I started my career with GSK as a development chemist and then moved to Superdrug Stores PLC as Head of Technical Services. During my 14 years in industry, I gained extensive experience of managing technical and research projects within both branded and retail environments. In 2003, I joined the Food, Consumer Behaviour and Health Research Centre (FCBH) at the University of Surrey, a multidisciplinary research centre which brings together skills and expertise in order to address research questions on food related policy, consumer behaviour and public health. I have played an instrumental role in the success of the Research Centre, working on a wide range of collaborative, multidisciplinary UK and EU funded research projects.
I have a keen interest in the communication of health-related information on foods to consumers i.e. nutrition labelling and health claims, this being the focus of my PhD thesis. In addition, I have expertise in exploring the design and delivery of interventions and m-health solutions to improve quality of life and to promote self-management of illness and/or healthier lifestyles.
Policy relevance and Responsible Research and Innovation (RRI) is a cross-cutting theme across my research, and my work is aimed at both understanding the processes of policy making and contributing high quality underpinning research evidence on which to base future policies.
Areas of specialism
University roles and responsibilities
- Associate Theme Lead: Understanding People's Relationships with Social and Physical Environments
- Athena Swan Committee Member (School of Psychology)
- REF2020 Impact Case Study support and mentoring (FHMS)
The focus of my research as part of the FCBH team, is to explore the impact of health-related information provision on consumer understanding. I have experience of conducting research employing both qualitative and quantitative methods. Whilst my main focus has been on nutrition information and health claims, more broadly, I am interested in all aspects of health and wellbeing and in the design and implementation of interventions that may be used to improve quality of life and to promote self-management of illness and/or healthier lifestyles.
Sweeteners and sweetness enhancers: Impact on health, obesity, safety and sustainability: 2018-2023, Funder: EU H2020
Background The rise in use of food supplements based on botanical ingredients (herbal supplements) is depicted as part of a trend empowering consumers to manage their day-to-day health needs, which presupposes access to clear and accurate information to make effective choices. Evidence regarding herbal supplement efficacy is extremely variable so recent regulations eliminating unsubstantiated claims about potential effects leave producers able to provide very little information about their products. Medical practitioners are rarely educated about herbal supplements and most users learn about them via word-of-mouth, allowing dangerous misconceptions to thrive, chief among them the assumption that natural products are inherently safe. Print media is prolific among the information channels still able to freely discuss herbal supplements. Method This study thematically analyses how 76 newspaper/magazine articles from the UK, Romania and Italy portray the potential risks and benefits of herbal supplements. Results Most articles referenced both risks and benefits and were factually accurate but often lacked context and impartiality. More telling was how the risks and benefits were framed in service of a chosen narrative, the paucity of authoritative information allowing journalists leeway to recontextualise herbal supplements in ways that serviced the goals and values of their specific publications and readerships. Conclusion Providing sufficient information to empower consumers should not be the responsibility of print media, instead an accessible source of objective information is required.
Background: Most food in the UK is purchased in supermarkets and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behaviour. Objectives: The FLICC study is a pilot randomised controlled trial of a digital behaviour change intervention. This pilot trial aimed to collect data on recruitment and retention rates and to provide estimates of effect sizes for the primary outcome (healthiness of ready meals and pizzas purchased) to inform a larger trial. Methods: The intervention consisted of a website where participants could access tailored feedback on previous purchases of ready meals and pizzas, set goals, model behaviour and practice using traffic light labels. The control consisted of web-based information on traffic light labelling. Participants were recruited via email from a list of loyalty card holders held by the participating supermarket. All food and drink purchases for the participants for the six months prior to recruitment, during the six week intervention period and during a twelve week wash out period were transferred to the research team by the participating supermarket. Healthiness of ready meal and pizzas was measured using a pre-developed scale based solely on the traffic light colours on the foods. Questionnaires were completed at recruitment, end of intervention and end of wash out to estimate the effect of the intervention on variables that mediate behaviour change (e.g. belief and intention formation). Results: We recruited 496 participants from an initial email to 50,000 people. Only three people withdrew from the study and purchase data were received for all other participants. 208 participants completed all three questionnaires. There was no difference in the healthiness of purchased ready meals and pizzas between the intervention and control arms either during the intervention period (P = 0.315) or at wash-out (P = 0.594). Conclusions: Whilst the FLICC study did not find evidence of an impact of the intervention on food purchasing behaviour, the unique methods used in this pilot trial are informative for future studies that plan to use supermarket loyalty card data in collaboration with supermarket partners. The experience of the trial showcases the possibilities and challenges associated with the use of loyalty card data in public health research.
The use of dietary supplements is increasing globally and this includes the use of plant food supplements (PFS). A variety of factors may be influencing this increased consumption including the increasing number of older people in society, mistrust in conventional medicine and the perception that natural is healthy. Consumer studies in this area are limited, with a focus on dietary supplements in general, and complicated by the use of certain plant food supplements as herbal medicines. Research indicates that higher use of dietary supplements has been associated with being female, being more educated, having a higher income, being white and being older, however the drivers for consumption of supplements are complex, being influenced by both demographic and health-related factors. The aim of this paper is to provide an overview of current knowledge about the users and the determinants of usage of plant food supplements. With growing consumption of these products, the need for effective risk-benefit assessment becomes ever more important and an insight into who uses these types of products and why is an important starting point for any future science-based decisions made by policy makers, PFS manufacturers and ultimately by consumers themselves.
Different front-of-pack (FOP) labelling systems have been developed in Europe by industry and organisations concerned with health promotion. A study (n 2068) was performed to establish the extent to which inclusion of the most prevalent FOP systems--guideline daily amounts (GDA), traffic lights (TL), GDA+TL hybrid (HYB) and health logos (HL)--impact consumer perceptions of healthiness over and above the provision of a FOP basic label (BL) containing numerical nutritional information alone. The design included within- and between-subjects factors. The within-subjects factors were: food (pizzas, yogurts and biscuits), healthiness of the food (high health, medium health and low health) and the repeated measurements under BL and test FOP label conditions. The between-subjects factors were: the system (GDA, TL, GDA+TL hybrid, HL), portion size (typical portion size and a 50% reduction of a typical portion) and country (the UK, Germany, Poland and Turkey). Although the FOP systems tested did result in small improvements for objective understanding under some conditions, there was little difference between the provision of an FOP label containing basic numerical nutritional information alone or between the various systems. Thus, any structured and legible presentation of key nutrient and energy information on the FOP label is sufficient to enable consumers to detect a healthier alternative within a food category when provided with foods that have distinctly different levels of healthiness. Future research should focus on developing greater understanding of the psychological and contextual factors that impact motivation and the opportunity to use the various FOP systems in real-world shopping settings.
Background Traffic light labelling of foods—a system that incorporates a colour-coded assessment of the level of total fat, saturated fat, sugar and salt on the front of packaged foods—has been recommended by the UK Government and is currently in use or being phased in by many UK manufacturers and retailers. This paper describes a protocol for a pilot randomised controlled trial of an intervention designed to increase the use of traffic light labelling during real-life food purchase decisions. Methods/design The objectives of this two-arm randomised controlled pilot trial are to assess recruitment, retention and data completion rates, to generate potential effect size estimates to inform sample size calculations for the main trial and to assess the feasibility of conducting such a trial. Participants will be recruited by email from a loyalty card database of a UK supermarket chain. Eligible participants will be over 18 and regular shoppers who frequently purchase ready meals or pizzas. The intervention is informed by a review of previous interventions encouraging the use of nutrition labelling and the broader behaviour change literature. It is designed to impact on mechanisms affecting belief and behavioural intention formation as well as those associated with planning and goal setting and the adoption and maintenance of the behaviour of interest, namely traffic light label use during purchases of ready meals and pizzas. Data will be collected using electronic sales data via supermarket loyalty cards and web-based questionnaires and will be used to estimate the effect of the intervention on the nutrition profile of purchased ready meals and pizzas and the behavioural mechanisms associated with label use. Data collection will take place over 48 weeks. A process evaluation including semi-structured interviews and web analytics will be conducted to assess feasibility of a full trial. Discussion The design of the pilot trial allows for efficient recruitment and data collection. The intervention could be generalised to a wider population if shown to be feasible in the main trial. Trial registration ISRCTN: ISRCTN19316955 webcite
Background The popularity of botanical products is on the rise in Europe, with consumers using them to complement their diets or to maintain health, and products are taken in many different forms (e.g. teas, juices, herbal medicinal products, plant food supplements (PFS)). However there is a scarcity of data on the usage of such products at European level. Objective To provide an overview of the characteristics and usage patterns of PFS consumers in six European countries. Design Data on PFS usage were collected in a cross-sectional, retrospective survey of PFS consumers using a bespoke frequency of PFS usage questionnaire. Subjects/setting A total sample of 2359 adult PFS consumers from Finland, Germany, Italy, Romania, Spain and the United Kingdom. Data analyses Descriptive analyses were conducted, with all data stratified by gender, age, and country. Absolute frequencies, percentages and 95% confidence intervals are reported. Results Overall, an estimated 18.8% of screened survey respondents used at least one PFS. Characteristics of PFS consumers included being older, well-educated, never having smoked and self-reporting health status as “good or very good”. Across countries, 491 different botanicals were identified in the PFS products used, with Ginkgo biloba (Ginkgo), Oenothera biennis (Evening primrose) and Cynara scolymus (Artichoke) being most frequently reported; the most popular dose forms were capsules and pills/tablets. Most consumers used one product and half of all users took single-botanical products. Some results varied across countries. Conclusions The PlantLIBRA consumer survey is unique in reporting on usage patterns of PFS consumers in six European countries. The survey highlights the complexity of measuring the intake of such products, particularly at pan-European level. Incorporating measures of the intake of botanicals in national dietary surveys would provide much-needed data for comprehensive risk and benefit assessments at the European level.
Background: Colour coded front-of-pack nutrition labelling (‘traffic light labelling’) has been recommended for use in the UK since 2006. The voluntary scheme is used by all the major retailers and some manufacturers. It is not clear how consumers use these labels to make a single decision about the relative healthiness of foods. Our research questions were: Which of the four nutrients on UK traffic light labels (total fat, saturated fat, sugar and salt) has the most influence on decisions? Do green lights or red lights have a greater influence? Are there age and gender differences in how people use the colour and nutrient information? Methods: We recruited participants from a UK supermarket chain membership list to conduct an online choice experiment in May 2014. We analysed data using multilevel logisitic models with food choices (n = 3321) nested in individuals (n = 187) as the unit of analysis. Results: A food with more reds was 11.4 (95 % confidence intervals: 10.3, 12.5) times less likely to be chosen as healthy, whereas a food with more greens was 6.1 (5.6, 6.6) times more likely to be chosen as healthy. Foods with better colours on saturated fat and salt were 7.3 (6.7, 8.0) and 7.1 (6.5, 7.8) times more likely to be chosen as healthy – significantly greater than for total fat (odds ratio 4.8 (4.4, 5.3)) and sugar (5.2 (4.7, 5.6)). Results were broadly similar for different genders and age groups. Conclusions: We found that participants were more concerned with avoiding reds than choosing greens, and that saturated fat and salt had a greater influence on decisions regarding healthiness than total fat and sugar. This could influence decisions about food reformulation and guidance on using nutrition labelling.
Background: While functional foods offer promise for public health and innovation in the food industry, the efficiency of such foods should be assured to protect consumers from misleading claims. Globally, many countries regulate the communication of the health effects of such foods to final consumers. Scope and approach: In the European Union (EU), the use of health claims was harmonized in 2006. All claims need to be scientifically assessed by the European Food Safety Authority (EFSA) and pre-approved. Implementing the regulation has involved a steep learning curve for stakeholders, resulting in many health claims being rejected. The EU-funded REDICLAIM project used existing guidance documents, analyses of Scientific Opinions on new health claim applications, and a series of interviews with experts involved in such applications to identify key points in the process of authorizing new health claims. Key findings and conclusions: Recommendations for the successful substantiation of new health claims in the EU were prepared. The substantiation of health claims is primarily based on human efficacy studies, and greater resources are required to authorize more innovative claims. The reported recommendations should be seen as a starting point for researchers in the area of nutrition and food technology, and for those dealing with functional foods, including the food industry.
Background/Objectives:The objective of this study was to identify the common requirements of users involved in the compilation of food composition data sets with a view to informing the development of a common access system to food composition data, within the European Food Information Resource (EuroFIR) project.Subjects/Methods:A number of examples of food composition data set compilation have been examined using the Use Case approach, namely the compilation of a data set for a national nutrition survey, for a cross-national nutrition study and for a nutritional software programme.Results:The key user requirement identified from the compilation step analysed by the Use Case approach is the increased availability of and access to more detailed food composition data on a wider range of foods and nutrients.Conclusions:Food composition data serve a variety of purposes, and different user groups will often have both common needs and more individual or specific needs of their data sets. The development of Use Cases for specific processes effectively identifies the needs of users, highlighting any similarities and/or differences in those needs. The application of the Use Case approach to support the software development activities within EuroFIR will ensure that user needs are effectively identified and captured in a systematic and documented way.
Background: mhealth, predominantly wearable technology and mobile apps, have been considered in Parkinson’s Disease to provide valuable ecological data between face to face visits and improve monitoring of motor symptoms remotely. Objective: In this study we explore the feasibility of using a technology based mhealth platform comprising a smartphone in combination with a smartwatch and a pair of smart insoles, described in the present study as the PD_manager system, to collect clinically meaningful data. We also explore outcomes and disease related factors which are important determinants to establish feasibility. Finally, we further validate a tremor evaluation method with data collected while patients perform their daily activities. Methods: PD_manager trial was an open label parallel group randomized study. The mheath platform consists of a wristband, a pair of sensor insoles, a smartphone (with dedicated mobile Android apps and a knowledge platform) serving as the cloud backend. The compliance was assessed with statistical analysis and the factors affecting it using appropriate regression analysis. The correlation of the scores of our previous algorithm for tremor evaluation and the respective UPDRS estimations by clinicians were explored. Results: There were 65 of the 75 study participants (87%) who completed the protocol. They used the PD_manager system for a median 11.57 days (Std. dev. 3.15). The regression analysis suggests that the main factor associated with high usage was caregivers’ burden. Motor Aspects of Experiences of Daily Living and patients’ self-rated health status also influence the system’s usage. Our algorithm provided clinically meaningful data for the detection and evaluation of tremor. Conclusions: We found that PD patients, regardless of their demographics and disease characteristics, used the system for 11-14 days. The study further supports that mhealth can be an effective tool for the ecologically valid, passive, unobtrusive monitoring and evaluation of symptoms. Future studies will be required to demonstrate that an mhealth platform can improve disease management and care.
BACKGROUND/OBJECTIVES: The research question addressed in this paper is how different reference amounts utilised in front of package nutrition labelling influence evaluation of product healthfulness. SUBJECTS/METHODS: A total of 13,117 participants from six European countries (Germany, UK, Spain, France, Poland and Sweden) were recruited via online panels. A mixed between/within-subject factorial design was employed with food (biscuits, sandwiches, yogurts), healthfulness and presence of Guideline Daily Amounts as within-subjects factors and reference amount ('per 100 g', 'typical portion', 'half portion') and country as between-subjects factors. RESULTS: Overall, people correctly ranked foods according to their objective healthfulness as defined by risk nutrients alone, and could distinguish between more and less healthful variants of foods. General healthfulness associations with the three product categories do not appear to have had a strong influence on product ratings. This study shows that where the reference amount of 'per 100 g' is very different from the 'typical' portion size, as was the case for biscuits, products with a 'per 100 g' label are rated significantly less healthful than the 'typical' or 'half typical' portions. CONCLUSION: The results indicate that across the three food categories, consumers do factor the reference amount, that is, the quantity of food for which the nutritional information is being presented, into their judgements of healthfulness. Therefore, appropriate reference amounts are also of importance for the effective presentation of nutritional information.
Introduction: Nutrition labelling is recognized as a key tool for combating this problem by providing consumers with information which promotes healthy eating. Objectives: To investigate the extent to which food labelling systems (FLS) encourage healthier choices. Method/Design: Laddering interviews with three groups (parents; 55+; teenagers) of 20 participants were carried out in the United Kingdom. The eight FLS studied varied in complexity (e.g. numerical, graphical and colour-based information), directiveness and benchmarking (nutrient- and product-level). Results: The relationship between gross amount of information presented and actual label use is mediated by the type of benchmarking used and by what participants think its level of directiveness implies about them. Participants suggested they could decrease the cognitive workload of an ostensibly complex FLS by initially engaging only with the traffic light colours. Participants were unlikely to engage with non-directive FLS without benchmarking because these were slow to use and difficult to understand, offering objective information but no tools for use; thus suggesting an erosion self-efficacy and decreased likelihood of use in future, particularly less experienced shoppers. Semi-directive FLS with nutrient-level benchmarking gave both information and tools for meaningful engagement, increasing self-efficacy and ability to use labels effectively. A product-level logo FLS sacrificed all else for speed and ease of use, reducing decisionmaking rather than empowering the making of informed choices. Conclusions: Future FLS designs need to consider the psychological as well as practical reasons why consumers choose to engage with some FLS and ignore others. In removing any obvious link between dietary recommendations and hard facts, overly simplified labels sacrifice flexibility, utility and persuasiveness on the assumption that ease and speed are all. By contextualising real information with colourful nutrient-level benchmarking an optimal FLS may encourage shoppers to make their own informed decisions, restoring that link and empowering them to take more interest in nutrition in the future.
Background: Parkinson’s disease is a degenerative neurological condition causing multiple motor and non-motor symptoms that have a serious adverse effect on quality of life. Management is problematic due to the variable and fluctuating nature of symptoms, often hourly and daily. The PD_Manager mHealth platform aims to provide a continuous feed of data on symptoms to improve clinical understanding of the status of any individual patient and inform care planning. The objectives of this trial are to (1) assess patient (and family carer) perspectives of PD_ Manager regarding comfort, acceptability and ease of use; (2) assess clinician views about the utility of the data generated by PD_Manager for clinical decision making and the acceptability of the system in clinical practice. Methods/design: This trial is an unblinded, parallel, two-group, randomised controlled pilot study. A total of 200 persons with Parkinson’s disease (Hoehn and Yahr stage 3, experiencing motor fluctuations at least 2 h per day), with primary family carers, in three countries (110 Rome, 50 Venice, Italy; 20 each in Ioannina, Greece and Surrey, England) will be recruited. Following informed consent, baseline information will be gathered, including the following: age, gender, education, attitudes to technology (patient and carer); time since Parkinson’s diagnosis, symptom status and comorbidities (patient only). Randomisation will assign participants (1:1 in each country), to PD_Manager vs control, stratifying by age (1 ≤ 70 : 1 > 70) and gender (60% M: 40% F). The PD_Manager system captures continuous data on motor symptoms, sleep, activity, speech quality and emotional state using wearable devices (wristband, insoles) and a smartphone (with apps) for storing and transmitting the information. Control group participants will be asked to keep a symptom diary covering the same elements as PD_Manager records. After a minimum of two weeks, each participant will attend a consultation with a specialist doctor for review of the data gathered (by either means), and changes to management will be initiated as indicated. Patients, carers and clinicians will be asked for feedback on the acceptability and utility of the data collection methods. The PD_ Manager intervention, compared to a symptom diary, will be evaluated in a cost-consequences framework Discussion: Information gathered will inform further development of the PD_Manager system and a larger effectiveness trial. Trial registration: ISRCTN Registry, ISRCTN17396879. Registered on 15 March 2017.
Many food and drink products now display nutritional information on the front of the food package, so called front-of-pack (FOP) nutrition labels or nutrition signpost labels, which serve to provide a simple and visible summary of the products nutritional quality. This chapter reviews FOP labelling in the EU. It covers the history of FOP development, the different types of FOP labelling, the underpinnings of the different FOP schemes as well as ways of classifying FOP schemes. The impact FOP labels have on consumers and the food industry are discussed with a useful section on future trends. A list of review papers are presented for further reading.
Objective: To examine the role of food composition data in Europe in four sectors, namely health, trade regulation and legislation, agriculture and the environment. Results: The need for further harmonization of data across Europe is clearly identified and evidenced from a number of previous successful European collaborations. Conclusions: Data on the nutritional composition of foods are essential for a broad spectrum of activities, including public health nutrition, research, the food industry and government policy development and implementation. With the expansion of the European Union and the concomitant increase in cross border trade and cooperation harmonizing food composition data becomes a more important issue than ever. Harmonization is not solely a technical issue, but also involves creating durable and sustainable structures to maintain the viability of the data. These are some of the issues currently being addressed by the European Food Information Resource Network of Excellence.
Responsibility is crucial to governance and key to achieving legitimacy within complex systems, yet there is limited attention to how it should be conceptualized within the context of food research and innovation (R&I). Understanding how diverse stakeholders in food R&I conceptualize responsibility is vital because it shapes the way problems are identified, goals are set and solutions are put in place. We report on empirical research with diverse stakeholders across Europe to understand and map the dimensions of responsibility for food R&I to support healthy and sustainable food systems. Semi-structured interviews were conducted with 32 stakeholders working in R&I in the cutting-edge domains of: cultured meat as a substitute for livestock meat; new crop breeding of potatoes; and a new approach to obesity reduction that focuses on weight acceptance. Drawing from the empirical evidence collected, we developed a classification system that reflects various conceptualizations of stakeholders' responsibility for food R&I to support healthy and sustainable food systems. Our thematic analysis revealed four overlapping rationales of responsibility—accountability, impact, reflexivity, and responsiveness, and characterized them in terms of: who the researcher is responsible to; whether the assessments of responsibility focus on R&I processes or impact; whether responsibility implies societal engagement; and how responsibility is assessed—retrospectively or prospectively. The article provides a basis for systematic application of these criteria to the specific instances of food R&I governance and for future joint decisions, about the ways to allocate responsibilities.
This is the most comprehensive and robust evaluation of FOP nutrition signpost labelling published to date. It provides information on how FOP labels are used by shoppers in a retail environment; the extent to which they are accurately interpreted and the impact of the co-existence of the current range of FOP labels on comprehension. This aim of this research was to establish which FOP labelling scheme(s), or which combination of elements of schemes, best facilitate the accurate interpretation of key nutritional information by consumers such that they are enabled to make informed choices about the foods they purchase. The research addressed three key questions: (1) How well do individual signpost schemes (or elements of the schemes) enable consumers to correctly interpret levels of key nutrients?; (2) How do consumers use FOP labels in real life contexts in the retail environment and at home?; (3) How does the coexistence of a range of FOP label formats affect accurate interpretation of FOP labels?
The Nutrition and Health Claims Regulation (NHCR) EC No 1924/2006 aims to provide an appropriate level of consumer protection whilst supporting future innovation and fair competition within the EU food industry. However, consumers’ interpretation of health claims is less well understood. There is a lack of evidence on the extent to which consumers are able to understand claims defined by this regulatory framework. Utilising the Multiple Sort Procedure (MSP), a study was performed (N = 100 participants across five countries: Germany, the Netherlands, Slovenia, Spain and the United Kingdom) to facilitate development of a framework of health-related claims encompassing dimensions derived from consumers. Our results provide useful insight into how consumers make sense of these claims and how claims may be optimised to enhance appropriate consumer understanding. They suggest consumers may not consciously differentiate between a nutrition claim and a health claim in the way that regulatory experts do and provide insight into where this might occur. A consumer-derived typology of health-related claims based on three key dimensions is proposed: (1) Familiarity with the nutrient, substance or food stated in the claim; (2) statement type in terms of simplicity/complexity; (3) relevance of the claim, either personally or for a stated population group.
Significant ongoing debate exists amongst stakeholders as to the best front-of-pack labelling approach and emerging evidence suggests that the plethora of schemes may cause confusion for the consumer. To gain a better understanding of the relevant psychological phenomena and consumer perspectives surrounding FoP labelling schemes and their optimal development a Multiple Sort Procedure study involving free sorting of a range of nutritional labels presented on cards was performed in four countries (n=60). The underlying structure of the qualitative data generated was explored using Multiple Scalogram Analysis. Elicitation of categorisations from consumers has the potential to provide a very important perspective in this arena and results demonstrated that the amount of information contained within a nutrition label has high salience for consumers, as does the health utility of the label although a dichotomy exists in the affective evaluation of the labels containing varying degrees of information aggregation. Classification of exiting front-of-pack labelling systems on a proposed dimension of 'directiveness' leads to a better understanding of why some schemes may be more effective than others in particular situations or for particular consumers. Based on this research an enhanced hypothetical front-of-pack labelling scheme which combines both directive and non-directive elements is proposed.
Objective: Health claims on food packaging are regulated to inform and protect consumers, however many consumers do not accurately interpret the meaning of the claims. Whilst research has shown different types of misinterpretation, it is not clear how those interpretations are formed. The aim of this study is to elicit the causal beliefs and causal models about food and health held by consumers, i.e. their understanding of the causal relationships between nutrients, health outcomes and the causal pathways connecting them, and investigate how well this knowledge explains the variation in inferences they draw about health benefits from health claims. Method: 400 participants from Germany, the Netherlands, Spain, Slovenia, and the UK were presented with 7 authorised health claims and drew inferences about the health benefits of consuming nutrients specified in the claim. Then their personal causal models of health were elicited along with their belief in the truth and familiarity with the claims. Results: The strength of inferences about health benefits that participants drew from the claims were predicted independently by the strength of the relevant causal pathways within the causal model, and belief in the truth of the claim, but not familiarity with the claim. Participants drew inferences about overall health benefits of the nutrients by extrapolating from their causal models of health. Conclusion: Consumers’ interpretation of claims is associated with their belief in the claim and their causal models of health. This prior knowledge is used to interpret the claim and draw inferences about overall health benefits that go beyond the information in the claim. Therefore efforts to improve consumers’ understanding and interpretation of health claims must address both their wider causal models of health and their knowledge of specific claims.
Objective: Images on food and dietary supplement packaging might lead people to infer (appropriately or inappropriately) certain health benefits of those products. Research on this issue largely involves direct questions, which could (a) elicit inferences that would not be made unprompted, and (b) fail to capture inferences made implicitly. Using a novel memory-based method, in the present research, we explored whether packaging imagery elicits health inferences without prompting, and the extent to which these inferences are made implicitly. Method: In 3 experiments, participants saw fictional product packages accompanied by written claims. Some packages contained an image that implied a health-related function (e.g., a brain), and some contained no image. Participants studied these packages and claims, and subsequently their memories for seen and unseen claims were tested. Results: When a health image was featured on a package, participants often subsequently recognized health claims that— despite being implied by the image—were not truly presented. In Experiment 2, these recognition errors persisted despite an explicit warning against treating the images as informative. In Experiment 3, these findings were replicated in a large consumer sample from 5 European countries, and with a cued-recall test. Conclusion: These findings confirm that images can act as health claims, by leading people to infer health benefits without prompting. These inferences appear often to be implicit, and could therefore be highly pervasive. The data underscore the importance of regulating imagery on product packaging; memory-based methods represent innovative ways to measure how leading (or misleading) specific images can be.