Danish University Colleges
‘Is there fish in fish cakes?’
An interdisciplinary inquiry into the influence of a sensory-based experiential cooking course on fish on children’s food literacy and fish-eating behavior
Højer, Rikke
Publication date:
2021
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Højer, R. (2021). ‘Is there fish in fish cakes?’: An interdisciplinary inquiry into the influence of a sensory-based experiential cooking course on fish on children’s food literacy and fish-eating behavior.
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- An interdisciplinary inquiry into the influence of a sensory-based experiential theme course on fish on children’s food literacy and fish-eating behavior
‘Is there fish in fish cakes?’
PhD thesis by
Rikke Højer
This PhD thesis has been submitted to the Faculty of Science, University of Copenhagen,
November, 2020
‘Is there fish in fish cakes?’
- An interdisciplinary inquiry into the influence of a sensory-based experiential cooking course on fish on children’s food literacy and fish-eating behavior
PhD thesis November 2020 Author: Rikke Højer
This thesis has been submitted to the Faculty of Science, University of Copenhagen
University of Copenhagen Department of Food Science
Faculty of Science
Rolighedsvej 26, DK-1958 Frederiksberg C Denmark
Title “Is there fish in fish cakes?” - An interdisciplinary inquiry into the influence of a sensory-based experiential cooking course on fish on children’s food literacy and fish-eating behavior
Author Rikke Højer
Place University of Copenhagen
Faculty of Science
Department of Food Science
Topic description This PhD thesis is an interdisciplinary inquiry into the influence of a sensory-based experiential cooking course on fish on children’s food literacy and fish-eating behavior.
Principal supervisor Michael Bom Frøst Associate Professor University of Copenhagen Department of Food Science
Co-supervisor Karen Wistoft
Professor (MSO)
Danish School of Education
Department of Educational Sociology Assessment committee
Chairman Lotte Holm
Professor
University of Copenhagen
Department of Food and Resource Economics
External Jacob Lahne
Assistant professor
Virginia Polytechnic Institute and State University, Virginia, U.S.A.
Department of Food Science and Technology
External Helen Coulthard
Senior Lecturer
De Montfort University, Leicester, UK
Department of School of Applied Social Sciences
Submission date: November 3, 2020
List of papers
I. Something fishy is cooking – A survey of 11- to 13- year old Danish children’s self-evaluated food neophobia and food behavior, knowledge, and skills in relation to fish
Højer, R. & Frøst, M.B. in (sumitted to Food Quality and Preference, October 2020)
II. Play with your food and cook it! Tactile play with fish as a way of promoting acceptance of fish in 11 to 13-year-old children in a school setting – a qualitative study
Højer, R., Wistoft, K., & Frøst, M.B. in Nutrients 2020, 12 (10), 3180;
https://doi.org/10.3390/nu12103180. (Published October 17th 2020).
III. Yes I can cook a fish; effects of a five-week sensory-based experiential theme course with fish on 11 to 13-year-old children’s food literacy and fish-eating behavior – a quasi-experimental study
Højer, R. Wistoft, K., & Frøst, M.B. in (sumitted to Food Quality and Preference, October 2020) IV. Children’s self-reported reasons for accepting and rejecting foods.
Sick, J., Højer, R. & Olsen, A. in Nutrients 2019, 11(10), 2455; https://doi.org/10.3390/nu11102455.
(Published October 14th 2019).
List of scientific posters presented at international conferences
I. Promoting children's acceptance of fish through sensory-based experiments and experiential learning: Breaking through the disgust barrier.
Højer, R. & Frøst, M.B.
Pangborn Sensory Science Symposium 2017, Providence, Rhode Island, USA.
II. What’s cooking? Promoting 10-13-year-old children’s acceptance of fish through experiential learning.
Højer, R. & Frøst, M.B.
SenseAsia 2018, Asian Sensory and Consumer Research Symposium, Kuala Lumpur, Malaysia.
III. Promoting 11- to 13-year-old children’s food literacy through a community of practice – case studies from an experiential sensory-based theme course on fish in a school setting.
Højer, R. and Frøst, M.B.
Pangborn Sensory Science Symposium 2019, Edinburgh, Scotland, United Kingdom.
i
TABLE OF CONTENT
Abbreviations v
Preface vi
Abstract viii
Resumé (Danish) x
1. INTRODUCTION 1
1.1. Child health 1
1.2. The school as setting for promoting children’s healthy food behavior 2
1.3. Research urgency and objective 3
1.4. Hypothesis and research issues addressed 3
1.5. Overview of studies 4
1.5.1. List of papers 4
1.6. Ethical approval 7
2. CHILDREN’S FISH INTAKE 8
2.1. Fish and health 8
2.2. Children’s intake of fish – perspectives from paper I 9
3. FOOD LITERACY 10
3.1. The concept of food literacy 10
3.2. Knowledge and skills; perspectives from paper I and III 13
4. CHILDREN’S ACCEPTANCE AND REJECTION OF FOOD 17
4.1. Food acceptance and rejection 17
4.1.1. Disgusting or distasteful? 19
ii
4.1.2. Food neophobia 21
4.2. Strategies for changing food behavior 23
4.2.1. Mere exposure 23
4.2.2. Evaluative conditioning 24
4.2.3. Modeling 25
4.2.4. The hands-on strategy 26
4.3. Intervention effects of applying a hands-on strategy on fish-eating behavior 27
5. COOKING COURSE MATERIALS - THEORY AND DIDACTICS 31
5.1. Presentation of materials developed 32
5.2. The subject Food Knowledge; official learning goals and expected learning 35
5.2.1. On legislation related to the subject Food Knowledge 36
5.2.2. Learning goals in teacher’s guide 37
5.3. Pedagogical theoretical foundation 38
5.4. Theme course material: didacticization 40
6. COLLECTING DATA WITH CHILDREN 43
6.1. Clarification of paradigmatic foundation 43
6.2. Children as informants 45
6.3. Research strategy & design; Mixed methods 46
6.3.1. Research strategy 46
6.3.2. Research design 47
6.4. Sampling and recruitment strategy 49
6.5. Data collection methods applied 50
6.5.1. Future workshops; exploring the field 51
6.5.2. Participant observation 53
6.5.3. Group interviews with children 54
6.5.4. Telephone interviews with teachers 56
6.5.5. Self-administrated survey questionnaire 57
iii
The Likert scale 58
Measurement of food neophobia 59
Measurement of liking to cook & fish-eating behavior 61
Measurement of opinion on Food Knowledge and individual learning conditions 62
Measurement of food literacy; knowledge & skills 62
Evaluation of theme course, main study group only 64
6.6. Analysis of results 67
6.6.1. Analysis of qualitative data 67
6.6.2. Analysis of quantitative data 68
Statistical analysis applied in paper I 68
The difference in included respondents between study I and III 69
Statistical analysis applied in paper III 70
6.7. Methods and quality criteria related to research methods 72
6.7.1. Methods applied – a look in the rearview mirror 72
6.7.2. Quality criteria 75
Quality criteria in qualitative research methods 75
Quality criteria in quantitative research methods 76
7. PERSPECTIVES ON VIDEOS, COMMENSALITY, AND SETTING 78
7.1. Self-evaluated skills and videos 78
7.2. Commensality; a community of practice 81
7.3. Food Knowledge as a setting for promoting healthy food behavior 84
8. CONCLUSIONS 86
9. THE FUTURE 89
REFERENCES 92
APPENDIX 121
iv
APPENDIX A: PAPERS & POSTERS
A1. Paper I A2. Paper II A3. Paper III A4. Paper IV
A5. Scientific poster I A6. Scientific poster II A7. Scientific poster III
APPENDIX B: PHD ACTIVITIES
B1. Study activities
B1.1. PhD course port folio B1.2. Teaching activities
B1.3. MSc thesis supervision activities B1.4. Dissemination activities (scientific) B1.5. Dissemination activities (public) B1.6. Committee activities
B1.7. Awards
B2. Curriculum Vitae B3. Acknowledgements
v Abbreviations
CG1 : Control group 1
CG2 : Control group 2
G.Cph. : Greater Copenhagen CoP : Community of Practice
GI : Group interview
FK : Food Knowledge (subject in Danish public school)
FNS : Food Neophobia Scale
FNTT : Food Neophobia Test Tool
MS : Main study group
Obs. : Participant observation Prov. : Province of Zealand QUAL : Qualitative method QUAN : Quantitative method
(UNI)ANOVA : (Univariate) analysis of variance
SD : Standard deviation
vi Preface
This thesis was submitted in fulfilment of the requirements for the PhD degree at Faculty of Science, University of Copenhagen, Denmark. The PhD project was funded by two parties: Taste for Life [Smag for Livet], which was a four-year research and dissemination project funded by the Nordea Foundation, and University College Absalon, Center for Nutrition and Rehabilitation, Nutrition and Health, Sorø, Denmark. The studies in this PhD project were conducted in
collaboration with Nordic Food Lab, Department of Food Science, University of Copenhagen, Taste for Life, and University College Absalon, Center for Nutrition and Rehabilitation, Nutrition and Health, Sorø, Denmark.
The thesis is based on three years of research, between June 2015 and May 2018, conducted at public schools within the subject Food Knowledge in the Regions of Zealand and the Capitol in Denmark with the purpose of investigating the effects of a five-week sensory-based experiential cooking course on fish on 11- to 13-year-old children’s food literacy and fish-eating behavior.
The structure of this thesis is as follows:
Abstract: In English and Danish
Chapter 1 is an introduction and clarifies the research setting and study objective, aim, hypothesis, and research issues addressed. It is followed by an overview of studies conducted as part of this PhD project and a list of papers related to the results of the studies.
Chapter 2: is an introduction to children’s fish-eating behavior where the subjects of fish intake and health, and children’s intake of fish are discussed and put into perspective by including results from relevant papers.
Chapter 3 is a clarification and discussion of the term food literacy. Furthermore, the concept of food literacy is put into perspective by including results from relevant papers.
Chapter 4 is a theoretical introduction to children’s food behavior in general where food choice, acceptance and rejection, and strategies for changing food behavior are discussed and put into perspective by including results from relevant papers.
vii
Chapter 5 is a presentation and discussion of the cooking course material developed to be included in the intervention in the main study; a five-week sensory-based experiential cooking course on the topic of fish. Furthermore, the pedagogical theoretic frame for the intervention is presented together with a didactical clarification of the cooking course materials.
Chapter 6 is a presentation of paradigmatic reflections and an extended presentation and discussion of collecting data with children, research strategy, data collection methods applied, and data
analysis methods. Finally, reflections on data collection methods applied, trustworthiness, and strengths and limitations are clarified.
Chapter 7 presents perspectives on the papers that represent results from the PhD project and perspectives on food literacy and development in liking after participating in the five-week sensory- based experiential cooking course on fish.
Chapter 8 provides conclusions based on the main findings with focus on the hypothesis, research objectives, and research issues.
Chapter 9 looks to the future with regard to future research needs and proposals for how to conduct research in the future within the complex area of investigating and promoting children’s healthy food behavior.
Appendixes: appendix A presents research papers and scientific posters produced during this PhD project work. An overview is given in appendix B of relevant PhD activities carried out during the PhD project period.
viii Abstract
Health promotion interventions aimed at improving children’s health have been conducted for several years. Still, worldwide, 18% of all children and adolescents between the age of 5 and 19 are overweight or obese. In Denmark, 18% of the 9- to 13-year-old children are overweight. Childhood and adolescence overweight and obesity are associated with, for example, an increased risk of adult obesity, low self-esteem, and type 2 diabetes. The World Health Organization and the Danish Health authorities both point to the importance of the educational system as a relevant setting for promoting health. Furthermore, dietary variety is among the ten official Danish dietary
recommendations; nevertheless, Danish children aged 11- to 13- years only consume one-third of the officially recommended amount of fish.
The objective of this study is to investigate the effect of a five-week (10 lectures of 45 minutes) sensory-based experiential cooking course with fish on 11- to 13- year old children’s food literacy and acceptance of fish. The aim is to promote children’s healthy food behavior.
This quasi-experimental study is based on a multi-phased mixed methods research strategy and includes five partial studies, which were developed to support an iterative exploration and investigation of the objective: Future workshops (n = 32), pre-test (n = 98), pilot test (n = 61), intervention based on a quasi-experimental design (n = 268), and control study (CG1: no
intervention n = 194; CG2: oral lecture 90 min. n = 207) (part of the quasi-experimental design). A total of 20 different schools and 48 5th and 6th grade classes from the geographical area of Greater Copenhagen and the province of Zealand participated. The following research methods were applied: Participant observation (total n = 217, intervention n = 58), group interview with children (total n = 27, intervention n = 17), telephone interview with teachers (total n = 7, intervention n = 5), baseline and follow-up self-administrated survey questionnaire (total n = 736, intervention n = 669).
Based on the food literacy building blocks the main effects of participating in the intervention; the five-week sensory-based experiential cooking course was 1) Plan and manage: the ability to organize and work together, 2) Select: the ability to assess fish freshness (p = 0.007, MG > CG, 0.44 units on 5-point Likert scale), 3) Prepare: skills related to handling and cooking fish; e.g.
filleting a flatfish (p < 0.001, MG > CG, 0.89 units) and autonomy, teamwork, and development of vocabulary. 4) Eat: no positive effects were observed for liking or assessment of fish
disgustingness; however, cooking course evaluation showed 47% had become curious on tasting
ix
other kinds of fish, and 38% stated a higher liking for fish after participation. Furthermore, Future workshops indicated that competition was an element of interest, but also that the lack of time for cooking in the subject Food Knowledge was of concern to the children, whereas the teachers were more concerned with for example allocation of resources. Participant observation during pre-tests indicated that tactile play and cooking were able to promote fish acceptance, but that rejection and acceptance was a continuum especially moved by the degree of perceived animalness of the fish.
Furthermore, a status of Danish children’s food literacy and fish behavior revealed that Danish children love to cook and like fish, but the liking of fish is not transformed into a concrete intake, for example, 42% had not eaten fish within the last week. Moreover, it was observed that Danish children had a neophilic tendency with regard to food, as liking to cook was not associated with self-evaluated skills in food and cooking but with food neophobia, which could imply that the enjoyment of cooking does not depend so much on self-perceived skills but rather on curiosity and food exploration.
In conclusion, food literacy and acceptance of fish increased through participation in a five-week sensory-based experiential cooking course with fish. Based on the output the partial studies it is concluded that sufficient support has been collected to accept the main hypothesis: an ‘open window’ for promoting food literacy and fish acceptance was created based on the concepts
experimentation, sensing, autonomy, knowledge and skills, and a social dimension. Furthermore, it can be concluded that the school was a natural setting for implementation as the subject of Food Knowledge already aims at promoting the children’s ability to make critical and reflected health and food decisions and choices. Nevertheless, challenges could be local resources (access to educated teachers, equipment, etc.) and subject prioritization at a local political level.
x Resumé (Danish)
Sundhedsfremmende interventioner, der sigter mod at fremme børns sundhed, er blevet gennemført i en lang årrække. Alligevel kan 18% af alle børn og unge mellem 5 og 19 år i Verden kategoriseres som overvægtige eller fede. I Danmark er 18% af de 9- til 13-årige børn overvægtige. Overvægt og fedme hos børn og unge er forbundet med for eksempel en øget risiko for fedme ind i voksenlivet, hvilket kan medføre lav selvtillid og type 2-diabetes. Verdenssundhedsorganisationen og de danske sundhedsmyndigheder peger begge på betydningen af uddannelsessystemet som en relevant ramme for sundhedsfremme. Endvidere er en varieret kost en del af de ti officielle danske kostanbefalinger, alligevel spiser danske børn i alderen 11 til 13 år kun en tredjedel af den officielt anbefalede
mængde fisk.
Målet med denne undersøgelse er at undersøge effekten af et fem ugers sansebaseret eksperimentelt madlavningskursus med fisk (5 x 2 lektioner af 45 min.) på 11 til 13 årige børns madkundskab og accept af fisk. Formålet er baseret på at fremme sund madadfærd hos børn.
Denne kvasi-eksperimentelle undersøgelse er baseret på en multi-fase-forskningsstrategi indenfor mixed methods design og inkluderer fem delstudier, der blev udviklet til at understøtte en iterativ udforskende undersøgelse af det overordnede mål: Fremtidsværksteder (n = 32), for-test (n = 98), pilottest (n = 61), intervention baseret på et kvasi-eksperimentelt design (n = 268) og
kontrolundersøgelse (CG1: ingen intervention n = 194; CG2: mundtlig forelæsning 90 min. n = 207) (del af kvasi-eksperimentelt design). I alt deltog 20 forskellige skoler og 48 5. og 6. klasser fra det geografiske område Storkøbenhavn og den sjællandske provins. Følgende forskningsmetoder blev anvendt: deltagerobservation (i alt n = 217, intervention n = 58), gruppeinterview med børn (i alt n = 27, intervention n = 17), telefoninterview med lærere (i alt n = 7, intervention n = 5), baseline og opfølgende selvadministreret survey spørgeskema (i alt n = 736, intervention n = 669).
Ud fra elementerne i begrebet maddannelse [food literacy] er de mest fremtrædende effekter af at deltage i interventionen; det fem ugers sensorisk-baserede eksperimentelle madlavningskursus, følgende: 1) Planlægning og styring: evnen til at organisere og arbejde sammen, 2) Udvælge: evnen til at vurdere fiskens friskhed (p = 0,007, MG> CG, 0,44 enheder på 5-punkts Likert skala), 3) Tilberedning: færdigheder relateret til håndtering og madlavning af fisk; for eksempel. filetering af en fladfisk (p <0,001, MG> CG, 0,89 enheder) og autonomi, teamarbejde og udvikling af ordforråd.
4) Spise: der blev ikke observeret positive effekter for at kunne lide fisk eller i forhold til vurdering af fiskens ’afskyelighed’ [disgustingness]; evaluering af madlavningskurset viste imidlertid, at 47%
xi
var blevet nysgerrige efter at smage andre former for fisk, og 38% kunne bedre lide fisk efter deltagelse i madlavningskurset sammenlignet med før. Fremtidsværkstederne indikerede, at konkurrence var et element af interesse hos børnene, men også at manglen på tid til madlavning i faget Madkundskab var noget, der optog børnene, mens lærerne mere var optaget af for eksempel ressourcetildeling. Deltagerobservation under forundersøgelserne viste, at taktil leg og madlavning var i stand til at fremme børns accept af fisk, men at afvisning og accept var et kontinuum, hvor bevægelsen frem og tilbage især blev styret af i hvilke grad fisken blev opfattet som ’dyrisk’
[animalness]. Endvidere afslørede en status af danske børns madkundskab og adfærd i forhold til fisk, at danske børn elsker at lave mad og at de godt kan lide fisk, men smagen af fisk omsættes ikke til konkret indtag; for eksempel havde 42% ikke spist fisk inden for den sidste uge. Derudover blev det observeret, at danske børn havde en neofil tendens med hensyn til mad, at det at kunne lide at lave mad ikke var forbundet med selvevaluerede færdigheder inden for mad og madlavning, men det var derimod forbundet med niveau af madneofobi, hvilket kunne antyde, at glæden ved at lave mad ikke afhænger så meget af selvopfattede færdigheder, men snarere afhænger af nysgerrighed og madudforskning.
Afslutningsvis blev maddannelse [food literacy] of accept af fisk øget gennem deltagelse i et fem ugers sanse-baseret eksperimentelt madlavningskursus med fisk. Baseret på resultater fra de forskellige undersøgelser kan det konkluderes, at der er indsamlet tilstrækkelig evidens, der kan understøtte en accept af hovedhypotesen: et 'åbent vindue' til fremme af madkundskab og accept af fisk blev oprettet baseret på begreberne eksperimentering, sansning, autonomi, viden og
færdigheder, og en social dimension. Derudover kan det konkluderes, at skolen er en naturlig ramme for implementering, da faget madkundskab allerede sigter mod at fremme børnenes evne til at foretage kritiske og reflekterede beslutninger og valg vedrørende sundhed og fødevarer.
Udfordringer fremadrettet kan dog være lokale ressourcer (adgang til uddannede lærere, udstyr osv.) og prioritering af faget på et lokalt politisk niveau.
1
1. INTRODUCTION
1.1. Child health
According to World Health Organization (WHO) (2018) almost 340 million (18,4 %) children and adolescents between the age of 5 and 19 were either overweight (BMI-for-age > 1 standard
deviation above the WHO Reference 2007 median) or obese (BMI-for-age > 2 standard deviations above the WHO Reference 2007 median) in 2016. In Denmark, 18% of the 9- to 13-year-old children are overweight (Sundhedsstyrelsen, 2019).
Childhood and adolescence obesity is associated with an increased risk of adult obesity, which can lead to low self-esteem, type 2 diabetes, and premature death and disabilities as a result of, e.g.
coronary heart disease (Agirbasli, Tanrikulu, & Berenson, 2016; Reilly & Kelly, 2011; Sahoo et al., 2015; Umer et al., 2017; World Health Organization, 2018). WHO (2018) highlights that a broad array of health promotion actions with engagement from multiple sectors is needed to break this tendency occurring childhood overweight and obesity. One of the sectors WHO (2018) points to is the educational system.
Factors influencing the risk of children becoming overweight or obese are many; varying from, e.g.
genes, the mother’s health during pregnancy, and infant feeding style to the food-related
environment, socioeconomics, and activity level (Gibbs & Forste, 2014; Hendrie, Sohonpal, Lange,
& Golley, 2013; van der Klaauw & Farooqi, 2015; Rando & Simmons, 2015; Sahoo et al., 2015).
Dietary variety, which is one of the ten official Danish dietary recommendations; ‘Eat a variety of foods, but not too much, and be physically active’ (The Danish Veterinary and Food
Administration, 2015), is related to diet quality, as a diet with greater variety is more likely to meet nutrition recommendations (Nicklaus, 2009; Skinner, Carruth, Bounds, Ziegler, & Reidy, 2002).
Furthermore, dietary variety is also connected to the psychological dimension of a meal as it contributes to the pleasure of eating (Rolls, 2000). Therefore, promoting diet variety through broadening children’s food preferences for healthy foods could be a gateway to meeting the official dietary recommendations. A food group less eaten among children in Denmark is fish as Danish children aged 10 to 17 only consume approximately 1/3 of the recommended amount of fish per week (Pedersen et al., 2015).
2
1.2. The school as setting for promoting children’s healthy food behavior
The core food habits are established in the home food environment (Lafraire, Rioux, Giboreau, &
Picard, 2016), but Danish children 11- to 13- years-of-age (5th and 6th grade; Primary Education) spend a minimum of 33 hours per week, 40 weeks a year in the school environment (Ministry of Children and Education, 2020). A significant part of basic life skills and experience-based life education; bildung, is transferred from the immediate family to an expert system, which Giddens (2013) refers to as disembedment, where the school system becomes an important part of the child’s reference and experience core. This also concerns the child’s development of healthy food behavior as the food environment is partly moved from the home to the expert system. According to
Colatruglio and Slater (2014) and Vileisis (2008), this shift is partly responsible for lack of informal food literacy and kitchen literacy in young people today.
This opens an opportunity for the school setting to function as an arena for promoting healthy food behavior through a focus on formal food literacy, which has also been suggested by, e.g. Story, Nanney, and Schwartz (2009), Nelson, Corbin, and Nickols-Richardsson (2013), Taylor, Evers and McKenna (2005), and the World Health Organization (2016).
According to the Public School Law of 2017 in Denmark, the aim of public school is to prepare the child for education later in life, educate in cultural diversity, create and promote social
understanding, promote understanding for own life, opportunities, and agency, and to promote trust and curiosity. Furthermore, it is mandatory to educate the child in the subject of health
(Bekendtgørelse af lov om folkeskolen, 2017). The setting of this study is the subject Food Knowledge (FK).
In 2014, the subject Home Economics was replaced by the subject Food Knowledge as part of reforming the compulsory primary and lower secondary schools in Denmark (Christensen &
Wistoft, 2016). In the Danish public school FK is a compulsory subject for one year in either 4th, 5th, 6th, or 7th grade (Bekendtgørelse af lov om folkeskolen, 2017). The subject of FK aims at promoting the child’s ability to make critical and reflected health and food decisions and choices, and is divided into four main competence areas: 1) Food and health, 2) Food awareness, 3) Food preparation, and 4) The meal and food culture (Bekendtgørelse om formål, kompetencemål, færdigheds- og vidensområder og opmærksomhedspunkter for folkeskolens fag og emner (Fælles Mål), 2020).
3 1.3. Research urgency and objective
With the advice from WHO (2018) in mind; that the educational setting should play an active role in promoting children’s health, and based on the aim of FK; promoting the child’s ability to make critical and reflected health and food decisions and choices (Bekendtgørelse om formål,
kompetencemål, færdigheds- og vidensområder og opmærksomhedspunkter for folkeskolens fag og emner (Fælles Mål), 2020), it is interesting to explore this setting as a way to promote children’s healthy food behavior and food acceptance through the concept of food literacy.
The objective of this study is to investigate the effect of a five-week (10 lectures of 45 minutes) sensory-based experiential cooking course with fish on 11- to 13- year old children’s food literacy and acceptance of fish. The long term the aim is promoting healthy food behavior through an experiential learning approach.
1.4. Hypothesis and research issues addressed
In relation to the study objective, a hypothesis was constructed. After conducting two future workshops with students in 6th grade and their teachers and pre-testing of experiments (see Figure 1) the hypothesis was adjusted to its present form:
Through the concepts experimentation, sensing, autonomy, knowledge and skills, and a social dimension, an “open window” exists for promoting food literacy and acceptance related to fish.
Based on the study objective and the hypothesis the following research issues have been addressed through submitted papers, and will be addressed and put into perspective in this PhD thesis (related papers are listed in parenthesis, also, see section 1.5.1. for an overview):
I. A status of Danish children’s fish eating behavior and liking of fish (paper I).
II. A status of Danish children’s food literacy with regard to fish (paper I).
III. Effects of participating in a sensory-based experiment focused on tactile play and cooking as a way of promoting 11- to 13-year-old children’s acceptance of fish (paper II).
IV. Effects of participating in a five-week sensory-based experiential, hands-on cooking course on fish on 11- to 13- year old Danish children’s fish-eating behavior and acceptance of fish (paper III).
V. Effects of participating in a five-week sensory-based experiential hands-on cooking course on fish on 11- to 13- year old Danish children’s food literacy (paper III).
VI. Children’s self-evaluated reasons for accepting and rejecting foods (paper IV)
4 1.5. Overview of studies
Five studies have been carried out as a part of this PhD project. Timeline, aim and single study information are illustrated in Figure 1.
Figure 1: Chronological overview of executed development activities and empirical studies, their aim, and methods
1.5.1. List of papers
This PhD thesis is based on three main papers (Paper I, II, III). Paper IV will serve as a supplement where relevant, as it is not directly a part of this study, but is inspired by its investigatory scope. In the text they will be referred to by their roman numbers. Furthermore, with each paper the author contributions are declared in compliance with the Vancouver Protocol (International Committee of Medical Journal Editors, 1997). The complete papers are included in the appendix (appendix A1 - A4).
I. Something fishy is cooking – A survey of 11- to 13- year old Danish children’s self- evaluated food neophobia and food behavior, knowledge, and skills in relation to fish Højer, R. & Frøst, M.B. (sumitted to Food Quality and Preference, October 2020)
5
Author contributions:Conceptualization, R.H. and M.B.F.; methodology, R.H. and M.B.F.; data collection;
R.H.; validation, R.H and M.B.F..; formal analysis, R.H.; investigation, R.H.; resources, R.H.; data curation, M.B.F. and R.H.; writing - original draft, preparation, R.H.; writing, review and editing, R.H. and M.B.F.;
visualization, R.H.; supervision, M.B.F.; project administration, R.H. and M.B.F.; funding acquisition, R.H.
and M.B.F.
II. Play with your food and cook it! Tactile play with fish as a way of promoting acceptance of fish in 11 to 13-year-old children in a school setting – a qualitative study
Højer, R., Wistoft, K., & Frøst, M.B. in Nutrients, 2020, 12 (10), 3180;
https://doi.org/10.3390/nu12103180 2020. (Published October 17th, 2020).
Author contributions:Conceptualization, R.H., K.W. and M.B.F.; methodology, R.H., K.W. and M.B.F.; data collection; R.H.; validation, R.H., M.B.F.; formal analysis, R.H.; investigation, R.H.; resources, R.H.; data curation, R.H.; writing - original draft, preparation, R.H.; writing, review and editing, R.H., K.W. and M.B.F.;
visualization, R.H.; supervision, K.W. and M.B.F.; project administration, R.H. and M.B.F.; funding acquisition, R.H. and M.B.F.
III. Yes I can cook a fish; effects of a five-week sensory-based experiential theme course with fish on 11 to 13-year-old children’s food literacy and fish-eating behavior – a quasi- experimental study
Højer, R. Wistoft, K., & Frøst, M.B. (sumitted to Food Quality and Preference, October 2020) Author contributions:Conceptualization, R.H., K.W. and M.B.F.; methodology, R.H., K.W. and M.B.F.; data collection; R.H.; validation, R.H.; formal analysis, R.H.; investigation, R.H.; resources, R.H.; data curation, R.H.; writing - original draft, preparation, R.H.; writing, review and editing, R.H., K.W. and M.B.F.;
visualization, R.H.; supervision, K.W. and M.B.F.; project administration, R.H. and M.B.F.; funding acquisition, R.H. and M.B.F.
IV. Children’s self-reported reasons for accepting and rejecting foods.
Sick, J., Højer, R. & Olsen, A. in Nutrients 2019, 11(10), 2455;
https://doi.org/10.3390/nu11102455. (Published October 14th 2019).
Author contributions:Conceptualization, J.S., R.H. and A.O.; methodology, J.S. and A.O.; validation, J.S.;
formal analysis, J.S. and A.O., investigation, J.S.; resources, J.S.; data curation, J.S..; writing - original draft, preparation, J.S.; writing, review and editing, J.S., R.H. and A.O.; visualization, J.S.; supervision, R.H. and A.O.; project administration, A.O.; funding acquisition, A.O.
Paper I, II, and III are related through the main objective and hypothesis and are building blocks supporting each other, moving the research inquiries towards the investigation of the main hypothesis and conclusions. Each paper has its own objective but also provides information and
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perspectives related to the full overview of the research issue of interest (see Figure 2 for an illustrated overview of how the papers are related to the main hypothesis). Paper IV is based on data not related directly to this study. Still, the results are of great interest to the perspectives in this thesis, especially the results related to curiosity as a motivator for exploring new foods.
Figure 2: Overview of how individual papers are related to the main hypothesis
The output and outcome evaluations generated based on the studies conducted as part of the present research could be of interest for multiple parties at different levels in society as it is intended to be both an inquiry and an exploration of the health promotion possibilities that lies within the school setting. As such, the output and outcome of the present research are intended to serve as a
foundation for the planning of future health promotion aimed at children. At micro-level, the experience and results generated could be of interest for parents (public dissemination activities have been a major part of the present research (see Appendix B)). On a meso-level, stakeholders are
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teachers, schools, local organizations etc. At the macro-level, stakeholders are policy-makers, educational institutions, students, and researchers in related research fields.
1.6. Ethical approval
This PhD project and all related studies were conducted in compliance with the Declaration of Helsinki, 1964/2000 (World Health Organization, 2001) and the Respect Code of Practice (Respect Project, Institute for Employment Studies, 2004). Ethics approval was provided by the joint
Research Ethics Committee of the Faculty of Science and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (reference 504-0005/17-5000).
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2. CHILDREN’S FISH INTAKE
In this chapter, child health benefits of eating fish is shortly presented, followed by a discussion on Danish children’s fish-eating behavior in contrast to children in comparable countries. This chapter will, in particular, refer and relate to results presented in paper I.
2.1. Fish and health
Aside from contributing to a diverse diet, consumption of fish also contributes with valuable nutrients of great importance for e.g. children’s cognitive development. Especially fatty fish like salmon, mackerel, and herring are rich in marine-derived chained omega-3 (n-3) polyunsaturated fatty acids (PUFA)(Strobel, Jahreis, & Kunth, 2012). The principal n-3 PUFA docosahexaenoic acid (DHA, 22:6n-3) is present in the human brain and may influence neurological function and brain development, and is important for children’s cognitive function (Dalton et al., 2009; Huss et al., 2013; Mouritsen & Bagatolli, 2016; Weiser, Butt, & Mohajeri, 2016). Fatty fish also have a high content of Vitamin D, which is important for e.g. calcium (Ca) absorption, bone health, and childhood growth stages (Braegger et al., 2013; Petersen et al., 2016). Regular consumption of fish will also have a health benefit later in life, as a regular intake of n-3 PUFA from early life reduces the incidences of individual components of the metabolic syndrome, a combination of risk factors including diabetes mellitus, systemic arterial hypertension, central obesity and hyperlipidemia; all metabolic diseases associated with the development of atherosclerotic cardiovascular disease (Kelli, Kassas, & Lattouf, 2015; Kim et al., 2016; Mouritsen & Bagatolli, 2016). Furthermore, the protein content in fish is 15 to 20%, it contains all the essential amino acids, also the sulphur-containing aminoacids, which are low in plant food, and fish proteins have a high degree of digestibility i.e.
85-95% (Balami, Sharma, & Karn, 2020; Tilami & Sampels, 2018). Decreased risk of developing the metabolic syndrome and increased insulin sensitivity are some of the positive health effects related to intake of fish protein (Aadland et al., 2016; 2015; Dort, Sirois, Leblanc, Côté, & Jacques, 2012; Tørris, Molin, & Cvancarova, 2016). Thus, broadening children’s food repertoire to include fish as part of a healthful, diverse diet is important both short and long term to promote good health through life.
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2.2. Children’s intake of fish – perspectives from paper I
The Danish Veterinary and Food Administration (2015) recommends that children ≥ 3-years-of-age eat 350 g of fish per week, nevertheless the intake of fish among children aged 10-17 is only 105 g per week; under one-third of the national recommendations (Pedersen et al., 2015 ). For public dissemination purposes, The Danish Veterinary and Food Administration (2015) recommends that fish is consumed in a meal twice a week and as cold cuts several times a week.
The results presented by Pedersen et al. (2015) correlates with the findings in the survey data presented in paper I (Appendix A1). The frequency of fish intake was relatively low (M = 0.7; scale 0-3, where 0 = no intake in the past week, 1 = one to two times in the past week): 42% had not eaten fish in the past week, 47% had eaten fish one to two times in the past week, and only 9% had eaten fish three to four times. Furthermore, a significant effect was observed for the geographical area (p = 0.006), with a more frequent fish intake in Greater Copenhagen than in the province of Zealand (MG.Cph. = 0.8; MProv. = 0.6). Most children only consumed one to two different types of fish (47%, M = 0.7;scale 0-3, where 0 = no intake in the past week, 1 = one to two types of fish in the past week), and boys had a significantly (p = 0.05) more varied intake of fish types than girls (Mboys
= 0.7; Mgirls = 0.6). Also, a significantly (p = 0.006) more varied intake of fish types was observed among children from the area of Greater Copenhagen compared to children from the province of Zealand (MG.Cph. = 0.8; MProv. = 0.6). Little research has been conducted within this specific research area with the investigated age group. The results of Eastern-Danish children’s fish intake frequency presented in paper I differ from results in a Swedish study, investigating adolescent’s fish intake by being lower (Kim et al., 2010), although results similar to the Danish intake of fish was found by Kranz, Jones, and Monsivais (2017) in United Kingdom. The higher fish intake in Swedish
adolescents compared to Danish children could be a result of Swedish schools’ obligation by law to serve lunch making fish dishes more accessible (Osowski, Lindroos, Barbieri, & Becker, 2015).
The findings presented in paper I support the research urgency of investigating possible strategies for promoting healthy (fish) eating behavior. However, findings presented in paper III (Appendix A3), did not support an increase in fish intake frequency as a result of participating in the cooking course intervention, although course evaluation showed that 47% of the children, who had
participated in the five-week cooking course had become curious on tasting other kinds of fish and 38% stated a higher liking for fish after participation. The result related to the curiosity element is in line with the results presented in paper IV (Appendix A4); curiosity was found to be a motivator for trying new foods.
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3. FOOD LITERACY
In this chapter the framing concept of food literacy is presented. This chapter will refer and relate to results primarily presented in paper I - III with regard to knowledge and skills related to handling, preparing and cooking fish.
The interest for formal food education has increased as a result of concerns with loss of knowledge of food and nutrition, loss of food competences (Benn, 2014), and an increase in child obesity (World Health Organization, 2018). Furthermore, according to Larson, Perry, Story, and Neumark- Sztalner (2006) young people who help to cook and acquire cooking skills early in life consume a diet more compliant with nutrition recommendations later in life. Therefore the school setting is interesting in promoting food literacy as a strategy for promoting healthy food behavior.
3.1. The concept of food literacy
The concept of food literacy was introduced in the early ‘90s by Jones (1994) and was aimed at specifying a functional ability of following a healthy diet without deprivation. No agreement on a fixed definition of food literacy exists. One of the most widely applied food literacy definitions, according to Truman, Lane, and Elliott (2017) and Rosas, Pimenta, Leal, and Schwarzer (2020), is the definition by Vidgen and Gallegos (2014, p. 54): ‘Food literacy is the scaffolding that
empowers individuals, households, communities or nations to protect diet quality through change and strengthen dietary resilience over time. It is composed of a collection of inter-related
knowledge, skills and behaviours required to plan, manage, select, prepare and eat food to meet needs and determine intake. This can simply be interpreted as the tools needed for a healthy lifelong relationship with food’.
The definition by Vidgen and Gallegos (2014) is not far from that of Jones (1994), as the primary focus is on health promotion. Rosas et al. (2020) revisited the concept of food literacy to investigate the main elements of the construct. They found that the main domains were very similar to that of Vidgen and Gallegos (2014), although being more detailed. Vidgen and Gallegos (2014) identified four main domains with eleven sub-components (see Figure 3 for details). Rosas et al. (2020) found eight main domains: origin, safety, choice and decision, select and acquire, plan, preserve, prepare,
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cook, and knowledge with 22 attributes; e.g. seasonal, additives, and pesticides. Comparing the 11 sub-components identified by Vidgen and Gallegos (2014) to the 22 attributes identified by Rosas et al. (2020), the latter is more detailed but also less flexible due to the high level of specification.
Figure 3: The four competencies and eleven components encapsulating the food literacy construct, according to Vidgen and Gallegos (2014). Figure adapted by R. Højer based on Vidgen and Gallegos (2014, fig. 3, p. 55).
In the construct of food literacy there is also integrated functional (knowledge), interactive (skills), and critical elements (transformation and empowerment), which relates to for example knowing what foods to eat and why, how to read food label information and what it means, and to cook food safely, and how and why this is done (Pendergast, Garvis, & Kanasa, 2011; Palumbo et al., 2017).
According to Pendergast et al. (2011), the mastery of these elements is achieved through the development of self-efficacy, which, according to Bandura (1977, 1982) is the belief in one’s capabilities to cope with, organize, and execute courses of action required to engage in and
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overcome a given task and/or situation. With an empirically based construction of food literacy Vidgen and Gallegos (2014) aimed at developing a health-promoting tool identifying the complex related set of skills, knowledge and behaviors needed to protect diet quality through change and strengthening dietary resilience over time. Although Vidgen and Gallegos’ (2014) concept of food literacy is aimed at the individual, they also acknowledge that food literacy has a social dimension, although it is not clearly visible in their model (Figure 3). Furthermore, according to Vidgen and Gallegos (2014), the construct of food literacy should be seen as an investigative tool to capture a broader perspective when investigating food choice and to conduct health-promoting interventions.
In the case of the latter, they also refer to empowerment as an important outcome of promoting health through food literacy (Vidgen & Gallegos, 2014), which is also supported by Thomas and Irwin (2011).
Moreover, food literacy can be understood from two perspectives; as formal food literacy, which is linked to a formal educational setting with a learning goal perspective. This perspective has been defined by for example Benn (2014, p. 18): ‘skills, competencies, knowledge, and self attributes regarding a functional, interactive, and critical level […], as knowing, doing, sensing, wanting and caring, all together as being practical prudent at a personal level but also regarding food and meals together with others in everyday life’. The other perspective is more closely related to
informal settings, for example, the family, friends, etc., where food literacy is perceived as a part of important life skills to lead a healthy life. The latter could be seen as a public health promotion perspective (for example, Vidgen and Gallegos, 2014). Nevertheless, the two perspectives are not different, as they are both related to health promotion as defined by the Ottawa Charter (1986, p 1):
‘[H]ealth promotion is the process of enabling people to increase control over, and to improve, their health’.
The food literacy concept applied as a framework in the present study is the concept defined by Vidgen and Gallegos (2014) as it has been applied widely as a framework for health promotion interventions (Truman et al., 2017; Rosas et al., 2020). Furthermore, with regard to the reason for applying Vidgen and Gallegos’ (2014) concept of food literacy, it is important to note that the present PhD project did not have a formal learning/educational inquiry interest but is aimed at promoting healthy food behavior by exploring the possibilities of a cooking course in a formal school setting. As such the cooking course on fish was a research design tool in the investigation of children’s food literacy and fish-eating behavior intended to explore a sensory-based experiential
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approach in promoting children’s acceptance of fish, fish-eating behavior, and food literacy with the aim of promoting healthy food behavior through life.
Furthermore, Vidgen and Gallegos’ (2014) concept of food literacy proved itself to be a solid concept throughout the analytical work in paper I and III (Appendix A1, A3) due to its flexibility in covering and including various aspects of capturing what happens to knowledge, practical skills, and the social dimension when learning and exploring through food in a formal setting.
3.2. Knowledge and skills; perspectives from paper I and III
As illustrated in Figure 3, food literacy, according to Vidgen and Gallegos (2014), is based on four primary competencies: plan and manage, select, prepare, and eat. Elements of knowledge and skills are the foundation of these competencies.
As observed in the status survey presented in paper I, the respondents (n = 669) evaluated1
themselves positively, but just, with regard to overall knowledge on fish and cooking (M = 2.4, min.
score = -12, max. score = 12). With regard to skills the respondents (n = 669) evaluated2 themselves positively, but again just so with a mean of 3.5 (min. score = -18, max. score = 18). Especially skills related to filleting fish3 was evaluated negatively (M = -0.4, -0.5, min. score = -2, max. score = 2).
Furthermore, paper I presented various significant positive correlations, with the two strongest positive correlations observed between theme 3) ‘Knowledge of fish and cooking’ and theme 4)
‘Skills in fish and cooking’ (r = 0.62, p <0.001) and theme 4) ‘Skills in fish and cooking’ and theme 6) ‘Skills in the senses’ (r = 0.61, p <0.001). The Pearson’s correlation coefficient between themes 3 and 4 indicates that knowledge is positively associated with skills: if you know it, you can do it, and the coefficient of determinations means that 38% of the variability observed in knowledge can be accounted for by skills. The correlation between themes 4 and 6 indicates that if skills in fish and cooking are present, then so too is the ability to use the senses in relation to food, and 37% of the variability observed in skills can be accounted for by the self-evaluated ability to use the senses.
These results indicate that the status of Eastern-Danish children in general functional (knowledge) and active (skills) elements are positive, but not overwhelming, but especially the element of
1 Items based on Likert (1932) with statements evaluated on a 5-point agreement scale. Overall knowledge based on six summed knowledge-themes items: min. score -12, max. score = 12. See section 6.5.5. for elaboration of survey
questionnaire.
2 Items based on Likert (1932) with statements evaluated on a 5-point agreement scale. Overall skills based on nine summed skills-themes items: min. score -18, max. score = 18. See section 6.5.5. for elaboration of survey questionnaire
3 Two items measured filleting skills: item 23c.: I can fillet a flat fish; item 23d.: I can fillet a round fish.
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preparing fish is lacking. As such, the foundation for the general hypothesis being tested in this PhD project is warranted.
From a status on food literacy and fish (eating) behavior in paper I to the presentation of the
intervention effect in paper III: the effects of the five-week cooking course on food literacy and fish acceptance were investigated (main study group: n = 185; control group: n = 198) based on
baseline and follow-up measurements by, among others, applying a self-administrated survey questionnaire. Major effects were observed especially within the main study group (MS), who had participated in the cooking course, in the areas of knowledge on fish and cooking; paired samples Wilcoxon signed rank test showed a significant difference between scores in meta-theme
KnowFishCook (Z = 3.885, p < 0.001) between baseline and follow-up. The median score at baseline was 2 compared to 4 at follow-up. For skills related to fish and cooking the same patterns was observed: significant difference (Z = 8.121, p < 0.001) between scores before participating in the five-week cooking course and after. The median score at baseline was 2 compared to 7 at follow-up. Especially the self-evaluated ability to fillet different kinds of fish was promoted by participation. Effects were also observed with regard to organization of work station, development of language/vocabulary, ability to work together, the ability to work autonomous (for more
examples of effects related to food literacy see paper III, Figure 2: Key effects of participating in a five-week experiential theme course on fish. Results from the study; Appendix A3).
To investigate the effects of participating in a five-week experiential, hands-on cooking course on food literacy and fish acceptance Pearson’s r and r squared (r2) were computed (see Table 1) and analyzed (data analysis not presented in papers).
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Table 1: Pearson’s r and r2: Main study group, effect sum scores by meta-theme (data analysis not presented in papers)
1) FNTT8 2) FishBehavior 3) KnowFishCook 4) CanFishCook 5) KnowSenses 6) CanSenses
1) FNTT8 Pearson’s r/r2 1 0.19/0.04 0.15/0.02 0.19/0.04 0.09/0.01 0.24/0.06
p value* 0.010 0.036 0.009 0.22 0.001
2) FishBehavior Pearson’s r/r2 1 0.18/0.03 0.24/0.06 0.25/0.06 0.18/0.03
p value 0.013 0.001 0.001 0.016
3) KnowFishCook Pearson’s r/r2 1 0.62/0.38** 0.61/0.37 0.42/0.18
p value < 0.001 < .,001 < 0.001
4) CanFishCook Pearson’s r/r2 1 0.53/0.28 0.59/0.35
p value < 0.001 < 0.001
5) KnowSenses Pearson’s r/r2 1 0.39/0.15
p value < 0.001
6) CanSenses Pearson’r/r2 1
p value
* Correlation is significant at the 0.01 level (2-tailed).
** Bold: correlations of interest. The value of Pearson’s r was interpreted based on the definition by Dancey and Reidy (2017): weak = 0.1 - 0.3/-0.1 - -0.3; moderate = 0.4 - 0.6/-0.4 - -0.6; strong = 0.7 - 0.9/-0.7 - -0.9.
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Four interesting positive significant correlations were observed: 3) KnowFishCook and 4)
CanFishCook (r = 0.62, p < 0.001, r2 = 0.38), 3) KnowFishCook and 5) KnowSenses (r = 0.61, p <
0.001, r2 = 0.37), 4) CanFishCook and 5) KnowSenses (r = 0.53, p < 0.001, r2 = 0.28), and 4) CanFishCook and 6) CanSenses (r = 0.59, p < 0.001, r2 = 0.35).
They are interesting as they provide information on how the effects of the cooking course on
knowledge and skills are interdependent, which demonstrates that the concept of food literacy is not only about knowledge or skills, but they are intertwined and if one is positively affected the other is likely to be positively affected too. This is also supported by, e.g. Muzaffar, Metcalfe, and Fiese (2018), who found that school cooking programs that applied a hands-on strategy successfully improved a number of key food-related topics: e.g. knowledge, cooking attitude and self-efficacy, behavioral intention for cooking and eating plant foods, preferences for cooking and healthy eating, and willingness to try new foods.
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4. CHILDREN’S ACCEPTANCE AND REJECTION OF FOOD
In this chapter children’s food behavior is put into perspective based on acceptance and rejection and strategies for changing food behavior.
This chapter will refer and relate to results presented in paper II- IV with regard to tactility, food exploration, curiosity and acceptance and rejection of food.
Healthy food habits and preferences are established early in life through the practice of the parents’, and especially the mother’s, food habits, knowledge, skills, beliefs, and values and will be the foundation on which the child will accept or reject food (Hendrie, Sohonpal et al., 2013; Lafraire et al., 2016; Nicklaus, 2009; Skinner et al., 2002).
From infancy children’s food options are primarily a result of parental food practices, and social, and environmental factors (Hursti, 1999; Lafraire et al., 2016; Scaglioni, Arrizza, Vecchi, &
Tedeschi, 2011). The infant is in its first months a univore, consuming a diet based exclusively on milk, the only variety being breast milk or formula. With age, the child broadens its food selection to a variety of foods, and thereby becomes, or at least has the potential to become an omnivore (Birch & Fischer, 1998; Birch, 1999; Rozin & Vollmecke, 1986).
4.1. Food acceptance and rejection
The question is what motivates acceptance and rejection of food? Rozin and Fallon (1980, 1987) have proposed a taxonomy of food acceptance and rejection in which they point to three prime motivations being the foundation for acceptance and rejection causing four rejection and four acceptance categories as presented in Table 2.
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Table 2: The taxonomy of food rejection and acceptance. Adapted by R. Højer from Rozin and Fallon (1986), Table 1, p. 60.
Motivation acceptance/
rejection
Categories of rejection Categories of acceptance
Distaste Danger Inappropriate Disgust Good taste Beneficial Appropriate Transvalued Sensory
Properties
+ + + +
Anticipated consequences
+ +
Ideational ?* + + ?* + +
* May be involved in response
The sensory-affective factors are related to for example the like or dislike of taste, smell etc., anticipated consequences: e.g. negative/positive physiological or social influences and ideational factors are related to for example knowledge of the nature or origin of a food (Rozin & Fallon, 1986, 1987). According to Rozin and Fallon (1986), this system of motivation promoting either rejection or acceptance is a simplification, as it only emphasizes the principal feature motivating acceptance or rejection, and many food choices are determined by more than one of these factors.
As an example Rozin and Fallon (1986) point to acceptance of milk: it can be driven by both good taste, which is a sensory-affective property, and by a health perspective, which is related to
anticipated consequences (Rozin & Fallon, 1986). Furthermore, factors influencing the liking and disliking of specific foods are many, but the influence of culture is one of the predominant factors as is the context in which the food is consumed (Rozin & Vollmecke, 1986; Lafraire et al., 2016).
Rozin and Vollmecke (1986) also point out that acquired likes can be promoted by social
encounters with people outside the family, in particular peers, which is a central assumption in the light of the setting of this study as the school is an important scene for children’s social activity.
The social dimension of promoting food acceptance was explored in both paper II and III
(Appendix A2, A3), and the findings pointed to great potential in including this dimension in health promotion interventions in the future. Furthermore, a rejection-acceptance continuum is presented in paper II based on participant observational data with a focus on tactility and cooking (Højer, Wistoft, & Frøst, 2020).
In the baseline survey questionnaire, the children (n = 669) were asked about the reasons for liking or disliking fish (data not presented in papers). The children could freely write whatever reason(s)
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they had for liking or not liking fish. 69% of the reasons were categorized as liking (n = 464), 16%
were categorized as not liking (n = 110), while 14% were ‘in-between/liking but…/don’t know’
reasons (n = 95). Within the categories ‘I like fish because…’ and ‘I do not like fish because...’ the following sub-themes were identified (based on times mentioned):
I like fish because…
1) good taste (353 times) 2) healthiness (67 times)
3) make many different dishes (32 times) 4) deliciousness (23 times)
5) like texture (16 times)
6) different from meat (14 times)
I do not like fish because…
1) bad taste (77 times) 2) disgusting (14 times) 3) dislike texture (14 times) 4) dislike smell (14 times) 5) bones (8 times)
These finding are comparable to those found in paper IV (Sick, Højer, & Olsen, 2018) regarding children’s self-evaluated reasons for accepting and rejection food. Good taste, healthiness,
deliciousness and like texture, which has also been found in other studies (e.g. Koivisto & Sjödén, 1996; Rozin & Fallon, 1986; Zampollo, Kniffin, Wansink, & Shimizu, 2012). However, two different sub-categories were detected: that you can make many different dishes with fish, which is an interesting observation, as this element has not been investigated before, and that fish is different from other meats. However, Nicklaus, Boggio, Chabanet, and Issanchou (2004) found a similar tendency, which indicated that a shift in evaluation of meat products occurs around the early adolescent phase, especially in girls, resulting in a lower rating of meat products as the teenage phase starts. The reasons given for not liking fish in this survey were also found by Prell, Berg, and Jonsson (2002). Even though curiosity was not mentioned by the children regarding liking or not liking fish, it was the most often stated reason for tasting the fish dish of the day in the evaluation of the cooking course: 40% gave this reason, whereas the most often stated reason for not tasting was
‘I did not feel like it’ (21%).
4.1.1. Disgusting or distasteful?
Rejection based on the concepts of disgustingness and distastefulness; how is it possible to properly distinguish between the two and determine which mechanism is at play? This is discussed in the following section, as it is a fundamental part of the analysis presented in paper II and III. Primarily due to findings by Angyal (1941), Rozin and Fallon (1987), Pliner and Pelchat (1991), and Martins
