Table 1.

Summary of studies reporting outcomes of “use” and “understanding” of nutrition labels.

Ref (Country)	Sample Characteristics (Size)	Intervention Program Description, Aims, and Delivery Format	Study Design, Follow-up (Control Group)	Setting	Session Duration	Theory	Nutrition Label Use		Nutrition label Understanding
							Outcome Measure	Impact	Outcome Measure	Impact
[27] U.S.	Older adults with type 2 diabetes. 53% women. ≥65 years old. (n = 93)	Nutrition labeling education program to improve food label knowledge and skills in diabetes management. Delivered in-person by dietitians.	Randomized controlled trial. Pre-posttest. (Control group: no contact other than mailed questionnaire)	Outpatient	10 weekly group sessions (each 1.5 h)	SCT. IP	Confidence in using food labels. i.e., “I can choose foods high in fiber”	Significantly increased in experimental not control group (p < 0.001)	Total, procedural and declarative knowledge of the food label and decision-making skills.	Procedural, declarative and total knowledge scores and decision-making skills increased significantly for intervention group but not for control group (all p < 0.01).
[25] U.S.	Women with type 2 diabetes. 40–60 years old. (n = 40)	Nutrition labeling education program to facilitate the application of information on the food label to meet patient’s needs. Delivered in-person by dietitians	Pre-posttest control group design. (Control group: no contact other than mailed questionnaire).	Community centres	9 weekly group sessions	TML	Confidence in skills using the food label.	Significantly increased in experimental, not control group (p < 0.01)	Nutrition and food label related knowledge: Total, procedural, and declarative.	Both total, procedural and declarative knowledge were significantly increased in experimental, not control group (p < 0.01).
[38] U.S.	Low-income adult patients. Mean age 50 years. 73% female. (n = 42)	Intervention to improve nutrition label comprehension. Brief interactive multi-media video and pocket card. Tutor delivered.	Randomized (controlled) trial, Pre-posttest. (Control group: received black and white reading materials only).	Healthcare center	1 group session, 45 min total.	NS	Confidence in nutrition knowledge.	No significant difference between groups.	Nutrition label knowledge comprehension quiz score (%), including accurate interpretation of %DV and serving size information.	Quiz score pre-post gains were greater for the intervention group than the control group (p < 0.05). Sub group analysis of (n = 7) participants with low health literacy found no significant increase for either group.
[39] U.S.	U.S. older adults with diabetes. Mean age 63 years. 73% female. (n = 239)	Dining with Diabetes: Diabetes education program about healthy eating and food label components. Group taught sessions delivered in person.	Cohort using pre- posttests.	Community-based	3-monthly group sessions, 2 h each.	SoC SCT	Confidence in ability to use labels	Significant pre-posttest improvement (p < 0.01).	Knowledge questions included the nutrition label items. Exact details NS	Knowledge scores were significantly better post, compared to pretest (p = 0.001). Knowledge scores were a significant factor for response to “Do you agree you know how to use food labels?”
[24] Canada	Adults. Aged 31–75 years. >90% female. (n = 19)	An in-store Nutrition Label Education Program designed to teach how to read nutrition facts panel. Delivered by a registered dietitian using a lecture with materials followed by a store tour	Cohort pre- postsurvey and one-month follow-up (n = 3).	Grocery Store	A 2-h group session.	NS	Self-confidence, awareness and ability to use nutrition labels	Self-confidence performing all seven activities were significantly increased posttest (p < 0.01).	Self-reported knowledge of the NFP assessed using two items (serving size and definition of the term “percent daily value”).	Increase in number of participants answering %DV question correct (15.8% to 57.9%). Smaller increase in number of participants correctly identifying serving size (26.3% to 36.8%).
[36] Australia	Disadvantaged adults. Age NS. 76% female. (n = 927)	FOODcents nutrition education program: aims to improve household food expenditure according to the healthy eating pyramid, includes food label reading. Delivered face-to-face with cooking sessions and supermarket tours.	Cohort comprising 54% of the FOODcent centers, includes different program durations. Pre-post survey and six-week online follow-up (n = 97).	Community-based	Single group session of 1–2 h or up to 8 sessions.	P&P.	Reading of the nutrition information panel (self-reported)	Significantly increased at six-week follow-up (p < 0.01).	Knowledge of interpreting food labels used three questions including one item on nutrition labels: “In 100 g of this product how many grams of sugar are there?”	Higher proportion of correct responses in post-session surveys. No significant differences by socioeconomic status.
[31] India	School children. Aged 12–15 years. Females: NS. (n = 175)	READ-B4-U-EAT multicomponent school module to promote use of food label information and informed food choices. Delivered using videos, handouts and presentations, by teachers.	Intervention group and comparison group using pre-post intervention questionnaires. (Comparison group received a lecture about food labels.)	School	4 sessions of 45 min	SCT	Use of nutrition labels evaluated with 5 questions(self-reported) i.e., “Do you read the sugar content when buying chocolate?”	1 question showed improvements in intervention compared to comparison group (p < 0.05), i.e., “Do you see the salt content when buying snacks?”	Knowledge of nutrition label assessed using item: “Is nutrition information present on this label”?	Significant improvement in intervention compared to control group (p < 0.05)
[37] U.S.	Low income U.S. adults Aged 18–50 years. 90% female. (n = 123)	Web based nutrition education program on healthy eating including nutrition label reading.	Randomized block equivalence (comparator group received in-person taught session).	Own home computer/community centre	3 sessions each 30–40 min	KEL	Frequency of use of labels when shopping (self-reported). “When shopping do you use nutrition labels to decide what food to buy?”	Both groups significantly increased at post-intervention but in-person group showed greatest improvement.	NP	NP
[28] U.S.	College students. Aged 17–24 years. 63% females. (n = 32)	Thumbs Up Healthy Eating Nutrition Education booklet designed to promote attention focus on nutrition labels on product packaging.	Randomized controlled, pre-posttest. (Control group viewed a word puzzle).	University	A 10-min session.	IP	Eye gaze time on nutrition labels on cereal box packaging images.	Participants in the experimental group gazed longer at nutrition labels during post-test compared to the pre-test (p < 0.01) and at posttest compared to the control group (p < 0.001).	NP	NP
[35] U.S.	Latinos with Type II diabetes. Median age 57 years. 73% female. (n = 203)	Diabetes among Latinos Best Practices Trial (DIALBEST) on food labels and glycemic control. Includes nutrition education and how to interpret food labels. Delivered with individuals by community health workers.	Block-randomized to either intervention or control groups which were evaluated at baseline, 3,6,12,18 months (control group received standard care).	Home-based (and store visit)	17 home-based sessions over a 12-month period.	NS	Frequency of use of food labels (self-reported).	Food label use significantly higher in the intervention vs control groups at 3, 12, and 18 months (p < 0.01).	NP	NP
[23] Canada	Adults. Aged 18–65 years. 81% female. (n = 259)	Healthy Eating is in Store for You—a nutrition labeling education program aiming to help consumers make food choices promoting healthy weight. Delivered by trained community health officers.	Cohort comprised of 18 workshops across the country. Pre-posttest and 3-month follow-up questionnaires. (n = 35)	Community-based	1 session	NS	Nutrition label attitudes and behaviors (self-reported). i.e., “Is it important to you to review the nutrition information before buying that food”?	Data on 35 participants only available at 3-month follow-up. Increased proportions of participants selecting higher responses.	NP	NP
[34] UK	Vulnerable adults. Aged >45 years. 68% female. (n = 62)	Eat Better Feel Better community-based cooking program aimed at tackling barriers to cooking and healthy eating. Delivered by community-trained chefs.	Single group repeated measures. Pre and post intervention and 3–4 month follow-up (n = 17).	Community-based	6-weekly sessions of 2 h.	NS	(1) Confidence reading food labels (self-reported). (2) Food label elements read (indicated using tick boxes)	(1) Significantly increased from baseline to post intervention (p < 0.01) (2) Reading of nutrition elements Significantly increased from baseline to post intervention and follow-up.	NP	NP
[32] U.S.	School children in grades 3–5 and 6–8. ~50% female. (n = 1334)	Choose Health: Food, Fun, and Fitness Youth Curriculum aimed at enhancing knowledge and skills building. Incudes label reading. Delivered by community health educators.	2 cohort sub-samples, across age groups and settings evaluated using pre-post surveys (which featured nutrition label items)	School, clubs, summer camp	6-weekly lessons 45–90 min each.	SCT EL	Reading of nutrition information (self-reported) i.e., “I read nutrition facts labels on food packages”	Significantly increased post-survey (p <0.01)	NP	NP
[26] U.S.	School children in grade 3. Mean age 8.7 years. 52% female. (n = 1487)	Nutrition Detectives and ABC for Fitness programs (standard intervention), alongside family, home, and supermarket sessions (enhanced intervention).	Quasi-experimental 3 group design. Schools randomized on district. Pre-posttests. (Control group received normal curriculum and no pre-posttests.)	School	90-min class session. 3-month follow-up, 30-min booster.	NS	NP	NP	Food Literacy and Label Nutrition Knowledge (FLLANK) test to evaluate knowledge of healthful food choices.	Both groups increased FLLANK scores compared to baseline values after first and booster sessions (p < 0.01). No significant difference in this improvement between the two intervention groups.
[29] U.S.	College students. Mean age 20.7 years. 60% female. (n = 140)	Web-based label-reading training tool to improve individuals’ ability to use labels to select more healthful foods. Training tasks required individuals to compare 3 × 24 different pairs of nutrition labels to select the healthiest.	Randomized to 2 groups. Prior knowledge group received short presentation. Basic group did not.	University	One session of 60–90 min.	Skill	NP	NP	Accuracy (of selecting correct answer in training tasks)	Accuracy increased with practice, across each of the three training blocks (p < 0.01). In block 3, the odds of a correct answer for the prior-knowledge group were 79% higher than those in the basic group (p = 0.02).
[33] U.S.	Young adolescents. Aged 11–14 years. 47% female. (n = 34)	How to read and use a nutrition facts label education program. Delivered by a registered dietitian.	Single cohort using pre-posttests.	NS	1 group session of 1 h.	NS	NP	NP	Nutrition Facts Label knowledge pre- posttests developed by author (calculating %DV with differing serving sizes and defining DV).	Overall test score improved significantly pre-posttest (p < 0.01) Correct answers to the questions concerning %DV definition improved significantly (p = 0.03) from 38% to 74%, as did correct answers to question concerning serving size modification calculations (p = 0.003). No difference in boys or girls scores.
[30] U.S.	Grade 5 school children. Age NS. 58% female. (n = 212)	Nutrition Detectives educational program on how to read food labels aimed at developing food-literacy skills. Taught by teacher within class (presentation and practical)	Cohort comprising of classes across 5 schools, using pre -posttests.	School class	1 session of 45 min	NS	NP	NP	Food label literacy (quiz) evaluating ability to distinguish between healthy and unhealthy foods using the Nutrition Facts panel.	Quiz scores increased significantly pre-posttest by 16.2% (ranging from 4.3%–23.6% among schools) (p < 0.01). Girls score improved significantly more than boys (p = 0.04)

NS = not stated; NP = not performed; NFP = Nutrition Facts Panel; SCT = Social Cognitive Theory; TML = Theory of Meaningful Learning; SoC = Stages of Change; Skill = skills acquisition, KEL = Kolb’s experiential learning; EL = experiential learning; IP=information processing; P&P = precede and proceed; % DVs = % daily values.