Consumers' health-related perceptions of bread - Implications for labeling and health communication.

There is a wide variety of commercial bread types and the present study identifies potential pitfalls in consumer evaluations of bread from a health perspective. The aim is to describe consumers' health-related perceptions of bread by exploring which health-related quality attributes consumers associate with bread and whether there are differences with regard to age, gender and education level. A postal and web-based sequential mixed-mode survey (n = 1134, 62% responded online and 38% by paper) with open-ended questions and an elicitation task with pictures of commercial breads were used. Responses were content analyzed and inductively categorized. Three fourths (n = 844) knew of breads they considered healthy; these were most commonly described using terms such as "coarse," "whole grain," "fiber rich," "sourdough," "crisp," "less sugar," "dark," "rye," "seeds," "a commercial brand," "homemade" and "kernels." The breads were perceived as healthy mainly because they "contain fiber," are "good for the stomach," have good "satiation" and beneficial "glycemic properties." The frequency of several elicited attributes and health effects differed as a function of age group (18-44 vs. 45-80 years), gender and education level group (up to secondary education vs. university). Difficulties identifying healthy bread were perceived as a barrier for consumption especially among consumers with a lower education level. Several of the health effects important to consumers cannot be communicated on food packages and consumers must therefore use their own cues to identify these properties. This may lead to consumers being misled especially if a bread is labeled e.g., as a sourdough bread or a rye bread, despite a low content.