A randomized controlled trial examining consumers' perceptions and opinions on using different versions of a FoodFlip© smartphone application for delivery of nutrition information

Mavra Ahmed, Angela Oh, Lana Vanderlee, Beatriz Franco-Arellano, Alyssa Schermel, Wendy Lou, Mary R L'Abbé, Mavra Ahmed, Angela Oh, Lana Vanderlee, Beatriz Franco-Arellano, Alyssa Schermel, Wendy Lou, Mary R L'Abbé

Abstract

Background: Food labelling is a common intervention to improve diets, where the back-of-pack Nutrition Information Panel (or Nutrition Facts table (NFt)) provides comprehensive nutrition information on food packages. However, many consumers find it difficult and time-consuming to identify healthier foods using the NFt. As a result, different interpretative nutrition rating systems (INRS) may enable healthier food choices and it is essential that consumers have the tools to allow for easily accessible nutrition information. The objective of this study was to examine consumers' perceptions of different (INRS) for delivery of nutrition information using different versions of a smartphone app, FoodFlip©.

Methods: This study was part of a larger randomized controlled trial examining consumer perceptions of different INRS on food products. A nationally representative commercial sample of 2008 Canadians were randomized to one of four INRS intervention groups: 1) traffic light, 2) health star rating, 3) 'high-in' warning labels or 4) no INRS (NFt only; control) and asked to scan or enter 20 products into FoodFlip© from a list of food products provided to them with varying levels of healthfulness. After completing the app task, participants were asked a series of 7-point Likert-scale and open-ended questions to provide opinions on the usability and functionality of the app.

Results: Of the survey sample of 1997 participants, 95% (n = 1907) completed the app task, with similar number of participants in each treatment group. The mean age was 40 ± 12 years with no differences in sociodemographic characteristics between treatment groups. The health star rating ranked significantly lower in comparison to the other treatment groups in terms of usefulness (OR, 95% CI -0.67, 0.52-0.85), believability (0.59, 0.46-0.75), and understanding (0.55, 0.44-0.71) (p < 0.001). The health star rating (1.20, 0.94-1.53) and control (NFt) (1,1,1) ranked significantly lower than the traffic light or the 'high-in' warning labels for their ability to compare the healthfulness of products (p < 0.001).

Conclusion: This study demonstrated Canadian consumers' preference for a nutrient-specific system (i.e. traffic light or 'high-in' warning labels). The app, which was liked by majority of the participants for its functionality and usability, has the potential to support healthy dietary decision making and may also encourage reformulation.

Trial registration: NCT03290118 (Clinicaltrials.gov).

Keywords: Front-of-pack labelling; Interpretative nutrition rating system; Mobile health; Smartphone application.

Conflict of interest statement

Mavra Ahmed was a Government of Canada Mitacs Elevate Postdoctoral Fellow from September 2017 – September 2019 and was jointly funded by Mitacs and Nestlé Research Center. However, neither of the organizations were involved in any way with respect to the research presented within this manuscript. Prior coming to the University of Toronto, Beatriz Franco-Arellano was a PepsiCo Mexico Foods employee; however, the company had no connection or funding in any way to this research. Remaining authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
App screenshots of FoodFlip© for each of the interpretative nutrition rating system (INRS): a Traffic Light Label, b ‘High in’ Warning Label, c Star Rating and d No Front-of-Pack (Nutrition Facts table (NFt) (Control; without healthfulness comparison feature))
Fig. 2
Fig. 2
CONSORT diagram
Fig. 3
Fig. 3
7-point Likert scale responses on the usability of the FoodFlip© smartphone application. Usability was defined as the ‘quality of user interface’ which assesses the user satisfaction and user engagement with the app. Four statements were used in assessing the usability features of the app: a ‘the product search feature was easy to use’, b ‘I liked the barcode scanner feature (if you used this feature)’, c ‘the app was easy to use’ and d ‘the app was confusing’. 7-point Likert scale ratings corresponded to completely disagreed (1) to completely agree (7)
Fig. 4
Fig. 4
7-point Likert scale responses on the functionality of the FoodFlip© smartphone application. Functionality was defined as the operability of app according to its purpose or design and in this study, measures the user-evaluated reliability of the nutritional information and comparisons of products. Four statements were used in assessing the functionality of the app: a ‘the app provided me with information I can use’, b ‘the app was believable’, c ‘the app helped me in understand the nutrient levels’, and d ‘the app helped me compare the healthiness between similar products’. 7-point Likert scale ratings corresponded to completely disagreed (1) to completely agree (7)
Fig. 5
Fig. 5
Self-reported opinions and challenges using the FoodFlip© app (n = 14381). Bars show the proportion of participants who provided written responses to the question: “What are some of the challenges you had when using the app?”. Data grouped by thematic analysis and analysed using chi-square test for proportions/counts and presented as % (number of participants)

References

    1. Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P, et al. Priority actions for the non-communicable disease crisis. Lancet. 2011;377(9775):1438–1447. doi: 10.1016/S0140-6736(11)60393-0.
    1. Government of Canada . Regulations Amending the Food and Drug Regulations (Nutrition Labelling, Other Labelling Provisions and Food Colours) 2016.
    1. Schermel A, Mendoza J, Henson S, Dukeshire S, Pasut L, Emrich TE, et al. Canadians’ perceptions of food, diet, and health--a national survey. PLoS One. 2014;9(1):e86000. doi: 10.1371/journal.pone.0086000.
    1. The Strategic Counsel . Canadians’ Understanding and Use of the Nutrition Facts Table: Survey Results. 2012.
    1. Colby SE, Johnson L, Scheett A, Hoverson B. Nutrition marketing on food labels. J Nutr Educ Behav. 2010;42(2):92–98. doi: 10.1016/j.jneb.2008.11.002.
    1. Grunert KG, Fernandez-Celemin L, Wills JM, Storcksdieck Genannt Bonsmann S, Nureeva L. Use and understanding of nutrition information on food labels in six European countries. Z Gesundh Wiss. 2010;18(3):261–277. doi: 10.1007/s10389-009-0307-0.
    1. Grunert KG, Wills JM, Fernandez-Celemin L. Nutrition knowledge, and use and understanding of nutrition information on food labels among consumers in the UK. Appetite. 2010;55(2):177–189. doi: 10.1016/j.appet.2010.05.045.
    1. Campos S, Doxey J, Hammond D. Nutrition labels on pre-packaged foods: a systematic review. Public Health Nutr. 2011;14(8):1496–1506. doi: 10.1017/S1368980010003290.
    1. Miller LM, Cassady DL, Applegate EA, Beckett LA, Wilson MD, Gibson TN, et al. Relationships among food label use, motivation, and dietary quality. Nutrients. 2015;7(2):1068–1080. doi: 10.3390/nu7021068.
    1. Miller LM, Cassady DL, Beckett LA, Applegate EA, Wilson MD, Gibson TN, et al. Misunderstanding of front-of-package nutrition information on US food products. PLoS One. 2015;10(4):e0125306. doi: 10.1371/journal.pone.0125306.
    1. Sinclair S, Hammond D, Goodman S. Sociodemographic differences in the comprehension of nutritional labels on food products. J Nutr Educ Behav. 2013;45(6):767–772. doi: 10.1016/j.jneb.2013.04.262.
    1. Emrich TE, L'Abbe M. Nutrition Labelling research synthesis. Toronto: Report submitted to Office of Nutrition Policy and Promotion, Health Canada; 2014.
    1. Vanderlee L, Goodman S, Sae Yang W, Hammond D. Consumer understanding of calorie amounts and serving size: implications for nutritional labelling. Can J Public Health. 2012;103(5):e327–e331. doi: 10.1007/BF03404435.
    1. Hobin E, Shen-Tu G, Sacco J, White C, Bowman C, Sheeshka J, et al. Comprehension and use of nutrition facts tables among adolescents and young adults in Canada. Can J Diet Pract Res. 2016;77(2):59–65. doi: 10.3148/cjdpr-2015-042.
    1. Emrich TE, Qi Y, Mendoza JE, Lou W, Cohen JE, L'Abbe MR. Consumer perceptions of the nutrition facts table and front-of-pack nutrition rating systems. Appl Physiol Nutr Metab. 2014;39(4):417–424. doi: 10.1139/apnm-2013-0304.
    1. Health Canada . Eating Well with Canada's Food Guide Canada. 2007.
    1. World Health Organization . Global status report on noncommunicable diseases 2014. Geneva: World Health Organization; 2014. p. 280.
    1. Institute of Medicine (U.S.) Committee on Examination of Front-of-Package Nutrition Rating Systems and Symbols, Lichtenstein AH, Wartella E, Boon CS. Front-of-package nutrition rating systems and symbols : phase I report. Washington, D.C: National Academies Press; 2010. p. 128.
    1. Neal Bruce, Crino Michelle, Dunford Elizabeth, Gao Annie, Greenland Rohan, Li Nicole, Ngai Judith, Ni Mhurchu Cliona, Pettigrew Simone, Sacks Gary, Webster Jacqui, Wu Jason. Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases—A Randomised Controlled Trial. Nutrients. 2017;9(12):1284. doi: 10.3390/nu9121284.
    1. Health Canada . Healthy Eating Strategy: Toward Front-of-Package Nutrition Labels for Canadians: Consultation Document Canada. 2016.
    1. Government of Canada. Regulations Amending Certain Regulations Made Under the Food and Drugs Act (Nutrition Symbols, Other Labelling Provisions, Partially Hydrogenated Oils and Vitamin D). Canada Gazette. 2018;152(51):No. 6. Available from: .
    1. Government of Canada . Regulations Amending Certain Regulations Made Under the Food and Drugs Act (Nutrition Symbols, Other Labelling Provisions, Partially Hydrogenated Oils and Vitamin D): The Canada Gazette. 2018. p. 6.
    1. Canadian Foundation for Dietetic Research . Tracking Nutrition Trends 2015. 2015.
    1. World Health Organization . WHO Regional Office for Europe nutrient profile model. 2015.
    1. Health Canada . Summary of proposed amendments published in Canada Gazette, Part I: nutrition symbols, other labelling provisions, partially hydrogenated oils and vitamin D. 2018.
    1. Statistics Canada . The Internet and Digital Technology. 2017.
    1. Canadian Technology Association . 3rd Annual Consumer Technology Ownership and Market Potential Study: Canada. 2018.
    1. Carroll JK, Moorhead A, Bond R, WG LB, Petrella RJ, Fiscella K. Who Uses Mobile Phone Health Apps and Does Use Matter? A Secondary Data Analytics Approach. J Med Internet Res. 2017;19(4):e125. doi: 10.2196/jmir.5604.
    1. Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–1367. doi: 10.1007/s11606-012-2077-6.
    1. Zhao J, Freeman B, Li M. Can Mobile phone apps influence People’s health behavior change? An evidence review. J Med Internet Res. 2016;18(11):e287. doi: 10.2196/jmir.5692.
    1. West JH, Belvedere LM, Andreasen R, Frandsen C, Hall PC, Crookston BT. Controlling your “app” etite: how diet and nutrition-related Mobile apps Lead to behavior change. JMIR Mhealth Uhealth. 2017;5(7):e95. doi: 10.2196/mhealth.7410.
    1. Turner-McGrievy GM, Beets MW, Moore JB, Kaczynski AT, Barr-Anderson DJ, Tate DF. Comparison of traditional versus mobile app self-monitoring of physical activity and dietary intake among overweight adults participating in an mHealth weight loss program. J Am Med Inform Assoc. 2013;20(3):513–518. doi: 10.1136/amiajnl-2012-001510.
    1. Eyles H, McLean R, Neal B, Jiang Y, Doughty RN, McLean R, et al. A salt-reduction smartphone app supports lower-salt food purchases for people with cardiovascular disease: findings from the SaltSwitch randomised controlled trial. Eur J Prev Cardiol. 2017;24(13):1435–1444. doi: 10.1177/2047487317715713.
    1. Dunford E, Trevena H, Goodsell C, Ng KH, Webster J, Millis A, et al. FoodSwitch: a Mobile phone app to enable consumers to make healthier food choices and crowdsourcing of National Food Composition Data. JMIR Mhealth Uhealth. 2014;2(3):e37. doi: 10.2196/mhealth.3230.
    1. Dubé LBU, Ansari A, Dagher A, Daniel M, DeSrabo WS, et al. Towards a brain-to-society systems model of individual choice. Marketing Letters. 2008;19(3–4):323–336. doi: 10.1007/s11002-008-9057-y.
    1. The George Institute for Global Health . FoodSwitch. 2019.
    1. Action on Salt . FoodSwitch. 2018.
    1. Michail N. Smartphone App FoodSwitch Shows UK Industry is Lagging on Salt Targets. 2017.
    1. Hartwell H, Appleton K, Bray J, Price S, Mavridis I, Giboreau A, Perez-Cueto F, Ronge M. Shaping smarter consumer food choices: the FoodSMART project. Nutr Bull. 2019;44:138–144. doi: 10.1111/nbu.12376.
    1. Palacios Cristina, Torres Michelle, López Desiree, Trak-Fellermeier Maria, Coccia Catherine, Pérez Cynthia. Effectiveness of the Nutritional App “MyNutriCart” on Food Choices Related to Purchase and Dietary Behavior: A Pilot Randomized Controlled Trial. Nutrients. 2018;10(12):1967. doi: 10.3390/nu10121967.
    1. Gilliland J, Sadler R, Clark A, O'Connor C, Milczarek M, Doherty S. Using a smartphone application to promote healthy dietary Behaviours and local food consumption. Biomed Res Int. 2015;2015:841368. doi: 10.1155/2015/841368.
    1. Keller HH, Goy R, Kane SL. Validity and reliability of SCREEN II (seniors in the community: risk evaluation for eating and nutrition, version II) Eur J Clin Nutr. 2005;59(10):1149–1157. doi: 10.1038/sj.ejcn.1602225.
    1. Keller HH. Nutri-eSCREEN®: descriptive analysis of a self-management site for older adults (50+ years) BMC Nutrition. 2016;2(1):1. doi: 10.1186/s40795-015-0041-7.
    1. Charlton KE, Steyn K, Levitt NS, Jonathan D, Zulu JV, Nel JH. Development and validation of a short questionnaire to assess sodium intake. Public Health Nutr. 2008;11(1):83–94. doi: 10.1017/S1368980007000146.
    1. Lose weight with MyFitnessPal: Free Calorie Counter, Diet & Exercise Journal 2016 Available from: .
    1. Franco RZ, Fallaize R, Lovegrove JA, Hwang F. Popular nutrition-related Mobile apps: a feature assessment. JMIR Mhealth Uhealth. 2016;4(3):e85. doi: 10.2196/mhealth.5846.
    1. Moubarac JC, Batal M, Louzada ML, Martinez Steele E, Monteiro CA. Consumption of ultra-processed foods predicts diet quality in Canada. Appetite. 2017;108:512–520. doi: 10.1016/j.appet.2016.11.006.
    1. Bernstein JT, Schermel A, Mills CM, L’Abbe MR. Total and Free Sugar Content of Canadian Prepackaged Foods and Beverages. Nutrients. 2016;8(9):582. doi: 10.3390/nu8090582.
    1. Health Canada . Schedule M Reference Amounts. 2017.
    1. Health Canada. Sodium Working Group . Sodium reduction strategy for Canada recommendations of the Sodium Working Group [Electronic monograph in PDF format] Ottawa: Sodium Working Group; 2010.
    1. Ni Mhurchu C, Volkova E, Jiang Y, Eyles H, Michie J, Neal B, et al. Effects of interpretive nutrition labels on consumer food purchases: the starlight randomized controlled trial. Am J Clin Nutr. 2017;105(3):695–704. doi: 10.3945/ajcn.116.144956.
    1. Machin L, Aschemann-Witzel J, Curutchet MR, Gimenez A, Ares G. Does front-of-pack nutrition information improve consumer ability to make healthful choices? Performance of warnings and the traffic light system in a simulated shopping experiment. Appetite. 2018;121:55–62. doi: 10.1016/j.appet.2017.10.037.
    1. United Kingdom Food Standards Agency . Front of Pack Nutritional Signpost Labelling Technical Guidance: Issue 1. London: FSA; 2007.
    1. Food Standards Australia New Zealand . Food Standards Australia New Zealand Nutrient Profiling. 2016.
    1. Food Standards Australia New Zealand . Health Star Rating Style Guide. 2017.
    1. Mansfield ED, Wahba R, Gillis DE, Weiss BD, L’Abbé M. Canadian adaptation of the newest vital sign©, a health literacy assessment tool. Public Health Nutr. 2018;21(11):2038–2045. doi: 10.1017/S1368980018000253.
    1. Poon T, Labonte ME, Mulligan C, Ahmed M, Dickinson KM, L’Abbe MR. Comparison of nutrient profiling models for assessing the nutritional quality of foods: a validation study. Br J Nutr. 2018;120(5):567–582. doi: 10.1017/S0007114518001575.
    1. Grundy QH, Wang Z, Bero LA. Challenges in assessing Mobile health app quality: a systematic review of prevalent and innovative methods. Am J Prev Med. 2016;51(6):1051–1059. doi: 10.1016/j.amepre.2016.07.009.
    1. Venkatesh VTJ, Xu X. Consumer acceptance and use of information technology: extending the unified theory of acceptance and use of technology. Mis Quart. 2012;36(1):157–178. doi: 10.2307/41410412.
    1. Cabrera M, Machin L, Arrua A, Antunez L, Curutchet MR, Gimenez A, et al. Nutrition warnings as front-of-pack labels: influence of design features on healthfulness perception and attentional capture. Public Health Nutr. 2017;20(18):3360–3371. doi: 10.1017/S136898001700249X.
    1. Arrua A, Curutchet MR, Rey N, Barreto P, Golovchenko N, Sellanes A, et al. Impact of front-of-pack nutrition information and label design on children's choice of two snack foods: comparison of warnings and the traffic-light system. Appetite. 2017;116:139–146. doi: 10.1016/j.appet.2017.04.012.
    1. Berning JP, Chouinard HH, McCluskey JJ. Consumer preferences for detailed versus summary formats of nutrition information on grocery store shelf labels. J Agric Food Industr Org. 2008;6(1):1–22.
    1. Signal L, Lanumata T, Robinson JA, Tavila A, Wilton J, Ni MC. Perceptions of New Zealand nutrition labels by Maori, Pacific and low-income shoppers. Public Health Nutr. 2008;11(7):706–713. doi: 10.1017/S1368980007001395.
    1. Feunekes GI, Gortemaker IA, Willems AA, Lion R, van den Kommer M. Front-of-pack nutrition labelling: testing effectiveness of different nutrition labelling formats front-of-pack in four European countries. Appetite. 2008;50(1):57–70. doi: 10.1016/j.appet.2007.05.009.
    1. Moeser A, Hoefkens C, Van Camp J, Verbeke W. Simplified nutrient labelling: consumers’ perceptions in Germany and Belgium. J Consum Prot Food Saf. 2010;5(2):169–180. doi: 10.1007/s00003-009-0531-0.
    1. Gorton D, Ni Mhurchu C, Chen MH, Dixon R. Nutrition labels: a survey of use, understanding and preferences among ethnically diverse shoppers in New Zealand. Public Health Nutr. 2009;12(9):1359–1365. doi: 10.1017/S1368980008004059.
    1. Savoie N, Barlow Gale K, Harvey KL, Binnie MA, Pasut L. Consumer perceptions of front-of-package labelling systems and healthiness of foods. Can J Public Health. 2013;104(5):e359–e363. doi: 10.17269/cjph.104.4027.
    1. Hersey JC, Wohlgenant KC, Arsenault JE, Kosa KM, Muth MK. Effects of front-of-package and shelf nutrition labeling systems on consumers. Nutr Rev. 2013;71(1):1–14. doi: 10.1111/nure.12000.
    1. Ares G, Aschemann-Witzel J, Curutchet MR, Antunez L, Moratorio X, Bove I. A citizen perspective on nutritional warnings as front-of-pack labels: insights for the design of accompanying policy measures. Public Health Nutr. 2018;21:1–12.
    1. Scarborough P, Mattews A, Eyles H, Kaur A, Hodgkins C, Raats M, et al. Reds are more important than greens: how UK supermarket shoppers use the different information on a traffic light nutrition label in a choice experiment. Int J Behav Nutr Phys Act. 2015;12:151. doi: 10.1186/s12966-015-0319-9.
    1. Gorski Findling MT, Werth PM, Musicus AA, Bragg MA, Graham DJ, Elbel B, et al. Comparing five front-of-pack nutrition labels’ influence on consumers’ perceptions and purchase intentions. Prev Med. 2018;106:114–121. doi: 10.1016/j.ypmed.2017.10.022.
    1. Arrua A, Machin L, Curutchet MR, Martinez J, Antunez L, Alcaire F, et al. Warnings as a directive front-of-pack nutrition labelling scheme: comparison with the guideline daily amount and traffic-light systems. Public Health Nutr. 2017;20(13):2308–2317. doi: 10.1017/S1368980017000866.
    1. Statistics Canada . Nutritional information on packaged foods. 2016.
    1. Oh A, Ahmed M, Vanderlee L, Franco-Arellano B, L’Abbé M. Self-reported food label use by Canadian consumers. 2018.
    1. Kanter R, Vanderlee L, Vandevijvere S. Front-of-package nutrition labelling policy: global progress and future directions. Public Health Nutr. 2018;21(8):1399–1408. doi: 10.1017/S1368980018000010.
    1. Julia C, Peneau S, Buscail C, Gonzalez R, Touvier M, Hercberg S, et al. Perception of different formats of front-of-pack nutrition labels according to sociodemographic, lifestyle and dietary factors in a French population: cross-sectional study among the NutriNet-Sante cohort participants. BMJ Open. 2017;7(6):e016108. doi: 10.1136/bmjopen-2017-016108.
    1. Boushey CJ, Harray AJ, Kerr DA, Schap TE, Paterson S, Aflague T, et al. How willing are adolescents to record their dietary intake? The mobile food record. JMIR Mhealth Uhealth. 2015;3(2):e47. doi: 10.2196/mhealth.4087.
    1. Samoggia A, Riedel A. Assessment of nutrition-focused mobile apps’ influence on consumers’ healthy food behaviour and nutrition knowledge. Food Res Int. 2019;128:108766. doi: 10.1016/j.foodres.2019.108766.
    1. Bol N, Helberger N, Weert J. Differences in mobile health app use: a source of new digital inequalities. Info Soc An Int J. 2018;34(3):183–193. doi: 10.1080/01972243.2018.1438550.

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