Household Food Security as a Mediating Pathway Linking Food Culture, Practices, and Values to Under-Five Nutritional Status among Rural Dayak Communities in Sarawak: A PLS-SEM Study

Abstract

Background: Child nutrition in remote Indigenous communities is shaped not only by food availability but also by household food routines, cultural norms and the ways families obtain, prepare and share food. Evidence on how these socio-cultural food factors operate through household food security remains limited in rural Sarawak. Objective: To examine direct and indirect pathways linking food culture, food practices and food values with the nutritional status of under-five Dayak children, with household food security and dietary diversity evaluated as intermediate constructs. Methods: This focused secondary analysis used data from a community-based cross-sectional survey of 808 parent/caregiver-child dyads from 50 Dayak villages in five divisions of Sarawak, Malaysia. Households were selected through multistage random and systematic sampling. Food culture, practices and values were measured using a study-specific Likert scale; household food security and 24-hour dietary diversity used established instruments; child anthropometry followed World Health Organization procedures. The measurement model was evaluated before partial least squares structural equation modelling and mediation analysis. Results: Food culture (β=0.254), food practices (β=0.307) and food values (β=0.196) were each associated with household food security (all p<0.001). Household food security showed the strongest association with child nutritional status (β=0.627, p<0.001). The three socio-cultural constructs also had smaller direct associations with nutritional status. Food security partially mediated the relationships of food culture, practices and values with nutritional status, with variance accounted for of 68.61%, 62.86% and 74.14%, respectively. Dietary diversity was not significantly associated with food security or nutritional status in the structural model. Conclusion: Among rural Dayak households, socio-cultural food behaviours appear to relate to child nutrition chiefly through household food security rather than through food-group diversity alone. Nutrition programmes should combine culturally grounded food skills and family practices with interventions that strengthen reliable household access to food.