Let’s talk about health: shoppers’ discourse regarding health while food shopping

Supporting healthier food choices through AI-tailored advice: A research agenda

Objective

To develop a research agenda to investigate the effectiveness of AI-tailored advice to support healthier home cooking. It aims to support healthier food choice in the context of hypertension, allergies, and sustainable diets.

Methods

We describe an agenda that has been formed between 2019 and 2022, through multiple rejected grant applications to the Research Council of Norway. We focus on the case of tailored recipe advice for individuals, formulating research questions and methods for three topics: "Acceptance of Personalized Food Advice", "Algorithm and Interface AI: App Development", and "Nutrition Modeling & Clinical Trials". The overall methodology focuses on mitigating health issues among individuals with hypertension.

Conclusion

The design of AI to support healthier home cooking should tap into computational principles, as well as (psychological) theories of behavioral change. The effectiveness of an AI-driven home cooking app can be evaluated in a clinical trial akin to 'regular' dietary intervention studies.

Innovation

The development of a research agenda requires an integrated effort between scientists from different domains, during both the development and writeup of ideas. The proposed project is innovative, as most food technology and AI approaches have yet to be tested in proper trials on changes in eating habits.

Factors influencing perceptions of processed baby foods and feeding practices among Indian mothers: a qualitative investigation

OBJECTIVE

To explore how professionally qualified, working Indian mothers conceptualize healthy foods in general, perceive processed infant and baby foods available commercially and what feeding practices they actually follow with their children at home.

DESIGN

Five focus groups with 8-12 participants were conducted around the participants' conceptualization of healthy food, their perceptions about commercially available processed baby and infant foods and their actual feeding practices that they routinely follow with their children. Discussion transcripts were analyzed using an inductive coding approach.

SETTING

India.

PARTICIPANTS

Fifty-one professionally qualified, working women with at least one child under 5 years of age.

RESULTS

Participants agreed that fresh food is healthiest. They also had favorable opinions about processed infant and baby foods with regards to healthfulness, hygiene and safety. Healthy foods were largely conceptualized in relation to nutrient claims, ingredients and discernible health outcomes. They use cues, such as health claims, brand, price, package design and others to determine healthfulness of the product. Perception was heavily influenced by these extrinsic cues rather than by participants' own nutrition knowledge. Despite having the knowledge, most participants admitted to using these foods on account of factors such as their own inability to lactate, social pressure, lack of time and convenience.

CONCLUSIONS

Most educated and well off people continue to use these products. While they rue the lack of stringent regulatory measures in India, they feel there is an urgent need to address this huge policy gap by way of legislation and regulation.

Smartphone Apps for Food Purchase Choices: Scoping Review of Designs, Opportunities, and Challenges

BACKGROUND

Smartphone apps can aid consumers in making healthier and more sustainable food purchases. However, there is still a limited understanding of the different app design approaches and their impact on food purchase choices. An overview of existing food purchase choice apps and an understanding of common challenges can help speed up effective future developments.

OBJECTIVE

We examined the academic literature on food purchase choice apps and provided an overview of the design characteristics, opportunities, and challenges for effective implementation. Thus, we contribute to an understanding of how technologies can effectively improve food purchase choice behavior and provide recommendations for future design efforts.

METHODS

Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we considered peer-reviewed literature on food purchase choice apps within IEEE Xplore, PubMed, Scopus, and ScienceDirect. We inductively coded and summarized design characteristics. Opportunities and challenges were addressed from both quantitative and qualitative perspectives. From the quantitative perspective, we coded and summarized outcomes of comparative evaluation trials. From the qualitative perspective, we performed a qualitative content analysis of commonly discussed opportunities and challenges.

RESULTS

We retrieved 55 articles, identified 46 unique apps, and grouped them into 5 distinct app types. Each app type supports a specific purchase choice stage and shares a common functional design. Most apps support the product selection stage (selection apps; 27/46, 59%), commonly by scanning the barcode and displaying a nutritional rating. In total, 73% (8/11) of the evaluation trials reported significant findings and indicated the potential of food purchase choice apps to support behavior change. However, relatively few evaluations covered the selection app type, and these studies showed mixed results. We found a common opportunity in apps contributing to learning (knowledge gain), whereas infrequent engagement presents a common challenge. The latter was associated with perceived burden of use, trust, and performance as well as with learning. In addition, there were technical challenges in establishing comprehensive product information databases or achieving performance accuracy with advanced identification methods such as image recognition.

CONCLUSIONS

Our findings suggest that designs of food purchase choice apps do not encourage repeated use or long-term adoption, compromising the effectiveness of behavior change through nudging. However, we found that smartphone apps can enhance learning, which plays an important role in behavior change. Compared with nudging as a mechanism for behavior change, this mechanism is less dependent on continued use. We argue that designs that optimize for learning within each interaction have a better chance of achieving behavior change. This review concludes with design recommendations, suggesting that food purchase choice app designers anticipate the possibility of early abandonment as part of their design process and design apps that optimize the learning experience.

Echinococcoses in Iran, Turkey, and Pakistan: Old Diseases in the New Millennium

Echinococcosis is considered a cosmopolitan zoonosis caused by different species of small taeniid tapeworms of the genus Echinococcus and is regarded as a neglected zoonosis. Cystic and alveolar echinococcoses are endemic diseases of Tibetan, Pamir, and Iranian plateaus. All of the countries within the Iranian plateau are affected by echinococcosis. Pakistan, Turkey, and Iran are the three most populous countries of the region, in which echinococcosis is highly endemic. The three neighboring countries share strong cultural and socioeconomic ties. The present study aimed to provide a broad review of the status of cystic and alveolar echinococcosis, summarizing the current knowledge about geographical distribution, molecular epidemiology, and transmission dynamics of Echinococcus granulosus sensu lato and Echinococcus multilocularis in this region. Additionally, we aimed to understand disease burden and risk factors as basic requirements for establishing a surveillance system and planning prevention and control programs. A considerable body of information is available on different aspects of echinococcosis in this region; however, several information and research gaps need to be filled before planning control programs. None of the countries in the region have an elaborate echinococcosis control program. Effective control programs require multi/intersectoral coordination within a One Health approach with a long-term political and administrative commitment and enhanced international collaboration among the three countries.

Using Supermarket Loyalty Card Data to Provide Personalised Advice to Help Reduce Saturated Fat Intake among Patients with Hypercholesterolemia: A Qualitative Study of Participants' Experiences

Background: The ‘Primary Care SHOPping Intervention for Cardiovascular Disease Prevention’ (PCSHOP) trial tested the effectiveness and feasibility of a behavioural intervention to reduce saturated fat in food purchases. The intervention offered feedback from data collected through a supermarket loyalty card to supplement brief advice from a nurse. This qualitative study aimed to describe participants’ experiences of receiving this intervention. Methods: We conducted semi-structured, one-to-one, telephone interviews with participants from the PCSHOP trial. Interviews were audio-recorded and transcribed verbatim. We employed the one sheet of paper technique and a thematic analysis to develop high-level themes in NVivo software. Results: Twenty-four participants were interviewed (mean age: 63 years (SD 12)). They reported that the brief advice did not provide any new information but they welcomed the sense of accountability the nurse provided. The personalised shopping feedback and healthier swap suggestions provided novel information that challenged previously held beliefs about the saturated fat content of food purchases and encouraged some positive dietary changes. However, the taste preferences of the participant or other household members were a barrier to changing food shopping behaviours. Conclusion: Harnessing loyalty card data is a novel and acceptable method to offering personalised dietary feedback. Yet, issues on the suitability of the healthier swap suggestions limited the extent of dietary change. Trial registration: ISRCTN14279335. Registered 1 September 2017.

Exploring External Factors Affecting the Intention-Behavior Gap When Trying to Adopt a Sustainable Diet: A Think Aloud Study

Not least from an ecological and health perspective, it can be posited that a broader part of consumers should practice sustainable diets. People who are already willing to do so are often confronted with the intention-behavior gap, caused by a range of internal and external factors. To eliminate these barriers requires a deeper and more comprehensive understanding of these factors and their interplay. Therefore, a think aloud study with 20 adult German participants was conducted to explore the four chosen external factors of availability, education, advertising and price. Furthermore, questionnaires for all four factors were handed out and a follow-up interview was conducted to gain additional qualitative data. Results show that these four external factors seem to have a major impact on the intention-behavior relation. According to the participants all factors interact in some way with other internal and external factors, making practicing sustainable diets a complex activity. In conclusion, the four external factors availability, education, advertising and price need to be addressed by various stakeholders within our food systems in order to move forward in the process of making sustainable diets practicable and sustainable food systems firmly established.

Consumers' Implicit and Explicit Recall, Understanding and Perceptions of Products with Nutrition-Related Messages: An Online Survey

This study aimed to assess consumers' implicit and explicit recall, understanding and perceptions of products with a nutrition claim and a symbol depicting 'health,' and to determine whether these perceptions differed among Nutrition Facts table (NFt) users vs. nonusers. In an online survey, participants (n = 1997) were randomized to one of eight conditions in a 2 × 2 × 2 factorial design, consisting of a label with a claim (present/absent) a heart-shaped symbol depicting 'health' (present/absent) for a healthier or less healthy soup. Participants were shown a label for 10 s and asked whether they recalled seeing a claim. If participants answered yes, they were then asked to describe their response using open-ended questions. Participants also rated the product's perceived nutritional quality and purchase intentions using seven-point Likert scales. In the claim condition, most participants (75%) were able to recall the presence of a claim, while 12% incorrectly mentioned the presence of a claim when there was none. Claims likely attracted consumers' attention and increased perceived nutritional quality, although with limited influence among NFt users (23%). The symbol depicting 'health' did not enhance perceived nutritional quality or purchase intentions. Although most participants (77%) made their decisions implicitly using the front of labels, those who used the NFt had a better understanding of the nutritional quality of products.

The heuristics that guide healthiness perception of ultra-processed foods: a qualitative exploration

Objective:

To explore the conceptualisation of healthy food by citizens and how they judge the healthiness of ultra-processed foods.

Design:

Four focus groups were conducted using a semi-structured discussion guide. Focus group discussions were held about the concept of healthy food, what characterise a healthy product and healthiness perception of ultra-processed products. Transcripts of the focus groups were analysed following an inductive coding approach.

Setting:

Uruguay, one of the Latin American countries with the highest prevalence of overweight and obesity.

Participants:

Fifty-two adult Uruguayan participants, diverse in terms of gender, age, educational level and socio-economic status.

Results:

In agreement with previous studies on lay perceptions of healthy eating, the conceptualisation of healthy food was mainly focused on food characteristics. Although participants regarded lack of processing as a cue for healthiness, they did not categorise all ultra-processed products as unhealthy. Albeit some product categories were automatically regarded as unhealthy, participants considered that other categories could include healthy and unhealthy products. In such cases, they explicitly referred to several simplified cognitive strategies to judge whether an ultra-processed product is healthy or not. Results showed that participants tended to rely on simple cues, such as label design, nutrient claims, brand, price and country of origin as indicators of product healthiness.

Conclusions:

Healthiness perception of ultra-processed products seems to be largely influenced by heuristics, which stresses the need to implement policies that make the potential negative effects of ultra-processed products salient.

Parents' and carers' awareness and perceptions of UK supermarket policies on less healthy food at checkouts: A qualitative study

BACKGROUND

In the retail environment strategic placement of food influences purchasing. Foods placed at checkouts have tended to be less healthy. In response to consumer concern some UK supermarkets voluntarily committed to removing less healthy food from their checkouts. We explored qualitatively the perceptions and experiences of parents and carers of younger children regarding food at supermarket checkouts, supermarket checkout food policies, and other supermarket stimuli which influences purchasing.

METHODS

Twelve focus groups were conducted in urban central Scotland with 91 parents/carers of primary school aged children (aged 5-11 years).

RESULTS

The availability of less healthy foods at checkouts was perceived as problematic, encouraging purchase requests by children and impulse buys by adults. Parents/carers were aware of a change in some supermarkets where less healthy foods had been replaced with healthier items and they were supportive of supermarket policies that placed restrictions on checkout food. Many parents/carers welcomed product-free checkouts, however the whole supermarket was perceived as manipulative and stimulating.

CONCLUSION

Voluntary supermarket policies which clearly and consistently restrict the placement of less healthy foods at checkouts have been welcomed by parents/carers of young children. Given that marketing strategies throughout the whole supermarket were viewed as problematic, public health policymakers and advocacy groups may want to encourage supermarkets to develop broader policies to support healthier food purchasing.

Breakfast eating patterns and drivers of a healthy breakfast composition

Breakfast has long been described as the most important meal of the day. While breakfast habits and their consequences on children's health and performance are well documented, studies on the adult population are lacking. The present study will fill this gap, providing a comprehensive picture of the Swiss breakfast habits and insights into the determinants of a healthy breakfast composition. Data were collected through a postal survey sent out to a randomly selected sample of 1917 German-speaking Swiss residents, yielding a final sample size of N = 460. Breakfast habits were disclosed, and individual breakfast healthiness scores were assessed by two nutrition specialists. A multiple regression analysis was then performed to investigate the influence of several motivational, socio-demographic, health- and knowledge-related determinants on breakfast healthiness. The sample showed recommendable habits in terms of consumption frequency and quite traditional eating patterns, illustrated by the prevalence of continental breakfasts and equally marked by the frequent consumption of dairy products. Overall, the Swiss breakfast composition is moderately healthy, lacking fruits and whole grain products. Paying attention to healthy food choices in general, higher education level, being a woman and reporting to be fit are factors linked to a healthier breakfast composition; while preferences for low-fat, familiar or convenient foods are correlated to less healthy patterns. Given the parallel between the determinants of a healthy breakfast composition and those of a healthy diet and taking some limiting factors, such as consumers preference for convenience and strong habits, into account, we support the current nutritional advice focusing on balancing the diet over the day or the week rather than on recommendations dedicated to specific meals.

Views of dairy farmers, agricultural advisors, and lay citizens on the ideal dairy farm

The aim of this qualitative study was to explore the shared and divergent views among Brazilian dairy farmers, agricultural advisors, and lay citizens on what characteristics they viewed were most important on an ideal dairy farm. Responses from 107 dairy farmers, 170 agricultural advisors (including veterinarians), and 280 lay citizens were subjected to thematic analyses. Five themes were identified: milk quality, animal welfare, economics, society, and the environment. Although all 3 groups made reference to each of the 5 themes, they emphasized different characteristics. The lay citizens placed the most emphasis on milk quality. In contrast, both the farmers and the advisors highlighted economics as the most important characteristic of an ideal dairy farm. When considering only animal welfare, we noted differences in the use of the constructs of animal welfare: farmers and advisors referred mostly to aspects related to biological functioning, whereas lay citizens emphasized affective states and naturalness. All 3 stakeholder groups referred to the use of pasture as being an important component of an ideal dairy farm but again differed in their reasons; citizens referred to pasture in the context of naturalness, whereas the other 2 stakeholder groups almost always referred to pasture using economic terms. Technology was highlighted by all 3 groups as an important characteristic of an ideal dairy farm but differences were noted in their justification for this view. For example, lay citizens viewed technology as a tool to improve milk quality, whereas farmers and advisors both referred to technology as an important vehicle to improve quality of life for those working in the industry. Lay citizens raised several concerns associated with the overuse of antibiotics and other chemicals, but farmers and advisors rarely mentioned these types of concerns. The latter 2 stakeholders placed considerable emphasis on the quality of life of dairy farmers and workers, an issue rarely discussed by lay citizens. Overall, our findings highlight several disconnects between the expectations of the lay citizens, and farmers and their advisors. We suggest that dairy farmers and agricultural advisors should both reflect on the desires of the lay public in what they view to be an ideal dairy farm, as this may help bridge some of the current disconnects.

Consumer accounts of favourable dietary behaviour change and comparison with official dietary guidelines

OBJECTIVE

The current study aimed to assess Uruguayan consumers' accounts of their own need to change their dietary patterns, their intended changes and the barriers related to doing so, and to compare the intentions and barriers with the recommendations of the national dietary guidelines.

DESIGN

An online survey with 2381 Uruguayan employed adults, aged between 18 and 65 years, 65 % females, was conducted. Participants had to answer two open-ended questions related to changes they could make in the foods they eat and/or the way in which they eat to improve the quality of their diet and the reasons why they had not implemented those changes yet. Content analysis using inductive coding by two researchers was used to analyse the responses.

RESULTS

Consumers mainly intended to change consumption of types of foods, particularly eating more fruits, vegetables and legumes and consuming less flour, but also intended to alter their eating patterns. Lack of time and the fact that healthy foods are perceived as being more expensive than unhealthy foods were major barriers to behaviour change. Some of the recommendations of the dietary guidelines, particularly those related to enjoying cooking and meals and engaging in it as a social activity, were not represented in consumer accounts.

CONCLUSIONS

Accompanying policies to the dietary guidelines need to underline the importance of changes in dietary patterns, including greater enjoyment and sharing food preparation and meals in the company with others, address misconceptions about flour, and provide concrete, consumer-derived recommendations on how to enact the guidelines.

Brazilian Citizens: Expectations Regarding Dairy Cattle Welfare and Awareness of Contentious Practices

Simple Summary

Animal welfare is an important issue for citizens in North America and Europe, but much less is known about how citizens from emergent countries, such as Brazil, view this topic. Our aim was to explore attitudes of urban Brazilian citizens about dairy production and, in particular, how they view four routine husbandry practices: early cow-calf separation; zero-grazing; culling of the newborn male calf; and dehorning without pain mitigation. Through in-depth interviews and a questionnaire using open-ended questions, we can conclude that animal welfare was a major issue for our participants, especially in terms of its perceived relation with milk quality. Although participants were initially unaware about any of the four management practices, they were all viewed as contentious and not supported. This study provides some insights that farmers and others working in the Brazilian dairy supply chain should take into consideration, particularly in terms of social sustainability.

Abstract

The primary aim of this study was to explore attitudes of urban Brazilian citizens about dairy production. A secondary aim was to determine their knowledge and attitudes about four potentially contentious routine dairy cattle management practices: early cow-calf separation; zero-grazing; culling of newborn male calves; and dehorning without pain mitigation. To address the first aim 40 participants were interviewed using open-ended semi-structured questions designed to probe their views and attitudes about dairy production in Brazil, and 300 participants answered a questionnaire that included an open-ended question about the welfare of dairy cattle. Primary concerns reported by the participants centered on milk quality, which included the rejection of any chemical additives, but also animal welfare, environmental and social issues. The interviewees rarely mentioned animal welfare directly but, when probed, expressed several concerns related to this topic. In particular, participants commented on factors that they perceived to influence milk quality, such as good animal health, feeding, clean facilities, and the need to avoid or reduce the use of drugs, hormones and pesticides, the avoidance of pain, frustration and suffering, and the ability of the animals to perform natural behaviors. To address our second aim, participants were asked questions about the four routine management practices. Although they self-reported being largely unaware of these practices, the majority of the participants rejected these practices outright. These data provide insight that animal welfare may be an important issue for members of the public. Failure to consider this information may increase the risk that certain dairy production practices may not be socially sustainable once lay citizens become aware of them.

Can existing mobile apps support healthier food purchasing behaviour? Content analysis of nutrition content, behaviour change theory and user quality integration

OBJECTIVE

To assess the quality of nutrition content and the integration of user quality components and behaviour change theory relevant to food purchasing behaviour in a sample of existing mobile apps.

DESIGN

Descriptive comparative analysis of eleven mobile apps comprising an assessment of their alignment with existing evidence on nutrition, behaviour change and user quality, and their potential ability to support healthier food purchasing behaviour.

SETTING

Mobile apps freely available for public use in GoogePlay were assessed and scored according to agreed criteria to assess nutrition content quality and integration of behaviour change theory and user quality components.

SUBJECTS

A sample of eleven mobile apps that met predefined inclusion criteria to ensure relevance and good quality.

RESULTS

The quality of the nutrition content varied. Improvements to the accuracy and appropriateness of nutrition content are needed to ensure mobile apps support a healthy behaviour change process and are accessible to a wider population. There appears to be a narrow focus towards behaviour change with an overemphasis on behavioural outcomes and a small number of behaviour change techniques, which may limit effectiveness. A significant effort from the user was required to use the mobile apps appropriately which may negatively influence user acceptability and subsequent utilisation.

CONCLUSIONS

Existing mobile apps may offer a potentially effective approach to supporting healthier food purchasing behaviour but improvements in mobile app design are required to maximise their potential effectiveness. Engagement of mobile app users and nutrition professionals is recommended to support effective design.

Substituting sugar confectionery with fruit and healthy snacks at checkout - a win-win strategy for consumers and food stores? a study on consumer attitudes and sales effects of a healthy supermarket intervention

Background

The widespread use of in-store marketing strategies to induce unhealthy impulsive purchases has implications for shopping experience, food choice and possibly adverse health outcomes. The aim of this study was to examine consumer attitudes and evaluate sales effects of a healthy checkout supermarket intervention. The study was part of Project Sundhed & Lokalsamfund (Project SoL); a Danish participatory community-based health promotion intervention.

Methods

Consumer attitudes towards unhealthy snack exposure in supermarkets were examined in a qualitative pre-intervention study (29 short in-store interviews, 11 semi-structured interviews and three focus group interviews). Findings were presented to food retailers and informed the decision to test a healthy checkout intervention. Sugar confectionery at one checkout counter was substituted with fruit and healthy snacking items in four stores for 4 weeks. The intervention was evaluated by 48 short exit interviews on consumer perceptions of the intervention and by linear mixed model analyses of supermarket sales data from the intervention area and a matched control area.

Results

The qualitative pre-intervention study identified consumer concern and annoyance with placement and promotion of unhealthy snacks in local stores. Store managers were willing to respond to local consumer concern and a healthy checkout intervention was therefore implemented. Exit interviews found positive attitudes towards the intervention, while intervention awareness was modest. Most participants believed that the intervention could help other consumers make healthier choices, while fewer expected to be influenced by the intervention themselves. Statistical analyses suggested an intervention effect on sales of carrot snack packs when compared with sales before the intervention in Bornholm control stores (P < 0.05). No significant intervention effect on sales of other intervention items or sugar confectionery was found.

Conclusions

The present study finds that the healthy checkout intervention was positively evaluated by consumers and provided a ‘responsible’ branding opportunity for supermarkets, thus representing a win-win strategy for store managers and consumers in the short term. However, the intervention was too modest to draw conclusions on long-term sales and health implications of this initiative. More research is needed to assess whether retailer-researcher collaborations on health promotion can be a winning strategy for public health.