Asia Pacific J Clin Nutr (2002) 11(Suppl): S579–S585
Nutrition knowledge and food consumption:
can nutrition knowledge change food behaviour?
Anthony Worsley BSc (Hons), PhD
School of Health Sciences, Deakin University, Melbourne, Australia
The status and explanatory role of nutrition knowledge is uncertain in public health nutrition. Much of the
uncertainty about this area has been generated by conceptual confusion about the nature of knowledge and
behaviours, and, nutrition knowledge and food behaviours in particular. So the paper describes several key
concepts in some detail. The main argument is that ‘nutrition knowledge’ is a necessary but not sufficient factor
for changes in consumers’ food behaviours. Several classes of food behaviours and their causation are discussed.
They are influenced by a number of environmental and intra-individual factors, including motivations. The
interplay between motivational factors and information processing is important for nutrition promoters as is the
distinction between declarative and procedural knowledge. Consideration of the domains of nutrition knowledge
shows that their utility is likely to be related to consumers’ and nutritionists’ particular goals and viewpoints.
A brief survey of the recent literature shows that the evidence for the influence of nutrition knowledge on food
behaviours is mixed. Nevertheless, recent work suggests that nutrition knowledge may play a small but pivotal
role in the adoption of healthier food habits. The implications of this overview for public health nutrition are:
(i) We need to pay greater attention to the development of children’s and adults’ knowledge frameworks
(schema building); (ii) There is a need for a renewed proactive role for the education sector; (iii) We need to take
account of consumers’ personal food goals and their acquisition of procedural knowledge which will enable
them to attain their goals; (iv) Finally, much more research into the ways people learn and use food-related
knowledge is required in the form of experimental interventions and longitudinal studies.
Key words: Behaviour change, food behaviour, nutrition knowledge.
We live in a knowledge society – knowledge is power – isn’t
it? But the status and role of nutrition knowledge is decid-
edly uncertain. Does nutrition knowledge influence food
behaviours? We usually assume that the answer must be in
the affirmative. Indeed, most of us implicitly accept the
simple knowledge–attitude–practice model. If people know
what is good for them then they are likely to behave in
their best interests. Like so many lay views, this model was
abandoned years ago as a complete explanation. However, as
we shall see it may have some currency and may be a good
short hand explanation for complex phenomena. Before
coming to answer the key question of this paper we need to
consider some basic concepts and definitions.
What kinds of knowledge are there?
Psychologists have distinguished two key types of know-
1. Declarative knowledge, knowledge of ‘what is’, aware-
ness of things and processes. For example, that lemons
are a good source of Vitamin C, that the Earth is round,
that high intakes of fruit and vegetables can prevent
hypertension, that milk contains psychotropic peptides,
that skin wrinkling is linked to the type of fats you con-
sume. Declarative knowledge is very important for indi-
viduals’ survival, (e.g. it can be important to know that
railway lines are not a good place to sleep, or, that ‘real
men drink beer’!). Obviously declarative knowledge can
be divided into many domains, some of which include
various types of nutritional knowledge.
2. Procedural knowledge, this is knowledge about how to do
things. For example, how to choose a red wine for a
meal, how to choose a low salt packet of soup, how to lay
out the cutlery for a dinner party, or how to make spotted
dick. We require a lot of procedural knowledge even to
perform the most basic tasks, such, as using an ATM or
programming a video recorder.
What is knowledge as distinct from beliefs?
You may believe that iodine deficiency can cause intel-
lectual disability. This is a belief – a perception of a link
between two concepts – ‘iodine deficiency’ and ‘intellectual
Correspondence address: Professor Tony Worsley, School of
Health Sciences, Deakin University, Melbourne, Australia.
Tel: +61 3 9251 7259; Fax: 61 3 9244 6017
S580 T Worsley
disability’. You may see a strong or a weak relation between
the two, and you may hold the belief with a particular degree
of strength. Scientists ‘make’ new beliefs (facts or factoids;
Bryce Courtney in the Power of One reckons fathers make
something called ‘dadfacts’ – beliefs that are made up on the
spur of the moment with little evidence but which turn out
later in life to be surprisingly correct!)
We can test the validity of beliefs (or perceptions), in fact
all humans do by asking questions, such as: ‘Is that pink
elephant I see at the bottom of the garden real?’ Psycho-
logists have often examined such questioning and identified
the ways that we check out perceptions and beliefs (attribu-
tion theory). But knowledge is more than just a collection of
‘true facts’, it is a system of beliefs – what psychologists
refer to as schema and meta schema that are skeletal
frameworks on which beliefs or facts are based.
What is knowledge for?
Knowledge helps us explain important aspects of the world
and gives predictability to events, thus meeting the human
need for cognitive consistency or predictability.1 We all
know when to go home from work; we know how to work
during an examination (as fast as possible) while people who
are unused to our ways do not.
Groups of people have different experiences so they have
different beliefs and knowledge. Nutritionists have their
own meta schema (e.g. energy balance, water soluble vs fat
soluble vitamins, antioxidants). Powerful social groups have
their own knowledge that they use to explain the world [e.g.
business parlance, scientists and their jargon (exact termin-
ology)] and weak groups of people have their own beliefs
and explanations of why things are as they are – what
Foucault calls ‘subjugated knowledge’ – imprecise, unoffi-
cial explanations (e.g. ‘He caught pneumonia because he sat
in a draught.’). Different groups of people have their own
systems of beliefs, (e.g. vegetarians and their quite distinct
views of most things in the world ranging from different
views of health and illness to different political opinions and
different dress sense). Note that belief systems help to create
solidarity and exclude non-believers. (e.g. religious vs secular
views of faith and reason).1
How logical is knowledge?
As recorded in scientific textbooks knowledge appears to be
firmly grounded on empirical evidence, but as Thomas Kuhn
showed many years ago, some knowledge is ignored while
other knowledge is highlighted in scientific consciousness.2
Two people watching the same football match may come
away with quite different views of the game depending on
their team allegiances. Events in the world are interpreted
and coloured by prior beliefs. Some beliefs (true and false)
are held to be more important by us than others. Thus to
vegetarians, say, eating meat is akin to killing animals and
since animals are part of Creation, as we are, so killing an
animal requires far more justification (if it ever can be
justified) than it does for a meat eater who may be less aware
of ‘crucial facts’ about animals (e.g. their sentient nature,
their ability to feel pain). Various balance theories and the
theory of cognitive dissonance, which emerged in the 1930s,
show quite clearly that beliefs or ‘messages’ are often
accepted or rejected according to their consonance with prior
beliefs. Many people acquire cognitive consistency only by
manipulating (quite unconsciously) the ‘facts’. Beliefs, then,
are not static but are held in a dynamic manner being
subjugated to deeper more ego related beliefs. Marketers are
well aware of this as a look at current consumer behaviour
texts will show. In contrast, I doubt if I have heard more than
one or two mentions of ‘cognitive consistency’ or the ‘theory
of cognitive dissonance’ in public health during the past
20 years – yet here we are trying to influence people’s food
What influences our beliefs and knowledge?
There are many influences. They include: our experiences,
and what influences our experiences, the people we mix with
– our social groups, the people we aspire to be like (reference
groups) and our beliefs about what they want for us (e.g.
most women think men want them to be about two sizes
smaller than what men want them to be). In addition, our
physical and biological environments certainly influence
our beliefs. If you have ever had ‘Montezuma’s Revenge’
you will have learned a lot about yourself and the world –
like the value of health insurance!
Our prior or established beliefs influence our acceptance
of new information. For example, if you believe the world is
flat, when you see the curved horizon from an aeroplane
you’ll have a bit of struggle and may ‘explain’ your new
perception as ‘something to do with the curved windscreen
in the cockpit’. That we see the world through rose tinted or
other tinted spectacles has long been understood. The sym-
bolic interactionists of the early 20th century drew attention
to the inherent symbolism of perceptions (created by culture
or prior experiences) and especially of language. Thus to a
food microbiologist a black pudding is a risky food with
interesting flora, to a Lancastrian it is likely to be a healthy
and delicious food. Different people often interpret the same
identical object or event in quite different ways according to
their origins, training and experiences.
Humans then are prime information processors. We sort
it all out but we can’t process everything (we have very
limited short-term memories) so we adopt all sorts of
‘clumping devices’ or ‘heuristics’. For example, rather than
considering all the nutrients listed on a packet of breakfast
cereal we may ‘measure’ the nutritiousness of the cereal by
the length in centimetres of the list, the longer the list the
more nutritious the cereal! This may be Illogical but is very
handy when the shopping has to be done in a hurry.
What is nutrition knowledge?
Somewhat cynically, but accurately, we can define know-
ledge as that which distinguishes experts from ignoramuses.
In fact this is how we decide which items to include in test
Nutrition knowledge and food consumption S581
banks. We expect experts to be able to answer items that
people unversed in the discipline cannot, with novices
occupying some middle position.3 Not many so-called nutri-
tion knowledge tests have been validated in this way.
What nutritionists think it is versus what consumers think
Nutrition knowledge is knowledge of nutrients and nutrition.
Immediately one can ask ‘so what’? As Gussow and
Contento4 observed two decades ago, nutritionists have
scientific needs and interests, so do ‘learners’ (consumers)
and so does society. What the various groups understand by
nutrition and nutrients requires careful examination. For now
let us assume that all there is to understand is what nutrition-
ists understand. What are the domains of nutrition know-
ledge? What are the most important things about nutrition
that we need to know? I asked a similar question about a
decade ago of nutritionists and shoppers when I asked them
which nutrition information should be printed on food
product labels.5 Figure 1 shows the differences between
shoppers’ and nutritionists’ answers; the longer the line to
the right, the greater was the difference between shoppers’
and nutritionists’ opinions (the longer the lines to the left, the
more nutritionists wanted the information). Do you agree
with these views?
How do we conceptualize the domains of nutrition
knowledge? Do we look at the functions that nutrients
undertake in the body, such as, energy turnover, or growth
and repair, or do we think about antioxidants and the various
defence mechanisms they operate. Or do we classify groups
of nutrients in some other way(s)? What sort of relevance do
such classifications have for the ‘consumer in the shop’?
Probably very little, except perhaps to confirm the misbelief
that fat is bad? Of course it’s not even this simple because
not only can we group nutrients (according to their functions
say, or to the disease processes they may be involved in) but
nutrition is a quantitative science so we know how much of
a nutrient is ‘too much’ or too little. So when we say ‘too
much saturated fat is not healthy’ what do we mean? How
does this relate to buying cheese? When we say we should
eat a varied diet do we mean at every meal, or everyday or
weekly? Such questions do raise the possibility that although
we may have a lot of facts in nutrition they may not be very
relevant to every day eating and they may not represent
much knowledge or certainty. They also cast doubt about
the validity of ‘nutrition knowledge’ tests that seem to be
frequently reported in publications and that are often
unrelated to food choice? It’s all very vague.
When it comes to consumers’ knowledge of nutrition –
this has been described as ‘a mile wide and a centimetre
deep’! Few investigators have asked consumers about what
they want to know about nutrition (and food).6 Consumers
seem to view nutrition as including much more than mere
nutrients; it includes ways to lose weight, ways to prevent
cancer, the effects of vitamins on skin condition, food safety,
‘additives’ and their effects, and much more. Why do the
differences shown in Fig. 1 exist? Perhaps because lay
people are unconstrained by ‘disciplines’ and have a much
greater number of interests, motivations and goals than
nutritionists – who frequently limit their domain of interest
to traditional nutrients (thus excluding alcohol, water, non-
traditional nutrients and physical activity – all of which have
rather widespread effects on body processes). The point is
that people have knowledge about what they are interested
in. Indeed recent studies show that interest and knowledge
Which areas of nutrition are worth consumers knowing
about? Here are some suggestions:
1. The energy content of food.
2. The roles of fats.
3. The sources of vitamins and minerals.
4. The sources of phytochemicals.
5. The links between food production and ecology and
6. What else? It depends on what you consider is important.
Are the things nutritionists are interested in the same as
those various groups of consumers are interested in?
How do you measure nutrition knowledge?
Most of us think that knowledge enables us to distinguish
true from false beliefs, facts from falsehood. So we often
pose questions and count the number of correct answers.
This can be well done (using validated methods)3 or badly
done. However, knowledge is not one-dimensional as tests
scores suggest, it is somewhat structured. We might measure
someone’s knowledge of various areas of nutrition and find
that they know about some areas but less about others. We
could derive profiles of their knowledge. Inside someone’s
mind, however, knowledge (and beliefs) may be more highly
structured or differentiated. Figure 2 shows 10-year-olds’
‘knowledge’ of some of the perceived nutrition properties of
some foods before and after a nutrition education program.
You can see that they associated various properties more
Figure 1. Differences between shoppers’ and nutritionists’ views
about information that should be on the food product label.5
S582 T Worsley
with some foods than others. Therefore, measurement of
nutrition knowledge is a little more complex than simple
summation of ‘true/false’ scores.
What do we mean by food behaviours? The term can cover
a multiplicity of distinct behaviours from ‘simple’ chewing
of food to food shopping, food preparation, etiquette, and
food policy decision-making. It can be general (e.g. doing
the weekly grocery shopping) or quite specific (e.g. choosing
brand A over brand B according to their saturated fat
contents). Much knowledge is required for these behaviours,
only a little of which is related to nutrition. For example,
imagine the steps required in making a pavlova, including
knowing where to buy the best ingredients, how to combine
and cook them. Where exactly in this chain of events does
nutrition knowledge play a part? Behaviours are dynamic
processes most of which involve ‘decision points’ (e.g.
knowing when it is safe to swallow that bolus of tough
meat). Simple linear measures of association between
knowledge indices and the final behavioural outcomes (as in
correlation-based statistics) are unlikely to reflect the key
influence of nutrition knowledge on decision-making.
Influences on food behaviours
There are many models of human behaviours in relation to
‘dietary’ behaviours, several of which have been reviewed
by Baranowski et al.7 They found that most of these models
yielded similar predictiveness (about 30% of variance) but
having any model was better than having no explicit model.
Some of the key components of these models are described
briefly to demonstrate that nutrition knowledge is only one
among many likely influential factors:
1. The perceived consequences of the behaviour. These can
be favourable or unfavourable, likely or less likely.
Expectancy value models like the health belief model,
theory of planned behaviour stress this aspect.8
2. Attitudes and beliefs about the behaviour and the object
of the behaviour (e.g. perceptions about ‘value for money’)
3. Skills like knowing how to shop and how to cook are
4. Confidence in being able to perform the behaviour is
stressed as self efficacy in models like Social Learning
5. The social and physical, internal and external environ-
ment. The situations in which foods are purchased and
Figure 2. Ten-year-old’s views of foods, nutrients and health.7 In this figure the closer a food is to a food characteristic the more that food was
perceived to have that characteristic (e.g. cakes and buns were seen to be more fattening than sweet cereal).
Nutrition knowledge and food consumption S583
used are extremely important as they often include both
social constraints (e.g. ‘It is not “cool” to drink with a
straw.’) and highly attractive or aversive physical stimuli
(e.g. the sight of a chocolate bar, the smell of freshly
6. Motivators are extremely important. These include social
influences (e.g. doing as your peer group does), environ-
mental rewards (reinforcers), biological needs (e.g.
hunger) psychogenic needs (e.g. need for ego recogni-
tion) and personal and cultural values – which define
what are ‘good’ and ‘bad’ consequences of behaviours.
Motivators are often subtle, for example, food may
signify desired states (e.g. eating caviar may signify
one’s wealth and influence) hence the importance of
hermeneutics. People make and use knowledge to meet
their own goals and purposes – do consumers and nutri-
tionists share the same goals? A relatively simple con-
crete example of a behavioural model is given in Grunert’s
Food Lifestyle Model (Fig. 3).9
Beyond the mainstream of food choice theory, consumer
behaviourists have invented models that attempt to simulate
the steps taken by humans in food purchasing decision-
making.10 They also show that many factors impinge on the
behavioural eventual outcome. A currently popular process
model is the transtheoretical theory. This assumes that
people go through a series of stages when changing their
behaviours.11 It has been successfully applied to fruit and
vegetable consumption by Ling and Horwath.12 This is an
important model if only because it emphasizes that indi-
viduals may be affected by almost unique combinations of
factors. This has led to tailoring methods of nutrition promo-
tion;13 which are about twice as effective in bringing about
dietary behaviour change as other approaches. Recent
work on personal food value systems also provides similar,
indeed greater richness, which is perhaps best provided by
qualitative or experimental studies.14
So where does nutrition knowledge fit? Somewhere
among the set of perceptions a person may hold about a food
and the behaviours they might perform in relation to that
food. In the pool of food behaviour variance it would not be
surprising if nutrition knowledge (however, well defined)
were drowned out. We need more studies which follow the
paths taken in real time (as distinct from timeless multiple
regression analyses) by consumers during their behaviours.
Such path analyses are rare.
Is nutrition knowledge related to food behaviours? Can it
change food behaviours?
Yes, a little! This is not a ‘systematic review’ in the Cochrane
Collaboration sense. Many studies show no relationship but
there are some that do, albeit mainly at ‘low’ levels of
A major, influential study was performed by Wardle
et al.15 This was a postal survey of 1040 18–75-year-old-
participants selected from General Practitioners’ lists in
England. Nutrition knowledge was significantly associated
with ‘healthy eating’ (e.g., fruit and vegetable intakes)
indeed knowledgeable individuals were 25 times more likely
to consume adequate amounts of fruit and vegetables daily.
Through analyses of covariance the authors were able to
show that nutrition knowledge was a partial mediator of the
socio-demographic variation in food intake (especially fruit
and vegetable intakes). This work is part of the bigger thrust
at University College London to explain the ways in which
social class differences influence health. Social economic,
cultural and psychological variables such as ‘powerlessness’
appear to be important predictors of health and disease
states.16 Similar deconstruction of socio-economic influ-
ences such as education has been achieved in other related
domains. For example, Davies at the University of Adelaide
showed that education background differences in children’s
dental status were explained through different sets of paren-
tal beliefs (i.e., subcultures) about the value of dental
hygiene and the prevention of dental caries.17 This suggests
that ‘education’ encourages a different set of beliefs and
values (or interests) among its participants. In a similar vein,
a study by the USDA’s Economic Research Service18 shows
that the more mothers know about food and nutrition the
better the quality of their children’s diets, especially younger
In another population study Harnack et al. in a national
US sample of adults, showed that fat, fibre, fruit and
vegetable intakes were closer to dietary recommendations
among respondents who had more cancer-prevention know-
ledge, after social economic and nutritional confounders
were taken into consideration.19
The possible role of interest in nutrition in Wardle et al.’s
findings is suggested by a study by Chew and Palmer.20 In a
three wave national survey they showed that differences in
nutrition interest, not education differences, were associated
with differences in nutrition knowledge. They also showed
that TV viewing was associated with greater interest in
nutrition and thus greater nutrition knowledge. We have also
shown that nutrition interest is a key mediator of the link
between personal values and dietary choices.21
Figure 3. The Food Lifestyle Model.10
S584 T Worsley
Kristal et al. found that among 97 middle aged women
knowledge of fat nutrition and social norms about fat were
positively related to the consumption of low fat diets.22
In a study of a random sample of 475 elderly Americans,
Elbon et al. found that high nutrition knowledge was
strongly associated with the reading of nutrition information
panels on food products (along with being female, and
positive nutrition-related health seeking behaviours, i.e.
The possible wide scope of influence of nutrition know-
ledge is further suggested by two studies. Elbon et al. found
that elders’ nutrition knowledge of dairy products did not
predict the amount of milk that they drank but instead it
predicted the type of milk consumed.24 In a structural
equation modelling study of primary teachers willingness to
teach nutrition. Finally, Britten found that knowledge was a
predictor of their confidence to teach.25
Finally, our systematic review of children’s healthy
eating literature clearly shows that the nutrition education of
school children can bring about change in their dietary
behaviour, which sometimes last for over 2 years.26
Why the scarcity of evidence?
There are several reasons for the scarcity of evidence, among
1. Poor conceptualization of nutrition knowledge.
2. Lack of relevance (e.g. knowledge of cholesterol may be
more relevant to 60 years olds than to 16 years olds – so
why teach it to children?).
3. Poor measurement – there is a lack of well validate
nutrition knowledge instruments, which measure know-
ledge that is of relevance both to consumers and to
4. Poor matching of knowledge and outcome variables –
Fishbein and Ajzen drew attention to the law of
specificity – dependent and independent variables must
be measured at the same levels of specificity (e.g. we
cannot correlate a person’s knowledge of world mal-
nutrition with their use of vitamin supplements).27 Even
more glaringly, general nutrition knowledge indices are
unlikely to predict specific domains of food consump-
tion, such as, vegetable or biscuit consumption.
5. Many studies have been small and did not have the statis-
tical power to detect the influence of nutrition knowledge
on food behaviours.
Implications for public health nutrition
We need to pay greater attention to the development of
children’s and adults’ knowledge frameworks (schema
building) via group and experiential learning. There should
be more studies of children’s nutrition knowledge and food
beliefs and how they develop their dietary patterns. There is
concern among community nutritionists and others that
many children have poor experiential knowledge of food and
have few buying and preparation skills.26
There is a need for a renewed proactive role for the
education sector. Much more documentation of the effects
of education is required. We have anecdotal evidence to
suggest that the effects may be widespread and far reaching.
We need to take education more seriously in order to work
out what it does. There is a need for new student-centred
life skills curricula in secondary schools that will prepare
students for adult life, and for the evaluation of the effects of
We need to take account of consumers’ personal food
goals and their acquisition of procedural knowledge that will
enable them to attain their goals. Which sets of knowledge
are required for people to get the best out of the current food
system and to satisfy their aspirations about their bodies,
their health and their aspirations about society and the
planet? That is, we should attend more to people’s food-
Knowledge is part of an open system not a closed system.
You may teach nutrition knowledge but consumers will
translate that knowledge and do what they like with it – often
years later. For example, our daily physical education inter-
vention study of 1978 (SHAPE28) appears to have resulted in
greater participation in vigorous activity and lower than
average smoking rates 20 years later.29 So, it is important in
evaluation to anticipate likely lateral and sleeper effects.
Greater attention to experiential and procedural know-
ledge – it is the ‘how to’ that is difficult, for example, how
to reduce energy intake. Perhaps different kinds of nutrition
knowledge are required, such as, an understanding of strate-
gies to influence metabolic regulation, energy intake and
Finally, we need much more research into the ways
people learn and use food-related knowledge in the form of
systematic reviews, experimental interventions, path model-
ling studies, decision process studies and longitudinal
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