Introduction
Materials and methods
Setting and ethics
Participants
Interviews
Statistical analysis
Thematic analysis
Results
Characteristic | Total (n = 20) | Control (n = 10) | Intervention (n = 10) | P-value |
---|---|---|---|---|
Age (years), median (IQR) | 39.5 (35.1, 42.2) | 40.8 (35.7, 43.3) | 37.2 (32.9, 40.4) | 0.17 |
White ethnicity, % (n) | 95% (19) | 90% (9) | 100% (10) | 0.31 |
Married, % (n) | 50% (10) | 40% (4) | 60% (6) | 0.59 |
People living in house, median (IQR) | 4 (3,4) | 4 (2,5) | 4 (4,4) | 1.00 |
Living with child aged under 18 years, % (n) | 80% (16) | 70% (7) | 90% (9) | 0.26 |
Low education (no qualifications beyond age 16), % (n) | 44% (8) | 33% (3) | 55% (5) | 0.78 |
Most deprived half of the neighbourhood (IMD), % (n) | 80% (16) | 80% (8) | 80% (8) | 0.32 |
Paid employment, % (n) | 70% (14) | 90% (9) | 50% (5) | 0.05 |
Pounds (£) spent on food per week, median (IQR) | 70 (50, 88) | 58 (45, 80) | 78 (60, 100) | 0.27 |
Research question 1: What are women’s perceptions of factors that influence their supermarket food shopping choices?
Physical environment
“just the convenience that they are just up the road.” – P043 Con
Many women commented that a logical store arrangement and wide aisles allowed for easy navigation and identification of the products they planned to purchase. Participants did not enjoy having to ‘hunt’ for items and stated that when they could not easily find their desired product, they were more likely to purchase unplanned products. Participants described how product placement strategies influenced their food shopping choices, including the purchase of healthy foods.“probably what’s easiest to get to, because I don’t drive, so somewhere accessible by bus.” – P074 Int
Women reported disliking supermarkets’ propensity to place unhealthy products in prominent locations that were tempting for children, which exacerbated an already difficult situation for some mothers in resisting their children’s requests.“they have just got all their fruit and veg and fresh stuff right at the front of the store as soon as you walk in, it is on your right hand side as you go in, and supermarket B do the same now, and so do supermarket C. Whereas when you go to supermarket D in the town, all their fresh stuff is right at the back in the middle so you kind of think a lot of people just by-pass it because they don’t have to walk through it" – P066 Int
“I’d rather it not be right at the checkout. I think I’d rather get them chocolates if they have been good or something, so I don’t like them seeing it there or while we are waiting, they might get irritated if I said no.” – P043 Con
Product quality, choice and variety, particularly for fresh products, were important for some customers in determining which supermarket they chose to shop at.“there’s always sweets at the checkout area when you’ve got your kids obviously it’s ‘oh can I have this, can I have that’ you know, the supermarkets aren’t daft.” – P010 Int
“it could be more variety, yeah, I think if the store was a bit bigger they would ‘cause when I go to other A stores, like I will go to London, their variety of salads is more bigger than the one here.” – P011 Con
“plus, they’ve got more of a choice as well, so that was good. It does make it more appealing to go in and buy fresh stuff in there. It’s been updated and more produce has made it a hell of a lot better.” – P066 Int
Value for money
“there’s certain places that sell things cheaper, yeah, so I’ve got a kind of like a routine, do you know that I can get my meat and that, in supermarkets D and E, which is much cheaper than going to supermarkets F or A.” – P011 Con
Participants spoke with pride and satisfaction at finding good deals and reported that many of their food choices were prompted by in-store price, multi-buy, and introductory offers. Some participants bought their usual food items in bulk if they were on offer to get better value for their money."at supermarket E they do the ehm, oh, I can’t think what it’s called, but it’s the Famous Five or something every week, or Super Five, each week they have a particular 5 fruit and vegs on offer for 50p that week" – P137 Int
“but then we sort of, you know, bargain hunt and bulk buy if things are on offer.” – P108 Con
“if they’re things that we like, and we use, like, say three for twos or buy one get one free, or there’s money off, then we’ll go towards them. Um, that can be quite an incentive actually, if it’s an introductory offer as well” – P041 Int
Influence of family
Most women commented that their children caused them to spend more money and buy more food, particularly unhealthy foods, when they attended food shopping trips. Children’s requests were frequently in response to environmental prompts and caused participants to shift from planned purchases to making impromptu purchases."yeah we try and eat relatively healthily in this house. Ehm, especially since having kids I try and set up a bit more of a good impression of like having our 5 a day of fruit and veg and things but ehm, we are not like obsessive about it. I mean, everything in moderation, I think. But yeah, it is important to us, sort of, eating healthy." – P137 Int
“I prefer to do it [shop] on my own because then I know what I’m doing, and I spend less! Less when they’re not around.” – P025 Con
“you know I just stood there waiting, and you can just see like they put sweets at the tills and then while my little boy is sat in the pram or in the trolley he’s like ‘can I have that, and can I have that?’ I think that you do tend to pick up things that you wouldn’t normally buy, but because they are stood in front of you, you think oh well, I will just get one, that’s what it’s there for.” – P066 Int
Physiological/psychological state
“so, the smell of croissants, if you walk in there and you’re hungry, yeah, the first thing you’re going to think is ‘ooh I’ll have a bit of that!’” – P011Con
“yeah I mean, when there’s sweets there, that’s always, if you’re feeling a bit tired and you think aah I’ll have a bar of chocolate before I get home for my tea.” – P137 Int
Level of awareness of food decisions in supermarkets
“um, just ask the family what they fancy eating during the week, and then write the shopping list from there, and only buy what I have to buy.” – P025 Con
Making unplanned purchases were frequently reported but most women described being conscious of making these purchases. For example, participants remembering, upon seeing an in-store prompt such as a price promotion, that a ‘usual’ household food item was needed at home.“we write a menu at the beginning of the week, so depends on what’s on that menu, where I would buy the things from.” – P112 Int
Most women claimed, initially, to never deviate from approaches to shopping of which they were highly aware, although they often gave conflicting information later in the interview, as evidenced below by two pairs of quotes from two different participants.“say if I’ve forgot to put something on my list that I realise we’re running short of” – P137 Int
“I normally do it you know, write a shopping list and I literally just stick to that, I am quite good at it”– P218 Con
“If there’s something at a checkout then I might grab it if I look at it and think ah yeah, like, sometimes in A they’ve always got like nice cakes there or something, so I always end up buying them.” – P218 Con
“I have a weekly food chart that swaps every two weeks…. usually vegetables first, because they are at the front, then the cupboard and then frozen and fridge.” – 074 Int
These purchasing behaviours, of which women were less aware about, were usually reported later in the interviews after women had reflected on their shopping habits. Unconscious habitual buying described a regular shopping routine, for example, navigating up and down the store aisles and grabbing items from the shelves without much thought. Participants described being less aware of their decision-making and had to think hard to be able to describe these experiences.“I guess if there’s something different in an aisle I usually go down, I might buy it.” – 074 Int
The final approach was characterised by unconscious spontaneous shopping choices that were driven almost entirely by environmental prompts and were unplanned. Women recognised that prominent placement, and promotions, of products, both unhealthy and healthy, within the supermarket encouraged this type of purchasing.“I think I go by habit really, what I know. I tend to buy the same things” – P043 Con
“the fruit and the vegetable being at the front of the store kind of changes what you buy afterwards because you might plan meals around that.” – P025 Con
“P: Well normally I have noticed that the special offers as you walk through the doors, it’s something that you see as you walk through the doors so it’s the first thing that you come in contact with.
I: And would that encourage you to buy?
P: Yes yeah. I feel like a child, I am afraid. *laughs*”– P107 Int
Research question 2: How do women feel they could be supported in making healthier food shopping choices?
Responsibilities: government, supermarkets and personal
“teach people about healthier living. Because I do not think a lot of people know what healthy living actually means and how to eat well” – P001 Int
When asked about what entailed a healthy diet, however, most participants demonstrated an understanding that it is important to eat fruit and vegetables frequently and processed foods infrequently.“I mean the packaging is also a little bit overwhelming sometimes, and everybody’s got different versions of how they’re telling you that’s really horrific and loads of fat and salt, because traffic light systems mean different things in different stores, and that’s confusing.” – P041 Int
Very few women indicated the need for stronger government intervention on labelling, advertising of unhealthy foods and easy access to takeaway foods.“having a balanced diet with fruit and veg in it, and not eating too many unhealthy takeaways and fatty food and fizzy drinks.” – P043 Con
The few women that suggested strategies supermarkets could take, mentioned improving the price, promotion and placement balance between healthy and unhealthy products or offering a better range of healthy meal options which were quick and convenient to cook.“there seems to be take-outs everywhere, there are just too many, I think. Far too many. The fruit and veg stalls or markets all seem to be shutting down” – P010 Int
“ rather than having so much of the you know, kind of, the unhealthy stuff on offer, all of the healthy foods on promotion and that kind of thing.” – P108 Con
“they could put the fruit at the counters and make it more accessible and attractive. They don’t, it’s all sweets and things like that, crisps and stuff, you don’t see apples and bananas and oranges that easy accessed.” – P 041 Int
A number of women acknowledged that while supermarkets could better support customers to make more healthy choices, they are ultimately businesses, driven by commercial interests.“I think having a good selection of healthy quick foods you know is helpful.” – P108 Con
“how they do their advertising and what they put … as you walk in, and the smell of the food... at the end of the day they want customers to spend.” – P011 Con
Women consistently described feeling that it was their personal responsibility to make healthy food choices for themselves and their families and described healthy eating in terms of buying and cooking fresh foods. A number of participants expressed the view that they needed more self-control, and to be better organised and plan ahead to ensure they made healthy food shopping, cooking and eating choices.“the supermarket’s aren’t silly, you know, they put things at the front where they know children will spot it straight away … they’re just trying to make money aren’t they?” – P010 Int
“if I choose to go in there and buy a packet of sweets, yeah, that is my choice, and I have to realise yeah the consequences of me eating that packet of sweets, right, that I’m going to maybe gain a few pounds.” – P011 Con
“I think at the tills. You know I just stood there waiting, and you can just see like they put sweets at the tills…..Mind you, it’s self-control as well, I suppose!” – P066 Int
Although women felt a desire and responsibility to cook healthy meals from scratch, they indicated that time, work and family pressures often prevented them from doing so.“…need to be more organised. It’s not just, you know the kind of secret is to plan and know what you need for the week, then it will be more economical, more practical and better for you. But that doesn’t always work in reality!” – P041 Int
“like Change4Life the kids have brought stuff home from school and they have got healthy recipes in it is just having the time to look at the recipe, to go out and buy the ingredients and then go home to make it. If you get what I mean, it is a process isn’t it, to be able to get there.” – P 172 Con
Some participants also commented that even though they have good intentions of eating healthily, it can be difficult to keep their resolve to eat healthily when faced with temptations in the supermarkets. Conversely, healthy environmental prompts can support eating healthy ambitions.“but, we both work full time, little one goes to school, and the reality is you can’t always guarantee that we’ll all sit down and enjoy a healthy home cooked meal.” – P041 Int
“oh actually you see something that catches your eye and you think ‘oh actually, I’ll have that’ or you smell the cakes in the bread department because there are some beautiful smells and you think ‘oh one cake is not going to hurt’ and then you buy it and when you get home you think, oh I really shouldn’t have brought that but oh well never mind I’ve got it, I may as well eat it and it is just too late.” – P 139 Con
I’ve pulled into D petrol station, they had bananas on the counter, and I grabbed one because I thought actually, I don’t want a bar of chocolate but I needed something. But it would have been, probably before I would have grabbed that [chocolate bar]. –P041 Int