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European consumers and health claims: attitudes, understanding and purchasing behaviour

Published online by Cambridge University Press:  05 March 2012

Josephine M. Wills*
Affiliation:
European Food Information Council (EUFIC), Tassel House, Rue Paul Emile Janson 6, B-1000 Brussels, Belgium
Stefan Storcksdieck genannt Bonsmann
Affiliation:
European Food Information Council (EUFIC), Tassel House, Rue Paul Emile Janson 6, B-1000 Brussels, Belgium
Magdalena Kolka
Affiliation:
European Food Information Council (EUFIC), Tassel House, Rue Paul Emile Janson 6, B-1000 Brussels, Belgium
Klaus G. Grunert
Affiliation:
MAPP Centre for Research on Customer Relations in the Food Sector, Aarhus University, Haslegaardsvej 10, DK-8210 Aarhus V, Denmark
*
*Corresponding author: Josephine M. Wills, fax +32 2 506 89 80, email jo.wills@eufic.org
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Abstract

Health claims on food products are often used as a means to highlight scientifically proven health benefits associated with consuming those foods. But do consumers understand and trust health claims? This paper provides an overview of recent research on consumers and health claims including attitudes, understanding and purchasing behaviour. A majority of studies investigated selective product–claim combinations, with ambiguous findings apart from consumers’ self-reported generic interest in health claims. There are clear indications that consumer responses differ substantially according to the nature of carrier product, the type of health claim, functional ingredient used or a combination of these components. Health claims tend to be perceived more positively when linked to a product with an overall positive health image, whereas some studies demonstrate higher perceived credibility of products with general health claims (e.g. omega-3 and brain development) compared to disease risk reduction claims (e.g. bioactive peptides to reduce risk of heart disease), others report the opposite. Inconsistent evidence also exists on the correlation between having a positive attitude towards products with health claims and purchase intentions. Familiarity with the functional ingredient and/or its claimed health effect seems to result in a more favourable evaluation. Better nutritional knowledge, however, does not automatically lead to a positive attitude towards products carrying health messages. Legislation in the European Union requires that the claim is understood by the average consumer. As most studies on consumers’ understanding of health claims are based on subjective understanding, this remains an area for more investigation.

Type
70th Anniversary Conference on ‘From plough through practice to policy’
Copyright
Copyright © The Authors 2012

According to European Commission Regulation 1924/2006(1), three types of claims are allowed to be made on foods throughout the European Union:

  1. (1) Nutrition claims, which state, suggest or imply that a food has particular beneficial properties due to its composition (regarding energy or a particular nutrient). Examples of this type of claim will be: ‘source of’, ‘free of’, ‘high’, ‘low’ or ‘reduced’ in energy or a particular nutrient.

  2. (2) Health claims, which state, suggest or imply that a relationship exists between a food or one of its components and health. This type of claim mentions the physiological function of a constituent such as ‘Calcium can help build strong bones’. The claim must be based on generally accepted scientific data and be well understood by the average consumer.

  3. (3) The third type are ‘disease risk factor reduction’ claims. They are a specific type of health claim, which state that a food or one of its components significantly reduces a risk factor for human disease. For example, phytosterols can help reduce blood cholesterol, thereby reducing a risk factor for CVD. For the first time, mention of disease will be allowed on food, but only after approval by the European Food Safety Authority.

The regulation requires that any claims promoting the nutrition and health benefits of a food are scientifically substantiated to help protect consumers from misleading claims. An essential aspect of the new legislation, laid down in Article 5.2, is the statement that ‘the use of nutrition and health claims shall only be permitted if the average consumer can be expected to understand the beneficial effects as expressed in the claim’(1).

People consider the healthfulness of food to be an important factor influencing their overall dietary choices(Reference Grunert2, Reference Krystallis, Maglaras and Mamalis3). Nutrition and health claims are used to highlight specific properties of foods that contain (added) beneficial ingredients or are lower in nutrients we should be eating less of. Some also view claims as a legitimate educational tool that will have a positive impact on consumer behaviour and nutrition awareness and as such contribute to public health(Reference Williams4). However, taste(Reference Lyly, Roininen and Honkapaa5Reference Vidigal, Minim and Carvalho9), brand and price(Reference Ares, Giménez and Deliza10), attractiveness of the product(Reference Krystallis, Maglaras and Mamalis3, Reference Siegrist, Stampfli and Kastenholz11) and packaging(Reference Lalor, Madden and McKenzie8) seem to be more important than health claims in influencing purchasing decisions.

An audit of nutrition-related labelling on food and drink products from five product categories (sweet biscuits, breakfast cereals, pre-packed fresh ready meals, carbonated soft drinks and yoghurts) revealed that the penetration of nutrition and health claims varies widely across the European Union(Reference Storcksdieck genannt Bonsmann, Celemin and Larranaga12). Nutrition claims appeared front-of-pack on 25% of all products audited (range 12–37%) and back-of-pack on 20% of products (range 6–31%). In contrast, health claims (including disease risk reduction claims) were used much less often, and tended to appear back-of-pack (4%, range 1–8%) more than front-of-pack (2%, range 0–6%).

Various studies have investigated how consumers respond to health claims on food and drink products, addressing attitudes to health claims and the products carrying them, understanding of health claims as well as purchasing intentions for foods with health claims on. This paper presents a comprehensive overview of the state of research in these areas, following a conceptual framework specifically developed for this purpose (Fig. 1). It shows that, depending on whether and how consumers understand the health claim, they will develop an attitude to the claim, which in turn may affect the attitude to the product bearing the claim. Attitudes may affect purchase intentions and ultimately purchasing behaviour. Understanding, attitudes and purchasing can be affected by both product and consumer variables. Product variables include the food/drink category, the format and wording of the health claim, the functional ingredient and benefit claimed, and taste and sensory attributes of the product. Consumer variables include personal beliefs not related to specific claims and products (e.g. about the usefulness of functional foods in general), personal relevance (e.g. due to health concerns or health problems), familiarity with functional ingredients or products containing them and nutrition knowledge. No study has investigated all of these effects, but we will use this model to structure our review of the literature. Throughout this review, it should be borne in mind that the comparability of findings is hampered both by differences in study methodology as well as large interindividual differences.

Fig. 1. Conceptual framework on how health claims affect consumers.

Effects on consumer attitudes to claims and products bearing them: product-related variables

Food/drink category

There is a tendency for health claims to be perceived more positively when linked to products with an overall positive health image, e.g. yoghurt or bread(Reference Siegrist, Stampfli and Kastenholz11, Reference Siegrist, Stampfli and Kastenholz13Reference Lähteenmäki, Lampila and Grunert16). Dutch(Reference van Kleef, van Trijp and Luning13) consumers reported health claims to be most attractive on yoghurt and brown bread and least attractive on meat replacer and chewing gum.

Whereas people thus view certain foods as more suitable than others to carry health claims(Reference Dean, Shepherd and Arvola14) no consistency exists as to the most appropriate product categories. Health claims are not by default transferable across product categories, and naturally occurring combinations of functional ingredients and carrier products seem to be preferred(Reference Dean, Shepherd and Arvola14, Reference Lähteenmäki, Lampila and Grunert16Reference Krutulyte, Grunert and Scholderer18).

Furthermore, health claims on various carrier products performed differently in different countries in terms of perceived healthiness. Whereas respondents in Finland, Germany, Italy and the UK all preferred bread and yoghurt over cake as the carrier product, the perceived healthiness of bread scored higher in Germany and Finland than in the UK and Italy(Reference Saba, Vassallo and Shepherd19).

The fact that people find health claims on certain products more acceptable than on others does not imply that the overall attitude to the product will become more positive due to the health claim. Several studies showed that products such as yoghurt(Reference Ares, Gimenez and Gambaro20), juices(Reference Jesionkowska, Sijtsema and Konopacka21, Reference Verbeke, Scholderer and Lähteenmäki22), honey(Reference Ares and Gambaro23) and low fat foods(Reference Lyly, Roininen and Honkapaa5), which tend to be perceived as being healthful per se, did not benefit from enrichment with a functional ingredient. On the other hand, certain products with a less ‘healthful’ image, e.g. candies, spreads(Reference Barreiro-Hurle, Gracia and De-Magistris24) or mayonnaise(Reference Ares, Gimenez and Gambaro20), were found to benefit from carrying health claims.

Health claim format

In addition to nutrition claims, there are two main formats of health claims regulated by European Commission Regulation 1924/2006(1); general health claims and reduction of disease risk claims. Health claims may differ in whether the functional ingredient is mentioned or not.

In general, the mere presence of a health claim has been found to increase the perceived healthiness of the product(Reference Lyly, Roininen and Honkapaa5, Reference Dean, Shepherd and Arvola14, Reference van Trijp and van der Lans25), whereas the study by Lähteenmäki et al.(Reference Lähteenmäki, Lampila and Grunert16) reported opposite findings. However, some evidence illustrates that reduction of disease risk claims have a stronger influence on perceived healthiness than general claims(Reference van Kleef, van Trijp and Luning13, Reference Saba, Vassallo and Shepherd19). Saba et al.(Reference Saba, Vassallo and Shepherd19) compared products carrying health claims with the same products without claims (control products), and the presence of a reduction of disease risk claim had a positive influence on the perceived healthiness of that product. In another study by van Kleef et al.(Reference van Kleef, van Trijp and Luning13), participants rated health claims relating to disease (heart disease, cancer and osteoporosis) as more attractive than claims related to mental health (stress) and appearance (youthfulness and skin protection). This pattern has been explained by the extent to which those health claims are personally relevant. For instance, a family history of cancer may lead to more positive attitudes towards health claims relating to this disease(Reference van Kleef, van Trijp and Luning13).

Nevertheless, other studies have yielded contradictory results(Reference Verbeke, Scholderer and Lähteenmäki22, Reference Ares, Giménez and Gámbaro26, Reference Lynam, McKevitt and Gibney27). As general health claims tend to be shorter(Reference Kapsak, Schmidt and Childs28), easier to understand and evoke positive associations from memory(Reference Francl29), they may be more likely to be preferred by consumers(Reference Williams4, Reference Ares, Giménez and Gámbaro26). This might explain why some studies reported disease risk reduction claims to be perceived as less credible and less attractive than general health claims, as was the case for Belgian(Reference Verbeke, Scholderer and Lähteenmäki22), Irish(Reference Lynam, McKevitt and Gibney27) and Nordic(Reference Grunert, Lähteenmäki and Boztug30) consumers.

Differences across countries as to which health claim format is preferred have been reported. Saba et al.(Reference Saba, Vassallo and Shepherd19) examined consumer attitudes towards products bearing health claims in Finland, Germany, Italy and the UK. The UK respondents preferred the general health claims over the disease risk reduction claims, whereas Finnish and German respondents preferred the opposite.

Another factor influencing the acceptance of the product is whether health claims mention the ingredient responsible for the benefit(Reference Jesionkowska, Sijtsema and Konopacka21, Reference Hasler31). Consumers tend to regard claims referring to a specific substance as more convincing than claims which state that the product is generally healthy(Reference Lalor, Madden and McKenzie8, Reference Aschemann-Witzel and Hamm32). Verbeke et al.(Reference Verbeke, Scholderer and Lähteenmäki22) compared the consumer perception of a claim that did not mention the functional ingredient responsible for the benefit with that of a health claim that did mention the functional ingredient. While reduction of disease risk claims lowered the credibility of the product, the reduction of disease risk in omega-3 enriched spread was well perceived.

Overall, the evidence on consumer reactions to the format of health claims is equivocal, as also noted in the reviews by Williams(Reference Williams4) and the UK Food Standards Agency(33). In addition, a cross-national internet-based survey in Italy, Germany and the UK (also including the USA) indicated that consumer perceptions differ by country more substantially than by the claim format(Reference van Trijp and van der Lans25).

Wording of claims

The terminology used in health claims is another factor shaping the extent to which consumers find health claims attractive(Reference Ares, Giménez and Gámbaro26). A previous review by Williams(Reference Williams4) concluded that consumers generally prefer short, succinct wording. However, Grunert et al.(Reference Grunert, Lähteenmäki and Boztug30) reported results showing that two types of consumers can be distinguished, those who prefer short messages and those who prefer more detailed information on health claims. Another way to increase consumer acceptance of claims may be to split the claim into a succinct statement on the front of the package and more detailed information provided elsewhere on the package(Reference Williams4, Reference Kapsak, Schmidt and Childs28).

Whether the claim is framed positively or negatively also may impact on consumers’ reactions (‘improves bone health’ v. ‘reduces risk of osteoporosis’), as does including a qualifier (e.g. ‘may reduce’ instead of ‘reduces’), although the effects seem to be small(Reference Lähteenmäki, Lampila and Grunert16, Reference Grunert, Lähteenmäki and Boztug30).

Functional ingredient and benefit claimed

The ingredient, the type of benefit claimed and the familiarity with both ingredient and benefit have a bigger impact on consumer attitude than the format and wording of the claim(Reference Storcksdieck genannt Bonsmann, Celemin and Larranaga12, Reference Lynam, McKevitt and Gibney27). When a health benefit is well known, e.g. Ca and osteoporosis (compared to e.g. K and hypertension), acceptance of the health claim is stronger, and the format of the health claim has no bearing on how strongly consumers believe in the promoted benefit(Reference van Kleef, van Trijp and Luning13). Also here, cross-national differences exist. This is well illustrated by Jesionkowska et al.(Reference Jesionkowska, Sijtsema and Konopacka21), who examined consumer attitudes to dried fruit as a carrier of various functional ingredients. This study involved Dutch, French and Polish consumers, and differences were found for both the ingredient used and the benefit claimed. Dutch respondents appreciated the presence of fibre most highly, whereas Polish consumers valued the content of vitamins most. Products that lowered the risk of cancer or heart diseases were mainly of interest to Dutch (54·8%) and Polish (45·9%) respondents, whereas French consumers in addition emphasised interest in the prevention of intestinal problems. Likewise, a cross-national internet-based survey in Italy, Germany and the UK (also including the USA) indicated that consumer perceptions differ by both country and by benefit being claimed(Reference van Trijp and van der Lans25). For instance, German consumers rated the weight-control benefits higher than cardiovascular and fatigue benefits. In Italy, immunity-related benefits and in Germany, anti-fatigue benefits scored highest in terms of perceived overall healthiness. This shows that although one of the factors affecting consumer responses to health claims is the benefit being claimed; this is further influenced by the respondent's nationality and it varies across different dimensions such as perceived naturalness, healthiness and appeal.

In addition, the familiarity of the functional ingredient plays a role. This was indicated in the Scandinavian ACCLAIM (Consumer acceptance and trust: Recommendation for using health related claims in marketing) project, where the acceptability of a claim was higher for ‘omega-3’ (considered well known) compared to the rather unfamiliar ingredient ‘bioactive peptides’(Reference Lähteenmäki, Lampila and Grunert16, Reference Grunert, Lähteenmäki and Boztug30). Familiarity with the ingredient also increased product appeal in another study(Reference Ares, Giménez and Gámbaro26).

Taste/sensory attributes

Another factor influencing the reactions towards products with health claims on is taste preference. It has been found that hedonic reasons are more important factors affecting willingness to try foods bearing health claims than the perceived healthiness of that product(Reference Lyly, Roininen and Honkapaa5Reference Miele, Di Monaco and Cavella7, Reference Vidigal, Minim and Carvalho9). This is in line with other studies where consumers have reported no willingness to compromise taste for health in functional foods(Reference Verbeke34). In addition, some of those studies showed that health claims might even have a negative impact on product acceptance, if an unpleasant tasting experience is also reported(Reference Lyly, Roininen and Honkapaa5, Reference Sabbe, Verbeke and Deliza6, Reference Vidigal, Minim and Carvalho9, Reference Lähteenmäki, Lampila and Grunert16). This points to the primary role of taste in driving consumer food choice in general. Nevertheless, Sabbe et al.(Reference Sabbe, Verbeke and Deliza6) found that individuals with a general interest in health are to some extent willing to compromise taste for the promised health benefit.

The earlier review gives clear evidence that product attributes can affect consumer reactions towards health claims and towards the products bearing them. Moreover, some of these attributes were found to be more influential than others, especially the nature of the carrier product(Reference Lyly, Roininen and Honkapaa5, Reference Ares and Gambaro23) and the health benefit claimed(Reference van Kleef, van Trijp and Luning13, Reference Lynam, McKevitt and Gibney27). These determinants vary by country.

Effects on consumer attitudes to claims and products bearing them: consumer-related variables

Personal beliefs

In addition to product attributes, consumer characteristics also determine consumer responses to health claims. In a study by Verbeke et al.(Reference Verbeke, Scholderer and Lähteenmäki22), the general attitude towards foods with health benefits had the strongest positive effect on how positively the health claims were rated. This has been termed the ‘congruence with own beliefs’ effect(Reference Lähteenmäki, Lampila and Grunert16, Reference Jesionkowska, Sijtsema and Konopacka21). Consumer belief in the positive link between diet and health may be important in shaping demand for functional food products.

Personal relevance

Claims that address a topic that is of personal relevance have more consumer appeal(Reference van Kleef, van Trijp and Luning13, Reference Dean, Shepherd and Arvola14, Reference Verbeke, Scholderer and Lähteenmäki22, Reference Lalor, Kennedy and Wall35). It has been illustrated that individuals tend to have a more positive attitude and increased acceptance of food products with health claims when a relative or friend is affected by the related condition(Reference Lalor, Madden and McKenzie8, 33). A study in Finland(Reference Urala36) found that people who are interested in their health in general also express more interest in foods promising additional benefits.

In a study by Dean et al.(Reference Dean, Shepherd and Arvola14), the self-reported need to pay attention to health was the most important factor affecting how people see the particular product bearing the health claim. Those who reported to feel a need to watch their health saw more benefits in all the products tested than those with less need to look after their health, thus indicating that perceived susceptibility to illness and personal relevance play a significant role in the perception of foods with health claims.

Consumers who do not appreciate the impact of their diet on health will consequently be more negative with regard to functional foods(Reference Lalor, Madden and McKenzie8). In other words, health status does not necessarily lead to a belief about the relevance of functional foods. However, it should be borne in mind that self-reported need to pay attention to health and objectively defined health status as assessed by a physician are two very different starting points that do not necessarily correlate.

Overall, female gender, a general interest in health and higher socio-economic status tended to enhance personal relevance and thus lead to more favourable attitudes towards health claims(Reference Sabbe, Verbeke and Deliza6, Reference Ares, Gimenez and Gambaro20, Reference Ares, Giménez and Gámbaro26).

Familiarity and experience

Consumer acceptance of products with health claims may depend on familiarity and previous experience with the functional ingredient(Reference Lähteenmäki, Lampila and Grunert16), the health claim itself, the specific phrases that are being used in the claim(Reference Verbeke, Scholderer and Lähteenmäki22, Reference Verbeke, Scholderer and Lähteenmäki26, Reference Verbeke, Scholderer and Lähteenmäki37Reference Verbeke39), and finally the functional food product itself. In a study by Verbeke et al.(Reference Verbeke, Scholderer and Lähteenmäki22) on consumer appeal of nutrition and health claims among Belgian consumers, previous experience boosted all ratings. Those participants who had used the product before, found claims and products more convincing, credible, attractive and also expressed higher intention to use them in the future. Therefore, it has been suggested that repeated exposure to health information and hence knowledge about the functional food can increase product liking(Reference Landstrom, Sidenvall and Koivisto Hursti40). For instance, ‘omega-3’ as a well-known ingredient increased convincingness of the functional food compared to unknown ‘bioactive peptides’(Reference Lähteenmäki, Lampila and Grunert16). This might be due to extensive marketing promotion and communication efforts, which could have built a healthy reputation of the omega-3 concept in recent years(Reference Verbeke, Scholderer and Lähteenmäki22). This is in agreement with the review by Williams(Reference Williams4) who found that the credibility of health messages also increases when they are repeated frequently by different and trusted sources.

Nutrition knowledge

Evidence of the impact of nutrition knowledge on consumer attitudes towards health claims and the corresponding carrier products is contradictory. Lack of nutrition knowledge was suggested by Ares et al.(Reference Ares, Gimenez and Gambaro20) to limit consumers’ abilities to understand or evaluate a health claim, thus leading to lower perceived credibility of those claims. In this study, the addition of fibre or antioxidants to certain products increased the interest of consumers with the highest level of nutrition knowledge to try these functional foods. In turn, a lack of nutrition knowledge might limit the acceptance of functional foods, yet Lalor et al.(Reference Lalor, Kennedy and Wall35) observed that higher levels of nutrition knowledge led to less trust in health claims.

Effects on understanding of claims

With regard to general consumer understanding of health claims, data are scarce. Recent studies that provide some insight into consumers’ understanding of health claims are those by van Trijp and van der Lans(Reference van Trijp and van der Lans25) and Grunert et al.(Reference Grunert, Scholderer and Rogeaux41). The former is about subjective understanding, i.e. how easy or difficult consumers perceive the claim to be understood, whereas the latter is on objective understanding, i.e. whether consumer understanding was in accordance with the scientific dossier on the claim.

The study by van Trijp and van der Lans(Reference van Trijp and van der Lans25) was undertaken in four countries (UK, Italy, Germany and USA), involved a relatively big sample size (n 6367) and used thirty different combinations of health claims. Five different types of claims were tested: (i) nutrient content claim, (ii) function claim, (iii) disease risk reduction claim, (iv) taste claim and (v) marketing claim. Moreover, each respondent had to evaluate two different health claims (both with respect to benefit and claim type). In all four countries, health claims were perceived to be moderately new, and somewhat difficult to understand. The understanding differed among various health claim types and types of benefits being used (five types of health claims used). Respondents reported the function claim the most difficult to understand. Overall, consumer understanding was influenced by several variables, such as knowledge about the claim or the substance in the claim, familiarity with the product and the claim and terminology used, and respondent's country of origin. These findings are in line with the review by Williams(Reference Williams4).

In the study by Grunert et al.(Reference Grunert, Scholderer and Rogeaux41), the understanding of a health claim on yoghurt was measured using open questions after exposure to the claim (sample of 720 Germans). Participants’ claim understanding was classified as safe (answers matched the scientific dossier), risky (answers not in line with the scientific dossier) or other (answers expressed a vague notion or an expression that was irrelevant). Individuals with a positive view of functional foods were more likely to think the product was even more beneficial than could reasonably be expected (‘risky’ consumers). On the other hand, consumers with negative or neutral reactions towards health claims tended to fall into the category ‘Other’. These findings invalidated the authors’ hypothesis that respondents with higher motivation also have better knowledge on health claims and make more correct inferences.

The findings of Grunert et al.(Reference Grunert, Scholderer and Rogeaux41) show that individuals may generalise messages in health claims from one benefit to another, which is called a ‘magic bullet’ effect, or they perceive the products as generally superior, which is referred to as a ‘halo effect’(Reference Lähteenmäki, Lampila and Grunert16). As health claims provide information only on health-related benefits, they should only influence the perception of health-related product attributes. Leathwood et al.(Reference Leathwood, Richardson and Strater42) also described processes through which health benefits may produce a ‘more positive’ response than the aim of the health message. This tendency to infer from claims unjustified qualities in other product attributes is in agreement with a previous review by Williams(Reference Williams4). However, the research undertaken by Lähteenmäki et al.(Reference Lähteenmäki, Lampila and Grunert16) reported no positive halo effect of health claims on other product attributes; on the contrary, perceived influences tended to be negative.

In summary, studies have provided evidence that people do not always understand health and nutrition claims as they are intended(Reference Verbeke, Scholderer and Lähteenmäki22, Reference Grunert, Scholderer and Rogeaux41, Reference Leathwood, Richardson and Strater42). However, there is limited quantitative information available on the proportion of consumers who correctly understand claims already in use, making it difficult to set targets for adequate levels of consumer understanding. Therefore, research is required to establish expected plausible benchmark proportions. Leathwood et al.(Reference Leathwood, Richardson and Strater42) explored a range of various methodologies used for assessing consumer understanding of health claims. It was concluded that a combination of qualitative and quantitative research should fulfil the requirements needed to establish that particular health claims are understood by a majority of consumers. However, there is a huge need for more research on consumer understanding of health claims.

Effects on purchase behaviour

Health is an important buying motive and nutrition and health claims can have a positive impact on purchasing behaviour(43). Since health claims can increase the perceived healthiness of a product(Reference Lyly, Roininen and Honkapaa5, Reference Saba, Vassallo and Shepherd19, Reference Verbeke, Scholderer and Lähteenmäki22, Reference Aschemann and Hamm44), some studies looked at the impact of health claims on buying intentions, with different results. Whereas some researchers reported very high correlations between people's perceived healthiness of products with health claims and their willingness to buy these products(Reference van Kleef, van Trijp and Luning13, Reference Dean, Shepherd and Arvola14, 45), other researchers failed to find such a link(Reference Saba, Vassallo and Shepherd19, Reference Verbeke, Scholderer and Lähteenmäki22). Some even reported lower credibility and intention to purchase for products bearing reduction of disease risk claims(Reference Verbeke, Scholderer and Lähteenmäki22).

Food/drink category and health claim format

Not only does the food/drink category affect consumer attitudes towards health claims, but also it can be expected to partly influence consumers’ intentions to purchase products bearing health claims (Fig. 1). Grunert et al.(Reference Grunert, Lähteenmäki and Boztug30) found that consumers were more willing to buy bread enriched with omega-3, than pork chops fortified with this ingredient. Two European studies have investigated the influence of claim format on purchase behaviour/willingness to try products carrying health claims(Reference Saba, Vassallo and Shepherd19, Reference Ares, Giménez and Gámbaro26), with equivocal results. In the study by Saba et al.(Reference Saba, Vassallo and Shepherd19) the presence of health claims, regardless of the format (general or disease risk), was found to have no influence on likelihood to buy the product. Ares et al.(Reference Ares, Giménez and Gámbaro26), on the other hand, observed that both formats had a positive impact on the perceived healthfulness of the product (milk dessert) and respondents’ willingness to try it compared to the product without a claim.

Other product attributes

Perceiving a food product as healthier does not necessarily result in the consumer purchasing the product(Reference Ares, Gimenez and Gambaro20). This implies that health claims may not play as vital a role in influencing purchasing decisions as taste(Reference Lyly, Roininen and Honkapaa5Reference Vidigal, Minim and Carvalho9), brand and price(Reference Ares, Giménez and Deliza10), attractiveness of the product(Reference Krystallis, Maglaras and Mamalis3, Reference Siegrist, Stampfli and Kastenholz11) and packaging(Reference Lalor, Madden and McKenzie8). Furthermore, the study by Ares et al.(Reference Ares, Giménez and Deliza10) found that the brand name had the greatest impact on buying food with health claims. They recognised two different types of people: the first group was willing to sacrifice liking for health and considered the brand and the type of enrichment equally important, and price and claim type are least relevant; the second group would not sacrifice taste for health and considered brand the most important attribute followed by the type of enrichment, then price and finally the type of health claim.

Other explanatory factors include: buying from habit(Reference Lalor, Madden and McKenzie8) and no tendency to read labels and/or lack of understanding of the information being read(Reference Pothoulaki and Chryssochoidis46). In addition, physico-chemical properties of the food may influence whether the health claim on food products is accepted or not(Reference Lalor, Madden and McKenzie8). Therefore, it can be concluded that at the point of sale there are other factors that might have a much greater combined influence on purchase behaviour than the health claim-related determinants analysed in most of the studies(Reference Aschemann and Hamm44).

Personal relevance and familiarity

Personal relevance (health enhancement and health risk prevention through appropriate dietary choices) was found as the most important motive for functional food purchases in a study by Krystallis et al.(Reference Krystallis, Maglaras and Mamalis3). The authors suggested that health-enhanced foods should bring their health benefits above and beyond the high perceived quality that is vital to consumers.

Limitations of studies cited

There is a wide range of determinants that can have an impact on consumers’ reactions towards health claims (partly summarised in Fig. 1), and most studies have investigated only a few of them. Furthermore, a majority of studies investigated selective claim–product combinations(Reference van Kleef, van Trijp and Luning13, 33) or focused only on the format of the health claim itself(43). Hence, the number of studies that investigated consumer perceptions across a wide range of different health benefits and claim types is limited(Reference Williams4, Reference van Trijp and van der Lans25). The findings are not easily comparable, as the methodologies and research designs employed vary greatly. Furthermore, there is a lack of studies measuring actual consumer behaviour, as many studies relied on self-reported data. In addition, different combinations of products, claims and functional ingredients were used across studies, making it difficult to derive a clear picture.

Conclusion

Studies show that the acceptance of products with health claims is influenced by many different factors. Familiarity with the product, health claim or functional ingredient used plus personal relevance (Fig. 1) appear as the most important determinants. The choice of carrier product can determine to what extent people trust a health claim or are willing to try the respective product. Furthermore, consumers like simple wording, but they may also demand detailed explanations.

However, more research is needed into consumer understanding of health claims in order to maximise the potential for functional foods to contribute to healthy, balanced diets.

Acknowledgements

The European Food Information Council receives some funding from companies in the European Food and Drink industry. However, no companies were consulted in the drafting of this review, and there are no conflicts of interest. K. G. G. declares no conflict of interests. J. W. devised the structure of the literature review, presented the results at the UK Nutrition Society Summer Meeting and critically reviewed the manuscript. S. S. G. B. provided input on the structure, helped with the literature search and carried out major revisions of the draft manuscript. M. K. carried out the literature review and wrote the first draft of the manuscript. K. G. G. devised the theoretical framework and critically reviewed the manuscript.

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Figure 0

Fig. 1. Conceptual framework on how health claims affect consumers.

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