Suggested explanations for the (in)effectiveness of nutrition information interventions among adults with a low socioeconomic status: a scoping review

Abstract

Unhealthy diets are a major threat to population health and are especially prevalent among those with a low socioeconomic status (SES). Health promotion initiatives often rely on nutrition information interventions (NIIs), but are usually less effective among adults with a low SES than in their high-SES counterparts. Explanations for this lower effectiveness are set out in extant studies. These have been conducted across a wide range of disciplines and subject fields and using a variety of methodological approaches. We have therefore conducted a scoping review to identify and synthesise the following: (1) explanations suggested in studies carried out in high-income countries for why NIIs are (in)effective among adults with a low SES and (2) whether these suggested explanations were studied empirically. Eight databases were searched for relevant studies published since 2009 across various disciplines. This identified 4951 papers, 27 of which were included in our review after screening. Only fifteen of these proposed an explanation for the (in)effectiveness of NIIs among adults with a low SES. The following four main themes were uncovered: health literacy, economic resources, social resources and convenience. Ten studies tested their explanations empirically, but the results were inconsistent. The reasons why NIIs are (in)effective among low-SES adults are therefore still largely unclear. Also, current literature predominantly relies on individualistic explanations, most notably focusing on psychological and economic attributes. Consequently, if the effectiveness of NIIs among low-SES populations is to be improved, future studies should examine a wider range of explanations and test them systematically and empirically.

Eating behavior dimensions and 9-year weight loss maintenance: a sub-study of the Finnish Diabetes prevention study

“…However, it should be ensured that such interventions are achievable and acceptable also in the vulnerable groups to not unintentionally widen health disparities. A recent review investigating explanations for the effectiveness of nutrition information interventions among adults with a low socioeconomic status (SES) emphasized tailored interventions including teaching of self-regulation skills as well as considering economic and social resources [ 41 ]. Furthermore, iterative design, use of visual and multimedia elements and social support have been identified as facilitators of eHealth interventions in groups with low SES [ 40 ].…”

Receptive to an authoritative voice? Experimental evidence on how patronizing language and stressing institutional sources affect public receptivity to nutrition information

“…Keeping information simple and direct is another common strategy ( Calderón & Beltran, 2005 ), e.g., using brief, easy to understand, sentences and placing an exaggerated emphasis on the key points. This probably has merit, since it is often argued that health information is less effective among those in the lower social strata for reasons such as cognitive factors ( Van Meurs, Çoban, De Koster, Van der Waal, & Oude Groeniger, 2022a , Van Meurs, Oude Groeniger, De Koster, & Van der Waal, 2022c ). Nevertheless, this type of language is sometimes also criticized for seeming to talk down to people who do not follow the guidelines being communicated ( Atkinson & Sloan, 2017 ).…”

“…Less-educated individuals make less use of health information than their more-educated counterparts ( Koç & van Kippersluis, 2017 ). Moreover, when it is taken into account, it is generally not as effective among the former group ( Van Meurs et al, 2022c ). This gap is strongly associated with the anti-institutionalism of less-educated individuals ( Van Meurs et al, 2022b ), meaning that the use of named institutional sources is potentially counterproductive.…”

“…Ideally, therefore, health-promotion efforts should have an impact on this group to an at least equal, but preferably greater, extent than on more-educated citizens. However, research has shown that less-educated individuals are less receptive to nutrition information than more-educated individuals ( Van Meurs et al, 2022c ), with this gap strongly associated with the former's more negative views toward institutions ( Van Meurs et al, 2022b ). This may be an indication that the two strategies tested in the present study will be less well received by this group.…”