title: Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part II: qualitative studies.
abstract: BACKGROUND
  Large proportions of children do not fulfil the World Health Organization recommendation of eating at least 400 grams of fruit and vegetables (FV) per day. To promote an increased FV intake among children it is important to identify factors which influence their consumption. Both qualitative and quantitative studies are needed. Earlier reviews have analysed evidence from quantitative studies. The aim of this paper is to present a systematic review of qualitative studies of determinants of children's FV intake.
  
  
  METHODS
  Relevant studies were identified by searching Anthropology Plus, Cinahl, CSA illumine, Embase, International Bibliography of the Social Sciences, Medline, PsycINFO, and Web of Science using combinations of synonyms for FV intake, children/adolescents and qualitative methods as search terms. The literature search was completed by December 1st 2010. Papers were included if they applied qualitative methods to investigate 6-18-year-olds' perceptions of factors influencing their FV consumption. Quantitative studies, review studies, studies reported in other languages than English, and non-peer reviewed or unpublished manuscripts were excluded. The papers were reviewed systematically using standardised templates for summary of papers, quality assessment, and synthesis of findings across papers.
  
  
  RESULTS
  The review included 31 studies, mostly based on US populations and focus group discussions. The synthesis identified the following potential determinants for FV intake which supplement the quantitative knowledge base: Time costs; lack of taste guarantee; satiety value; appropriate time/occasions/settings for eating FV; sensory and physical aspects; variety, visibility, methods of preparation; access to unhealthy food; the symbolic value of food for image, gender identity and social interaction with peers; short term outcome expectancies.
  
  
  CONCLUSIONS
  The review highlights numerous potential determinants which have not been investigated thoroughly in quantitative studies. Future large scale quantitative studies should attempt to quantify the importance of these factors. Further, mechanisms behind gender, age and socioeconomic differences in FV consumption are proposed which should be tested quantitatively in order to better tailor interventions to vulnerable groups. Finally, the review provides input to the conceptualisation and measurements of concepts (i.e. peer influence, availability in schools) which may refine survey instruments and theoretical frameworks concerning eating behaviours.
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. rkr@niph.dk
authors: Rikke
authors: R
authors: Krølner
authors: Mette
authors: M
authors: Rasmussen
authors: Johannes
authors: J
authors: Brug
authors: Knut-Inge
authors: KI
authors: Klepp
authors: Marianne
authors: M
authors: Wind
authors: Pernille
authors: P
authors: Due
mesh_terms: D000293:Adolescent; D017195:Adolescent Nutritional Physiological Phenomena; D000367:Age Factors; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D003365:Costs and Cost Analysis; D004032:Diet; D005260:Female; D005518:Food Preferences; D005638:Fruit / Q000191:economics; D006801:Humans; D008297:Male; D009753:Nutritive Value; D010290:Parents; D012527:Satiation; D012677:Sensation; D012737:Sex Factors; D012959:Socioeconomic Factors; D014675:Vegetables / Q000191:economics