Willingness to use functional breads. Applying the Health Belief Model across four European countries

Abstract

The present study focused on the role of the Health Belief Model (HBM) in predicting willingness to use functional breads, across four European countries: UK (N = 552), Italy (N = 504), Germany (N = 525) and Finland (N = 513). The behavioural evaluation components of the HBM (the perceived benefits and barriers conceptualized respectively as perceived healthiness and pleasantness) and the health motivation component were good predictors of willingness to use functional breads whereas threat perception components (perceived susceptibility and perceived anticipated severity) failed as predictors. This result was common in all four countries and across products. The role of ‘cue to action’ was marginal. On the whole the HBM fit was similar across the countries and products in terms of significant predictors (the perceived benefits, barriers and health motivation) with the exception of self-efficacy which was significant only in Finland. Young consumers seemed more interested in the functional bread with a health claim promoting health rather than in reducing risk of disease, whereas the opposite was true for older people. However, functional staple foods, such as bread in this European study, are still perceived as common foods rather than as a means of avoiding diseases. Consumers seek these foods for their healthiness (the perceived benefits) as they expect them to be healthier than regular foods and for the pleasantness (the perceived barriers) as they do not expect any change in the sensory characteristics due to the addition of the functional ingredients. The importance of health motivation in willingness to use products with health claims implies that there is an opening for developing better models for explaining health-promoting food choices that take into account both food and health-related factors without making a reference to disease-related outcome.

Introduction

Grain products are the major source of carbohydrate in the diet and dietary recommendations consistently stress the importance of grain choices, including whole grain products (Dietary Guidelines for Americans, 2005, LARN, 1996). Epidemiological studies found associations of habitual consumption of wholegrain foods with diseases, such as coronary heart disease (Wolk et al., 1999), ischemic stroke (Liu et al., 2000) and type 2 diabetes (Montonen, Knekt, Järvinen, Aromaa, & Reunanen, 2003). Cereal products can contain a considerable amount of fibre components and these have been linked to well-being of the gut and lowering the risk of cardio-vascular diseases in several studies (Pereira et al., 2004). Bread and pasta are probably the most studied cereal products regarding healthy effects when consumed (Järvi et al., 1995, Jenkins et al., 1986, Juntunen et al., 2002).

In recent years, cereals or cereal constituents have also been investigated regarding their potential use in developing functional foods (Charalampopoulos, Wang, Pandiella, & Webb, 2002). The definition of “functional food” is still an issue of debate (for an overview of definitions see Roberfroid, 2000). A widely accepted definition describes a functional food as a food that ‘affects beneficially one or more target functions of the body, beyond adequate nutritional effects, in a way that is relevant to either an improved state of health and well-being and/or reduction of risk of disease’ (Diplock et al., 1999). Functional foods with their specific health effects could, in the future, indicate a new mode of thinking about the relationships between food and health in everyday life. As consumers are reluctant to change eating habits, even when these are known to be unhealthy (Williamson, Hunt, Pope, & Tolman, 2000) but at the same time want to buy healthy foods (Brunsø, Grunert, & Bredahl, 1996), the potential for functional foods such as grain products might be promising. Enhancing the beneficial components in a cereal product creates the possibility of developing products that can be marketed with specific health claims, labelled according to the rules laid out in the new health claim regulation, if these claims are accepted by the EU commission (EC, 2006).

However, there is little research about which combinations of health claims and food carriers are most appealing to consumers (van Kleef, van Trijp, & Luning, 2005). Previous research (Bech-Larsen & Grunert, 2003) showed that the evaluation of health claims is partially determined by healthiness perceptions of the product. Even though there is increasing scientific evidence that some food components have beneficial effects beyond the provision of the basic nutrients, the development of effective persuasive health claims has proven to be rather difficult. Studies found that the effectiveness of health claims depends among other things on the strength of the association between consumers’ values and their attitudes to functional foods (Frewer, Scholderer, & Lambert, 2003). Foods are typically chosen for their good taste, convenience and price with health being only one reason among many (Margetts, Martinez, Saba, Holm, & Kearney, 1997) and so-called functional foods are not exceptions in this (Urala & Lähteenmäki, 2003). Consumers can only be expected to substitute conventional with functional foods if these latter are perceived as comparatively healthy (Ares & Gámbaro, 2007) and the promised health benefits are regarded as relevant (Verbeke, 2005). Consumers’ perceptions of the healthiness of the products, processes and enrichments involved in the production of functional foods are crucial in determining consumers’ acceptance of this type of food (Bech-Larsen & Grunert, 2003; Verbeke, 2005) as well as perceptions of taste, pleasure and familiarity (Poulsen, 1999; Urala and Lähteenmäki, 2003, Urala and Lähteenmäki, 2004). Despite the prospect of a promising future for cereal-based functional foods, there is again little research reporting empirical studies of consumer acceptance of such products (Arvola et al., 2007, Dean et al., 2007).

Products with health claims bring food into the domain of health behaviour over and above eating behaviour which is largely governed by factors such as taste, pleasure and familiarity. Many theories and models have been used to understand health behaviour: the Transtheoretical Model (Prochaska & DiClemente, 1992), Theory of Self-Efficacy (Bandura, 1977), and Health Belief Model (HBM) (Rosenstock, 1974). In particular, the Health Belief Model has a long history and was proposed to help explain why individuals do not participate in health prevention programmes (Stretcher & Rosenstock, 1997). In addition, throughout the decades this theoretical model has been broadly applied in predicting health-related behaviours, preventive health behaviours, sick role behaviours and clinic use (Sheeran & Abraham, 1995). On the other hand, the applications of the HBM in the food choice area have been largely lacking with some sporadic exceptions relating to food safety (Schafer, Shafer, Bultena, Hoiberg, 1993), food-handling behaviour (Hanson & Benedict, 2002) and folate knowledge (Kloeblen, 1999).

Briefly, the concept of the HBM focuses on two aspects of heath behaviour: threat perception and behavioural evaluation. Threat perception refers to a ‘perceived susceptibility’ to illness and a ‘perceived anticipated severity’ of the consequences of such an illness, whilst behavioural evaluation concerns the ‘benefits’ and the ‘barriers’ to enacting a behaviour (Sheeran & Abraham, 1995). Additionally, the HBM proposes ‘cue to action’ and ‘health motivation’ as two other cognitive components that refer respectively to ‘the trigger of health behaviour when appropriate beliefs are held’ and as the ‘readiness to be concerned about health matters’ (Becker, Haefner, & Maiman, 1977; Sheeran & Abraham, 1995). More recently, Becker and Rosenstock (1987) suggested ‘perceived behavioural control’ as a further predictor of health behaviour that should be added to the HBM. Specifically, in the context of the HBM, this control component was measured as ‘perceived self-efficacy’ defined by Bandura, 1977, Bandura, 1991 as the extent to which performance of the behaviour is easy or difficult for the individual.

In light of this, one of the objectives of the present study is to fill the gap in the food choice domain investigating how well the HBM is able to predict willingness to use functional food products and which components of the HBM are the best predictors of health-related food choices. The choice of the HBM as a predicting model was based on the key reason that these new types of functional foods clearly belong both in the food choice behaviour domain, and in the health behaviour domain. Additionally the HBM, proposes threat perception variables upon which health-related claims are supposed to be based. Consequently, another important objective of this study is to investigate whether a model from health psychology can be applied to predict choices of foods with health claims and whether the type of health claim (promoting health or reducing risk of disease) has an impact on the predictive power of the model in different European countries.