N09017: A critical review of the psychosocial basis of food choice and identification of tools to effect positive food choice

Study Duration: January 2003 to March 2004

Contractor: British Nutrition Foundation

Dietary advice to the public (for example, the Government's Eight Guidelines for a healthy diet) is now well established and has been depicted in food guides worldwide, including the Balance of Good Health model in Britain. However, the real challenge is encouraging people to change their diets to encompass these messages and supporting them in the maintenance of beneficial changes. It is clear that it is not sufficient just to popularise the message, eg eat less fat or eat more fibre. Even when people have the necessary knowledge, there has to be the will to actually change their behaviour.

It is this that is proving most challenging to health professionals. An important aspect of the challenge is that a vast array of factors influence the choices individuals make about the foods they consume; and the profile of these factors, for any particular individual, will be particularly influenced by economic and cultural factors, health and attitudes to health, knowledge and understanding (of the message bearer and of the recipient), and preparedness to change.

Aim
This project aims to use an in-depth and structured approach to produce a written critical review of the literature on the psychosocial basis of food choice, identifying factors that influence positive food choices, examples of positive interventions and gaps in the evidence base.

Objectives

• To use an in-depth and structured approach to produce a critical review of the literature on the psychosocial basis of food choice, identifying factors that influence positive food choices, examples of positive interventions and gaps in the evidence base.
• To establish and utilise the expertise of a steering group of experts to guide the project and to help formulate recommendations.
• To disseminate the findings in user friendly and relevant formats to key stakeholders.

Approaches and research plan
Considerable effort has already been invested in the search for interventions that might result in improving dietary patterns, using an array of approaches, from national campaigns geared to increase knowledge and change attitudes to practical hands on interventions that increase life skills.

This review will assess a wide variety of international literature sources (published and unpublished) using an in-depth and structured approach. (It is not intended to conduct a formal systematic review as this would take several years to compile given the enormity of the field.) The review will comprise two strands:

(a) consideration of the major psycho-social factors that affect food choice to provide an overview; and

(b) a critical appraisal of published intervention studies and identification of interventions in progress.

The review will also include consideration of the applicability of health promotion models and theories (including barriers and opportunities); techniques used in work on consumer attitudes and preferences related to diet, and the factors that influence acceptability; and the impact on food choice of income, life skills and access.

To limit the scope of the review it will exclude specialist areas such as slimming and sensory analysis, and will focus on the general population (excluding those with special dietary needs/studies conducted in a clinical setting), and will focus on the age range 5-65 years.

The BNF team will be guided by a steering group comprising up to eight experts in aspects of food choice and message delivery.

In addition, it is planned to use the FLAIR-FLOW network (of which BNF is UK National Network Leader) to liaise with colleagues in other parts of Europe regarding work in progress. BNF is also Action Leader for health professionals for the entire 24 countries.

The role of the steering group will be to help fine tune the literature search and (with officials) to participate in a workshop to discuss and refine the provisional findings of the review and to help shape the recommendations.

Dissemination of this information to stakeholders is crucial if progress is to be made. The experience and resources of the contractor and staff will be used to disseminate the findings of the review to relevant stakeholders including researchers and health professionals (including GPs, dietitians, public health nutritionists and community nurses) involved in nutrition communication and public health nutrition. The objective will be to make these communications relevant, practical and user-friendly.

This is a very detailed review of a considerable literature in which each study is described in depth and its strengths and weaknesses assessed. It also includes discussion of the problems encountered in study design. The interventions identified are presented by setting, e.g. supermarkets, catering settings, primary care, schools and colleges, the workplace, community, and in some cases by approach, e.g. peer-led interventions and those employing computer-based approaches.

The scope of the review excluded specialist areas such as slimming and sensory analysis, and focussed on evaluations (published since 1990) of interventions in the general free-living population (excluding those with special dietary needs and underlying medical conditions), within the age range 5-65 years.

The review concludes with 15 priority recommendations for action or research. In formulating these, consideration has been given to gaps in the evidence base and opportunities with the greatest potential for making a difference, taking into account 'quick wins' versus longer term objectives; the range of Government activities currently underway; the fit with findings of the National Diet and Nutrition Survey (NDNS) series and other government surveys (i.e. poor dietary patterns and micronutrient intakes of older children, young adults and low income groups); the fit with the provisional goals identified for the Food and Health Action Plan; and the need to address health inequalities and to identify rate limiting steps.

A user-friendly summary (around 38 pages), which draws together the findings, is available free of charge from the Agency's library. Also, the full report is available, however this is lengthy and runs to around 700 pages.

To obtain a copy of the summary or full report, please contact the Enquiry Desk, Dr Elsie Widdowson Library and Information Services, Food Standards Agency Tel: 020 7276 8181/8182 or email: library&info@foodstandards.gsi.gov.uk

Some findings from the review were presented at a talk by the British Nutrition Foundation in May 2004 at a primary care conference.

The findings have also been used as a basis for a workshop on potential future research which was held on 20 January 2005. (See link at the foot of this page)

Contact: For any enquiries concerning this research project, please contact the relevant Programme contact or email science@foodstandards.gsi.gov.uk