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Appendix: Study approach and limitations

The project was organized as follows: First, we conducted a comprehensive literature review to identify relevant studies that could shed light on measures capable of influencing behaviour change within a Nordic context. Second, we hosted a workshop, bringing together stakeholders and interested parties from the Nordic countries to gather valuable input on stakeholder engagement. Third, we crafted a policy brief based on our initial findings, with the aim of sharing insights at the NNR2023 release and the ministerial meeting. Finally, we synthesised our discoveries in a comprehensive final report.

Literature search strategy and assessment of relevance

A literature search was conducted to identify literature describing behavioural change in relation to food environments in a Nordic context. The rationale was that Nordic countries have similar cultural backgrounds and more trust in authorities compared to other countries often used as comparisons. Time-period for the literature search was set to studies published 2010 and later. The reasoning for this was to cover status on literature published in the period immediately before and after launching of the previous Nordic Nutrition Recommendations in 2012.
In summary, the search found that information about nutrition recommendations must be easily available and findable (i.e. internet), in formats that reach consumers with different needs and characteristics (brochures, fact sheets, illustrations etc.), and from trusted sources (health personnel, government, sources without vested interests). Furthermore, the information should be presented in a way that is understandable, engaging, relevant, and provides guidance for implementation. Nudging strategies, making it easier for consumers to make healthier choices through changing the environment, provide good results in changing consumers’ behaviour (Thaler & Sunstein, 2009). Nudges typically involve one or more of the following factors: Product, price, place, promotion, priming, packaging, proof, presentation, people, and personality. Above all, pricing has been shown to be major predictor of food choice and might thus facilitate behaviour change. However, none of these prerequisites guarantee that consumers follow the advice and/or change their behaviour. The results of the literature search are presented in the complementary document Literature search Nordic Food Environment project. This document is available upon request to the reports’ authors.

National dietary surveys in the Nordic countries

Denmark: Danskernes kostvaner 2011-2013." Age group: 18-75 years, Sample size: n=3016. Technical University of Denmark. Accessed at DTU Food
Data were collected as part of the Danish National Survey of Dietary Habits and Physical Activity (DANSDA), representing a sample of 3,946 individuals aged 4-75 (only data from ages 18-75 are used in this report). Participants recorded their food intake over seven consecutive days using a pre-coded (semi-closed) questionnaire, which included answering categories for the most consumed foods and dishes in the Danish diet.

Finland: “FinDiet 2017." Age group: 25-74 years, Sample size: N=3099. European Food Safety Authority. Acessed at EFSA.
A sample of adults aged 18 years and over was randomly selected from the Population Register (n=10,247). A 30% random subsample aged 18–74 years (n=3,099) from the FinHealth 2017 Survey was invited to participate in the FinDiet 2017 Survey. Dietary intake was assessed using two non-consecutive 24-hour dietary recalls.

Iceland: "Hvad bordar Islendingar 2022." Age group: 18-80 years, Sample size: N=1312. Accessed at Hvadbordaislendingar_vefur_endanlegt.pdf (hi.is).
Data were collected for the Hvað borða Íslendingar Diet Survey from a random sample of 2,000 individuals, randomly selected from the national registry. Of these, 1,545 had a registered telephone number and were contacted. A total of 822 participants completed both interviews. Dietary intake was assessed using two non-consecutive 24-hour dietary recalls and a frequency questionnaire.

Norway: "Norkost 3, 2011." Age group: 18-70 years, Sample size: N=1787. "Norkost 3 – En landsomfattende kostholdsundersøkelse blant menn og kvinner i Norge i alderen 18–70 år, 2010–11." Accessed from Kudos.
The methodology for the survey comprised two randomly assigned non-consecutive 24-hour recalls and a food frequency questionnaire. Data collection for Norkost 4 is currently in progress, undertaken and funded by the Department of Nutrition at the University of Oslo and the Norwegian Institute of Public Health

Sweden: "Riksmaten vuxna 2010-2011." Age group: 18-80 years, Sample size: N=1797. National Food Agency, Sweden. Accessed from Livsmedelsverket:
Data from the Riksmaten 2010–11 dietary survey were obtained from a stratified random sample by sex, age groups, and regions. The total number of respondents was 1,797, representing a 36 percent response rate. The diet was assessed using a food and drink diary over four days.

Study limitations

The report does not aim to provide an exhaustive review covering all measures intended to influence consumer behaviour in the Nordic countries. The specific focus has been on the role of public sector actors in facilitating behaviour change, while the role of other actors in the food production and supply chain have not been addressed. Furthermore, the report specifically focuses on policy instruments that can support greater adherence to national dietary guidelines and/or NNR2023 (Nordic Nutrition Recommendations). Consequently, we do not delve into aspects related to food waste, seasonality, and local food consumption.
Certain limitations are associated with the study's specific focus on the Nordic countries, where search terms and strategies may not adequately encompass all relevant literature from these regions. Additionally, studies containing pertinent information may have been unintentionally omitted if they fell outside the scope of our search strategies. Despite our best efforts to capture reports, governmental documents, and other grey literature shedding light on the topic, omissions are possible as these sources are not as readily accessible as scientific publications.
However, despite these limitations, the collected background literature conveys a relatively consistent understanding of measures that policymakers can implement to effect changes in consumer behaviour. Consequently, we believe that the overview of the types and effectiveness of measures presented in this report hold relevance for stakeholders and policymakers as they strategize and plan actions to encourage healthier and more sustainable food behaviours within the population.
Certain limitations are also associated with research methodologies and data quality in studies assessing the effectiveness of policy interventions aimed at promoting dietary shifts (Capacci et al. 2012; Reisch et al. 2021). One of the key reasons is that the existing evaluations often focus primarily on changes in attitudes, which do not always lead to healthier eating habits or improved nutritional status. Tracking the actual behavioural responses to these policies over an extended period is challenging, making it difficult to determine the success or failure of these interventions in improving public health (Capacci et al. 2012; Röös et al. 2021). Furthermore, empirical studies are missing (Röös et al. 2021) and often rely on fragmented evidence and inadequate data (Capacci et al. 2012). Consequently, this necessitates a cautious approach in drawing conclusions from these studies. Further research is needed to bridge these knowledge gaps, potentially involving more longitudinal studies and robust data collection methods, to provide a clearer understanding of how policy interventions can effectively influence dietary behaviours and improve public health outcomes.

Complimentary literature search document

This document is available upon request from the report´s authors.