Multi-stakeholder perspectives on food labeling and health claims: Qualitative insights from South Africa.

Globally, the role of food labels in reducing non-communicable disease remains a point of debate. A particular area of contention is the use of health claims, an approach currently under consideration in South Africa - a developing country with vast socio-economic disparity. In the present study, in-depth interviews were conducted with 49 diverse stakeholders, including consumers and professionals from the food industry and other occupations, who shared their views about the use of health claims in a developing country context. The qualitative approach and inclusion of multiple perspectives that had not been motivated by a single stakeholder group added a novel view. Themes identified based on inductive analysis included: (i) practical barriers to label use; (ii) contextual and personal variables influencing engagement with label information; (iii) messaging preferences (for positively worded claims, compared to more cautionary statements); (iv) stakeholder complexities - mainly related to responsibility and trust; and (v) ambassadors to change. Findings indicate that there are persistent barriers to label use, such as challenges related to literacy and legibility. Furthermore, the socio-economic circumstances prevalent in South Africa drive large volumes of food sales in informal markets where labels are often not present. Unresolved questions about the substantiation and enforcement of health claims, combined with no solution being apparent for reaching consumers in the informal market, would limit the benefits that could be associated with the implementation of health claims at this point in time.