Perception is reality: qualitative insights into how consumers perceive alcohol warning labels.

AIMS: This study explores perspectives of on-pack alcohol warning labels, and how they might influence alcohol purchase and/or consumption behavior to inform culturally appropriate label design for effective behavior change. METHODS: New Zealand participants ≥18 years, who reported having purchased and consumed alcoholic beverages in the last month were recruited via a market research panel and grouped into 10 focus groups (n = 53) by ethnicity (general population, Maori, and Pacific peoples), age group, and level of alcohol consumption. Participants were shown six potential alcohol health warning labels, with design informed by relevant literature, label framework, and stakeholder feedback. Interviews were transcribed and analyzed via qualitative (directed) content analysis. RESULTS: Effective alcohol labels should be prominent, featuring large red and/or black text with a red border, combining text with visuals, and words like "WARNING" in capitals. Labels should contrast with bottle color, be easily understood, and avoid excessive text and confusing imagery. Participants preferred specific health outcomes, such as heart disease and cancer, increasing message urgency and relevance. Anticipated behavior change included reduced drinking and increased awareness of harms, but some may attempt to mitigate warnings by covering or removing labels. Contextual factors, including consistent design and targeted labels for different beverages and populations, are crucial. There was a strong emphasis on collective health impacts, particularly among Maori and Pacific participants. CONCLUSIONS: Our findings indicate that implementing alcohol warning labels, combined with comprehensive strategies like retail and social marketing campaigns, could effectively inform and influence the behavior of New Zealand's varied drinkers.

Empowering Young Women: A Qualitative Co-Design Study of a Social Media Health Promotion Programme.

Social media platforms may be promising intervention tools to address the nutrition literacy and associated health behaviours of young women. We aimed to co-design a lifestyle intervention on social media targeting eating, physical activity, and social wellbeing that is evidence-based, acceptable, and engaging for young women aged 18-24 years. The study used a participatory design framework and previously published iterative mixed methods approach to intervention development. Matrices for workshop objectives were constructed using expert discussions and insights were sought from young women in participatory workshops. A 10-step qualitative data analysis process resulted in relevant themes, which guided intervention development. The resulting intervention, the Daily Health Coach, uses multiple features of Instagram to disseminate health information. Co-created nutrition content considers themes such as holism, food relationships, and food neutrality and acknowledges commonly experienced barriers associated with social media use such as nutrition confusion, body image concerns, and harmful comparison. This study may guide other researchers or health professionals seeking to engage young women in the co-design of women's health promotion or intervention content on social media.

Co-design of digital health interventions with young people: A scoping review.

Introduction: Innovative health promotion strategies are crucial for enhancing global quality of life and curbing premature deaths. Digital health promotion is particularly impactful for young individuals often using internet-connected devices. Collaborative methodologies in digital intervention research offer insights into supporting youth during key life stages, such as adolescence. This review sought to examine the literature on digital health interventions for youth co-designed via participatory frameworks. Methods: Following the Joanna Briggs Institute Manual and an adapted Arksey & O'Malley's 6-stage framework, this review utilised the PRISMA-ScR checklist for structured reporting. Peer-reviewed research where young individuals (15-35 years) contributed to digital health intervention design was analysed. Systematic synthesis adhered to Braun & Clarke's Thematic Analysis Guidelines, mapping data to research queries and thematic framework. Results: Eighteen articles were systematically synthesised, revealing seven main themes: digital tool, inquiry field, report aim, participatory activities, intervention attributes and behavioural change support. Seventeen distinctive digital health interventions were assessed, mostly within risk mitigation and mental health domains. Predominantly, interventions were web-based, with mental wellness websites emerging as the prevalent tool. User experience testing stood out as the primary reported outcome. Conclusion: Several innovative digital health interventions targeting youth have been identified. Platforms including social media, specialised apps, websites and video games are instrumental for health advice and clinical support dissemination, overcoming access and cost barriers. Participatory techniques are integral for the efficacy of digital health resources, encompassing youth aspirations and anticipations. Continued efforts will enrich comprehension of optimal practices in digital health promotion and intervention formulation.

Food practices adaptation: Exploring the coping strategies of low-socioeconomic status families in times of disruption.

COVID-19 impact on global and national food systems, along with associated physical restrictions, lockdowns, and school closures, have led to dramatic changes in families' everyday food practices. Our research explored the way food practices adapted and emerged, allowing families to cope with the disruption caused by COVID-19. We recruited 18 low socio-economic status families with primary school children across the United Kingdom and New Zealand to partake in two interviews, a survey, and the use of an ethnographic app. Analysis illuminates that this disruption triggered the emergence of three practices that were necessary to carry on and mitigate the impact of disrupted food practices; 'asking for help', 'planning' and 'research and experimentation'. As a way to deal with disruption to their food practices, many participants called on the support of the community, including the use of food banks and the sharing of food. Participants discussed the way they had to plan their food, which often involved the expansion of practices formerly enacted to a small degree, such as curation of online shopping lists and stockpiling. Food research and experimentation also emerged as largely new practices, such as freezing foods, learning new recipes online (YouTube), experimenting with new ingredients and recipes. As such, for some participants, experimentation and research transformed cooking practices into leisure practices. The findings have practical implications for policy makers and non-governmental organisations, such as providing formal support that is accessible while reducing any associated stigma. Designing interventions that integrate planning routines within food practices can help build skills (e.g., bulk cooking and freezing) which can be vital during disruptions, aiding families to cope with the difficulties and aftermath of sudden and large-scale disruption, such as a pandemic.

Co-design of Digital Health Interventions for Young Adults: Protocol for a Scoping Review.

BACKGROUND: Digital health interventions, including apps and web-based services, are on the rise due to their facilitated access to target groups. The constant evolution of technology calls for participatory research methodologies to understand youth expectations and the use of technology. The creative and collaborative nature of co-design allows for the active integration of youth desires and may enhance acceptability when it comes to digital health tools. OBJECTIVE: The primary objective of this review is to assess the breadth of literature on digital health interventions that have been co-designed for and by young adults, including the types of available evidence, the identification of key characteristics relevant to young adult co-design, and the examination of research conduct in this space. METHODS: The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) Manual for Scoping Reviews. As well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for reporting scoping reviews, an adaptation of Arksey and O'Malley's 6-stage framework for scoping reviews will be referenced. Peer-reviewed primary research, where young adults (aged 15-35 years) were actively involved in the design and development process of digital health interventions, will be collated for analyses. Five databases, including MEDLINE (Ovid), Cochrane, CINAHL Plus, Google Scholar, and Scopus, will be searched for relevant papers. Search strategies will be comprehensive to identify both published and unpublished literature. Relevant gray literature and secondary research will be excluded but pooled for separate analysis and citation chaining. Results will be presented in one or multiple forms, including narrative, tabular, or diagrammatic. RESULTS: Data collection commenced in October 2021. Following data extraction according to the JBI results extraction instrument and independent quality assurance of included studies, a narrative synthesis of each paper included in the final pool will allow for data charting. As of May 2022, 19 papers are included for analysis. We expect the results to be published by autumn 2022. CONCLUSIONS: This protocol provides guidance for researchers who plan to conduct a similar style of investigation and promotes standardization of the scoping review process. We anticipate the provision of an overview of participatory digital health research involving young adults, highlighting any gaps in this research area, as well as potential areas for further study. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38635.

Exploring the medical cannabis prescribing behaviours of New Zealand physicians.

INTRODUCTION: Many countries are changing their regulations for prescribing medical cannabis. As gatekeepers, physicians significantly impact patient access to cannabis treatments. It is important to explore how physicians view prescribing cannabis in terms of their existing beliefs, knowledge, possible concerns and personal perceptions. METHODS: Individual, semi-structured telephone interviews were undertaken with 14 New Zealand physicians from various specialties. The interviews were thematically analysed using a phenomenological approach. RESULTS: The physician-patient relationship was of extreme importance in making prescription decisions, driven largely by trust in the patient. Barriers to prescribing included concern over possible side effects, the quality and standardisation of medication, uncertainty about indications and equity concerns from the high cost for lower socio-economic patients. Some physicians held concerns over their liability and risks to their reputation if issues arose for patients. DISCUSSION AND CONCLUSION: The way physicians regard prescribing medical cannabis is based on their personal beliefs and knowledge built up over their medical career. It is important that these are taken into consideration in the design of future guidelines to help alleviate uncertainties and reduce barriers for informed prescribing. While our research and previous research find that physicians generally will follow clinical guidelines based on institutional logics (i.e. the standardised approach to medicine), we find that physicians often allow their personal construals to determine their perceptions and prescribing behaviour to a considerable extent when they practice medicine. Our findings have implications for Continuing Medical Education, marketing and regulation for medical cannabis, especially about the wording of guideline adherence.

What's your beef with meat substitutes? Exploring barriers and facilitators for meat substitutes in omnivores, vegetarians, and vegans.

The overconsumption of meat has been related to negative health, environmental, and animal welfare effects. As such, many people are now reducing their meat consumption, and for some this includes increasing their consumption of meat substitutes. While research has discussed the barriers towards the adoption of meat substitutes, there is a lack of studies examining the differences between omnivores and veg*ns. The objective of this research is to explore the facilitators, barriers, and negotiations (i.e., tensions) that various dietary groups encounter with meat substitutes. Six focus groups were conducted and our analysis found clear tension between many influences in food choice. These tensions result in the influences (sensory preferences, meat substitutes' classification, health perceptions, and social/culture) being both facilitators and barriers dependent on the dietary group. Yet, there are also key facilitators across all dietary groups such as resources (packaging and labelling), and food context (restaurants, takeaways), as well as barriers such as the "vegan tax" (high price) and lack of trust. A main value negotiation was also exhibited by all dietary groups, balancing familiarity with food/meal freedom and versatility. We provide a reflection on the practical implications for meat substitute companies.

Young adults' experiences with flexitarianism: The 4Cs.

Meat reduction has important implications for public health and the environment. With people more likely to reduce their meat consumption than eliminate it completely, there is increased interest in flexitarian (reduced meat) diets. Young adults in particular are transitioning towards a flexitarian diet, yet there is very little research on this crucial sub-set of the population. In this research, 23 interviews are conducted with young adults aged 18-35 in New Zealand to explore their lived experiences (i.e., motivations, strategies and barriers) towards flexitarianism. The research finds young adults are encouraged to transition towards flexitarianism due to increased control, through a transition away from home which is enabled through cooking strategies, social support and experimentation. Young flexitarians are motivated to reduce meat consumption due to concern about various individual (health, variety, price, reduce social unease) and altruistic (environment and ethics) motivations. Continued meat consumption is mainly driven by a need to compromise at social gatherings, and due to positive associations with variety, nutrients and fullness as well as taste due to cravings. The findings have several implications for social marketing and public health, particularly around supportive social settings, seeing flexitarianism as a 'not all or nothing approach' (one does not have to be a full vegetarian or a meat eater, but can instead be something in between), positive emotions such as pride associated with meat reduction, and that documentaries and social networks are key triggers for meat reduction.

Motivations, barriers, and strategies for meat reduction at different family lifecycle stages.

The consumption of animal products, especially meat, contributes heavily to climate change. Despite an increased number of individuals reducing their meat consumption, little research has explored flexitarianism. The objective of this study was to explore the motivations, barriers, and strategies for reduced meat consumption. The qualitative study, utilizing six focus groups in New Zealand, explores the cognitive, affective, and cultural components of meat reduction through the examination of the different stages of the family lifecycle. The research finds significant differences in motivations for meat reduction between young adults, families, and retirees, with health, environmental and cost important factors but to different degrees. However, all continue to eat meat due to cravings, taste and nutrition beliefs. Strategies for substitution are similar for young adults and families but differ from retirees, with the former populations exhibiting greater creativity and exploration, not seeing meat reduction as 'meat replacement' but instead as a recreation of the main meal. The barriers to meat reduction are similar across the family lifecycle with a lack of information and cultural, media, and institutional discourse large inhibitors to reduction. Yet, social and cultural factors also encourage individuals to reflect on their meat consumption and social connections (including social media) provide accessible and persuasive messaging for meat reduction. Consequently, public education and social marketing campaigns need to be implemented to provide information and recipes, and such information should be in varied formats to appeal to different consumer segments.

Effects of brand variants on smokers' choice behaviours and risk perceptions.

BACKGROUND: Australian tobacco companies have introduced evocative variant names that could re-create the aspirational connotations plain packaging aims to remove. To inform future regulation, we explored how brand descriptors affected smokers' responses to plain packs featuring different variant name combinations. METHODS: An online survey of 254 daily smokers or social smokers aged between 18 and 34 used a within-subjects best-worst experiment to estimate the relative effects of variant names. A 2×4×4×4 design contained four attributes: quality (premium or none), taste (smooth, fine, rich or none) connotation (classic, midnight, infinite or none) and colour (red, blue, white or none). In a between-subjects component, respondents evaluated one of two alternative packs according to its perceived harm and ease of quitting. RESULTS: The most important variant attribute was connotation, followed by taste, colour and quality; within these attributes, the most attractive descriptors were 'classic' and 'smooth'. We identified four distinct segments that differed significantly in their sociodemographic attributes and variant preferences, although not in their perceptions of the harm or quitting ease associated with two different variants. CONCLUSIONS: Some descriptors significantly enhance the appeal of tobacco products among different groups of smokers and may undermine plain packaging's dissuasive intent. Policymakers should explicitly regulate variant names to avoid the 'poetry on a package' evident in Australia. Options include disallowing new descriptors, limiting the number of descriptors permitted or banning descriptors altogether.