Since 2012, foods supplemented with ingredients such as herbals, bioactives, amino acids, vitamins and/or minerals, have been marketed in Canada subject to specific conditions until regulatory requirements, including package labelling, are finalized for these “Supplemented Foods” (SFs).

To determine a key set of labelling tools that enable health intermediaries and consumers to identify SFs, their supplemental ingredients, and any guidance or caution for their use.

Health intermediaries and consumers of varying health literacy levels were recruited by convenience sampling to participate in individual interviews or discussion groups. Ten discussion groups were conducted with health Intermediaries (exercise professionals, food/nutrition professionals, medical professionals, complementary/alternative medicine specialists). 31 interviews and 8 discussion groups were conducted with consumers (parents with children under the age of 18, adults 55 years and older, physically active adults). An a-priori codebook was developed by the research team based on an adapted conceptual health literacy framework. Transcripts were thematically analysed for the core health literacy competencies of access,
understanding, and appraisal of label information using NVivo.

Front-of-pack, SF product identifiers were found to be accessible and recognizable. Integration of a prominent “Supplemental Ingredients” box in proximity to the Nutrition Facts table facilitated access and understanding of the type and amount of the supplemental ingredients. Addition of a prominent “Caution” section, placed in a clutter-free area close to other regulated label information improved the credibility of the approach.

This study helped identify key labelling attributes for SFs. These initial findings are being used to inform a nation-wide mock-package trial that will objectively test these labelling tools with consumers of varying health literacy levels.

To our knowledge, this is the first study to incorporate a health literacy lens into the development of labelling tools that help consumers to access, understand and appraise nutrition labelling information in order to make informed dietary choices.