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FoodFLIP: Testing the Effectiveness of a Food Information App to Promote the Selection of Healthier Foods

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ClinicalTrials.gov Identifier: NCT02814604
Recruitment Status : Not yet recruiting
First Posted : June 28, 2016
Last Update Posted : September 28, 2018
Sponsor:
Collaborators:
Heart and Stroke Foundation of Canada
Dietitians of Canada
Information provided by (Responsible Party):
Mary L'Abbe, University of Toronto

Brief Summary:
There is a lot of confusion when it comes to understanding nutrition information on food packages, thus making it difficult for consumers to choose healthy products. In today's busy and fast-paced shopping environment, mobile digital technology (for example, Smartphone applications) can help consumers make 'healthier' food choices when they are shopping. This study will investigate whether a traffic light front-of-pack system or an overall star rating system, coupled with an automated healthfulness comparison feature, on a Smartphone app can help consumers identify and purchase healthier foods.

Condition or disease Intervention/treatment Phase
Consumer Behavior Diet, Food, and Nutrition Other: Nutrition Rating Systems Not Applicable

Detailed Description:

The rising rate of obesity and diet-related chronic diseases illustrate that Canadians' eating habits need to change. Equipping Canadians with information and tools to enable healthy food choices that decrease risk for disease is imperative. While the Nutrition Facts table (NFt) is the most standardized and complete form of nutrition labelling, studies have shown that consumers are confused about serving size, nutrient quantities, and the interpretation of the % Daily Value. Thus, expert groups have proposed the introduction of interpretive front-of-pack (FOP) nutrition rating systems (e.g. traffic light labelling or star ratings) that also help consumers understand the significance of the levels of nutrients in relation to the "healthiness" of a food. One of the main barriers to the introduction of such a system is the absence of high quality studies that objectively measure the impact of nutrition information on actual food purchases. This is a consequence of both the practical challenges associated with designing and conducting such studies in 'real-world' settings, and the lack of food industry support to quantitatively examine or publish the potential for enhanced nutrition labels to modify consumer food choices. With the growing burden of diet-related disease, there is an urgent need for robust evidence to evaluate the potential for additional interpretive nutrition labelling systems to modify and improve food purchasing patterns. Given the relative ubiquity of mobile digital technologies, our Canadian Smartphone application (FoodFLIP) provides us with an unprecedented opportunity to examine and improve consumers' diets.

This study will investigate whether a traffic light FOP system or an overall star rating system, coupled with an automated healthfulness comparison feature, on a Smartphone app can help consumers identify and purchase healthier foods.

Objective 1: To evaluate the effects of two technology-enabled FOP systems on the nutritional quality of foods purchased by consumers compared to a control, and analyze the moderating effects of key consumer characteristics, including nutrition literacy.

Objective 2: To determine which of the two FOP systems support healthier food choices and are preferred by Canadian consumers.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 1020 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Other
Official Title: FoodFLIP: Testing the Effectiveness of a Food Information App to Promote the Selection of Healthier Foods
Estimated Study Start Date : November 2018
Estimated Primary Completion Date : December 2019
Estimated Study Completion Date : December 2019

Arm Intervention/treatment
Experimental: Traffic Light

Participants in this group will download an app which features the nutrition information of the selected product in a multiple coloured traffic light format (i.e. the traffic light system shows a coloured round indicator for each of saturated fat, sugar, and sodium; shaded red (high), amber (medium) or green (low), according to thresholds set for each nutrient). In addition, a list of healthier similar products will appear on screen to facilitate comparisons.

Intervention: Device:Smartphone, Behavioural: Nutrition Rating Systems

Other: Nutrition Rating Systems
Behavioural: Nutrition Rating Systems (shown on a mobile app) provide consumers with an interpretation of the healthfulness of a food or beverage product.
Other Name: Device: Smartphone

Experimental: Health Star Rating System

Participants in this group will download an app which features the nutrition information of the selected product in a form of 0-5 stars to provide an overall "healthy" rating. The Health Star Rating provides a rating for all products and products not meeting the criteria still carry the symbol (with no colored stars). In addition, a list of healthier similar products will appear on screen to facilitate comparisons.

Intervention: Device:Smartphone, Behavioural: Nutrition Rating Systems

Other: Nutrition Rating Systems
Behavioural: Nutrition Rating Systems (shown on a mobile app) provide consumers with an interpretation of the healthfulness of a food or beverage product.
Other Name: Device: Smartphone

No Intervention: Control
Participants in this group will only see the Nutrition Facts Table (as it appears on the product's package) when the product is scanned in the app.



Primary Outcome Measures :
  1. The mean FSANZ nutrient profile score (ranging from -18 to +81) of foods purchased by each intervention group will be compared. [ Time Frame: 6 weeks ]
    Using the mean FSANZ nutrient profile score, the nutritional quality of foods purchased by the three intervention groups will be compared (mixed models). The FSANZ nutrient profile score is assigned to each food/beverage product by scoring individual points for calories, sugar, sodium, fat, fibre, protein, fruits/vegetables/legumes/seeds/nuts and added/deleted (based on FSANZ nutrient profile criteria) to arrive at a final score (ranging from -18 to +81). Mean nutrient profile scores for all products in each category (e.g Beverages, Dairy Products, Bakery Products etc.) in each intervention arm will be calculated and compared among the intervention groups.


Secondary Outcome Measures :
  1. The mean concentration of calories(kcal/d) in the foods purchased will be compared among traffic light, star system and control groups (Foods purchased and submitted by scanned receipts) [ Time Frame: 6 weeks ]
    Mean concentration of calories (kcal/d) will be calculated from the Food Label Information Program (FLIP) database of packaged foods and the nutrient will be compared among the three intervention groups using generalized linear models.

  2. The mean concentration of saturated fat (g/d) in the foods purchased will be compared among traffic light, star system and control groups (Foods purchased and submitted by scanned receipts) [ Time Frame: 6 weeks ]
    Mean concentration of saturated fat (g/d) will be calculated from the Food Label Information Program (FLIP) database of packaged foods and the nutrient will be compared among the three intervention groups using generalized linear models.

  3. The mean concentration of sodium (mg/d) in the foods purchased will be compared among traffic light, star system and control groups (Foods purchased and submitted by scanned receipts) [ Time Frame: 6 weeks ]
    Mean concentration of sodium (mg/d) will be calculated from the Food Label Information Program (FLIP) database of packaged foods and the nutrient will be compared among the three intervention groups using generalized linear models.

  4. The mean concentration of sugar (mg/d) in the foods purchased will be compared among traffic light, star system and control groups (Foods purchased and submitted by scanned receipts) [ Time Frame: 6 weeks ]
    Mean concentration of sugar (mg/d) will be calculated from the Food Label Information Program (FLIP) database of packaged foods and the nutrient will be compared among the three intervention groups using generalized linear models.


Other Outcome Measures:
  1. A qualitative assessment of the usability of the smartphone app (FoodFLIP) will be assessed through questionnaires on a 5-point Likert Scale (the percentage of users finding the app easy to use/easy to understand etc). [ Time Frame: 6 weeks ]
    The usability of the smartphone app is assessed through questionnaires (e.g easy to use, easy to understand etc). Responses on these questionnaires are scaled using a five-point Likert-scale and scores for each question are recorded separately to assess the usability of the smartphone app (e.g 1 least liked to 5 most liked).



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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Shop at a supermarket owned by one of the largest four national retailers at least twice a month. This includes Loblaws, Sobeys, Metro or Safeway
  • Own a smartphone (iPhone version 3 or later or android)
  • Are 18 years or over and provide informed consent to participate
  • Reside in Canada, excluding Northern Territories

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02814604


Contacts
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Contact: Mary R L'Abbe, Ph.D. 4169787235 mary.labbe@utoronto.ca
Contact: Mavra Ahmed, M.Sc. mavz.ahmed@mail.utoronto.ca

Locations
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Canada, Ontario
University of Toronto Not yet recruiting
Toronto, Ontario, Canada, M5S3E2
Contact: Mary R L'Abbe, Ph.D.    4169787235    mary.labbe@utoronto.ca   
Sponsors and Collaborators
University of Toronto
Heart and Stroke Foundation of Canada
Dietitians of Canada
Investigators
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Principal Investigator: Mary R L'Abbe, Ph.D. University of Toronto

Publications:
The Standing Committee on Health. Healthy Weights for Healthy Kids. 2007
Committee on Examination of Front-of-Package Nutrition Rating Systems and Symbols (Phase II), Institute of Medicine. Front-of-Package Nutrition Rating Systems and Symbols: Promoting Healthier Choices. 2011 October 20.

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Responsible Party: Mary L'Abbe, Earle W. McHenry Professor and Chair, University of Toronto
ClinicalTrials.gov Identifier: NCT02814604     History of Changes
Other Study ID Numbers: 499174
First Posted: June 28, 2016    Key Record Dates
Last Update Posted: September 28, 2018
Last Verified: June 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Mary L'Abbe, University of Toronto:
Front-of-Pack Labelling
Star rating system
Traffic light rating system
Consumer Behavior
Health Literacy
Mobile Apps
Nutrition Labeling
Healthy food choices