This study involved participants from the Palestinian society from different age groups through online recruitment, however females and younger adults were more willing to participate in the study. In our study 24% of the study group had adequate nutrition literacy which is slightly lower than what was reported in other groups (17). Our study group were low to middle income group, with the group with higher income having better literacy than compared to other groups. Studies and public campaigns to improve the general Palestinian society on nutrition awareness and skills to read food labels and perform simple nutrition calculations are not present. We have performed a study of food label use among Palestinian group and found that although the use of food labels among Palestinian society is very common, they only seeked information on crude values of calories, sugar and fat without looking into important information such as sodium content and types of harmful lipids(21) in food products which indicate that nutrition education in Palestinian society is imperative and should be supported with appropriate funding that direct resources on important tools such as raising awareness to nutrition comprehension skills among the various sectors of the society.
Similar to what others found(20), majority of study participants did not answer the calculation question correctly. The first three question required document literacy and numeracy literacy skills but the other two did not require that. This is in accordance with what was found for a group of Americans which could indicate that numeracy represents a challenge for many. Dietitian and nutritionists should perform more efforts in trying to simplify nutrition guidance which requires some numeracy skills by providing the client with more simplified information.
Income and whether the participant is from village or city were significantly related to nutrition literacy. Participants with higher income and from cities had higher nutrition literacy than participants from villages and lower income. Since most of our study participants were females this could represent more patriarchy (22) than mere socio-demographic variables as the income gap and geographical locations of Palestinian villages is not very remote from cities centers, and despite the fact Palestinian cities have higher concentration of nutrition care services, reaching out to these centers is feasible with the strong transportation system in the West Bank(23).
Most of our study participants did not use food label, or used information on them on calories, health benefits of the product. Less than half of our study group did not use low fat or low calorie diet or even low fat milk products, despite the fact that 50% reported using low fat meat. The low use of food label could be because the participants do not understand them and the low purchase of low calorie or low fat milk products could be related to the fact they are expensive and our study group were mostly from low to middle income category (24, 25).
Our study indicated low association between health literacy and food behavior. People with adequate literacy were more likely to eat reduced fat meat and to avoid eating fried chicken. One possible conclusion from this finding is that even people with adequate health literacy are unable to understand nutrition messages sent by nutrition practitioners in the society. In a previous study(26) for us under review, although most of participants health field students were able to understand how to use MyPlate American application, they reported their low efficiency in applying what they learn from this website on their practical life. Which indicate to health care providers need to simplify nutrition by providing practical workshops with graphs and cooking skills to the participants who wish to change their diet style.
Our study indicate that food security issues is not common in the studied group of mostly young Palestinians. Food security was very rare in this study, given that all studied participants had access to internet to participate in the study, it is expected that food security was uncommon. Previous studies on food security in Palestinian society indicated that prevalence of severe food insecurity 24.6%. Food insecurity was related to poverty, unemployment, low education and having more than seven members in the family(27). We did not find any common poor dietary habit among the 11 participants who reported some form of food insecurity, neither had we found differences in BMI category or food literacy.
We studied the relationship between BMI category and food habits and food literacy. Obesity and being underweight were not related to food literacy, whereas obese adults were more likely to practice healthier habits and underweight less likely to practice health habits. In a study among university female students obese, overweight and normal weight females did not have significant difference is dietary habits or sleeping duration(28). Although obese youth may avoid some unhealthy food items, they may have unhealthy practices such as skipping breakfast(29).
In summary in a group of Palestinian adults mostly in their twenties and females, we found low prevalence of nutrition literacy and use of food label. The studied group had high rate of unhealthy dietary habits but low food security. Nutrition literacy, food insecurity were related to only few unhealthy habits, whereas unhealthy dietary habits were common among underweight Palestinians.