The Efficacy of Front-of-package Labelling Schemes: an Experimental Study

Study Overview
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Brief Summary
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This is an online study that aims to test the effectiveness of Interpretative Nutrition Rating Systems (INRS) such as the Health Star Rating System (HSR or Star System), traffic light system and warning labels (high sodium, saturated fat and sugar) proposed by Health Canada. The study will incorporate the use of a Smartphone application (app), FoodFlip®, to help educate consumers on each INRS prior to their exposure on food packages.

Official Title
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The Efficacy of Front-of-package Labelling Schemes: an Experimental Study

Conditions
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Diet Modification, Cardiovascular Diseases, Nutrition

Intervention / Treatment
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* Other: Nutrition Rating System - Traffic Light
* Other: Nutrition Rating System - Health Star
* Other: Nutrition Rating System - Warning Label
* Device: Smartphone application FoodFlip Device®


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: speak English as a primary language reside in Canada excluding the Northern Territories are 18 years or over provide informed consent do at least some of the household grocery shopping own a smartphone (version iPhone 3 or later or Android) are able to complete the survey on a minimum screen size of 9.7 inches.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Traffic Light<br>Participants in this group will be provided with a survey that shows the food and beverage packages with traffic light front of pack labels only. Intervention is the Nutrition Rating System - Traffic Light | Other: Nutrition Rating System - Traffic Light<br>* Behavioural: Nutrition Rating Systems (shown on the online survey and the mobile app) provide consumers with an interpretation of the healthfulness of a food or beverage, by indicating the levels (low=green, moderate=amber, high=red) of sodium, saturated fat and sugar in a product based on modified Food Standards Australia New Zealand (FSANZ) criteria.<br>Device: Smartphone application FoodFlip Device®<br>* This is embedded within each condition to inform and educate consumers about the labelling condition/intervention to which they are randomized. All participants are assigned to an app task to view 20 products and see the 'rating' these products would get according to their condition.<br>|
| Experimental: Star System<br>Participants in this group will be provided with a survey that shows the food and beverage packages with health star rating front of pack labels only. Intervention is the Nutrition Rating System - Health Star Rating | Other: Nutrition Rating System - Health Star<br>* Behavioural: Nutrition Rating Systems (shown on the online survey and the mobile app) provide consumers with an interpretation of the healthfulness of a food or beverage product by indicating the number of stars awarded to a product, from 0.5 to 5 stars, based on modified Food Standards Australia New Zealand (FSANZ) nutrient profiling criteria.<br>Device: Smartphone application FoodFlip Device®<br>* This is embedded within each condition to inform and educate consumers about the labelling condition/intervention to which they are randomized. All participants are assigned to an app task to view 20 products and see the 'rating' these products would get according to their condition.<br>|
| Experimental: Warning Label<br>Participants in this group will be provided with a survey that shows the food and beverage packages with warning front of pack labels only. Intervention is the Nutrition Rating System - Warning Labels | Other: Nutrition Rating System - Warning Label<br>* Behavioural: Nutrition Rating Systems (shown on the online survey and the mobile app) provide consumers with an interpretation of the healthfulness of a food or beverage product by indicating with a warning label products that are high in sodium, saturated fat and sugar, based on a percent daily value (%DV) greater than 15% for individual products and 30% for combination dishes.<br>Device: Smartphone application FoodFlip Device®<br>* This is embedded within each condition to inform and educate consumers about the labelling condition/intervention to which they are randomized. All participants are assigned to an app task to view 20 products and see the 'rating' these products would get according to their condition.<br>|
| No Intervention: Control<br>Participants in this group will be provided with a survey that shows the food and beverage packages without any front of pack labels. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comprehension task - ability to identify healthy products (survey measure) | The participant's ability to identify the most healthy product in a group of 5 products in a task rating 5 products with varying levels of 'healthiness' according to modified FSANZ criteria. Question wording: Please rank these products in terms of healthiness where 1 is themost healthy and 5 is the least healthy cereal | 1 day (assessed immediately after app task and while viewing products with labelling system applied | 
| Comprehension task - ability to identify unhealthy products (survey measure) | The participant's ability to identify the least healthy product in a group of products in a group of 5 products in a task rating 5 products with varying levels of 'healthiness' according to modified FSANZ criteria. Question wording: Please rank these products in terms of healthiness where 1 is themost healthy and 5 is the least healthy cereal | 1 day (assessed immediately after app task and while viewing products with labelling system applied | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comprehension task - ability to identify the overall 'healthiness' of a product (survey measure - Likert scale) | The participant's ability to accurately rate a product as more or less healthy according to the type and amount of nutritional information on the product, using a 7 point Likert scale. Question wording: How healthy is this (product) for you? | 1 day (assessed immediately after app task and while viewing products with labelling system applied | 
| Hypothetical purchasing of products (survey measure - Likert scale) | The participant's perceived likelihood of purchasing a product according to the type and amount of nutritional information on the product, using a 7 point Likert scale. Question wording: Assume this product has a cost similar to other (product category). If you were shopping for (product), how likely would you be to purchase this one? | 1 day (assessed immediately after app task and while viewing products with labelling system applied |