Abstract
Background
The prevalence of chronic disease in Australia is rising, and poor nutrition behaviour is a modifiable risk factor for many chronic diseases. The utilization of appropriate nutrition information has been recommended to promote optimal nutrition behaviour.
Objective
To investigate individuals’ utilization and preference of nutrition information sources as well as perceptions of trustworthiness, credibility and effectiveness of sources.
Design
Cross‐sectional online survey.
Setting and Participants
Ninety‐four residents of the Gold Coast, Australia.
Main Outcome Measures Studied
Respondents’ demographic variables, previously utilized and preferred nutrition information sources, perceptions of trustworthiness, credibility and effectiveness of nutrition information sources.
Results
Dietitians, nutritionists and GPs were the three most preferred sources and were perceived to be most trustworthy, credible and effective. However, the most utilized nutrition information sources were the Internet (62.9%), friends (59.8%), family (58.8%) and magazines (57.7%). Over 30% of respondents reported time to attend appointments as a barrier to accessing their most preferred nutrition information sources. Between 32 and 60% of respondents reported neutral perceptions of the most frequently utilized nutrition information sources in relation to trustworthiness, credibility and effectiveness.
Conclusion
Individuals frequently receive nutrition information from sources that are not their most preferred and sources that they do not perceive as trustworthy, credible or effective. Further research is warranted on the impact of these discrepancies on overall nutrition‐related health literacy and behaviour.
Keywords: chronic disease, credibility, effectiveness, nutrition information, nutrition information source, trustworthiness
Introduction
The prevalence of chronic disease in Australia is rising and accounts for approximately 80% of the total burden of disease.1 Once detected, individuals with chronic disease require long‐term management involving a range of public, private and not‐for‐profit services provided in hospitals, in the community and at home.1 Chronic disease affects not only individuals in terms of disability and reduced quality of life, but has broader social and economic implications.2
The 2011–2012 Australian Health Survey reported the most common risk factors for chronic disease in Australia as poor nutrition and excess weight gain.3 The National Chronic Disease Strategy has identified nutrition as a priority area in the prevention and management of chronic disease and specifies self‐management of chronic disease as a key principle.1 Self‐management of chronic disease involves individuals taking responsibility to manage their condition.4 For individuals at risk of chronic disease, or living with chronic disease, learning the skills to enhance their nutrition behaviour through appropriate information is central to the concept of self‐management.4
Content, nutrition competencies of providers, cost and time required to access. Nutrition information can be tailored to specific population groups, focused on a particular condition or intended to promote general health and well‐being. Nutrition information sources include health professionals such as general practitioners (GPs), dietitians, nurses, exercise physiologists, pharmacists, naturopaths and nutritionists, as well as government pamphlets, the media and Internet, family, friends and the fitness industry.5, 6, 7, 8, 9, 10 The limitations and advantages of nutrition information sources are anticipated to influence individuals differently depending on personal factors such as age, economic resources and health literacy. Nutrition information sources need to provide appropriate information to facilitate greater self‐efficacy and consequently better self‐management for those with or at risk of chronic disease. It is therefore important to understand the factors that may influence individuals’ choice and preference for nutrition information sources in order to reduce barriers to accessing appropriate nutrition information in Australia.
Trust and trustworthiness, credibility and effectiveness are often cited as reasons for preference of a nutrition information source9, 11 and are closely linked to patient satisfaction, increased continuity with health providers and enhanced patient adherence to treatment resulting in better health outcomes.12 However, those sources perceived as most trustworthy, credible and effective are not always the most frequently utilized.5 The influence that perceptions of trustworthiness, credibility and effectiveness have on the utilization of a nutrition information source has not previously been investigated in Australia. An investigation of perceptions of nutrition information sources in relation to these characteristics is needed to inform effective strategies for the provision of appropriate nutrition information for the prevention and management of chronic disease. Therefore, the aim of the following study was to investigate individuals’ utilization and preference of nutrition information sources, as well as perceptions of trustworthiness, credibility and effectiveness of sources.
Methods
A cross‐sectional online survey was used to investigate the utilization and preference of nutrition information sources of individuals living on the Gold Coast, Australia, as well as perceptions of trustworthiness, credibility and effectiveness of those sources.
Using a convenience sampling method, e‐mails were sent to members of school communities, sporting associations and a panel of community members of a local health organization inviting their participation in the survey. Only respondents who were adults residing on the Gold Coast were eligible for inclusion (n = 190). The study protocol was approved by Griffith University Human Research Ethics Committee (PBH/04/13/HREC).
An online survey was developed using LimeSurvey ™ version 1.9x (An open source survey tool by Carsten Schmitz, Hamburg, Germany). A review of relevant literature regarding nutrition information sources and factors affecting individuals’ choice of nutrition information source including trust, credibility and effectiveness was used to inform the survey content.5, 6, 7, 8, 9, 10, 11, 12, 13, 14 Sources of nutrition information were identified by the literature and included for investigation in this research. The survey was piloted online by nine academics known to the research team who provided feedback on face validity, navigation, interpretation of survey items. The final survey included 16 items grouped into six sections as shown in Table 1. Most preferred and utilized nutrition information sources were ranked, and perceptions of trustworthiness, credibility and effectiveness of nutrition information sources were reported using a four‐point Likert scale. The finalized survey was intended to take approximately 15 min to complete and was only available in English.
Table 1.
Online survey design, including rationale for investigation and modes of responses
| Section | Rationale for investigation | Area of enquiry | Response |
|---|---|---|---|
| General demographics | Allows indication of representativeness of sample. Allows analysis of associations between demographic characteristics and participants’ perceptions | Gender | Dichotomous |
| Age | MCQ | ||
| Education level | MCQ | ||
| Health‐related education | MCQ | ||
| Private health insurance | Dichotomous | ||
| Household income | MCQ | ||
| Chronic diseases | MCQ | ||
| Chronic disease management plan | Dichotomous | ||
| Sources of nutrition information | Allows analysis of associations between nutrition information sources utilized and demographic and personal characteristics of respondents | Previous sources of nutrition information utilized | MCQ |
| Ideal sources of nutrition information | Allows analysis of associations between preferred nutrition information source and demographic characteristics and investigates barriers to use | Preferred nutrition information source | 1‐5 ranking |
| Barriers to using preferred sources of nutrition information | MCQ | ||
| Trustworthiness of nutrition information sources | Allows ranking and analysis of perceived trustworthiness of nutrition information sources and analysis of associations with demographic and personal characteristics of participants | Trustworthiness of sources for general health | 4‐pt Likerta |
| Trustworthiness of source for chronic disease management | 4‐pt Likerta | ||
| Credibility of nutrition information sources | Allows ranking and analysis of perceived credibility of nutrition information source and analysis of associations demographic and personal characteristics of participants | Credibility of source for general health | 4‐pt Likertb |
| Credibility of source for chronic disease management | 4‐pt Likertb | ||
| Effectiveness of nutrition information sources | Allows ranking and analysis of the perceived effectiveness of nutrition information sources and analysis of associations with demographic and personal characteristics of participants | Effectiveness of source in enabling nutrition behaviour change | 4‐pt Likertc |
MCQ, multiple choice question; Pt, point.
Not trustworthy/Neutral/Somewhat trustworthy/Very trustworthy.
Not credible/Neutral/Somewhat credible/Very credible.
Not effective/Neutral/Somewhat effective/Very effective.
All analyses were conducted using spss statistical software package version 21 (IBM, Chicago, IL, USA). Descriptive statistics were calculated for each survey item including frequency, distribution, mean and mode responses. Gender, age, household income and level of education were compared between survey respondents and the Australian Bureau of Statistics 2011, Gold Coast Community Profile15 using chi‐squared goodness‐of‐fit analysis to test for representation of the survey sample. Respondents were asked to nominate their five most preferred sources ranking them from one to five. To rank preferences across all respondents, those nutrition information sources that received a ranking of one scored five points, a ranking of two scored four points and so on with a ranking of five scoring one point. The scores for each nutrition information source were then totalled to identify the top five scoring nutrition information sources. Pearson's chi‐squared tests were used to compare participants’ demographic characteristics with responses to other survey questions including their utilization of nutrition information sources and preferred information sources. Categories were collapsed if required to comply with the assumptions underpinning chi‐squared analyses. Statistical significance level was set at P > 0.05.
Results
There were 97 respondents to the online survey (49%). The general demographics of respondents are illustrated in Table 2.
Table 2.
Demographic profile of respondents (n = 97)
| Demographic characteristic | N a (%) |
|---|---|
| Gendera | |
| Male | 22 (23.4) |
| Female | 72 (76.6) |
| Age (years) | |
| 18–29 | 18 (18.9) |
| 30–39 | 18 (18.9) |
| 40–49 | 20 (21.3) |
| 50–59 | 23 (24.4) |
| ≥60 | 16 (16.5) |
| Gross household weekly incomeb | |
| ≤$999 | 32 (33.7) |
| $1000–$1599 | 36 (37.9) |
| ≥$1600 | 27 (28.4) |
| Highest level of educationb | |
| School level | 22 (23.2) |
| TAFE level | 35 (36.8) |
| University level | 38 (40.0) |
| Formal health education | |
| Yes | 35 (36.8) |
| No | 60 (63.2) |
| Extras health insurance | |
| Yes | 64 (67.4) |
| No | 31 (32.6) |
| Previous diagnosis of a chronic diseasec | |
| Yes | 49 (51.6) |
| No | 48 (48.4) |
| Recipient of a chronic disease management plan | |
| Yes | 18 (43.9) |
| No | 23 (56.1) |
Numbers may not total 97 due to incomplete survey response by some respondents.
Proportion significantly different from the Gold Coast population.
Chronic diseases included heart disease, stroke, type 2 diabetes, kidney disease, arthritis, osteoporosis, lung cancer, colorectal cancer, asthma, depression, oral disease.
Table 3 presents the number and percentage of respondents who had previously utilized each nutrition information source. The Internet (62.9%), friends (59.8%), family (58.8%) and magazines (57.7%) were the most frequently utilized nutrition information sources. Of the health professionals, GPs (53.6%) were the most frequently utilized, followed by naturopaths (34%), dietitians (32%) and nutritionists (23.7%).
Table 3.
Previous utilization of nutrition information sources (in descending order)
| N (%) | |
|---|---|
| Internet search | 61 (62.9) |
| Friends | 58 (59.8) |
| Family | 57 (58.8) |
| Magazines | 56 (57.7) |
| General practitioner | 52 (53.6) |
| Pamphlets | 38 (39.2) |
| Personal trainer | 37 (38.1) |
| Weight loss group | 36 (37.1) |
| Naturopath | 33 (34.0) |
| Dietitian | 31 (32.0) |
| Social media | 28 (28.9) |
| Television | 27 (27.8) |
| Nutritionist | 23 (23.7) |
| Pharmacist | 14 (14.4) |
| Nurse | 10 (10.3) |
| Radio | 10 (10.3) |
| Exercise physiologist | 7 (7.2) |
There were very few influences of demographic characteristics on the utilization of nutrition information sources. There was an influence of education on the utilization of some nutrition information sources. For example, respondents with a tertiary health education reported greater use of naturopaths (51 vs. 25%, χ2 = 6.811, P = 0.009) and nutritionists (37 vs. 17% χ2 = 5.051, P = 0.025), and lower use of family (46 vs. 68% χ2 = 4.712, P = 0.03) as a source of nutrition information. In addition, respondents with a diagnosed chronic disease had a higher utilization of GPs as a source of nutrition information (68.29 vs. 45.28%, χ2 = 4.952, P = 0.026) compared with those without a diagnosed chronic disease.
The five most preferred nutrition information sources were dietitians (240 points), nutritionists (208 points), GPs (135 points), naturopaths (105 points) and the Internet (90 points). The most commonly reported barrier to respondents accessing their preferred nutrition information source was ‘not having time to attend appointments’ (30.9%). There was an association between the age of respondents and the frequency of reporting this barrier (χ2 = 12.063, P = 0.002) with respondents in the oldest and youngest age categories less likely to report this as a barrier.
Dietitians, nutritionists and GPs were most often perceived as being very trustworthy, credible and effective, whilst television, radio, magazines and social media were most often perceived as not trustworthy, credible and effective. Table 4 presents responses for the five nutrition information sources perceived to be most trustworthy, credible and effective and the five nutrition information sources perceived to be not trustworthy, credible and effective for information relating to general health and well‐being and chronic disease. For the most frequently utilized nutrition information sources, a notable number of responses were ‘neutral’ regarding perceptions of trustworthiness, credibility and effectiveness. Neutral responses were reported by between 32 and 60% of respondents for the four most frequently utilized nutrition information sources (magazines, family, friends and the Internet).
Table 4.
Top five nutrition information sources perceived to be most trustworthy, credible and effective and the five nutrition information sources perceived to be not trustworthy, credible and effective for information relating to general health and well‐being and chronic disease
| General health and well‐being | Chronic Disease | ||||||
|---|---|---|---|---|---|---|---|
| Very trustworthy | Not trustworthy | Very trustworthy | Not trustworthy | ||||
| N (%) | N (%) | N (%) | N (%) | ||||
| Dietitian | 49 (62.8) | Online social media | 25 (40.3) | GP | 45 (58.4) | Television | 40 (51.9) |
| Nutritionist | 48 (61.5) | Radio | 31 (39.7) | Dietitian | 44 (57.1) | Radio | 39 (50.6) |
| GP | 29 (37.2) | Television | 31 (39.7) | Nutritionist | 38 (49.4) | Social media | 37 (48.1) |
| EP | 28 (35.9) | Magazines | 15 (19.2) | EP | 18 (23.4) | Magazines | 32 (41.6) |
| Naturopath | 14 (24.6) | Personal trainer | 12 (16.2) | Pharmacist | 16 (20.8) | Weight loss group | 29 (37.7) |
| Very credible | Not credible | Very credible | Not credible | ||||
|---|---|---|---|---|---|---|---|
| N (%) | N (%) | N (%) | N (%) | ||||
| Dietitian | 45 (59.2) | Television | 40 (52.6) | Dietitian | 47 (61.8) | Social Media | 42 (55.3) |
| Nutritionist | 41 (53.9) | Radio | 39 (51.3) | GP | 41 (53.9) | Television | 41 (53.9) |
| GP | 34 (44.7) | Social Media | 38 (50.0) | Nutritionist | 37 (48.7) | Radio | 38 (50.0) |
| EP | 21 (27.6) | Magazines | 27 (35.5) | Nurse | 18 (23.7) | Magazines | 38 (50.0) |
| Naturopath | 16 (21.1) | Weight loss group | 21 (27.6) | EP | 17 (22.4) | Weight loss group | 28 (36.8) |
| Very effective | Not effective | ||
|---|---|---|---|
| N (%) | N (%) | ||
| Dietitian | 47 (61.8) | Television | 36 (48.0) |
| GP | 41 (53.9) | Radio | 36 (48.0) |
| Nutritionist | 37 (48.7) | Online social media | 36 (46.7) |
| Nurse | 18 (23.7) | Magazines | 26 (34.7) |
| EP | 17 (22.4) | Weight loss group | 22 (29.3) |
EP, exercise physiologist.
Relatively few associations were found between demographic characteristics of respondents and perceptions of nutrition information sources as trustworthy, credible and effective. Notably, education was found to be associated with perceptions of trust and credibility of nutrition information sources. A higher proportion than expected of respondents with tertiary level health education perceived the Internet, television and government pamphlets as trustworthy compared to respondents without tertiary health education (for the Internet, 62.1 vs. 29.2%, χ2 = 4.821, P = 0.028; for television, 31.0 vs. 10.2%, χ2 = 5.368, P = 0.021; for government pamphlets, 79.3 vs. 43.8%, χ2 = 9.335, P = 0.002). There were other isolated associations found, but these were deemed to not be meaningful due to inconsistencies across outcome variables.
Discussion
This study explored individuals’ utilization and preference of nutrition information sources as well as perceptions of trustworthiness, credibility and effectiveness of sources. Overall, the results suggest that there is a great deal of variability between nutrition information sources in terms of utilization and individuals’ perceptions of trustworthiness, credibility and effectiveness. Further, the most frequently utilized nutrition information sources are not the most preferred or perceived as trustworthy, credible and effective. A considerable proportion of respondents reported having neutral perceptions of trustworthiness, credibility and effectiveness of many of the frequently utilized nutrition information sources. These neutral perceptions were also demonstrated in a recent Australian study that found respondents were unsure about frequently utilized health information sources in relation to trustworthiness and importance as a source.9 This suggests that individuals frequently seek nutrition information from sources in which they are unsure of the trustworthiness, credibility and effectiveness and may indicate low levels of health literacy in this group. Health literacy is a measure of an individuals’ ability to access, interpret, evaluate and apply information relating to their health16 including nutrition information. Health literacy has been found to have a profound effect on individuals’ capacity to adopt preventative health behaviours.17, 18 Therefore, the possible low levels of nutrition‐related health literacy in the current study is concerning and warrants further investigation on how this may impact on nutrition behaviours and risk of chronic disease.
Over 50% of respondents in this study reported a previous diagnosis of a nutrition‐related chronic disease, and between 32 and 60% of all respondents were uncertain about the trustworthiness, credibility and effectiveness of the nutrition information provided by the most frequently utilized sources. These findings further highlight the need for improved health literacy within the Australian population in order for individuals to access, interpret, evaluate and apply nutrition information to improve nutrition behaviours. Improved nutrition literacy is particularly important as nutrition behaviour influences individuals’ health and optimal nutrition is important in the prevention and self‐management of chronic disease.1 This study highlights the need for a range of education campaigns that provide individuals with the skills and knowledge to consider the trustworthiness, credibility and effectiveness of nutrition information in relation to their specific circumstances to enhance the likelihood of improved nutrition behaviour and subsequent health outcomes.
The frequent utilization of nutrition information sources such as the Internet, friends, family and magazines has previously been attributed to the nature of individuals’ information‐seeking behaviours being largely fortuitous and informal.5 However, this study found that almost one‐third of respondents reported a lack of time as a barrier to utilizing their most preferred nutrition information sources. The four most preferred sources were health professionals who generally provide information during face‐to‐face consultations. The Internet was the next most preferred nutrition information source and has been found to be effective when delivering tailored nutrition information.19 These findings suggest potential for strategies that provide access to appropriate nutrition information provided by health professionals in a format that is convenient and timely (such as via the Internet) for individuals unable to attend face‐to‐face appointments.
This research accords with the findings of a 2005 Canadian study, where respondents reported higher levels of confidence in nutrition information received from health professionals such as dietitians, GPs and nurses than from more frequently utilized sources such as magazines, family/friends and television.5 The study found significant differences between age groups and the use of the media as a source of nutrition information.5 The current study explored the influence of a number of personal factors (including age) on the utilization of nutrition information sources. Whilst there was no significant difference between age groups and utilization of nutrition information sources, age was found to be significant in relation to barriers to accessing preferred nutrition information sources. The current study also explored other personal factors such as education, income and health status which were found to influence the utilization of nutrition information sources as well as perceptions of trustworthiness, credibility and effectiveness.
Noteworthy limitations to this study were that it included a smaller sample size compared with other similar studies and may have benefited from a larger sample size. Demographic characteristics of gender, income and education were also not fully reflective of the Gold Coast population upon which it was based. However, the sample was large enough and included a large enough sample of participants from each demographic group to investigate the associations between demographic characteristics and respondents’ perceptions of nutrition information sources. Finally, the respondents in this study were all residents of the Gold Coast City region, and their access and exposure to varying nutrition information sources may not be reflective of the overall Australian population. Therefore, the current study provides valuable information regarding nutrition information sources available to Gold Coast residents, but may not be generalizable to other regions of Australia.
Despite these limitations, the current study highlights the need to identify strategies to maximize the scope of trustworthy, credible and effective health professionals providing nutrition information in a manner that is acceptable and accessible to those seeking it. The prevalence of chronic disease continues to rise in Australia impacting individuals, families and communities in terms of reduced quality of life, economic uncertainty and increased demand on health‐care services. The National Chronic Disease Strategy has identified access to appropriate and accurate nutrition information as a priority action area for the prevention and self‐management of chronic disease. As such, continuing research is necessary to facilitate improved access to nutrition information that is trustworthy, credible and effective.
This study has found that there is a great deal of variability between nutrition information sources in terms of utilization and individuals’ perception of trustworthiness, credibility and effectiveness. The most frequently utilized nutrition information sources are often not the most preferred of perceived as trustworthy, credible and effective. Further research is warranted on the impact of these discrepancies on overall nutrition‐related health literacy and behaviour.
Funding
None.
Conflict of interest
None.
Acknowledgements
None.
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