Knowledge, attitudes and practices of primary caregivers of foundation phase learners in Bloemfontein regarding breakfast and lunchboxes
Healthy breakfasts and school lunchboxes contribute to optimal nutrition during the school day and also influences the development of healthy eating habits in children over the long term. Caregivers are the most important role players in the food intake of their child, as they decide what the children in their care eat through food procurement and the meals they prepare. Children are also dependent on their caregiver to learn about healthy food practices from them. It is therefore important to determine whether caregivers are informed about healthy eating and practices and whether they have a positive or negative attitude towards providing healthy food to the children in their care. The aim of this study was to examine caregivers’ knowledge, attitudes and practices regarding healthy breakfasts and school lunchboxes and to determine whether the attitudes of the caregivers reflected in their practices regarding the provision of breakfast and lunchbox foods. The knowledge, attitudes and practices of the caregivers were also compared to socio-demographic variables to determine aspects that may affect the practices of caregivers. A cross-sectional, descriptive study was conducted, using in a sample of 1286 caregivers of foundation phase learners (aged 6 – 12 years) attending independent and public Quintile 5 primary schools in Bloemfontein, South Africa. Data on knowledge, attitudes and practices regarding breakfast and lunchbox provision were collected through printed questionnaires and caregivers had to be willing to complete the questionnaire in English. The median breakfast knowledge score of caregivers was 55.6% and median lunchbox knowledge score 73.1%. Breakfast and lunchbox food knowledge were higher for caregivers older than 35 years (median=55.6, P=0.0479 and median=76.9, P<0.0001 respectively) and those who possessed a tertiary qualification (median=55.6, P=0.0009 and median=76.9, P<0.0001 respectively), than for caregivers younger than 35 years and those without a tertiary qualification. The attitudes of caregivers were generally positive towards providing healthy breakfast and lunchbox foods to the children in their care (median=71.4% and 82.5% respectively), except for caregivers with an income of less than R20 000/month that had a lower attitude score towards providing lunchboxes (P=0.0086). Caregivers with a higher income provided a daily breakfast more often (P=0.0014) than caregivers with a lower income. Higher income caregivers however ate breakfast together with children less often (P=0.0296). Caregivers with a higher qualification also provided children more often with a daily breakfast (P=0.0011) than those with lower qualifications; and provided children with fruit (P<0.0001) and vegetables (P=0.0027) in the lunchbox more often than those with a secondary qualification. In contrast, caregivers with a lower income provided tuck shop money (P<0.0001) and fast foods (P=0.0006) more often than those with a higher income and were less positive towards healthy eating habits (P=0.0089). Caregivers with a higher income and those living with a life partner perceived healthy food to be more expensive than less healthy food (P=0.0003 and P=0.0045 respectively) and that lunchbox preparation results in an extra workload (P=0.0027 and P=0.003 respectively). Caregivers’ primary objective when providing a lunchbox was health considerations (54.2%, n=658) followed by to be filling (22.8%, n=277). The average practices score for the provision of healthy breakfast foods was 26.7% and for lunchbox foods 35.6%. Even though the practice scores were low, healthier breakfast (P=0.0013) and lunchbox foods (P=0.0001) were provided to children with caregivers that had a tertiary qualification. Overall, caregivers had a positive attitude towards providing children in their care with healthy breakfast and lunchbox foods. Unfortunately, differences still exist between the nutritional knowledge of caregivers older than 35 years and those with a tertiary qualification and younger caregivers and those with a lower qualification and the food they provide to their children. Caregivers with a higher level of nutritional knowledge tended to provide the children in their care with healthier breakfast and lunchbox foods. Therefore, the focus should be on the improvement of the nutritional knowledge of primary caregivers.