No abstract

Marketers have long targeted children in an attempt to influence food purchases. This is not the case for regulators; nutrition information is complex, using decimal places, percentages, and units of measure. It has been suggested that the approach to nutrition labelling in the United States is difficult for some adults to interpret, let alone children. This is unfortunate as children influence purchase decisions and childhood is a critical time for developing long-lasting eating habits. An alternative approach to traditional nutrition labelling employs the use of front-of-pack (FOP) nutrition labels. FOPs provide simplified, truncated nutrition information on the front of packages.The objective of this work was to evaluate how four different FOP label designs impact the ability of children to assess product healthfulness and time to assessment. Children aged 6 to 10 played a video game where they fed "Munchy Monster" the healthier of two products. The principal display panels (PDPs) of two mock brands of cereal appeared together on a computer screen, and children were instructed to feed Munchy Monster the healthier of the two options as quickly as they could by pressing one of two arrows. Across trials, the FOP format varied in a 2 (colour/no colour) × 2 (facial icon/no facial icon) factorial design. Within a trial, both cereals presented the same FOP format, with one healthier than the other. Two groups of children participated in trials; those in the uninstructed group were simply asked to feed the monster the healthier cereal (n = 38); the "minimally instructed group" (n = 41) was told that "this part of the package" (the FOP) might help you decide which is healthier." Accuracy of selection and time to selection were dependent variables. With regard to accuracy, both groups showed evidence of a significant face by colour interaction (P < .001), with the colour or facial icon presence improving accuracy. For uninstructed participants, accuracy of selection significantly improved with any combination of colour or facial icon, and all other labels were improved when accuracy was compared with the treatments with no face/no colour, but none containing colour and/or facial icons differed from one another. Minimally instructed participants were also more accurate in identifying the healthier product for all FOP label designs compared with the no face/no colour condition (P < .001). However, the trials with FOPs including both face with colour also performed better than the face with no colour label, P = .001. A main -This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

members of the same organization that responded to a targeted email blast. Measures: We adapted the comprehension portion of ISO 9186-1: 2007 to test 38 standardized symbols developed for the medical device industry. Participants were asked to provide an open-ended response regarding the meaning of each symbol. Survey responses were categorized into five levels of comprehension: correct, wrong, opposite, don't know or no response. Symbols receiving response rates of ≥85% in the correct category were considered successful. Conversely, if responses categorized as opposite were ≥5%, symbols were considered 'critically confusing.' Main Results: Six of 38 symbols were classified as 'successful'; five of the six had text (in English) imbedded within. Three out of the 38 were categorized as 'critically confusing'; they were not only misunderstood, but, in fact, interpreted to mean the opposite of what was intended by ≥5% of participants surveyed. Conclusions: Given that the medical device industry in the US has requested permission from the US Food and Drug Administration (FDA) to use stand-alone symbols to better harmonize with EU Directives, the exploration of healthcare providers' comprehension of the same is an important and timely topic. Our work suggests that symbols commonly incorporated into the labeling of medical devices may not be readily understood at present. As such, policy decisions should be carefully considered. Limitations: Although we provided participants with a general context of use (i.e. these symbols are used on medical devices), the specific part of the hospital, or type of procedure where the symbol would be found was not noted. Further research to evaluate symbol comprehension with specific context (e.g. IVD, general procedure, etc.) is recommended.Run order was presented consistently throughout the experiment in the same booklet. We tested whether or not this impacted results in two ways: (a) by correlating run order with mean performance to see if there was a trend through the data (toward improvement or decline) and (b) by assuming repeated measures from subjects to test if the subject response changes with time. Neither of these analyses suggested significant effects because of run order.

PurposeEffective standardization of medical device labels requires objective study of varied designs. Insufficient empirical evidence exists regarding how practitioners utilize and view labeling.ObjectiveMeasure the effect of graphic elements (boxing information, grouping information, symbol use and color-coding) to optimize a label for comparison with those typical of commercial medical devices.DesignParticipants viewed 54 trials on a computer screen. Trials were comprised of two labels that were identical with regard to graphics, but differed in one aspect of information (e.g., one had latex, the other did not). Participants were instructed to select the label along a given criteria (e.g., latex containing) as quickly as possible. Dependent variables were binary (correct selection) and continuous (time to correct selection).ParticipantsEighty-nine healthcare professionals were recruited at Association of Surgical Technologists (AST) conferences, and using a targeted e-mail of AST members.ResultsSymbol presence, color coding and grouping critical pieces of information all significantly improved selection rates and sped time to correct selection (α = 0.05). Conversely, when critical information was graphically boxed, probability of correct selection and time to selection were impaired (α = 0.05). Subsequently, responses from trials containing optimal treatments (color coded, critical information grouped with symbols) were compared to two labels created based on a review of those commercially available. Optimal labels yielded a significant positive benefit regarding the probability of correct choice ((P<0.0001) LSM; UCL, LCL: 97.3%; 98.4%, 95.5%)), as compared to the two labels we created based on commercial designs (92.0%; 94.7%, 87.9% and 89.8%; 93.0%, 85.3%) and time to selection.ConclusionsOur study provides data regarding design factors, namely: color coding, symbol use and grouping of critical information that can be used to significantly enhance the performance of medical device labels.