour can be facilitated. Our conclusions were that ‘a lack of knowledge and skills, lack of cultural norms, and reduced accessibility and availability of pulse foods’ were identified as factors limiting the sustainability of diets and consumption of pulses, and that to address this, education in conjunction with simultaneous multicomponent strategies across the food system (particularly the food environment) are needed. To further strengthen the conclusion, we have added ‘practical training (including cooking classes)’ to line 657, and ‘(not education alone)’ in line 664. We have also changed the wording in the conclusion of the abstract to ‘Education and cooking classes, in conjunction with increased availability of tasty pulse foods are recommended to increase students’ pulse consumption as part of a healthy and sustainable diet’ (line 34).

Reviewer 2 Report

Comments and Suggestions for Authors

Suggestions below are aimed at improving the clarity and quality of the final manuscript.

1. Introduction - underlining that adolescent dietary habit is often the worst among children and young people/the wider population should be possible using either national or global data.
2. Methods - further information is required to rationalise the choice of a single school for representativeness of a wider population (adolescents in Queensland or Australia?). As described, this appears to be convenience sampling. This is valid but should be stated directly. Demographically, support for focus of this group might also support your findings.
3. Line 132 (and possible elsewhere) - this should read "Data were...". The term data is plural. Please check and update elsewhere through the manuscript for similar issues.
4. Methods - further detail on the process of data analysis should be included to ensure this manuscript is standalone. Was additional software involved in the process of coding or evaluation of data? How did researchers confirm themes or deal with data not defined by existing COM-B themes?
5. Table 1 (and 2) - consider limiting use of shading within tables here. This does not seem to add anything to the clarity or structure f results presentation. Should suggested interventions have n-values, or are these author interpretations rather than participant inputs?
6. Discussion - the context of adolescent food decision-making is important within the elements of discussion. While improved habits may track in later life, this is at a life stage where decision-making around food choices are expanding but still very limited. Food preparation and purchasing opportunities are generally limited within this population. Further context would help support the authors' suggestions for exposure through e.g. tuck shops/canteens but may offer less support for general recommendations around increased education.
7. Conclusions - the first line of the Conclusions "Supporting adolescents to consume healthy and sustainable diets is a priority to promote shifts in the food system that have positive and long-term human health and planetary outcomes" is not supported by information presented here. Why is improving adolescent choices more important than any other age group? I suggest removing this statement and starting with the second line is more aligned with the findings of the current research. Be careful to further consider education as a strategy to improve habit. I'm not sure there is much data to support evidence that education benefits dietary behaviours in any population group.

Author Response

Comment 1: Introduction - underlining that adolescent dietary habit is often the worst among children and young people/the wider population should be possible using either national or global data.

Response 1: Thank you for this comment. To highlight the importance of addressing adolescents’ nutrition, we have added a statement in line 41, ‘Adolescence is a period of critical and formative development for attitudes and behaviours, as well as physical growth, yet research and strategies addressing poor nutrition among adolescents have been scarce in comparison to other age groups’ and restructured the second paragraph from line 53: ‘Adherence to dietary guidelines is low, with only 5% of Australians consuming the recommended intake of fruits and vegetables [7]. Diet quality is particularly poor amongst Australian adolescents’ and is characterised by overconsumption of processed foods and underconsumption of consumption of fruits and vegetables [8]. Recent data suggests that adolescents have a lower intake of legumes than any other age group (with the exception of 2-4 year olds)[9].

Comment 2: Methods - further information is required to rationalise the choice of a single school for representativeness of a wider population (adolescents in Queensland or Australia?). As described, this appears to be convenience sampling. This is valid but should be stated directly. Demographically, support for focus of this group might also support your findings.

Response 2: The use of convenience sampling has been clearly stated in line 115: ‘The school was approached using convenience sampling through existing links…’. The word ‘Queensland’ has been removed from line 108 to avoid confusion. Further justification of the single school selection and its implications have been added in line 638 and 645 ‘In the preliminary stages of this study, several challenges were experienced in the ethical approval processes and recruitment of schools to conduct research across multiple jurisdictions and locations, which had been the original goal. Therefore future studies with Australian adolescents should develop and nurture relationship with schools and plan the research resources needed for broader, more representative data collection efforts. Alternatively, future research could consider alternate setting such as recreational or sporting facilities, or digital platforms for data collection or delivery of interventions, however sample bias must be considered in these settings.’

Comment 3: Line 132 (and possible elsewhere) - this should read "Data were...". The term data is plural. Please check and update elsewhere through the manuscript for similar issues.

Response 3: Thank you for this comment. This has been amended to ‘Data were…” in lines 137, 141 and 190.

Comment 4: Methods - further detail on the process of data analysis should be included to ensure this manuscript is standalone. Was additional software involved in the process of coding or evaluation of data? How did researchers confirm themes or deal with data not defined by existing COM-B themes?

              Response 4: No additional software was used in the coding or evaluation of data other than Microsoft Excel. The process of the identification, categorising and reporting of codes has been clarified in lines 192-197: ‘The identification of themes and supporting codes was undertaken by one author, then reviewed and agreed upon by two other authors of the research team. Some codes were identified as supporting more than one component of the COM-B model and therefore categorised under more than one theme but discussed under that which the authors agreed was most appropriate. Suggested interventions were derived directly from participants’ responses, and categorised according to the BCW.’

Comment 5: Table 1 (and 2) - consider limiting use of shading within tables here. This does not seem to add anything to the clarity or structure f results presentation. Should suggested interventions have n-values, or are these author interpretations rather than participant inputs?

• Response 5: Thank you for the suggestion to remove the shading. We have removed the coloured shading but made the headings/sub-headings more obvious through the use of bolding and italics. Thank you for your comment regarding the n-values of the suggested interventions. We have not listed n-values here has the codes were grouped according to the COM-B model (capability, opportunity, motivation and/or behaviour). The suggested interventions were derived directly from participants responses and stated according to the categories in the Behavior Change Wheel (an extension to the COM-B model, outlining relevant intervention types depending on the identified factors using the COM-B model). This has now been clarified in line 196, ‘Suggested interventions were derived directly from participants responses, and categorised according to theBCW’ but n-values have not been reported as ‘suggested interventions’ was not considered a theme under the COM-B model used for deductive data analysis.

Comment 6: Discussion - the context of adolescent food decision-making is important within the elements of discussion. While improved habits may track in later life, this is at a life stage where decision-making around food choices are expanding but still very limited. Food preparation and purchasing opportunities are generally limited within this population. Further context would help support the authors' suggestions for exposure through e.g. tuck shops/canteens but may offer less support for general recommendations around increased education.

• Response 6: Thank you for your comment here. We agree that the food environment and level of autonomy in food choice varies greatly amongst adolescents and therefore should be considered when interpreting research and designing nutrition interventions. We have specified the school lunch model context of this study, and the implications of considering this are discussed in line 543-548: ‘Importantly, the primary model for sourcing and preparing meals in the context of the target population must be considered as this can vary greatly (e.g. lunchbox model with or without a tuckshop (as common in Australia and in this study’s sample population)), full meal provision, or outsourcing meals from home or local food outlets), influences the autonomy of adolescents’ food choice, and should guide the relevant strategies that may be implemented and be considered in the identification of stakeholders.'

Comment 7: Conclusions - the first line of the Conclusions "Supporting adolescents to consume healthy and sustainable diets is a priority to promote shifts in the food system that have positive and long-term human health and planetary outcomes" is not supported by information presented here. Why is improving adolescent choices more important than any other age group? I suggest removing this statement and starting with the second line is more aligned with the findings of the current research. Be careful to further consider education as a strategy to improve habit. I'm not sure there is much data to support evidence that education benefits dietary behaviours in any population group.

Response 7: Thank you for your comments here. The first sentence has been removed, as you suggested. We agree that education alone will have little impact on changing dietary behaviour, yet when delivered in conjunction with training/practical skills and changes to the food environmental, education can address knowledge gaps and changes in dietary behaviour can be facilitated. We have added ‘practical training (including cooking classes)' to line 657, and ‘(not education alone)’ in line 664.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

This reviewer thanks the authors who made the effort to implement all the corrections requested by this reviewer. Therefore, my suggestion now is that the article can be accepted for publication.