Reframing healthy food choices: a content analysis of Australian healthy eating blogs

Content quality versus sharing practices on social media: a cross-sectional analysis of nutrition information on Twitter

OBJECTIVE

To use the validated Online Quality Assessment Tool (OQAT) to assess the quality of online nutrition information.

SETTING

The social networking platform was formerly known as Twitter (now X).

DESIGN

Utilising the Twitter search application programming interface (API; v1·1), all tweets that included the word 'nutrition', along with associated metadata, were collected on seven randomly selected days in 2021. Tweets were screened, those without a URL were removed and the remainder were grouped on retweet status. Articles (shared via URL) were assessed using the OQAT, and quality levels were assigned (low, satisfactory, high). Mean differences between retweeted and non-retweeted data were assessed by the Mann-Whitney U test. The Cochran-Mantel-Haenszel test was used to compare information quality by source.

RESULTS

In total, 10 573 URL were collected from 18 230 tweets. After screening for relevance, 1005 articles were assessed (9568 were out of scope) sourced from professional blogs (n 354), news outlets (n 213), companies (n 166), personal blogs (n 120), NGO (n 60), magazines (n 55), universities (n 19) and government (n 18). Rasch measures indicated the quality levels: 0-3·48, poor, 3·49-6·3, satisfactory and 6·4-10, high quality. Personal and company-authored blogs were more likely to rank as poor quality. There was a significant difference in the quality of retweeted (n 267, sum of rank, 461·6) and non-retweeted articles (n 738, sum of rank, 518·0), U = 87 475, P= 0·006 but no significant effect of information source on quality.

CONCLUSIONS

Lower-quality nutrition articles were more likely to be retweeted. Caution is required when using or sharing articles, particularly from companies and personal blogs, which tend to be lower-quality sources of nutritional information.

Updated-Food Choice Questionnaire: Cultural Adaptation and Validation in a Spanish-Speaking Population from Mexico

BACKGROUND

Determinants and motives related to food selection have evolved in a globalized and changing world. The traditional and useful Food Choice Questionnaire (FCQ), created in 1995, needs to be updated, adapted to new scenarios, and validated.

OBJECTIVES

This study aimed to: (1) assess face validity (FV) of the original 36-item FCQ, (2) generate an Updated-FCQ (U-FCQ) and assess its content validity (CV) (instrument suitability), and (3) evaluate its construct validity and reliability in a Spanish-speaking population from Mexico.

METHODS

FV involved a panel of nutrition professionals (NPs) rating the original items' clarity, relevance, specificity, and representativeness. A literature review process updated the FCQ by adding new items. CV with a second NP panel allowed calculating content validity ratio (CVR). Construct validation was performed via exploratory and confirmatory factor analysis (EFA-CFA). Internal consistency through Cronbach's alpha (CA) and test-retest reliability via intra-class correlation (ICC) were assessed.

RESULTS

The FV (n = 8) resulted in the modification of 11 original items. The literature review added 36 new items (15 from previous adaptations and 21 original items). The CV (n = 13) identified nine items (non-acceptable CVR), prompting reformulation of seven and removal of two. The NPs' feedback added six new items. The EFA-CFA (n = 788) developed a 75-item U-FCQ with eight dimensions: sensory appeal, mood, health and nutritional content, price, food identity, environmental and wildlife awareness, convenience, and image management. CA ranged from 0.74-0.97 (good-excellent) and ICC from 0.51-0.78 (moderate-good).

CONCLUSIONS

This study provides a useful instrument for the assessment of food choices and lays the groundwork for future cross-cultural comparisons, expanding its applicability in wider settings.

Factors influencing perceptions of processed baby foods and feeding practices among Indian mothers: a qualitative investigation

OBJECTIVE

To explore how professionally qualified, working Indian mothers conceptualize healthy foods in general, perceive processed infant and baby foods available commercially and what feeding practices they actually follow with their children at home.

DESIGN

Five focus groups with 8-12 participants were conducted around the participants' conceptualization of healthy food, their perceptions about commercially available processed baby and infant foods and their actual feeding practices that they routinely follow with their children. Discussion transcripts were analyzed using an inductive coding approach.

SETTING

India.

PARTICIPANTS

Fifty-one professionally qualified, working women with at least one child under 5 years of age.

RESULTS

Participants agreed that fresh food is healthiest. They also had favorable opinions about processed infant and baby foods with regards to healthfulness, hygiene and safety. Healthy foods were largely conceptualized in relation to nutrient claims, ingredients and discernible health outcomes. They use cues, such as health claims, brand, price, package design and others to determine healthfulness of the product. Perception was heavily influenced by these extrinsic cues rather than by participants' own nutrition knowledge. Despite having the knowledge, most participants admitted to using these foods on account of factors such as their own inability to lactate, social pressure, lack of time and convenience.

CONCLUSIONS

Most educated and well off people continue to use these products. While they rue the lack of stringent regulatory measures in India, they feel there is an urgent need to address this huge policy gap by way of legislation and regulation.

'You Are Not Alone, We've Got You': Power Plays, Devotion, and Punishment on Healthy Eating and Pro-Eating Disorder Websites

Healthy eating (HE) and pro-eating disorder (pro-ED) websites are popular sources of dietary and weight loss information, social support, and lifestyle inspiration. However, the discursive styles and language used by authors/moderators and users of these two site genres have not been widely studied or compared. Forty-three HE websites and twenty-four pro-ED websites were analysed using Fairclough's model of critical discourse analysis. Findings indicate that sites share common characteristics in terms of power relations played out by authors, 'successful' dieters, and those attending these sites. These power plays encourage moral and spiritual commitment to the care of one's body, with authoritative language used to support readers' loyalty and adherence to dietary plans. On HE sites, medicinal properties were attributed to 'clean' or 'pure' foods, whereas pro-ED sites conveyed their importance for weight reduction. Healthy eating sites were largely entrepreneurial, promoting products or themselves. Pro-eating disorder sites typically featured discussions of bodily disgust, the chastisement of others, and self-discipline in the name of 'Ana', such that dieting came to be framed as part of a devotional, often punitive, body project. On both sites, morality discourses were gendered around the thin female body and the 'ideal mother', with occasional praise for muscular male bodies. Our findings indicate how transitioning from healthy eating preoccupations to eating disorders may be facilitated by normalising discussions about restrictive dieting and the shaming of bodies, overseen by self-appointed diet 'experts' and 'buddies' online.

"We know what we should be eating, but we don't always do that." How and why people eat the way they do: a qualitative study with rural australians

BACKGROUND

There is evidence that most people are aware of the importance of healthy eating and have a broad understanding regarding types of food that enhance or detract from health. However, greater health literacy does not always result in healthier eating. Andreasen's Social Marketing Model and Community-Based Social Marketing both posit that, in order to change health behaviours, it is crucial to understand reasons for current behaviours and perceived barriers and benefits to improved behaviours. Limited research has been conducted, however, that explores these issues with general populations. This study aimed to help address this gap in the evidence using a qualitative methodology.

METHODS

Three group discussions were conducted with a total of 23 participants: (1) young women aged 18-24 with no children; (2) women aged 35-45 with primary school aged children; and (3) men aged 35-50 living with a partner and with pre- or primary school aged children. The discussions took place in a regional centre of Victoria, Australia. Transcriptions were thematically analysed using an inductive descriptive approach and with reference to a recent integrated framework of food choice that identified five key interrelated determinants: food- internal factors; food- external factors; personal-state factors; cognitive factors; and sociocultural factors.

RESULTS

We found that food choice was complex, with all five determinants evident from the discussions. However, the "Social environment" sub-category of "Food-external factors", which included family, work, and social structures, and expectations (or perceived expectations) of family members, colleagues, friends, and others, was particularly prominent. Knowledge that one should practice healthy eating, which falls under the "Cognitive factor" category, while seen as an aspiration by most participants, was often viewed as unrealistic, trumped by the need and/or desire for convenience, a combination of Food-external factor: Social environment and Personal-state factor: Psychological components.

CONCLUSIONS

We found that decisions regarding what, when, and how much to eat are seen as heavily influenced by factors outside the control of the individual. It appears, therefore, that a key to improving people's eating behaviours is to make it easy to eat more healthfully, or at least not much harder than eating poorly.

#Fail: the quality and accuracy of nutrition-related information by influential Australian Instagram accounts

BACKGROUND

Social media is a popular source of information about food and nutrition. There is a high degree of inaccurate and poor-quality nutrition-related information present online. The aim of this study was to evaluate the quality and accuracy of nutrition-related information posted by popular Australian Instagram accounts and examine trends in quality and accuracy based on author, topic, post engagement, account verification and number of followers.

METHODS

A sample of posts by Australian Instagram accounts with ≥ 100,000 followers who primarily posted about nutrition was collected between September 2020 and September 2021. Posts containing nutrition-related information were evaluated to determine the quality and accuracy of the information. Quality was assessed using the Principles for Health-Related Information on Social Media tool and accuracy was assessed against information contained in the Australian Dietary Guidelines, Practice-based Evidence in Nutrition database, Nutrient Reference Values and Metafact.

RESULTS

A total of 676 posts were evaluated for quality and 510 posts for accuracy, originating from 47 Instagram accounts. Overall, 34.8% of posts were classified as being of poor quality, 59.2% mediocre, 6.1% good and no posts were of excellent quality. A total of 44.7% of posts contained inaccuracies. Posts authored by nutritionists or dietitians were associated with higher quality scores (β, 17.8, CI 13.94-21.65; P < 0.001) and higher accuracy scores (OR 4.69, CI 1.81-12.14, P = 0.001) compared to brands and other accounts. Information about supplements was of lower accuracy (OR 0.23, CI 0.10-0.51, P < 0.001) compared to information about weight loss and other nutrition topics. Engagement tended to be higher for posts of lower quality (β -0.59, P = 0.012), as did engagement rate (β -0.57, P = 0.016). There was no relationship between followers or account verification and information quality or accuracy and no relationship between engagement and accuracy.

CONCLUSIONS

Nutrition-related information published by influential Australian Instagram accounts is often inaccurate and of suboptimal quality. Information about supplements and posts by brand accounts is of the lowest quality and accuracy and information posted by nutritionists and dietitians is of a higher standard. Instagram users are at risk of being misinformed when engaging with Australian Instagram content for information about nutrition.

Quality and accuracy of online nutrition-related information: a systematic review of content analysis studies

OBJECTIVE

This systematic review aimed to summarise the level of quality and accuracy of nutrition-related information on websites and social media and determine if quality and accuracy varied between websites and social media or publishers of information.

DESIGN

This systematic review was registered with PROSPERO (CRD42021224277). CINAHL, MEDLINE, Embase, Global Health and Academic Search Complete were systematically searched on 15 January 2021 to identify content analysis studies, published in English after 1989, that evaluated the quality and/or accuracy of nutrition-related information published on websites or social media. A coding framework was used to classify studies' findings about information quality and/or accuracy as poor, good, moderate or varied. The Academy of Nutrition and Dietetics Quality Criteria Checklist was used to assess the risk of bias.

SETTING

N/A.

PARTICIPANTS

N/A.

RESULTS

From 10 482 articles retrieved, sixty-four were included. Most studies evaluated information from websites (n 53, 82·8 %). Similar numbers of studies assessed quality (n 41, 64·1 %) and accuracy (n 47, 73·4 %). Almost half of the studies reported that quality (n 20, 48·8 %) or accuracy (n 23, 48·9 %) was low. Quality and accuracy of information were similar on social media and websites, however, varied between information publishers. High risk of bias in sample selection and quality or accuracy evaluations was a common limitation.

CONCLUSION

Online nutrition-related information is often inaccurate and of low quality. Consumers seeking information online are at risk of being misinformed. More action is needed to improve the public's eHealth and media literacy and the reliability of online nutrition-related information.

Effect of perception of sustainability in local food experiences on healthy eating tendency: mediator and moderator effects

Tourists who favor local food typically care about healthy food choices. Their view of locally produced food as healthy is related to perceptions of sustainability. This relationship can be explained by tourists' personality traits and tendency to eat local food. This study aimed to establish the effect of tourists' perceptions of sustainability in the context of local food experiences on healthy eating tendencies. In addition, we aimed to determine the role of tourists' personality traits and local eating tendencies and elucidate the moderating role of searching online for information on food choices. An online questionnaire (via e-mail and WhatsApp) was used to obtain data from 379 research participants, recruited using a non-probabilistic sampling technique. A research model and hypotheses were formed based on Hayes PROCESS Macro models 90 and 6, and moderator and mediator effects were analyzed using these models. Healthy eating was well-explained by the model, and the perception of social and environmental sustainability in local food experiences (LFE-SES) positively affected food-related personality traits (FRPT), local food eating tendencies (LFET), and healthy eating (HE). While food-related personality traits did not mediate the relationship between the perception of sustainability and healthy eating, local food eating tended to mediate this relationship. In addition, when food-related personality traits and local food eating tendencies were evaluated together, they had a mediating role between the perception of sustainability and healthy eating. Searching online for information had an insignificant moderating effect. These findings help promote an understanding of healthy eating tendencies. Within the context of local food, they suggest critical theoretical and practical implications for the relationship between the perception of sustainability, food-related personality traits, local food eating tendencies, and healthy eating.

Nutrition-Related Information on Instagram: A Content Analysis of Posts by Popular Australian Accounts

Social media is a popular source of nutrition information and can influence food choice. Instagram is widely used in Australia, and nutrition is frequently discussed on Instagram. However, little is known about the content of nutrition information published on Instagram. The aim of this study was to examine the content of nutrition-related posts from popular Australian Instagram accounts. Australian Instagram accounts with ≥100,000 followers, that primarily posted about nutrition, were identified. All posts from included accounts, from September 2020 to September 2021, were extracted and posts about nutrition were included. Post captions were analysed using Leximancer, a content analysis software, to identify concepts and themes. Text from each theme was read to develop a description and select illustrative quotes. The final sample included 10,964 posts from 61 accounts. Five themes were identified: (1) recipes; (2) food and nutrition practices; (3) body goals; (4) food literacy and (5) cooking at home. Recipes and practical information about nutrition and food preparation are popular on Instagram. Content about weight loss and physique-related goals is also popular and nutrition-related Instagram posts frequently include marketing of supplements, food and online programs. The popularity of nutrition-related content indicates that Instagram may be a useful health-promotion setting.

Development and validation of a quality assessment tool to assess online nutrition information

Setting

The internet is an important source of health information but is unregulated. Little research has focused on the assessment of digital information related to nutrition.

Aim

To develop and validate a novel online quality assessment tool (OQAT) for quality assessment of online nutrition information.

Method

The OQAT was developed and validated in six distinct stages. After reviewing the literature, a framework and criteria were developed and formalised. Next, the quality assessment criteria were piloted on a subset of data and criteria refined. The established criteria were then validated against a previously validated assessment tool, and reliability was tested. Finally, the validated OQAT was used to assess the quality of articles from a 24-h collection period, 19 April 2021.

Results

The final OQAT consisted of 10 key questions. Twenty-six news articles were assessed independently by two raters. Comparison of scores found moderate internal consistency (α = 0.382). Cohen's Kappa coefficient demonstrated high interrater agreement (k = 0.653, p < 0.001). The OQAT was tested on 291 relevant Uniform Resource Locators (URLs), which were determined to be either poor 3% (n = 9), satisfactory 49% (n = 144), or high-quality 48% (n = 139) articles. There was a statistically significant difference in OQAT scores between blogs, news articles, and press releases, χ2(2) = 23.22, p < 0.001, with a mean rank OQAT score of 138.2 for blogs, 216.6 for news articles, and 188.7 for press releases.

Conclusion

This novel tool provides a reliable and objective method for assessing the quality of nutrition content online. It could potentially be used by researchers to assess the quality of online information in different settings and by organisations to inform readers of the quality of information being accessed.

Communication of nutrition information by influencers on social media: A scoping review

ISSUE ADDRESSED

Although government promoted public health, social media and media campaigns have communicated nutrition information, the Australian population remains chronic under-consumers of fruit and vegetables and overconsumers of ultra-processed foods. This scoping review aimed to determine how social media influencers (SMI) communicate nutrition information and the factors that influence the popularity of messages. Identified factors could inform how governments may utilise social media to impact positively on food choices.

METHODS

Nine databases were searched in the past 5 years (2016-2021). After relevant sources were identified, entire texts of the grey literature and the "Results" sections of the academic literature were coded. Using Microsoft Word, each key feature of the relevant text was highlighted, and the relevant code was recorded. Inductive coding was utilised where codes were created based on the text itself. These codes were then sorted iteratively into relevant themes and subthemes.

RESULTS

Eleven studies were included. From these sources, five themes were identified. These were, (i) promoting dietary change, (ii) certain modes/styles of content delivery, (iii) an attractive individual, (iv) language features and (v) appearing connected to the audience.

CONCLUSION

SMI are selective in their content and communication techniques to ensure their nutrition messages are popular with social media users. These methods exhibited by SMI could inform strategies to build trust in government messages about food and nutrition.

Food Supply Chain Safety Research Trends From 1997 to 2020: A Bibliometric Analysis

Background

The COVID-19 pandemic has exposed the fragility of the global food supply chain, strengthened consumers' awareness of the traceability system throughout the supply chain, and gradually changed consumers' consumption concepts and consumption patterns. Therefore, the aim of this study was to analyse the relevant literature on food safety in the food supply chain, examine its current status, hot spots, and development trends, and provide some suggestions for academics and relevant government departments in food supply chain safety research.

Methods

We collected the literature on the food safety research of the food supply chain from the Scopus database, used BibExcel to count the subject categories, published journals, geographical distributions, research institutions, authors, and keywords in the literature, and used Pajek software to analyse the keywords in the literature, perform co-occurrence analysis, draw related knowledge maps, and perform cluster analysis on primary keywords. Finally, to study the development trend, we used CorTexT software to illustrate the theme evolution path map in this research field.

Results

The keyword visualization network revealed the following key research topics: (1) food safety at the consumer end of the food supply chain, (2) food safety management in the food supply chain, (3) risk management of food safety in the food safety chain, and (4) food safety at the production end of the food supply chain.

Conclusions

After comprehensive discussion and analysis, we concluded that food supply chain management may be a hot topic in the future, especially in traceability management combined with the blockchain. It is necessary to explore in-depth how the blockchain can affect the food supply chain to provide a theoretical basis for managing the latter.

Mapping the digital food environment: A systematic scoping review

Food environments are directly linked to diets and health outcomes such as overweight, obesity, and noncommunicable diseases. The digitalization of food environments is becoming a central issue in public health, yet little is known about this emerging field. We performed a systematic scoping review to map the research on the digital food environment and investigate how the eight dimensions of the food environment, according to an established framework (availability, prices, vendor and product properties, marketing and regulation, accessibility, affordability, convenience, and desirability), might be shifting in the context of a digital society. We searched MEDLINE, EMBASE, Scopus, and Web of Science for studies published between 2000 and 2019, using search terms covering digital technology and food environment, which yielded 13,580 unique records. Our analysis of 357 studies shows that digitalization is taking place in all dimensions of the food environment, and enabling the emergence of new forms of buying and selling food, such as online grocery shopping and online food delivery, which may be changing availability of foods and affecting the physical distance to shops and time allocated for shopping. Systematic reviews identified indicated that digital food marketing and social media can influence food choices, preferences and consumption. Our findings suggest that digital and physical food environments are interconnected and influencing one another, but the impact of the digital on health and nutrition is yet unclear.

Analysing Credibility of UK Social Media Influencers' Weight-Management Blogs: A Pilot Study

Social media influencers (SMI) are individuals with large follower engagement, who can shape the thoughts and dietary behaviours of their audience. Concerns exist surrounding the spread of dietary misinformation by SMI, which may impact negatively on public health, yet no standards currently exist to assess the credibility of their information. This study aimed to evaluate the credibility of key SMI weight management (WM) blogs (n = 9), piloting a pre-prepared credibility checklist. SMI were included if they had a blue-tick verification on ≥2 social media (SM) and an active WM blog. A sample of blog posts were systematically evaluated against thirteen credibility indicators under four themes: ‘transparency’, ‘use of other resources’, ‘trustworthiness and adherence to nutritional criteria’ and ‘bias’. Indicators were yes/no questions to determine an overall credibility percentage for each SMI. The ten most recent meal recipes from each blog were evaluated against Public Health England’s (PHE) calorie targets and the UK ‘traffic light’ food labelling scheme to assess nutritional quality. Percentages ranged from 23–85%, the highest gained by a Registered Nutritionist. SMI blogs may not be credible as WM resources. Given the popularity and impact of SM in the context of overweight, obesity and WM, this study may inform the methodological approach for future research.

The heuristics that guide healthiness perception of ultra-processed foods: a qualitative exploration

Objective:

To explore the conceptualisation of healthy food by citizens and how they judge the healthiness of ultra-processed foods.

Design:

Four focus groups were conducted using a semi-structured discussion guide. Focus group discussions were held about the concept of healthy food, what characterise a healthy product and healthiness perception of ultra-processed products. Transcripts of the focus groups were analysed following an inductive coding approach.

Setting:

Uruguay, one of the Latin American countries with the highest prevalence of overweight and obesity.

Participants:

Fifty-two adult Uruguayan participants, diverse in terms of gender, age, educational level and socio-economic status.

Results:

In agreement with previous studies on lay perceptions of healthy eating, the conceptualisation of healthy food was mainly focused on food characteristics. Although participants regarded lack of processing as a cue for healthiness, they did not categorise all ultra-processed products as unhealthy. Albeit some product categories were automatically regarded as unhealthy, participants considered that other categories could include healthy and unhealthy products. In such cases, they explicitly referred to several simplified cognitive strategies to judge whether an ultra-processed product is healthy or not. Results showed that participants tended to rely on simple cues, such as label design, nutrient claims, brand, price and country of origin as indicators of product healthiness.

Conclusions:

Healthiness perception of ultra-processed products seems to be largely influenced by heuristics, which stresses the need to implement policies that make the potential negative effects of ultra-processed products salient.