Informed choice or guessing game? Understanding caregivers' perceptions and use of infant formula labelling.

OBJECTIVE: Although breast-feeding is the recommended way to feed an infant, a safe and nutritious substitute for breast milk is needed for infants who are not breast-fed. Labelling information on infant formula (IF) products aims to enable caregivers (who have already made the decision to use IF) to make informed product choices. Yet, there is limited data on how caregivers understand and use the information provided on IF packaging. The present study aimed to increase understanding of caregivers' interpretation and use of the following label elements on IF products: the nutrition information statement; the ingredients list; and statements around nutrition content and health claims. DESIGN: Qualitative data were obtained from twenty-one focus group discussions. To enable comparison of findings by education level and ethnicity, focus group participants were homogeneous with respect to educational attainment (Australian groups) or ethnic background (New Zealand groups). SETTING: Focus groups were conducted in metropolitan and regional areas of Australia and New Zealand.ParticipantsCaregivers (n 136) of formula-fed infants. RESULTS: Framework analysis revealed that caregivers commonly experience difficulties when using labelling information, particularly when trying to identify and understand key differences between products. Moreover, comparing products can be a complex task regardless of education level and ethnicity. CONCLUSIONS: Further research is required to determine the most effective strategies for meeting information needs of caregivers and allowing easier identification and understanding of product differences. This is especially important given that the vast range of IF products across large price ranges in the market adds to the complexity of purchase decisions.

Committed vs. uncommitted meat eaters: Understanding willingness to change protein consumption.

There is a growing trend of consumers in developed countries substituting alternative protein sources for meat and purchasing meat products with specific production-system related credence attributes. This study of Australian meat consumers identifies consumer segments with varying levels of willingness to make the following changes to their protein consumption: reduce meat consumption, follow a meat-free diet most of the time, avoid meat consumption altogether, and follow a strict plant-based diet (i.e., stop eating all animal-products). Segments are characterised, and predictors of segment membership are determined. Discrete Factor analysis, based on a nationally-representative sample of 287 Australian meat consumers surveyed in 2016, identified four unique segments. Findings show that 46% of consumers are not willing to make any changes to their meat/protein consumption ('Committed Meat Eaters'), 22% are willing to reduce meat consumption ('Willing Meat Reducers'), 15% are willing to stop meat consumption/consume plant-based protein foods only ('Prospective Veg*ns'), and 17% are undecided about future change ('Undecided Meat Eaters'). The key factor differentiating Committed Meat Eaters from other segments is the perception that food choices are inadequate in meat-free diets. Committed Meat Eaters are also less likely to believe livestock farming contributes to climate change, and to report a recent reduction in the consumption of at least one type of meat than are Willing Meat Reducers and Prospective Veg*ns. These findings are expected to be of interest to individuals and organisations who may play a role in meeting current and future consumer demand for meat and alternative protein products.

Predicting healthy eating intention and adherence to dietary recommendations during pregnancy in Australia using the Theory of Planned Behaviour.

This study aims to aid in the development of more effective healthy eating intervention strategies for pregnant women by understanding the relationship between healthy eating intention and actual eating behaviour. Specifically, the study explored whether Theory of Planned Behaviour (TPB) constructs [attitude, subjective-norm, perceived-behavioural-control (PBC)] and additional psychosocial variables (perceived stress, health value and self-identity as a healthy eater) are useful in explaining variance in women's 1) intentions to consume a healthy diet during pregnancy and 2) food consumption behaviour (e.g. adherence to food group recommendations) during pregnancy. A cross-sectional sample of 455 Australian pregnant women completed a TPB questionnaire as part of a larger comprehensive web-based nutrition questionnaire. Women's perceived stress, health value and self-identity as a healthy eater were also measured. Dietary intake was assessed using six-items based on the 2013 Australian Dietary Guidelines. Hierarchical multiple linear regression models were estimated (significance level <0.05), which explained 70% of the variance in healthy eating intention scores and 12% of the variance in adherence to food group recommendations. TPB constructs explained 66% of the total variance in healthy eating intention. Significant predictors of stronger healthy eating intention were greater PBC and subjective norm, followed by positive attitude and stronger self-identity as a healthy eater. Conversely, TPB constructs collectively explained only 3.4% of total variance in adherence to food group recommendations. These findings reveal that the TPB framework explains considerable variance in healthy eating intention during pregnancy, but explains little variance in actual food consumption behaviour. Further research is required to understand this weak relationship between healthy eating intention and behaviour during pregnancy. Alternative behavioural frameworks, particularly those that account for the automatic nature of most dietary choices, should also be considered.

Adherence to the Australian dietary guidelines during pregnancy: evidence from a national study.

OBJECTIVE: To assess dietary intake of pregnant women against the Australian Dietary Guidelines with respect to the Five Food Group recommendations and determine predictors of adherence to the recommendations. DESIGN: Cross-sectional web-based survey. Data were analysed using descriptive statistics and logistic regression. SETTING: Pregnant women living in Australia. A national sample was recruited using an online panel provider and a South Australian sample was recruited through the antenatal clinic of a large public maternity hospital. SUBJECTS: A total of 857 pregnant women. RESULTS: Fifty-six per cent, 29% and less than 10% of women met the recommendations for the fruit, dairy and other core food groups, respectively. None of the women met the recommendations for all Five Food Groups. Women who were born overseas and who were less physically active pre-pregnancy were less likely to adhere to the fruit and dairy recommendations. Women who smoked during pregnancy, were overweight pre-pregnancy and had lower household incomes were also less likely to meet the fruit recommendations; and women living in metropolitan areas were less likely to meet the vegetable recommendations. Sixty-one per cent believed their diet during this pregnancy was healthy. CONCLUSIONS: The majority of pregnant women in Australia perceive their diets to be healthy yet they do not consume the recommended daily servings from the Five Food Groups. Intervention strategies are warranted, particularly those that increase women's ability to evaluate their diet and also encourage positive dietary changes. These strategies may increase adoption of dietary guidelines and optimise pregnancy and other long-term health outcomes.

Testing the Impact of Familiarity with Health Benefits Information on Dietary Supplement Choice in Pregnancy: An Online Choice Experiment.

To help meet the increased requirements for critical nutrients during and around pregnancy, supplementation with essential nutrients is recommended. This study aims to determine how the previous awareness of nutrient health benefits and/or the provision of this information influences the importance placed on nutrients (folate, iodine, omega-3 fatty acids, and vitamin D) when choosing between dietary supplement products for pregnancy. Discrete choice experiment data were collected as part of a cross-sectional online survey administered to 857 pregnant women living in Australia. Four segments of women were identified that differ in their preference criteria when choosing among dietary supplement products for pregnancy. When choosing between products, the reinforcement of perceived health benefits (i.e., showing information on health benefits to those already aware of the benefits) was most effective at increasing the importance of folate (in all segments) and iodine (in two segments, 63% of the sample). Neither prior awareness of health benefits alone nor information provided at the point-of-purchase without prior awareness were enough to increase the importance of folate. Our findings suggest a need for simultaneous strategies that (1) provide information on health benefits before purchase and (2) ensure that information on health benefits is available at the point-of-purchase.

Knowledge and practices regarding iodine supplementation: A national survey of healthcare providers.

BACKGROUND: Little is known of healthcare providers' awareness and implementation of the National Health and Medical Research Council's recommendation regarding iodine supplementation during pre-conception, pregnancy and lactation. AIM: To assess knowledge and practices of Australian healthcare providers in relation to the National Health and Medical Research Council's iodine supplement recommendation. METHODS: Obstetricians, gynaecologists, general practitioners, dietitians and midwives were recruited through their relevant professional bodies to participate in an online survey. FINDINGS: The survey was completed by 396 healthcare providers Australia-wide. While 71% of healthcare providers' were aware of the National Health and Medical Research Council's recommendation for iodine supplementation, fewer were aware of the recommended dose (38%) or duration (44%). Seventy-three percent of healthcare providers recommended iodine supplements in pregnancy, 56% when planning pregnancy and 52% during lactation. The main reasons for not recommending iodine supplements included belief there was no need for iodine supplements due to mandatory iodine fortification of food (28%) and unawareness of the recommendation (25%). Awareness of the recommendation was positively associated with recommending iodine supplements while length of practice, time spent per consultation, age or area of practice were not associated with recommending iodine supplements. DISCUSSION AND CONCLUSIONS: There is a need to improve healthcare providers' knowledge of and adherence to the National Health and Medical Research Council's iodine supplement recommendation. Strategies within antenatal and postnatal services, as well as public health initiatives, are required to improve the knowledge and practices of healthcare providers.

Poor adherence to folic acid and iodine supplement recommendations in preconception and pregnancy: a cross-sectional analysis.

OBJECTIVE: To determine pregnant women's knowledge of and adherence to the recommendations for periconceptional folic acid supplementation (PFS) and iodine supplementation (IS). Secondary objectives include determining predictors of adherence, and identifying influential nutrition information sources. METHODS: A cross-sectional online survey was completed by 857 pregnant women, including a national cohort (n=455) recruited using an online panel provider and a South Australian cohort (n=402) recruited from a public maternity hospital. RESULTS: Adherence to PFS and IS recommendations was 27% and 23%, respectively. Planning pregnancy and awareness of the correct timing of recommendations were predictors of adherence for both recommendations. Not consuming any alcohol during pregnancy and living in metropolitan areas also predicted adherence to the IS recommendation. Awareness of the recommendation was greater for folic acid (more than 90%) than iodine (56-69%). Knowledge of the importance of folic acid and iodine was greater than knowledge regarding the recommended dose and timing of supplementation. Main healthcare providers were considered the most influential nutrition information sources. CONCLUSIONS AND IMPLICATIONS: Knowledge of and adherence to supplement recommendations for preconception and pregnancy needs improvement. While main healthcare providers may play an important role, further research is needed to explore strategies for increasing adoption of recommendations.

The Assessment of Diet Quality and Its Effects on Health Outcomes Pre-pregnancy and during Pregnancy.

Overweight and obesity pre pregnancy or during pregnancy is associated with an increased risk for maternal obstetric and fetal complications. Diet is one modifiable risk factor that women may be motivated to improve. General healthy eating guidelines, micronutrient sufficiency and macronutrient quantity and quality are important nutrition considerations pre and during pregnancy. With regards to specific nutrients, health authorities have recommendations for folate and/or iodine supplementation; but not consistently for iron and omega-3 despite evidence for their association with health outcomes. There are modest additional requirements for energy and protein, but not fat or carbohydrate, in mid-late pregnancy. Diet indices and dietary pattern analysis are additional tools or methodologies used to assess diet quality. These tools have been used to determine dietary intakes and patterns and their association with pregnancy complications and birth outcomes pre or during pregnancy. Women who may unnecessarily resist foods due to fear of food contamination from listeriosis and methylmercury may limit their diet quality and a balanced approached is required. Dietary intake may also vary according to certain population characteristics. Additional support for women who are younger, less educated, overweight and obese, from socially disadvantaged areas, smokers and those who unnecessarily avoid healthy foods, is required to achieve a higher quality diet and optimal lifestyle peri conception.