Perceptions on the use of pricing strategies to stimulate healthy eating among residents of deprived neighbourhoods: a focus group study

BackgroundPricing strategies are mentioned frequently as a potentially effective tool to stimulate healthy eating, mainly for consumers with a low socio-economic status. Still, it is not known how these consumers perceive pricing strategies, which pricing strategies are favoured and what contextual factors are important in achieving the anticipated effects.MethodsWe conducted seven focus groups among 59 residents of deprived neighbourhoods in two large Dutch cities. The focus group topics were based on insights from Rogers' Diffusion of Innovations Theory and consisted of four parts: 1) discussion on factors in food selection; 2) attitudes and perceptions towards food prices; 3) thinking up pricing strategies; 4) attitudes and perceptions regarding nine pricing strategies that were nominated by experts in a former Delphi Study. Analyses were conducted with Atlas.ti 5.2 computer software, using the framework approach.ResultsQualitative analyses revealed that this group of consumers consider price to be a core factor in food choice and that they experience financial barriers against buying certain foods. Price was also experienced as a proficient tool to stimulate healthier food choices. Yet, consumers indicated that significant effects could only be achieved by combining price with information and promotion techniques. In general, pricing strategies focusing on encouraging healthy eating were valued to be more helpful than pricing strategies which focused on discouraging unhealthy eating. Suggested high reward strategies were: reducing the price of healthier options of comparable products (e.g., whole meal bread) compared to unhealthier options (e.g., white bread); providing a healthy food discount card for low-income groups; and combining price discounts on healthier foods with other marketing techniques such as displaying cheap and healthy foods at the cash desk.ConclusionThis focus group study provides important new insights regarding the use of pricing strategies to stimulate healthy eating. The observed perceptions and attitudes of residents of deprived neighbourhoods can be integrated into future experimental studies and be used to reveal if and how pricing strategies are effective in stimulating healthy eating.

[1]  J. Seidell,et al.  The public health impact of obesity. , 2001, Annual review of public health.

[2]  Donald Kennedy,et al.  The Obesity Epidemic , 2004, Science.

[3]  Sunil Gupta,et al.  Consumer price sensitivity and price thresholds , 2001 .

[4]  D. Herman,et al.  Choices made by low-income women provided with an economic supplement for fresh fruit and vegetable purchase. , 2006, Journal of the American Dietetic Association.

[5]  A. Drewnowski Obesity and the food environment: dietary energy density and diet costs. , 2004, American journal of preventive medicine.

[6]  What is known about the effectiveness of economic instruments to reduce consumption of foods high in saturated fats and other energy-dense foods for preventing and treating obesity? , 2006 .

[7]  Andrew Leicester,et al.  The 'fat tax': economic incentives to reduce obesity , 2004 .

[8]  I. Kawachi,et al.  Food taxation and pricing strategies to "thin out" the obesity epidemic. , 2006, American Journal of Preventive Medicine.

[9]  M. Caraher,et al.  Taxing food: implications for public health nutrition , 2005, Public Health Nutrition.

[10]  Marion Nestle,et al.  Can the food industry play a constructive role in the obesity epidemic? , 2008, JAMA.

[11]  E. Rogers,et al.  Diffusion of innovations , 1964, Encyclopedia of Sport Management.

[12]  J. Seidell,et al.  Prevalence of overweight and obesity in the Netherlands , 2007, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[13]  Tony Blakely,et al.  Effects of price discounts and tailored nutrition education on supermarket purchases: a randomized controlled trial. , 2010, The American journal of clinical nutrition.

[14]  Sue Ziebland,et al.  Analysing qualitative data , 2000, BMJ : British Medical Journal.

[15]  A. Drewnowski,et al.  Food choices and diet costs: an economic analysis. , 2005, The Journal of nutrition.

[16]  A. Drewnowski,et al.  Low energy density and high nutritional quality are each associated with higher diet costs in French adults. , 2007, The American journal of clinical nutrition.

[17]  L. Frewer,et al.  Low-income consumers' attitudes and behaviour towards access, availability and motivation to eat fruit and vegetables , 2003, Public Health Nutrition.

[18]  Laura Johnson,et al.  How Many Interviews Are Enough? , 2006 .

[19]  Lynn Stockley,et al.  Consumer understanding and use of nutrition labelling: a systematic review , 2005, Public Health Nutrition.

[20]  Johannes Brug,et al.  Perceived environmental determinants of physical activity and fruit and vegetable consumption among high and low socioeconomic groups in the Netherlands. , 2007, Health & place.

[21]  E. Rogers Diffusion of Innovations , 1962 .

[22]  L. Frewer,et al.  Russian consumers’ motives for food choice , 2009, Appetite.

[23]  Wilma E Waterlander,et al.  Expert views on most suitable monetary incentives on food to stimulate healthy eating. , 2010, European journal of public health.

[24]  D. B. Baarda,et al.  Kwalitatief onderzoek : praktische handleiding voor het opzetten en uitvoeren van kwalitatief onderzoek , 1997 .

[25]  Corinna Hawkes,et al.  Sales promotions and food consumption. , 2009, Nutrition reviews.

[26]  H. Sauerwein,et al.  Prevalentie van diabetes mellitus en hart- en vaatziekten onder Turkse, Marokkaanse en autochtone Nederlanders , 2003 .

[27]  D. Cassady,et al.  The availability and cost of healthier food alternatives. , 2006, American journal of preventive medicine.

[28]  D. Cassady,et al.  Is price a barrier to eating more fruits and vegetables for low-income families? , 2007, Journal of the American Dietetic Association.

[29]  J. Coveney The Politics of Food , 2006 .

[30]  A. Tegene,et al.  Taxing Snack Foods: Manipulating Diet Quality or Financing Information Programs? , 2005 .

[31]  K. Glanz,et al.  Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption. , 1998, Journal of the American Dietetic Association.

[32]  Marc Vanhuele,et al.  Consumers' Immediate Memory for Prices , 2006 .

[33]  S. van Buuren,et al.  Prevalence of overweight and obesity in the Netherlands in 2003 compared to 1980 and 1997 , 2007, Archives of Disease in Childhood.

[34]  C. Pope,et al.  Qualitative Research in Health Care , 1999 .

[35]  M. Cabanac Palatability vs. Money: Experimental Study of a Conflict of Motivations , 1995, Appetite.

[36]  M. Visser,et al.  Energy density, energy costs and income – how are they related? , 2010, Public Health Nutrition.

[37]  K. Brownell,et al.  Comparison of price change and health message interventions in promoting healthy food choices. , 2002, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[38]  S. French,et al.  School-based research and initiatives: fruit and vegetable environment, policy, and pricing workshop. , 2004, Preventive Medicine.

[39]  F. Chaloupka,et al.  Food prices and obesity: evidence and policy implications for taxes and subsidies. , 2009, The Milbank quarterly.

[40]  S. French,et al.  Pricing effects on food choices. , 2003, The Journal of nutrition.

[41]  A. Drewnowski,et al.  Low-energy-density diets are associated with higher diet quality and higher diet costs in French adults. , 2007, Journal of the American Dietetic Association.

[42]  Chery Smith,et al.  Healthful eating: perceptions, motivations, barriers, and promoters in low-income Minnesota communities. , 2004, Journal of the American Dietetic Association.

[43]  S. Ziebland,et al.  Analysing qualitative data , 2000, BMJ : British Medical Journal.

[44]  Linda Teunter,et al.  Analysis of Sales Promotion Effects on Household Purchase Behavior , 2002 .

[45]  K. Flegal,et al.  Prevalence of overweight and obesity in the United States, 1999-2004. , 2006, JAMA.

[46]  K. Ball,et al.  Why do women of low socioeconomic status have poorer dietary behaviours than women of higher socioeconomic status? A qualitative exploration , 2005, Appetite.