Aims and objectives
This work uses an action research model to identify and test steps taken by study participants to make changes in food choices. The many and varied forms of information on food labels (labels) are explored. Literature is reviewed relating to action research, health promotion, behavioural change, food labelling and the risks of dietary related disease, including an overview of the cost to the NHS. Reflection on the literature reviewed led to the development of a plan to investigate people's use and understanding of nutrition and food labels using action research. An initial research question evolved:
Can increased knowledge and understanding in relation to nutrition and food
labelling bring about a change in eating habits?
With the development of a subsequent question:
Can supermarket till receipts be used to provide information to measure change?
Methodology
A series of 3 studies using action research with mixed methodology, integrating
qualitative and quantitative methods; examined people's eating habits, knowledge and understanding of nutrition, food labels and food shopping. Factors were examined which influence choices of food purchased thus the food eaten. A Food Label Guidance Tool (FoLaG) and nutrition information leaflet were developed in partnership with the participants to clarify and help people to understand nutrition and labelling information on food packets. These were tested as educational interventions to discover if people's shopping behaviour could change. During the course of this research, new types food labels were introduced in Britain. The Food Standards Agency developed the "Traffic
Lights" system. Concurrently, the Institute of Grocery Distribution (IGD 1998, 2006) together with Ministry of Agriculture, the Department of Health (DoH) and others developed the Guideline Daily Amounts (GDA) labelling.
Study Phases
The research is divided into four parts, as each stage developed, reflection on the process and findings informed the next phase. Firstly, the Calon Lân Survey (n=2562) identified the specific geographical areas of poor nutrition and risk factors for coronary heart disease (CHD) amongst the population of Anglesey, and identified some areas of poor nutrition, e.g. very low intakes of fruit and vegetables. As a result of reflection on these findings a series of studies were designed to discover whether changes to improve food choices could be made. Study 1: 'Identifying the Use of Food Labels' (n=lO0) investigated the extent to which people read labels. This led to Study 2 'Identifying Knowledge of nutrition and Refining the FoLaG Tool' that examined the level of understanding of nutrition and the extent of label use by the participants (n=30) whilst
concurrently the intervention tool 'FoLaG' was developed in participation with various groups. Study 3 'Evaluation and Measuring Changes' (n=l03) addressed the findings from Studies 1 and 2 by providing educational material as an intervention and comparing the participants' purchases of various categories of foods, before and after the intervention with a control group. Study 3 also used supermarket till receipts as an indicator to measure the quantities of foods purchased in various categories. These were compared over a month measuring the changes in purchases, pre and post intervention by people undertaking their normal weekly food shopping in a "real life" situation. At each stage reflection on findings, pa11icipants views and the process informed the route taken, following an action research methodology.
Findings
Changes showing improved choices in the desired direction were found in 3 categories of foods; In the case of purchases of fruit and vegetable, an increase was required and was found. Fruit and vegetable purchases increased (p<0.001). For saturated fat purchases and white refined cereals, decreases in purchases were required and were found, purchases of saturated fats decreased (p<0.001), purchases of white refined cereals decreased (p=0.037). Other food categories showed trends of changes in the desired direction but were not significant. The control group showed no changes in 4 categories and changes in the wrong direction in 3 categories.
This research explored education and understanding as the activation to generate change and adds to knowledge by advocating the use of specific education in nutrition and understanding food labelling to elicit change used in a 'real-life' situation, together with the use of novel methods of measuring modifications to diet (itemised till receipts) using reflective practice working within an action research framework with the participants.