Governments worldwide make substantial efforts to reduce the contribution of poor diets to NCDs. Scotland has higher rates of NCDs than most other European countries and it has proved difficult to improve this situation(Reference Wrieden, Armstrong and Sherriff1). While health promotion messages have some impact on consumer awareness of ‘eating for health’, this does not necessarily translate into changes in consumer behaviour(Reference Wells, Wyness and Coe2). Common terminology used to communicate the concept of ‘eating for health’ such as ‘healthy eating’ is often confused with dieting for weight loss(Reference Paquette3). Additionally, food marketing has found value in using ‘healthy eating’ terminology, which may dilute or confuse genuine health promotion messages(Reference Schofield and Mullainathan4). The present study aimed to define public perceptions around ‘eating for health’ terminology.
Consumer understanding was assessed for four commonly used prompt-terms: Healthy Eating, Eating for Health, Balanced Diet and Nutritional Balance. Adults, with no background in nutrition or health-care, were recruited at random from Scottish urban areas of varying levels of deprivation. A mixed-methods approach involved an interviewer-led semi-quantitative word-association exercise with individuals (n = 270), and qualitative focus groups (n = 4) enabled in-depth discussion of perceptions around current and alternative health promotion interventions.
The four prompt-terms produced different response patterns in both the word-association exercise and focus groups.
1 ↑ ↓ Indicates whether the number of responses for each theme was higher (↑) or lower (↓) than the expected count in the χ2 test of association, with levels of significance * p < 0·05, ** p < 0·01, *** p < 0·001
This study revealed a partial understanding of what ‘eat for health’ means for participants. The emphasis was on favouring consumption of foods thought to be healthy (e.g. fruit and vegetables, water and salad), and the avoidance of those thought to be unhealthy (e.g. those high in fat, calories, sugar and fast food). None of the prompt-terms tested elicited a consideration of how to achieve an overall balance of nutrition in the diet. All four terms elicited negative responses relative to the expense and difficulty of ‘eating for health’. Only Eating for Health and Balanced Diet resulted in people saying “I don't do it”. Both the terminology and the survey method used affected how participants understood ‘eating for health’ messages. There was agreement that existing nutritional health promotion interventions were confusing and unhelpful and that the government should take stronger action with the food industry to ensure the healthfulness of food.
Awareness of consumer interpretation of messages, and more consistent language usage would enhance effectiveness of public health interventions.
