Parental knowledge, attitudes, and practices related to school children nutrition in urban settings: cross-sectional study from Central Kazakhstan

Introduction In urban settings, the relationship between parents' nutrition knowledge and children's actual dietary intake is often unstable, limiting the applicability of the linear interpretation of the Knowledge-Attitudes-Practices (KAP) model. The aim of this study was to assess how family sociodemographic characteristics and neighborhood characteristics are associated with parental KAP components and the organization of children's meals at school in Karaganda, Kazakhstan. Methods A cross-sectional study was conducted using a stratified cluster sample. A total of 863 parents participated. The parent survey assessed knowledge about healthy eating ( K ), attitudes toward school meals ( A ), and school meal management practices ( P ). Linear and logistic regression models were used to analyze the associations between parental age, neighborhood, education level, and food expenditures with KAP indicators. Results Parents' knowledge level was not statistically significantly associated with the organization of children's meals at school, indicating a gap between knowledge and practice. The most pronounced associations were observed with contextual factors. Children of parents under 30 years of age were more likely to eat in the school canteen ( OR = 1.82; p < 0.05), while parents over 40 years of age were less likely to use it ( OR = 0.32; p < 0.001) with a simultaneous increase in the likelihood of consuming sweets ( OR = 1.34; p < 0.05). Living in the South-East district was associated with more frequent food purchases by children outside of school ( OR = 1.87; p < 0.001) with a lower likelihood of bringing fast food from home ( OR = 0.20; p < 0.001). Conclusion The limitations of strategies focused solely on education and highlights the need for comprehensive measures that combine the modernization of school meals with the regulation of the food environment around schools.