A Conceptual Nutrition Literacy Framework for Adults in the United States: A Scoping Review and Thematic Analysis.

Poor dietary behavior is a major contributor to preventable chronic conditions in the United States. Although nutrition literacy (NL) is increasingly recognized as an important determinant of diet quality, the lack of a unified framework has limited its use in education, assessment, and intervention design. Therefore, this scoping review and thematic analysis aimed to synthesize existing NL definitions, frameworks, and measures to develop an evidence-based conceptual framework to guide assessment and intervention efforts among United States adults. A literature search was conducted using 4 databases: PubMed, Web of Science, CINAHL, and Google Scholar (inception to August 2025). Peer-reviewed studies were included if they examined NL frameworks, models, programs, interventions, assessment tools, or reviews. Studies were excluded if they focused on minors (<18 y of age), combined constructs of nutrition and food literacy, or are observational studies without tool/intervention development. Two independent reviewers screened and extracted study data in Covidence, resulting in 43 included studies. Reviewers then analyzed textual content to create themes using Nutbeam's functional, interactive, and critical literacy domains. Thematic analysis allowed for concept mapping of emerging themes. Experts (n = 5) reviewed the preliminary framework using a structured 25-item internal questionnaire. Quantitative and qualitative feedback informed refinement of domains and framework organization. A total of 105 unique NL themes were identified and organized into 11 levels: knowledge, understand, obtain, apply (functional), advanced cognitive and application, motivation, communication (interactive), appraisal, advocacy, and translational (critical). The resulting NL conceptual framework defines NL as a multidimensional continuum encompassing functional, interactive, and critical domains for accessing, understanding, communicating, and applying nutrition information. This framework provides a foundation to support consistent measurement and inform the development of NL assessments and interventions for United States adults.