Developing and refining behaviour-change messages based on the Brazilian dietary guidelines: use of a sequential, mixed-methods approach

Sato, Priscila de Morais; Neto, Jose Ribeiro Gouveia; Scagliusi, Fernanda Baeza; Jaime, Patrícia Constante

doi:10.1186/s12937-020-00585-1

Cited by 6 publications

(8 citation statements)

References 37 publications

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“… 64 - 66 For example, milk, which is considered a minimally processed food, was often misclassified as ultra-processed in Argentina, Ecuador and Uruguay. 64 , 65 In Brazil, the first country to include explicit advice to avoid UPFs in their dietary guidelines in 2014, a recent study found that consumer behaviour has not changed substantially and identified the need to make dietary advice “more accessible, and actionable to be potentially more effective.” 67 To ensure that consumers understand messages about UPFs, similar research is needed in other regions, incorporating specific cultural and socio-economic circumstances to ensure that the NOVA framework and concept of ultra-processing is communicated in ways relevant and understandable to communities.…”

Section: Discussionmentioning

confidence: 99%

Representations of Ultra-Processed Foods: A Global Analysis of How Dietary Guidelines Refer to Levels of Food Processing

Koios

Machado

Lacy-Nichols

2022

Int J Health Policy Manag

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Background: As evidence grows about negative health impacts of ultra-processed foods, nutrient-centred advice is contested, and food-based dietary guidelines are increasingly utilised. Previous analyses of dietary guidelines evaluated their potential impact on health and sustainability, but little research has been conducted to examine how the concept of ultra-processed foods is reflected in dietary advice for consumers. This paper systematically analyses whether and how ultra-processed foods are represented in dietary guidelines internationally. Methods: Based on a systematic online search, the consumer-targeted key messages of 106 dietary guidelines were identified and a qualitative content analysis was conducted. A coding framework was developed to classify messages as ‘eat more’ or ‘eat less’ according to the language used (e.g. ‘choose’ vs ‘avoid’) and to differentiate between a focus on nutrients or food processing. Specific foods mentioned in ‘eat less’ guidelines were classified according to their level of processing using the NOVA framework. Results: 99% of guidelines utilised some type of nutrient-based message, either promoting ‘positive’ nutrients (e.g. vitamins) or discouraging the consumption of ‘negative’ nutrients (mainly salt, sugar and fat). Explicit references to food processing were present in 45% of ‘eat less’ guidelines and 5% of ‘eat more’ guidelines. Implicit references (e.g. promoting ‘raw’ or discouraging ‘packaged’ foods) were found in 43% of ‘eat less’ and 75% of ‘eat more’ guidelines. 53% of the specific foods referred to in ‘eat less’ advice were ultra-processed foods. Conclusion: Overall, nutrient-based messages were more common than messages about processing levels. The majority of discouraged foods were ultra-processed foods, however some minimally processed foods were discouraged, which points to tensions and contradictions between nutrient- and processing-based dietary advice. As dietary guidelines begin to include advice about food processing, it is important to consider both consumer understanding of the terms used and their capacity to act on the advice.

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Section: Discussionmentioning

confidence: 99%

Representations of Ultra-Processed Foods: A Global Analysis of How Dietary Guidelines Refer to Levels of Food Processing

Koios

Machado

Lacy-Nichols

2022

Int J Health Policy Manag

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“…It is generally recommended that messages are short, simple, specific and easy to understand, based on the food and nutrition literacy of the intended audience [71,76,109]. As an example, the core messages of the Brazilian FBDG were refined to be less than three sentences long with direct, one-sided messages [69].…”

Section: Language and Tonementioning

confidence: 99%

“…The Australian, Canadian and Brazilian FBDG communications address barriers such as availability, cost, time, lack of cooking skills and the temptation of unhealthy food advertising [69,113,115,117]. Currently, Eatwell Guide communications do not adequately address the benefits of and barriers to adopting the recommendations.…”

Section: Addressing Barriers and Benefitsmentioning

confidence: 99%

Improving Communication of the UK Sustainable Healthy Dietary Guidelines the Eatwell Guide: A Rapid Review

Culliford¹,

Bradbury

Medici³

2023

Sustainability

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Background: Food-based dietary guidelines (FBDG) are a key public health tool, providing evidence-based recommendations for a healthy and more environmentally sustainable diet. Current adherence to national FBDG in the UK is poor with only 0.1% of the population meeting all of the recommendations set out in the Eatwell Guide. Communication of the Eatwell Guide is one of the many essential strategies needed to improve adherence and to support the necessary shift towards sustainable diets in the UK. An effective strategy is needed to communicate this information to policy makers, the food industry, health professionals and the public in order to drive dietary behaviour change. Methods: The authors conducted a rapid review of the scientific literature available in the SCOPUS database published between 2012 and 2022 (inclusive). Keywords searched related to the communication and implementation of FBDG. Additionally, examples of communication strategies for national FBDG globally are presented to demonstrate examples of good practice in this field. Results: The review highlighted several key themes relating to effective communication of FBDG. As a result, five recommendations are made for how communication of the Eatwell Guide could be improved to drive better adherence to these sustainable healthy guidelines. The recommendations are (1) review of language and tone of nutrition and sustainability related messages; (2) targeting of FBDG and communications to specific population segments; (3) addressing barriers to and benefits of adopting the Eatwell Guide recommendations; (4) development of practical tools and resources to support implementation of the guidelines; and (5) leveraging social media and social marketing techniques to increase public engagement. Conclusions: This research summarises the current scientific literature on the effective communication of FBDG. The recommendations may be used to improve future communication strategies for the Eatwell Guide as well as other national and international sustainable healthy FBDG.

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“…The details of message development and refinement have been presented in a separate manuscript [17]. Briefly, a sequential, five-step, mixed-methods approach was undertaken prior to this study that included: (i) content extraction of 63 excerpts from the 2014 Brazilian Dietary Guidelines; (ii) a secondary analysis of the literature to highlight barriers to healthy eating among adult, urban-dwelling Brazilians who were the intended audience of these messages (audience analysis); (iii) input from a 4-member expert review panel to help prioritize the excerpts for message development; (iv) the development of 111 messages by the research team, guided by the use of the Theoretical Domains Framework [18], and; (v) a test of the content validity of the messages conducted among 36 researchers across Brazil who had contributed to the development of the Dietary Guidelines or used it in their current research, on the clarity and importance of the messages.…”

Section: Development Of the Behavior-change Messagesmentioning

confidence: 99%

“…Theory-informed strategies or constructs were incorporated into the messages [17]. These included providing substitutions for, or solutions to, the barriers associated with planning and organizing healthy meals, or shopping or cooking; they highlighted the health benefits, cost gains, gender equity or environmental benefits of the behaviors they were promoting.…”

Section: Message Constructsmentioning

confidence: 99%

A quantitative test of the face validity of behavior-change messages based on the Brazilian Dietary Guidelines

Quinta

Jaime

2021

Nutr J

Self Cite

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Background Implementation science has scant evidence of how dietary guidelines can be developed into actionable behavior-change messages and even less evidence on their motivating potential and perceived effect on behavior. This may explain the widening gap between nutrition science and individual behavior and the low uptake of dietary recommendations by the population for which they are intended. This study aimed to: (i) assess participant receptivity and acceptance of behavior-change messages; (ii) determine if the behavior-change strategies used in the messages and the main theme they relayed influenced participant evaluation of the messages; (iii) explore if evaluations varied by participants’ stage of behavior-change; and (iv) elucidate reasons for non-compliance with the messages. Methods An online survey was used to test the face validity and participant receptivity of 28 behavior-change messages, among a diverse sample of 2400 adult Brazilians. Participants’ understanding of the messages, message likeability and convincingness, and the probability that participants would change behavior in accordance with the message were measured, along with reasons for non-compliance. Results The mean overall scores suggested that participants liked the messages, understood them, and found them convincing. As expected, the probability of complying with the messages scored lower compared to other study outcomes. Messages about shopping practices, cooking practices, and planning and organization performed better than those on other themes. Participants were more receptive to messages that included behavior-change strategies like goals, social identity, and pleasure, however, the probability of compliance was higher for messages with constructs that emphasized health and cost consequences. Participants trying to change their diet or seeking resources to support healthier dietary choices had greater engagement with and receptivity to the messages. Time and effort, and high costs associated with making healthy changes, were barriers to compliance. Conclusions Messages may help improve individual understanding, stimulate interest in a topic and get participants engaged, particularly if messages are goal-oriented and highlight the pleasure and collective identity of these food-related behaviors. However, messages stop short of addressing the structural, social, and economic barriers to healthy diets. These aspects will need to be targeted through legislative action for sustainable behavior change.

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Developing and refining behaviour-change messages based on the Brazilian dietary guidelines: use of a sequential, mixed-methods approach

Cited by 6 publications

References 37 publications

Representations of Ultra-Processed Foods: A Global Analysis of How Dietary Guidelines Refer to Levels of Food Processing

Representations of Ultra-Processed Foods: A Global Analysis of How Dietary Guidelines Refer to Levels of Food Processing

Improving Communication of the UK Sustainable Healthy Dietary Guidelines the Eatwell Guide: A Rapid Review

A quantitative test of the face validity of behavior-change messages based on the Brazilian Dietary Guidelines

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