Utilising An Ecological Model As A Structural Framework For The Results This chapter will present the results and discussion of three different stages of the research:

The large-scale survey on children’s food preferences and consumption habits; the focus group interviews with children on various aspects of food choice; and the telephone

interviews with parents on factors related to their children’s food intake. Appendix 4.1 offers an overview of the information obtained in these different stages. Several aspects of the data were linked to each other in various ways, whereas some components of the data were deemed as more relevant to the research questions than others. I have therefore decided to present the most salient themes emerging from the results utilising an ecological-type model adapted from Bronfenbrenner’s (1989a) Ecological Model of environmental influences on behaviour, McLeroy et al’s (1988) Socio-Ecological Model for nutrition education evaluation and Story, Neumark-Sztainer & French’s (2002) composite theoretical framework for understanding adolescent eating behaviour. The latter two are very similar to

Bronfenbrenner’s framework which I used earlier to guide my review of the literature, but the different levels of influence in Story et al’s model seem to be more distinct and applicable to the Maltese children’s context; thus, I feel this model is more functional as a framework for organising my results. Elements of Satia-Abouta et al’s (2002) proposed model of dietary acculturation have also been included due to the culture-cuisine interest of my research. In this model, the researchers suggest a link between a group of environmental factors which lead to changes in food procurement and preparation and in turn help to maintain traditional eating patterns or generate bi-cultural eating patterns. This seemed very relevant to my findings. Finally I have also included elements of Social Cognitive Theory (Bandura, 1986;

Reynolds et al., 1999), particularly because of the clear role of preferences, health value cognition and modelling in children’s food intake. My working ecological model can be seen in Figure 4 and it will serve as a structural framework for this chapter.

A model based on concentric ellipses was chosen to emphasise the different ecological levels and the functioning of systems within systems in relation to children’s food intake. The four broad levels of influence are Intrapersonal, Interpersonal, Community and Macro. The Intrapersonal level includes individual characteristics that influence eating behaviour, such as biological factors (e.g. gender), psychosocial factors (e.g. beliefs, attitudes and

preferences) and behavioural factors (e.g. meal and snack patterns). The Interpersonal

Child’s food intake orms for children’s food

Food

Working model showing factors from

level includes the social systems a child functions in. These primarily involve the processes and relationships within the immediate and extended family, within peer groups and within the school, which affect children’s food intake; such as through food provision, modelling, instruction and social support. The Community level includes physical, economic and cultural factors, which influence food accessibility, availability and value; such as region of

residence, the tourism industry and food-related norms. The Macro level includes factors which impact the various factors in the other levels and have an indirect influence on the child’s food intake; such as climate, seasons and global food marketing and advertising.

The multi-level model is useful for trying to explain the determinants of food intake amongst Maltese children. It emerged from the results that sometimes the specific influence of one factor on the child’s ultimate intake was direct and distinct; however, more often than not, a number of factors worked together in influencing food intake. In other words, factors in one level sometimes influenced factors in inner or outer levels before ultimately determining a child’s intake. Moreover, within a particular level or across levels there could be interaction between two or more factors creating an embedded system. This two-way interaction is known as reciprocal determinism in Socio-Ecological Models and Social Cognitive Theory and is used to explain that behaviour and environment are continuously interacting and that influence occurs in both directions (McLeroy et al., 1988; Reynolds et al, 1999).

This chapter will present the various results obtained from the latter three stages of the research and explain them within different levels of the model, whilst looking at the inter-relationships between specific factors. A comparison with the literature will also be made.

Part 1 will focus on the Intrapersonal level - mainly Maltese children’s food-related beliefs, knowledge and perceptions, their food preferences, their food intake in different settings and specific dietary patterns. Part 2 will highlight the role of factors from the Interpersonal level – primarily the mother, family dining practices and the school. Part 3 will look at one particular aspect of the Community level - namely the culture-cuisine orientation of meals. Part 4 will also look at one specific factor in the Macro level - specifically TV food portrayal and

messages, including food advertising. I must point out, however, that despite my seeking to focus on a distinct level of the ecological model in Parts 1-4, the reciprocal dynamism between levels and factors will be clear and was quite unavoidable in my discussion.

To facilitate reading, throughout this chapter the word ‘food’ should be taken to include both solid food and beverage items, unless it is clearly referring to solid food only. Similarly, the

phrase ‘Maltese children’ should be considered to include both Maltese and Gozitan children, unless it is clearly indicated that only children from the island of Malta are being referred to. When quotations from the focus group or parent interviews are given to

substantiate commentary, the specific school source (and the gender of the child in the case of parent interviews) will be indicated in brackets. (See List of Abbreviations). An index and full details of each focus group and parent interviewed were presented in Tables 43 and 46 in the Methodology chapter. (See Sections 3.2.4.2 and 3.2.5.2).