Healthy or Not Healthy? A Mixed-Methods Approach to Evaluate Front-of-Pack Nutrition Labels as a Tool to Guide Consumers

Abstract

This study explored how South African food labels could be improved, with a focus on comparison of front-of-pack (FOP) nutrition labels as a quick assessment tool to enhance customer evaluation of the overall healthiness of packaged food. The exploratory sequential mixed-methods design used qualitative interviews (n = 49) to gain insight into labeling challenges and select FOP nutrition labels for consumer testing. Consumers (n = 1261) randomly assessed two of six possible FOP nutrition labels relative to a ‘no-label’ control applied to a fictitious cereal product in 12 online surveys. A mixed-model analysis of variance was used to compare the differences in health ratings for the different FOP nutrition labels. The interviews revealed three themes for label improvement, that are presented over three time horizons. In terms of helping consumers identify less healthy products, the effect sizes were most prominent for health warnings (p < 0.01) and low health star ratings (p < 0.01). The findings of this research not only clarify whether FOP nutrition labeling formats used in other regions such as Europe, South America and Australia could be useful in the South African context, but they can assist policymakers and decision-makers in selecting an effective FOP label.

Uncovering the Effect of European Policy-Making Initiatives in Addressing Nutrition-Related Issues: A Systematic Literature Review and Bibliometric Analysis on Front-of-Pack Labels

“…More recent contributions continue to highlight the relevance of FoPL and their positive effects on consumers' choices [5,[131][132][133][134][135][136][137]. However, there is still a multitude of valid effects demonstrated without a full convergence of the authors [3].…”

Front‐of‐package nutrition labeling as a driver for healthier food choices: Lessons learned and future perspectives

“…The literature has already discussed that labeling systems based on colors can increase the perceived healthiness of products that display a green color FOPL, thanks to the positive, “healthy,” “natural,” and “light” aura associated with this color (Carruba et al., 2021; De Temmerman et al., 2021). Despite this effect, not only the green color but also positive labels (e.g., health or positive logos, “healthful” ratings) may not be sufficient to influence consumer decisions (Alcantara et al., 2020; Todd et al., 2022). For instance, a study carried out with South African consumers demonstrated that products displaying a Tick logo or an HSR with a high score were rated as healthier than the control (Todd et al., 2022).…”

“…Despite this effect, not only the green color but also positive labels (e.g., health or positive logos, “healthful” ratings) may not be sufficient to influence consumer decisions (Alcantara et al., 2020; Todd et al., 2022). For instance, a study carried out with South African consumers demonstrated that products displaying a Tick logo or an HSR with a high score were rated as healthier than the control (Todd et al., 2022). Controversially, a test of MTL on a UK sample found that red color elicited more avoidance behavior than green, which encouraged purchases (Scarborough et al., 2015), but possible mediators of this result were not examined in this case.…”

“…Lower health literacy is associated with higher perceived healthiness of packaged foods and consequently higher purchase intentions (Vanderlee et al., 2021). Studies testing different FOPL schemes have shown that participants with higher levels of education respond differently to FOPL, as they have been shown to make more conscious, understandable, and healthier purchases than participants with lower levels of education (Dourado et al., 2021; Ducrot et al., 2015a; Goodman et al., 2013; Jáuregui et al., 2020; Packer et al., 2021; Taillie et al., 2020; Todd et al., 2022). In addition, the income also appears to have an impact on perceived health, as low‐income individuals are more likely to perceive packaged foods as healthier than middle‐ and high‐income individuals (Machin et al., 2017; Todd et al., 2022), and are more likely to declare no preference or liking for any type of FOPL (Pettigrew et al., 2017).…”

“…Studies testing different FOPL schemes have shown that participants with higher levels of education respond differently to FOPL, as they have been shown to make more conscious, understandable, and healthier purchases than participants with lower levels of education (Dourado et al., 2021; Ducrot et al., 2015a; Goodman et al., 2013; Jáuregui et al., 2020; Packer et al., 2021; Taillie et al., 2020; Todd et al., 2022). In addition, the income also appears to have an impact on perceived health, as low‐income individuals are more likely to perceive packaged foods as healthier than middle‐ and high‐income individuals (Machin et al., 2017; Todd et al., 2022), and are more likely to declare no preference or liking for any type of FOPL (Pettigrew et al., 2017). In practice, it has been shown that the nutritional quality of shopping carts tends to be lower among participants with the lowest household income and education level (Jáuregui et al., 2020; Sandoval et al., 2019).…”