Assessing food acquisition, preparation, and consumption practices in South Asia: A systematic review of assessment tools

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Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Assessing food acquisition, preparation, and consumption practices in South Asia: A systematic review of assessment tools Sharvari Patwardhan , Morgan Boncyk , Rasmi Avula , Christine Blake , Fahmida Akter , Jai K Das , Renuka Silva , Purnima Menon , Samuel Scott doi: https://doi.org/10.1101/2025.01.06.25320042 Sharvari Patwardhan 1 International Food Policy Research Institute , New Delhi, India Find this author on Google Scholar Find this author on PubMed Search for this author on this site Morgan Boncyk 2 Arnold School of Public Health, University of South Carolina , Columbia, S.C., USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Rasmi Avula 1 International Food Policy Research Institute , New Delhi, India Find this author on Google Scholar Find this author on PubMed Search for this author on this site Christine Blake 2 Arnold School of Public Health, University of South Carolina , Columbia, S.C., USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Fahmida Akter 3 BRAC James P Grant School of Public Health, BRAC University , Dhaka, Bangladesh Find this author on Google Scholar Find this author on PubMed Search for this author on this site Jai K Das 4 Institute for Global Health and Development, Aga Khan University , Karachi, Pakistan Find this author on Google Scholar Find this author on PubMed Search for this author on this site Renuka Silva 5 Wayamba University of Sri Lanka , Kuliyapitiya, Sri Lanka Find this author on Google Scholar Find this author on PubMed Search for this author on this site Purnima Menon 1 International Food Policy Research Institute , New Delhi, India Find this author on Google Scholar Find this author on PubMed Search for this author on this site Samuel Scott 6 International Food Policy Research Institute , Washington DC, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: samuel.scott{at}cgiar.org Abstract Full Text Info/History Metrics Data/Code Preview PDF ABSTRACT Assessing behaviors related to food choice at individual- and household-levels is essential for improving household diets, but assessment tools are limited. We conducted a systematic review to identify gaps in existing assessment tools for food acquisition, preparation, and household consumption practices in South Asia, wherein diets are rapidly changing, and triple burden of malnutrition is emerging. Systematic search of three academic databases (PubMed, Scopus, and Web of Science Core Collection) using pre-defined keywords were undertaken to identify studies assessing food acquisition, food preparation, and household consumption practices in South Asia, published in English between 2000 and December 2023. Following PRISMA guidelines, two reviewers independently screened titles, abstracts, and full texts based on the inclusion criteria, and extracted data on study characteristics and the assessment tools used to examine the food choice behaviors. Of 11,288 unique articles identified, 46 were included for synthesis. Food acquisition behaviors were assessed by 25 studies, food preparation by eight studies and household consumption practices by 26 studies. Most studies used quantitative methods (n=30), some used qualitative (n=13), and few used mixed methods (n=3), and varied by type of behavior assessed. Likert scales were the most widely used tools of quantitative assessments, while semi-structured interviews were the most common for qualitative assessments. Across the 46 studies, 59 different tools were used to assess food-related behaviors and only 14 studies claimed using validated tools and many studies did not include the full tool in the text or supplement (n=22). Our review highlights the need for expanding food choice behavior assessments to include the less-studied populations such as exploring young children and adolescents’ food choice behaviors and developing a contextually adaptable repository of validated tools to advance our understanding of food choice behaviors in various settings. Registry : Open Science Framework Registries Registration DOI : https://doi.org/10.17605/OSF.IO/5GPEF INTRODUCTION Healthy diets play an important role in preventing all forms of malnutrition and diet-related non- communicable diseases (NCDs) 1 . Individual food choices that shape dietary patterns are important for achieving healthy diets in South Asia, where dietary choices are challenged by poverty, high food prices relative to income, and availability and access constraints 1 , 2 . Solutions to these diet-related challenges require an understanding of the external food environment along with an examination of food choice behaviors at the household and individual levels 4 – 6 . Limited knowledge of food choice behaviors and their linkages stems partly from dearth of valid and reliable assessment tools for these behaviors 3 . Food choice encompasses the processes by which individuals decide what, how, and why to acquire, prepare, allocate, store, consume, and dispose food 7 . This process involves a series of food-related decisions and behaviors that lead to the consumption of particular foods within the context of a specific food environment. Food choice is not limited to food consumption alone. Food choice behaviors can include food acquisition, preparation, allocation, food safety and storage, and waste and disposal behaviors. Food choice is deeply intertwined with expressions of identity, preferences, and socio-cultural values that ultimately shape dietary intake and health outcomes. Such “drivers” of food choice span individual and household levels and are shaped by broader community and macro factors 7 . Food acquisition, preparation and consumption span the point at which the individual interacts with their food environment to the point when food is consumed. Food acquisition refers to what people acquire, how they acquire it, and where they acquire it, while food preparation refers to actions performed to transform food from raw or partially or fully processed ingredients to a consumable form in the household 7 . Household consumption practices are described according to their patterning (e.g., regularity, skipping, timing), format (e.g., sequence of consumption of food groups), and context (e.g., family meals, engagement in co- occurring behaviors such as watching television) 7 . Recent methodological advancements to assess food environments in low- and middle-income countries (LMICs) emphasize the external food environment (availability, prices, vendors and product properties, marketing, and regulation) 4 – 6 . Assessment of individual and household food choice behaviors within the personal food environment , however, has received less attention 3 . Knowing which behaviors to assess and how, can help guide efforts to improve diets. Providing clarity on which food choice behaviors to measure and the most appropriate tools to measure these behaviors will reduce the need for time-consuming re- creation of data collection protocols. This systematic evidence and methods review aims to understand whether and how these three food choice behaviors – food acquisition, food preparation, and household consumption practices – have been assessed in South Asia. A secondary aim was to understand the types of food choice drivers being studied (but not how these drivers were assessed). The overarching aim of this work was to identify common themes and best practices for future measurement of food choice behaviors, which is needed to inform interventions to improve diets and wellbeing. METHODS Data search, screening, and inclusion criteria This review was registered in OSF (Open Science Framework) Registries ( https://doi.org/10.17605/OSF.IO/5GPEF ) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Referring to the drivers of food choice and food choice behaviors constructs 7 , an iterative scoping exercise was conducted to identify, test, and refine the appropriate search strings for the three food choice behaviors of interest – food acquisition, preparation, and household consumption practices ( Table S1 ). The emphasis was on research that assessed how people eat rather than what people eat. We did not include intra-household food allocation in the review as there is an existing systematic review on this behavior 8 . Although food storage and disposal are important behaviors, we did not include them in the study. Two authors (SP, MB) ran and filtered the searches in December 2023 in PubMed, Scopus, and the Web of Science Core Collection, which focused on publications in English since the year 2000. The keyword search in the three databases was restricted to the title and abstract. A separate search was conducted for each of the three food choice behaviors. The results from all the searches – for all three behaviors and from all three databases – were pooled and duplicates were removed prior to screening. Search results were imported into Rayyan, a web tool designed for systematic literature reviews 9 , to aid in identifying duplicates and carry out the screening process. Titles, abstracts, and full texts were screened independently by two reviewers (SP, MB) and disagreements were resolved by a third reviewer (SS, RA, or CEB). All reviewers met weekly during the screening process to ensure consensus and discussed any uncertainties until resolution was achieved. Articles were included if they were based in a country in South Asia (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), assessed food acquisition, food preparation, or household consumption practices and had at least one driver of food choice at the individual or household level, described the tool used to assess the food choice behavior(s), were peer-reviewed, published in English language from January 2000 to December 2023, and involved a healthy population aged five years or older. Data extraction and analysis Two authors (SP, MB) independently extracted data, and a third reviewer (SS, RA, or CEB) independently reviewed the extracted data to minimize potential bias and verify the accuracy of the extracted data. Data were extracted on authors, title, study country, residence type (rural/urban/peri-urban), study objectives, study population (age and gender), method of assessment, study design, behaviors and drivers assessed, tools used to assess the behavior(s), availability of assessment tool and whether the assessment tool was validated. Data were grouped according to the classifications of food choice behaviors 7 . Food choice drivers were grouped according to the domains described in Boncyk et al. 2023 7 . Quantitative assessment tools were further categorized as self-administered or interviewer-administered questionnaires and qualitative tools were further categorized as semi-structured interviews, focus group discussions, pile sorting, or photovoice. The availability of questionnaires or tools used to assess the behavior(s) were categorized as ‘descriptions of questions specified’, ‘few questions specified’, or ‘complete tool included’. The article text and supplemental material were reviewed to locate specific questions. Tools were described as validated if the authors directly stated that the tool has been validated within the study context. Validity was not applicable for qualitative tools such as focus group discussions (FGDs). RESULTS Summary of evidence across food choice behaviors A total of 22,339 articles were identified. After removing duplicates, 11,288 titles, 562 abstracts, and 167 full texts were screened ( Figure 1 ). A total of 46 studies met our inclusion criteria and were included for synthesis. Details on the study population, data collection method, food choice behaviors assessed, and domains of food choice drivers assessed in each of the 46 studies are shown in Table S2 . Download figure Open in new tab Figure 1: PRISMA-driven flowchart for selection of studies included in the review. Food acquisition behaviors were assessed by 25 studies, food preparation by eight studies and household consumption practices by 26 studies ( Table 1 ). Most studies were from India (n=36), with few from Pakistan (n=4), Bangladesh (n=3), Nepal (n=2), and Sri Lanka (n=1). No studies were identified from Afghanistan, Bhutan, or Maldives and no studies examined multiple countries. Over two-thirds of the studies occurred in an urban setting (n=25), three studies were from a rural setting, one study was from a peri-urban setting and six studies did not specify the region. Most studies included only adults (n=29) while few included only adolescents (n=6), younger children (n=1), or mixed age groups (n=10). Fewer studies examined only females (n=3) or males (n=2) as most examined a mixed-gender population (n=38). View this table: View inline View popup Download powerpoint Table 1: Summary of the number of included studies by food choice behavior. Thirty studies used quantitative methods, 13 studies used qualitative methods, and 3 studies used mixed methods for their analyses. Quantitative tools included questionnaires (self- and interviewer-administered) with various scales and qualitative tools included semi-structured interviews and FGDs. Across the 46 studies, 59 different tools were used, only 14 of which were reported by the authors to be validated. The complete tool was provided in 22 studies, with the remaining studies only describing the questions or providing a few questions. Tools used to assess food choice behaviors Assessment of food acquisition behaviors Twenty-five studies described food acquisition behaviors in terms of frequency of purchases (e.g., frequency of buying outside food, buying from the school canteen) 10 – 12 , purchase of specialty foods (e.g., supersized foods, halal food, organic food) 13 – 26 , influence of the COVID-19 pandemic on food buying behavior (e.g., changes in food shopping behavior, market frequency) 27 – 30 , intra-household acquisition practices (e.g., where and who acquires food) 31 – 32 , and online purchasing (e.g., pattern of online food orders, consumption occasions for ordering online food) 33 – 34 ( Table 2 ). Frequency of food purchases were assessed using both quantitative (questionnaires) 10 , 12 and qualitative (FGDs) 11 approaches. Most studies assessing purchase behavior for specialty foods (in terms of purchase frequency, purchase patterns, purchase preferences) used quantitative tools; Likert scales 13 – 15 , 17 – 18 , 22 , 24 were most commonly used by interviewer-administered surveys 16 , 19 , 25 and online questionnaires 23 . Few studies used qualitative tools such as semi-structured interviews 21 , 26 including open-ended questions 20 to assess purchase behavior. Changes in food acquisition behaviors during the COVID-19 pandemic were assessed primarily using quantitative self-administered questionnaires 27 – 29 while only one study conducted qualitative FGDs 30 . Studies examined intra-household food acquisition practices using qualitative interviews 31 – 33 which were supplemented with photovoice 31 and quantitative surveys 32 administered via phone and mail 34 . Likert scales were the most commonly used quantitative tools and semi-structured interviews were the most commonly used qualitative tool. View this table: View inline View popup Table 2: Summary of tools used to assess food acquisition behaviors Assessment of food preparation behaviors Eight studies 11 , 27 , 30 – 31 , 33 , 35 – 37 described assessment of food preparation behaviors, including intra-household distribution of food preparation responsibilities 31 , 35 and cooking habits (e.g., the type of food typically prepared, time spent in the kitchen) 11 , 27 , 30 , 36 – 37 ( Table 3 ). Intra-household distribution of food preparation responsibilities was assessed using qualitative tools such as semi-structured interviews 31 , 35 and photovoice 31 . Although two studies conducted semi-structured interviews, their approach was different - one study focused on general intra-household preparation 31 while the other study enquired about how food preparation and cooking responsibilities differ between household members 35 . Cooking habits were examined using qualitative interviews 30 , 33 , 37 , FGDs 11 , 37 , pile sorting 36 , and quantitative surveys 27 . Most studies assessing food preparation behaviors used qualitative tools such as semi-structured interviews. Quantitative self-administered questionnaires were implemented only by two studies 27 , 33 . View this table: View inline View popup Download powerpoint Table 3: Summary of tools used to assess food preparation behaviors Assessment of household consumption practices Twenty-six studies described household consumption practices, including intra-household food distribution and consumption 30 , 32 , 38 – 41 , foods consumed during various eating occasions 12 , 36 , eating habits 31 , 42 , 44 – 46 , eating behaviours 37 , 43 , snack consumption patterns 10 , 11 , 47 – 51 , and eating out behavior 52 – 55 ( Table 4 ). View this table: View inline View popup Table 4: Summary of tools used to assess household consumption practices Qualitative semi-structured interviews 30 , 32 , 40 FGDs 38 , and systematic data collection methods 38 , 40 were the most common approaches to assess intra-household food distribution and consumption followed by quantitative Likert scales 39 and importance scores 41 . A combination of qualitative interviews 36 , pile sorting 36 , FGDs 12 , and quantitative survey tools 12 were used to examine foods consumed during various eating occasions. For instance, in the pile sorting exercises, respondents were requested to sort a list of a-priori hypothesized drivers into piles of always/sometimes/never influencing food choice 36 . Eating habits and behaviors were assessed primarily using quantitative tools 42 – 46 ; some articles used qualitative interviews 37 , photovoice 31 , and FGDs 37 . A higher proportion of studies assessing snack consumption patterns and eating out behavior used quantitative tools 10 , 47 – 48 , 50 – 52 , 54 – 55 followed by FGDs 11 , 53 and qualitative interviews 49 . Out of the two studies conducting FGDs, one enquired about how frequently adolescents were given money to buy outside food and which foods were bough using that money 11 , while the other study enquired about the frequency of eating out and what the reasons might be for dining out 53 . A combination of quantitative and qualitative tools were used to assess household consumption practices. Quantitative questionnaires followed by semi-structured interviews and FGDs were the most commonly used tools. DISCUSSION This review of studies from South Asia examined the tools used to assess three food choice behaviors and showed that most evidence exists for household consumption practices, followed by food acquisition behaviors and a few studies on food preparation. Most studies were conducted in India and two-thirds of the studies assessed these food related behaviors for adults only. Most of the included studies used quantitative methods. Likert scales were the most widely used quantitative tools, while semi-structured interviews were the most common qualitative tools. There was large heterogeneity between studies in terms of methods and tools used to assess food choice behaviors, limiting comparison of findings across studies. The aforementioned gap in existing literature has implications in planning culturally sensitive, contextually appropriate interventions and developing policies aimed at improving dietary practices and nutritional outcomes. The lack of standardized tools to measure food choice behaviors among children and in rural areas complicates efforts to accurately assess and compare food preparation practices across diverse settings. Therefore, further research is needed to be conducted in diverse rural settings and population subgroups to understand context-specific roles and challenges, and specially to explore children’s involvement in food preparation which may establish long-term favorable dietary habits among them. Only a few studies combined quantitative surveys with qualitative interviews or FGDs to triangulate findings and gain a comprehensive understanding of food choice behaviors. Even when assessing similar food choice behaviors using similar methods, the specific tools used differed. For instance, when assessing purchase frequency of organic foods using 5-point Likert scales, one study asked about how often respondents shopped for organic foods while the other study asked respondents level of agreement to a statement about occasionally purchasing organic foods. Moreover, there was a lack of studies using validated tools. Developing and implementing new tools to assess food choice behaviors that have been previously examined in a different setting is a time and resource-consuming exercise. Hence, efforts are needed to develop a repository of validated tools that can be adapted to different contexts to optimize research resources and maximize comparability between different studies. Gathering data using valid and effective tools provides policymakers with evidence-based guidance for supporting individuals and communities during challenging times. The key strength of this study is that it provides a comprehensive review of tools used to assess three crucial food choice behaviors - food acquisition, food preparation, and household consumption practices - in South Asia. However, several included studies considered specific foods, such as non-packaged non- branded rice, unhealthy snacks, probiotic food and beverages, halal food, rather than general food choices, which may limit generalizability. Additionally, some studies examined food purchasing behaviors during the COVID-19 pandemic, which may not be reflective of usual practices. Furthermore, the review may have missed relevant articles due to limitations in the type of publication (e.g., exclusion of gray literature), or language restrictions (non-English articles were excluded). Lastly, the lack of consistency and comparability in measurement tools across studies posed challenges in drawing conclusions about the tools used for different types of food choice behaviors. Food choice behaviors were assessed using various tools, often tailored to specific behaviors, which are valuable for capturing their complexity. While this diversity enhances understanding, inconsistent approaches to measuring the same elements across studies create significant heterogeneity, limiting opportunities for comparability and cumulative understanding. With multiple tools to measure the same element, many tools lack thorough development, validation, and accessibility, further complicating high- quality measurement. Over half the included studies did not report the complete set of tools used, hindering researchers from reproducing, adapting, and improving existing methods. Efforts have started to develop a centralized repository of existing measures, instruments, and protocols to assess food choice behaviors but remains incomplete and requires further refinement to maximize its utility 1 . There is a need for greater standardization across contexts and clear documentation of methods and instruments used. Journals should require the inclusion of assessment tools for newly developed measures to ensure rigor and accessibility. Adapting and validating existing tools, rather than creating new ones, can improve efficiency, continuity, and comparability, enabling researchers to focus on advancing our understanding of food choice behaviors. Our review highlights the need for expanding food choice behavior assessments to include the less-studied populations such as exploring young children and adolescents’ food choice behaviors and developing a contextually adaptable repository of validated tools to advance our understanding of food choice behaviors in various settings. Data Availability All data produced in the present study are available upon reasonable request to the authors SUPPLEMENTARY TABLES AND FIGURES View this table: View inline View popup Download powerpoint Table S1: Search strings used after initial scoping. View this table: View inline View popup Table S2: Geographical, population, and methodological characteristics of included studies REFERENCES 1. ↵ International Food Policy Research Institute . 2024 . 2024 Global Food Policy Report: Food Systems for Healthy Diets and Nutrition . 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