Search Results (506)

Objectives: Type 2 diabetes mellitus (T2DM) is an increasing public health concern in Thailand, particularly in rural communities where dietary practices and contextual factors may influence glycemic control. This study aimed to assess nutritional knowledge, attitude, and eating behavior using the Knowledge–Attitude–Practice (KAP) framework and to compare nutritional intake profiles between patients with controlled and uncontrolled glycemic status. Methods: A cross-sectional study was conducted among 70 patients with T2DM attending a health-promoting hospital in northeastern Thailand. Participants were classified into glycemic-controlled (GC; HbA1c < 7%, n = 36) and glycemic-uncontrolled (UC; HbA1c ≥ 7%, n = 34) groups. Data were collected using a semi-structured questionnaire covering demographics, anthropometry, body composition, biochemical parameters, and KAP domains. Dietary intake was assessed using three-day food records (two weekdays and one weekend day) and analyzed with the INMUCAL Nutrients program. Statistical analyses included descriptive statistics, group comparisons, logistic regression, and Spearman’s correlation. Results: Overall, participants demonstrated high levels of nutritional knowledge (71.4%) and fair attitude (52.9%), but moderate levels of appropriate eating behavior (58.6%). Eating behavior differed significantly between GC and UC groups (p = 0.038). The UC group consumed significantly higher amounts of total energy, carbohydrates, simple carbohydrates, and protein than the GC group. HbA1c and fasting blood glucose were positively correlated with total energy, carbohydrate, simple carbohydrate, and zinc intake, while protein and phosphorus intake were positively associated with fasting blood glucose only. Logistic regression analysis showed no significant associations between KAP domains and glycemic control. Conclusions: Glycemic control among rural Thai patients with T2DM was more closely related to dietary intake patterns than to nutritional knowledge or attitude alone, highlighting the need for context-specific, community-based dietary interventions. Full article

Migrant agricultural workers (MAWs), predominantly individuals from countries in the Global South, play a vital role in maintaining Canadian food security. Employed in low-income positions across the country, they often face workplace hazards and numerous occupational health and safety (OHS) challenges related to long working hours, limited access to OHS information, gaps in knowledge, structural power imbalances with employers, and language and cultural barriers. This pilot study explored the knowledge, attitudes, and perceptions of OHS issues among MAWs in Southern and Eastern Ontario during the COVID-19 pandemic. Participants completed survey questions on working conditions, OHS hazards, and living conditions. A total of 93 questionnaires were completed, 55 by Spanish-speaking and 38 by English-speaking individuals, with 91% of respondents identifying as male. Several participants reported awareness of positive COVID-19 cases in their workplaces, and some indicated having experienced OHS-related illnesses or injuries but felt uncomfortable reporting them to supervisors. Knowledge of OHS rights varied, with a notable minority uncertain about their entitlement to sick leave. The findings indicate a need for further research and targeted interventions to strengthen health and safety practices among MAWs and to ensure they are informed, protected, and supported in exercising their workplace rights. Full article

Background/Objectives: Colorectal cancer (CRC) disproportionately affects Romania, where mortality exceeds the EU average and screening uptake remains low. Diet is among the most modifiable CRC risk factors, yet no validated instrument for assessing nutritional knowledge, attitudes, and practices (KAP) related to CRC prevention exists for the Romanian population. We developed and pilot-tested the EduNutriCRC questionnaire and characterised the corresponding nutritional KAP profile of Romanian adults. Methods: In a cross-sectional pilot study (April–May 2026), a convenience sample of 301 Romanian adults aged 18–74 years completed the 51-item self-administered questionnaire. The instrument was evaluated for internal consistency and dimensional structure (exploratory factor analysis), with non-parametric tests used for group comparisons. Results: The composite knowledge score (C1–C9; maximum 9) was 6.12 ± 2.25 with wide item-level variation. Internal consistency was acceptable, and the Attitudes subscale resolved into two factors (Motivation & Self-Efficacy and Perceived Barriers). Screening engagement was critically low (92.4% never tested; 81.7% unaware of the national programme). Although 64.1% expressed willingness to change their diet, 46.2% reported consuming processed meat at least weekly. Motivation & Self-Efficacy, but not the knowledge score, was inversely correlated with risk-food consumption (ρ = −0.39, p < 0.001). Conclusions: EduNutriCRC demonstrated acceptable psychometric properties at the pilot stage. The study identified prevalent nutritional misconceptions, a marked knowledge–behaviour gap, low screening awareness, and a structural mismatch between information sources used and those trusted. Attitudes and self-efficacy, rather than factual knowledge, were the more proximal correlates of dietary behaviour, supporting the development of self-efficacy-focused, culturally adapted educational interventions for CRC prevention in Romania, with EduNutriCRC serving as a baseline and monitoring instrument. Full article

Protein intake recommendations for patients with chronic kidney disease (CKD) stages 3–5 without kidney replacement therapy (KRT) remain controversial. This study investigated current practice trends related to the 2020 Kidney Disease Outcomes Quality Initiative (KDOQI) protein guidelines and dietitians’ perspectives on low-protein diets (LPDs) and plant-based diets in CKD. This mixed-methods explanatory sequential study included a secondary analysis of an online survey (N = 87), followed by a conventional content analysis of two virtual focus groups (N = 11). Most survey respondents reported prescribing the KDOQI-recommended protein amounts of 0.55–0.6 g/kg/d in patients without diabetes (65.9%) and 0.6–0.8 g/kg/d in patients with diabetes (81.5%). Use of keto-acid analogs (KAs) was low among survey participants (18.4%). Focus group participants described varied approaches for calculating protein goals but overwhelmingly stressed the importance of individualized care. Key factors influencing recommendations included nutritional status, food preferences, comorbidities, current intake, and knowledge, beliefs, attitudes, and motivations. In summary, most participants recommended LPDs consistent with the KDOQI guidelines; however, KA use was uncommon. Despite differences in decision-making, participants emphasized individualizing protein recommendations to each patient’s unique needs. Given the exploratory nature of this work and the small, self-selected sample, these results provide preliminary insights that warrant further investigation in more diverse samples. Full article

Background/Objectives: Early childhood is a critical period for establishing lifelong dietary patterns, and early learning environments play a central role in shaping children’s eating behaviors. However, many childhood educators receive limited training in evidence-based nutrition practices. This study evaluated the impact of the Feeding Brighter Futures workshop, an experiential, case-based training intervention, on participants’ nutrition-related knowledge, perceptions, and attitudes. Methods: Using a pre–post survey design, undergraduate and graduate students, faculty, and staff (n = 33 pre; n = 19 post) from universities in Mississippi and southeastern Arkansas completed electronic surveys before and after the workshop. Survey questions aimed to assess participants’ knowledge of nutrition-focused regulations pertaining to early learning centers and comprehension of USDA MyPlate recommendations. Results: Results showed a statistically significant increase in agreement that teachers should only consume snacks available to children and further strengthening of already positive attitudes toward involving children in snack preparation. Attitudes toward using food as a reward did not significantly change. Conclusions: These findings suggest that brief experiential training may improve alignment with evidence-based nutrition practices, though further research with larger samples is warranted. Full article

Background/Objectives: Nutrition during childhood and adolescence is a key determinant of long-term health, influencing metabolic homeostasis, neurocognitive development, and immune system maturation. Globalization and technological advances have reshaped food production and consumption, increasing the availability of ultra-processed foods (UPF) of low nutritional quality. This study aimed to investigate the relationship between parental factors, namely food literacy, perceived barriers and enablers, dietary attitudes, and healthy eating behaviors, and the consumption of discretionary UPF among children and adolescents living in 5 Mediterranean countries. Methods: This cross-sectional study was based on a survey completed by 2011 parents of children and adolescents aged 6–17 years from 5 Mediterranean countries, who reported on their children’s dietary and lifestyle habits. Adherence to the Mediterranean diet was assessed through the KIDMED index. Parental food literacy was measured using the Short Food Literacy Questionnaire (SFLQ). Perceived barriers and enablers were assessed based on the Theory of Planned Behavior, and parents’ attitudes toward their child’s diet were evaluated using the Healthy-Eating Attitudes Questionnaire (HEAQ). Finally, the Theory of Internet Use Related to Health (TIUH) questionnaire was used to assess parents’ tendencies related to health information use online. Results: Higher perceived barriers and enablers were significantly associated with lower discretionary UPF consumption across all models. Parental food literacy (SFLQ) showed a positive association with discretionary UPF consumption, remaining significant in the fully adjusted model, although with reduced magnitude. Healthy-eating attitudes (HEAQ) were initially positively associated with discretionary UPF intake but lost statistical significance after full adjustment. Regarding health-related internet use (TIUH), the Health Information dimension showed a strong positive association with discretionary UPF consumption, while other dimensions (Consciousness and Beliefs) showed inconsistent and non-significant associations in the fully adjusted model. Conclusions: Children’s consumption of discretionary UPF is shaped by several interrelated factors, such as family environment, eating patterns, and parents’ perceptions, rather than solely by knowledge or attitudes. Full article

Spirulina, a cyanobacterium recognized for its nutritional and environmental advantages, has emerged as a potential ingredient for sustainable diets. Consumer acceptance remains limited despite its benefits, particularly due to sensory challenges and limited prior awareness. This study aimed to investigate knowledge, consumption patterns, and attitudes toward Spirulina among a Brazilian sample. A cross-sectional online questionnaire distributed via social media and public spaces yielded 933 valid responses, categorized into three groups based on prior awareness and consumption history. Results indicated limited prior awareness and low consumption, with more than half of consumers having tried Spirulina only once. Education, income, generation, and health-related behaviors were associated with knowledge and consumption, although most effect sizes were small. Knowledge of Spirulina was concentrated on nutritional attributes, whereas environmental and technological attributes were less widely recognized. Health and environmental benefits were most often rated as increasing willingness to consume Spirulina, while self-reported barriers included taste, smell, and issues related to powdered and capsule forms. Preferred applications were in familiar food categories such as baked goods and powdered mixes. These findings indicate that Spirulina occupies a niche position among respondents and suggest the relevance of sensorially acceptable formulations, tailored communication strategies, and inclusive educational efforts. Full article

Despite the growing attention paid to sustainability education, limited quasi-experimental research has examined how metacognitive guidance can integrate cognitive, affective, and agency-oriented learning in food-related climate education. This classroom-based quasi-experimental study, complemented by student interviews, investigated a six-lesson metacognitive guidance-based unit designed to strengthen ninth-grade students’ sustainable food literacy (SFL), climate-change perceptions and attitudes, and constructive hope. Participants were 59 students from two intact classes in northern Israel; one class received the intervention, and the other received traditional instruction on the same content. Quantitative data were collected through a sustainable food and climate change knowledge test and a climate change literacy questionnaire and were analyzed using mixed-design repeated-measures ANOVA, t-tests, and multiple regression. Qualitative data were obtained from individual semi-structured interviews with students in the experimental group. Results indicated significant intervention-related gains in SFL knowledge, climate-change perceptions, climate-change attitudes, and constructive hope, with moderate-to-large time × group effects across the main outcomes (partial η² = 0.16–0.33). Climate-change perceptions emerged as the strongest post-intervention predictor of constructive hope (β = 0.92, p < 0.001). Interviews illustrated how reflective prompts, self-monitoring, discussion, and learning artifacts supported conceptual understanding, moral responsibility, perceived agency, and self-reported short-term intentions for sustainable food choices. The findings suggest that metacognitive guidance can support integrative, hope-oriented sustainability learning among adolescents. These findings should be interpreted cautiously given the small non-random sample, the use of two intact classes, the short six-lesson intervention, and the reliance on short-term self-reported outcomes. The study’s novelty lies in integrating sustainable food literacy, climate-change perceptions and attitudes, and constructive hope within a metacognitively guided food–climate unit in a culturally underrepresented Druze school context. Full article

Owning a pet dog provides significant mental and physical health benefits for humans. However, undesirable canine behaviors may result in bite or scratch injuries, leading to infection risks, psychological consequences, and potential dog abandonment. This study hypothesized that specific human–dog interactions are associated with unwanted canine behaviors and may increase the risk of injury in humans. The objectives were to determine the prevalence of dog-related bite and scratch injuries; assess dog owners’ knowledge, attitudes, and practices; and evaluate their associations with specific interaction patterns. Data were collected through an online survey of dog owners in Thailand. Most respondents were young women with a bachelor’s degree, residing in Central Thailand, and owning a single dog. Interactions associated with increased injury occurrence included grooming; administering medication; removing food or toys; interrupting dog fights; and close physical contact including petting, hugging, and kissing. Injuries in strangers were most commonly triggered by entry into the dog’s territory. Younger owners (18–34 years) were at increased risk, particularly during grooming and frequent petting. General awareness of rabies, bacterial infection, and wound management was adequate. However, there were still misconceptions about dog behavior. These findings highlight key risk factors and support targeted educational interventions to reduce injuries and improve animal welfare. Full article

Background: Food contamination in institutional food service settings remains a significant public health concern, particularly where large numbers of consumers are exposed daily. This study aimed to assess chemical and microbiological contamination, evaluate food handlers’ knowledge, attitudes, and practices (KAP), and identify contamination patterns in university food outlets. Methods: A cross-sectional study was conducted across all 77 food outlets within a university in northern Thailand. KAP was assessed using a structured questionnaire, while chemical and microbiological contamination were evaluated using standard screening methods. Results: Food handlers demonstrated generally high KAP scores; however, microbiological contamination was still observed, including Escherichia coli on food handlers’ hands (27.3%) and food-contact utensils (14.3%), as well as Salmonella spp. in ready-to-eat food (6.5%). In contrast, chemical contamination was rarely detected in screening tests. Moreover, cluster analysis identified four distinct contamination patterns, indicating heterogeneity in contamination risk across outlets. Conclusions: These findings suggest that reported food safety practices may not fully prevent contamination and that food safety management should incorporate both behavioral and operational controls to effectively reduce contamination risks in institutional settings. Full article

The water, food, and energy nexus has become central to debates on sustainability and climate adaptation, yet students’ capacity to understand these interdependencies remains unclear. This study examined knowledge and attitudes toward the nexus among 397 students enrolled in nine faculties at Bursa Uludağ University in Türkiye. Data were collected through a structured questionnaire covering demographic characteristics, conceptual knowledge, attitudes, behavioural tendencies and perceived barriers. Nexus knowledge was operationalised as a summative index of ten equally weighted items scored as correct (1) or incorrect/uncertain (0). Hierarchical regression was used to identify the determinants of nexus knowledge, and path analysis was used to test the indirect effects of knowledge on behavioural intention through professional confidence. Only 38.8% of respondents correctly identified the nexus as an interconnected resource framework and 60.7% reported no prior coursework on sustainability or climate change. Information exposure and course participation explained substantially more variance in nexus knowledge (ΔR² = 0.192) than demographic (ΔR² = 0.043) and socioeconomic variables (ΔR² = 0.074) combined. Knowledge had a significant indirect effect on behavioural intention through professional confidence (indirect effect = 0.16, 95% CI [0.09, 0.24]; final model R² = 0.398, Adjusted R² = 0.385). Attitudes were generally moderate rather than strongly environmental, and behavioural responses were highly polarised, pointing to a persistent gap between concern and action. Students identified knowledge deficits and technological limitations as the main barriers to nexus management and strongly preferred interdisciplinary coursework as the most effective educational intervention. The findings indicate that formal educational exposure plays a larger role than background characteristics in shaping nexus literacy and that embedding systems thinking into disciplinary curricula may strengthen sustainability competence among future professionals. Full article

Traditional food systems are increasingly threatened by industrialised agri-food production based on standardised processes, economies of scale, and lower production costs. This transformation risks undermining not only the economic viability of artisanal producers but also the cultural heritage, pastoral knowledge, and territorial identities embedded in traditional foods. This study contributes to rural studies and food heritage research by examining whether consumers’ willingness to pay a premium for traditionally produced foods can sustain endangered rural production systems within competitive PDO markets. Focusing on Fiore Sardo PDO cheese, the study combines a Bertrand duopoly framework with the Theory of Planned Behaviour (TPB) to connect market competition, consumer beliefs, and support for traditional agri-food systems. Data from 1640 Italian consumers were analysed using structural equation modelling. The findings show that attitudes towards cultural preservation, social recognition of traditional production, and perceived support for shepherd communities significantly influence consumers’ willingness to purchase and pay premium prices for traditionally produced cheese. Consumers associate artisanal production not only with superior sensory quality and authenticity but also with the protection of cultural identity, traditional pastoral practices, and rural landscapes. By integrating behavioural and economic perspectives, the study demonstrates that willingness to pay operates as a market mechanism through which consumers actively contribute to the resilience of traditional food systems facing industrial competition. The study advances existing literature by showing how cultural values, behavioural intentions, and market dynamics jointly shape the economic sustainability of traditional foods. Full article

Background: Dietitians play a critical role in preventing food–drug interactions (FDIs) and drug–nutrient interactions (DNIs); however, evidence regarding their knowledge, attitudes, and practices (KAP) in Saudi Arabia remains limited. Objective: The aim of this study was to assess dietitians’ KAP regarding FDIs and DNIs and examine their associations with socio-demographic and professional characteristics. Methods: A national cross-sectional study was conducted among 353 dietitians using a validated and modified questionnaire. Knowledge was assessed via 15 multiple-choice items (score range 0–15) and categorized as poor (0–5), moderate (6–10), or good (11–15). Attitudes were assessed using 8 Likert-scale statements (score range 8–40) and classified as negative (8–19), neutral (20–29), or positive (30–40). Practices were assessed via 6 frequency-scale items (score range 6–30) and categorized as poor (6–14), moderate (15–23), or good (24–30). Associations were analyzed using chi-square tests. Results: In total, 65.2% of participants demonstrated poor knowledge. Knowledge level was significantly associated with nationality (p = 0.011), educational qualification (p = 0.042), attendance at FDI/DNI training courses (p = 0.003), and inclusion of related topics during university education (p = 0.013). Higher knowledge levels were also associated with managing digestive diseases (p = 0.001), cardiovascular diseases (p = 0.020), and cancer (p = 0.031). Positive attitudes were reported by 77.6% of participants and were significantly associated with managing cardiovascular disease (p < 0.001) and obesity (p = 0.008). Good practices were observed in 36.3% of dietitians and were significantly associated with younger age (p = 0.024), more recent graduation (p = 0.006), fewer years of professional experience (p = 0.002), and managing obesity (p = 0.016). Knowledge was positively associated with practice (p < 0.001). Conclusions: Despite generally positive attitudes, substantial gaps in knowledge and practice regarding FDIs and DNIs exist among dietitians in Saudi Arabia. Strengthening academic curricula and continuing professional education is essential to enhance competency and improve patient safety. Full article

This paper evaluated low environmental risk awareness related to the food industry among students in Romanian high schools offering food-related educational programs, within the framework of Sustainable Development Goal 4 (SDG4). The study used a questionnaire based on 349 self-reported answers and interviews conducted with an independent group of 20 students. Using an informed theory of planned behavior (TPB) model and a structural equation modeling (SEM) approach, the influence of knowledge, attitude, and subjective norms on low environmental risk awareness was tested in order to understand the potential of Romanian high school students to become responsible food citizens. Subjective norms and knowledge showed significant effects on self-reported low environmental risk awareness (p < 0.001), indicating the need for interventions to consolidate pro-environmental social norms and offset low environmental risk awareness in Romanian high schools with food-related educational programs. The interviews supported the dominant importance of subjective norms over the other variables in relation to low environmental risk awareness and in shaping future food citizens. Full article

Background: The role of healthcare workers (HCWs) is crucial in promoting and educating about sustainable behaviors. This study aimed to assess Italian HCWs’ knowledge, attitudes, practices, and educational role regarding climate change and its health implications. Methods: A cross-sectional study was conducted from May to December 2024. Results: Among the 564 HCWs who participated, 45% and 40.3% considered climate change very important and urgent, respectively. Nurses, who had at least one chronic disease, who self-assessed their knowledge of climate change as good/very good, who needed additional information, and those who knew that problems in global food supply are consequences of climate change were more likely to consider it an urgent problem. Women, those married/cohabitant, and who knew that the spread of infectious diseases, problems in the global food supply, water scarcity or clean water conservation were consequences of climate change, were more likely to believe that climate change is causing health problems. Men, who had at least one chronic disease, who knew that infants/children, elderly and people with multiple medical conditions are more sensitive to climate change, those very scared of climate change, and who received information in training courses were more likely to educate patients for improving sustainability and health protection. Conclusions: Tailored training and integrating sustainability for HCWs could significantly support the health sector in adapting in climate change mitigation. Full article