NEW BEGINNINGS THERAPY
Media influence affecting parents’ perceptions of sugary drinks study
Acknowledgements: The study data was collected by four independent researchers but coding and analyses were conducted independently. Below it is a submission of my own interpretation of data collected.
The study’s main objective was to explore the various ways and the extent to which media reporting influences parents’ perceptions of sugary drinks. This research question was addressed by conducting six semi- structured interviews with parents of primary school children aged 5-11 years. The findings of this investigation suggest that parents’ personal health- related beliefs, the knowledge and values they convey to their children are frequent responses to the relative media impact on their consumer behaviour overall and for sugary drinks in particular. In the light of these findings, future considerations for research in this area could include a more in-depth exploration of the emerging themes between parents’ perceptions of healthy drinks and factors of influence affecting their buying behaviour.
Once something is highlighted in the media definitely you would take notice of it, and the perception may be that an orange juice in a carton is good for you because you may believe it has a lot of vitamin C. Once you are told it is not healthy, you have to take notice of that…so, yes, I think campaigns are good (I5, transcript page 2)
Most recently a 20% tax on sugar sweetened drinks in the UK has been recommended as an effective measure to tackle several health-related concerns such as adverse weight gain, dental caries, type 2 diabetes and cardiovascular disease. The study by Biggs et al. (2013) has been published by the British Medical Journal and reported by the main national newspapers The Guardian ( Boseley, 2013), The Independent (Cooper, 2013), Daily Mail (Hope, 2013) as well as BBC News (BBC News, 2013) and NHS choices (NHS, 2013).
In a review of literature on the use and impact of mass media campaigns to change health behaviour, Wakefield et al (2010) found that such campaigns are usually competing with other factors such as product marketing, powerful social norms and behaviours as a result of habit or addiction. Wakefield’s et al (2010) findings suggest that in order for health-related campaigns to be successful and produce positive changes other concurrent services and aspects need to be present, such as community-based programmes and policies supportive of such research.
Consumption of sugary soft drinks has risen significantly over the past three decades; in United States of all individual food types, soft drinks represent the single larger caloric intake (Block et al, 2010). In the United Kingdom, due to the negative health effects of sugar sweetened drinks,
the sale of sugar sweetened drinks in schools and their advertisement during children’s television programmes is banned (Biggs at al., 2013).
There is significant growing evidence that one major factor contributing to obesity in children is the consumption of carbonated drinks sweetened with sugar (James, 2004). Worldwide, it has been reported that obesity has nearly doubled since 1980 with more than 1.4 billion adults, 20 and older, being overweight in 2008 and more than 40 million children under the age of five being overweight in 2011 (World Health Organisation, 2013).
Guthman (2011, p.9) defines obesity as:
“Obesity, I suggest, is an ecological condition that like the global warming requires….that we pay attention to the broader political-economic and cultural context in which individual decisions affecting ecologies are made. It also requires that we pay attention to the role of corporate behaviour, state regulation, and the political economy more generally in producing or allowing pollution and degraded food.”
Guthman’s definition of obesity is compelling in highlighting the importance of understanding health concerns and media impact not only as a mere connection to strategies for health behaviour change, but for drawing attention to how knowledge of obesity as a biological condition is constructed and interpreted. Parents are considered as being the prime medium and context where a child is developing his or her understanding about the world. As such, parents are considered highly influential and an intermediary in behaviour change strategies needed and/or employed and aimed at improving health-related behaviours of young children.
It has been argued that, in order to successfully achieve such an aim, parents need to be accurately informed and equally motivated to acknowledge dietary guidelines (Hart et al, 2003). Parents are faced with an extensive and regular reporting of sugary drinks which may be unhealthy for them and especially unhealthy for their young children. It is therefore important to understand parents’ perceptions as unhealthy sugary drinks as a result of this reporting and consider its implications for any press regulation, or government responsibility in responding to erroneous reporting. Willig (2008) defines research derived from a social constructionist perspective as being concerned with identifying the various ways of constructing social reality that are available in a culture, investigating the conditions of their use and highlighting their implications for human experience and social practice. In a similar perspective, the current practical study was concerned with an exploration of ways and the extent of which media reporting influences parents’ perception of sugary drinks. In order to answer our main research question, we chose to conduct semi-structured interviews as our main method of data collection and access and investigate our participants opinions and thought responses. The transcripts were coded through content analysis.
METHOD - Participants
The inclusion criteria for participants was that of being a parent of primary school children (ages between 5 to 11 years) and reside within Greater London and North Surrey areas. There were several exclusion criteria including that of participants not having marketing, advertising media or journalistic employment/ background. No health organizations employees or individuals working for food regulating bodies such as Food Standard Agency were interviewed. For the purposes of this study such domains of work were considered biased towards the findings and our research group decided to apply it as an exclusion criteria to our sample. Another exclusion criteria was that of participants not being members and/or employees of other governmental or non-governmental departments directly involved in relevant regulatory legislation – such as with decision making on a possible 20% tax on sugary drinks in the UK.
There were six participants of which 4 female and 2 male. The mean age of participants was 38.8 (49, 38, 39, 39, 39, 33, 35) and all participants were college and university graduates, self-identified as middle class or working class background. An opportunity sampling method was used to select our participants with an inclusion criteria of parents of primary school children at local schools.
METHOD: Materials/ Apparatus
The interview agenda was collectively devised from two main initial topics: the media campaigns promoting free school dinners/ meals or the most recent reporting on a possible tax on sugary drinks. It has been decided that a possible tax on sugary drinks it is a more current development within both the academic world as well as media and it would represent an excellent opportunity to explore it with our parent sample. Hence the interview schedule included a series of open-ended questions accounting for media influence on diet and specifically design to facilitate an exploration as to what prospective participant may consider as a healthy or unhealthy drink (see Appendix 1). The structure of the interview was designed around three main questions with several sub-questions and prompts, starting from a more general simple subtopic to a more complex subheading - that of interviewees thoughts of media impact. The questions were deliberately formulated to allow the interviewee to elaborate on their knowledge of media campaigns, but more importantly allowing the researcher to incorporate the interviewee’s own opinions in subsequent interview questions. For instance, the actual formulation of question three could have been decided during the interview and dependent upon participant’s answer to question 2 (see Appendix1). Such flexibility was permissive of more relevant and/or appropriate material to be discussed by the interviewee as well as a more intense involvement in the interview process. One valid critique in such
instance is that such involvement in the interview process by both participant and researcher may result in the researcher becoming more directive and questions less open. Willing (2008) suggested that a better approach to a flexible interview schedule would be to consider and reflect upon alternative formulations of questions prior to the interview, as well as incorporating interviewee’s own comments into further questions throughout the interview. Such approach was employed by all researchers on current project and the interview schedule had numerous alternative questions as options added to main structure of the interview agenda prior to our pilot interview (see Appenndix1). The briefing sheet described both the scope and implications of the study including that of an overview on media reporting and possible influence on what it is perceived as healthy or unhealthy children’s drinks. It is essential to note that the consent form clearly stated that the interview is going to be recorded and that the recording is going to be used for the purposes of this practical report only (see Appendix 2.1, 2.2, 2.3 for a full copy of the briefing form, consent form and debriefing statement). To record the interviews a Sony IC recorder was used, model number ICD-UX 200.
METHOD – Procedure
Participants were contacted by telephone and an arrangement with a fixed date and time was made for the interview to take place. It was allowed up to an hour for the initial meeting as it was considered necessary that a significant period of time prior to actual recording taking place, it’s going to be used to form rapport. The interviews were carried out in a quiet room in the researcher’s office, ensuring a calm and no interruptions environment favorable to an interview process. The length of all six interviews varied from 7 minutes to 18 minutes (mean= 12.5 minutes).
All participants were briefed and consent obtained prior to interviews taking place. All participants were informed about their right to withdraw at any stage during the interview process should they so wish. Also, participants were introduced to the topic and purpose of the study and permissions were obtained for audio-recording to be used. The questions were asked at a suitable pace allowing the participant to reflect on their answers. Considering that most of the original questions were about the interviewee knowledge and how he or she organizes that knowledge, sufficient time for answering was accounted for when the interview schedule was agreed upon. This type of questions can be described as structural questions, prompting interviewees to identify the categories of meaning that they employ to make sense of the world (Willig, 2011).
METHOD – pilot study
The initial interview schedule was tested out prior to completing the semi-structured interviews and it was collectively agreed by the investigators that both the main research question and interview schedule stand valid to the purpose of the current practical study. The pilot participant was parent of a primary school children, having the same inclusion criteria like participants in main practical study. As a result of the pilot study, one significant aspect that became very apparent was a clear recognition and acknowledgement of the non-directive style of the interviewing. Slight concerns were expressed in terms of maintaining control of the interview and its direction – line of questioning - and ensuring a balance between creating a flexible framework while remaining with exploring original research question. It was agreed that having additional sub-questions and several optional questions embedded in interview agenda is ensuring such a balance.
METHOD – data preparation and analysis
All interviews were audio-recorded and transcribed. A code name was agreed with the participant prior to the interview to ensure confidentiality and anonymity. Some specific notations were added for interruptions or to express emotions such as laughter, hesitations and pauses (see Appendix 4 for all transcripts). The coding frame was developed using a combination of theory - driven categories such as category A (perceptions of healthy and unhealthy drinks) and data-driven categories such as categories B awareness of media reporting and of factors influencing parental behaviour (see Table A coding frame). Prior to developing the coding frame, collectively we agreed upon category A - theory driven category using definitions for both healthy drinks and unhealthy drinks:
Healthy drinks: natural, free from artificial sugars and preservatives, no added sugar and health promoting.
Unhealthy drinks: contains sugar, preservatives, artificial sweeteners and not health promoting.
It is important to note that all categories were defined before data analysis were complete on all transcripts and all categories were designed to be mutually exclusive.
Inter-rater reliability was established during coding formulation and data analysis with two out of the six transcripts coded by the research team. Table A. Coding frame/Categorization
CATEGORY DEFINITION SUB-CATEGORY CODE
A: Parent’s perception of healthy drink
(i.e., what parent consider to be healthy or unhealthy drinks for their children) A1: Perception of healthy drinks PHD
A2: Perception on unhealthy drinks PUD
B: Awareness of media reporting
(i.e., awareness of marketing and advertising of drinks brands)
B1: Reported awareness of media
(i.e., awareness of media campaigns or adverts for healthy or unhealthy drinks) RAM
B2: Reported non-awareness of media.
(i.e., non-awareness of any media campaigns or adverts for healthy or unhealthy drinks) RNAM
C: Factors influencing parental behaviour C1: Health related issues
(i.e., illness or allergies)
C2: Financial / deals
(i.e., spending power and promotions/special offers in retail outlets) F2
C3: Children’s pressure
(i.e., children’s insistence that parents buy certain drinks) F3
C4: Background / upbringing
(i.e., how parents were raised and the values they impart in raising their own children) F4
C5: Parents beliefs
(i.e., personal beliefs regarding health) F5
C6: acquired knowledge of health
(i.e., academic, scientific, self-study, NOT media related) F6
D: Media influence
(i.e., statements regarding the positive and negative affect of media/advertising) D1: Statement of affect
(i.e., statement affirming that media/advertising has an influence) MI1
D2: Statement of non-affect
(i.e., statement denying that media/advertising has an influence) MI2
The coding frame was applied to all transcripts and all results were collated and accounted for providing both a quantitative account of the findings as well as use of quotations to illustrate main findings. Two of the categories were singled out and further frequencies and percentages were collated and extracted in order to assess individual impact of the two variables (media impact and factors influencing parents’ buying behaviour).
METHOD – ethics
Prior to conducting the practical study the research question has been approved eligible by our lecturer supervisor. Considering that this study involved human participants, as a requirement of the briefing document was added an investigator statement acknowledging both an
understanding and agreement to the British Psychological Society’s Code of Conduct, Ethical Principles and Guidelines for conducting research with human participants. The participants were informed of their right to withdraw as well as offered an opportunity to ask further questions about the study during the debriefing period. One other ethical consideration needed for this study was the potentially sensitive topic - children’s drinks choices – to be discussed.
Through our data analysis we identified four category groups: category A of perceptions of healthy and unhealthy drinks, category B reported awareness and non-awareness of media campaigns, category C concerned with factors influencing parental behaviour and our last category, category D on statements of affect and statements of non-affect by media advertising (please refer to coding framework for a detailed definitions of each category in method/data analysis).
I am not aware of any specific campaigns, as such, but I have seen programs on television. I can’t tell you who made it, but they will be on mainstream television and, they are discussing the things we just have been discussing about fruit juices contain more sugar than most people believe and fizzy drinks contain sugar. So, I have seen couple of programs discussing this matter and the sort of conclusions are pretty much what I came down to…. water is the best thing to my children
The above quote illustrates our exploratory research main finding that of a close relation between factors of influence, perceptions of healthy drinks and awareness of media campaigns impact.
Category A was concerned with parents’ perceptions of healthy and unhealthy drinks and all participants identified water as being one of the healthy drinks choices for their children. For instance:
I tend to give my kids water… I would consider water to be healthy.
Water and juice, natural fruit juices.
Water, anything freshly made, so freshly made orange juice..
Yeah, is mainly water, we drink water a lot
For my children, personally, water obviously….
I think water, uh, very important to have a lot of water to keep you hydrated and everything.
The interviewees’ accounts of healthy and unhealthy drinks came second in our data analysis representing 21% of the total. What it is essential to note is that all participants without exception referred to water as being a healthy option in contrast to or rather as opposed to sugary drinks as unhealthy drinks. Rather than perceiving water as a fundamental necessity and survival, all participants categorized it as main healthy drink. For a more detailed discussion as to what constitutes a healthy drink, perhaps in future accounts of parent’s perception of healthy drinks, water could be excluded as to allow for other options to be more fully discussed.
There were several instances when the participants in the study have linked statements of non affect of media impact ( MI1) to factors influencing parental buying behaviour. For instance:
I have a bit of gripe against squashes.. because they have artificial sweeteners , especially aspartame in most of them.. and I do find with aspartame… one of my children have not reacted very well to the effects that aspartame has on them (category factor F1).
Same participant answered to interviewer’s question regarding media influence affecting their decisions to buy something for their children:
.. not me personally no.. definitely not my decisions, especially for drinks for my children (the decision) is a personal one .. because of my children’s subsequent behaviour to artificial additives. (category MI1)
Similarly, another participant makes a connection statement between media impact (MI2) and her buying behaviour:
I think for a lot of parents there would be the pressure to have the product because it says that it is high in vitamins or minerals or one of your five a day, but I mean, the reality is if you buy a smoothie that it is in the shop, it has been processed more than two or three days ago, the nutritional value in it is negligent, it’s nearly taste and thirst. I am not easily seduced by marketing, I’m afraid.
Table 1 summarizes all our findings and frequencies per category and subcategory. It is a clear predominance of category C occurrence with 45% of the total and with statements of affect and non-affect accounting for 20% of the total. What can be observed from such findings is that despite of not being able to infer a causal relationship between our categories, our analysis of occurrence of statements and factors of influence also offers a qualitative and in-depth understanding as to how essential it is to our participants to educate their children and transfer their own personal health beliefs and knowledge.
Such statements were provided by five of our participants:
So you know, you… you find coke, you find all the cans everywhere. They come in different sizes, different tastes, flavours. So it’s literally everywhere. You walk into the shop and it’s one of the things that you see piled up in front of you. There is always an offer on it as if it’s something that is there that has to be taken and it’s … and yes…it’s literally in your face… I think it’s…just to say it so much in abundance now and that’s what has made it necessary for me to educate my children about it more or less.
Another participant illustrates this point in a very convinced and eloquent matter, also:
I uh…think the media…um have a strong influence in trying to sell people things that…uh…for want of a better word…is not good for them…um…you know everything is great in moderation but uh…we are in a society where uh…people don’t really know where to draw the line…you know…and I think if you don’t educate the little ones, from a very early age…as to what is good for you and what is not good for you.. it’s ok to have a treat you know…have the drink…but know that there are certain repercussions.
Through our analysis we identified six main factors influencing parental buying behaviour including health related issues such allergies and/or illnesses – of children or close family and friends, financial and marketing deals, children’s pressure that parents purchase certain sugary drinks, background and upbringing, parents personal health-related beliefs and acquired knowledge of health (Table 2 of category C factors of influence).
Of all factors, the predominant trend with highest frequency percentage of the total 54% was factor F5 - parents’ health-related beliefs. Attesting statements of such factor was provided across all six interviews and by all participants:
But because it is this marketing thing as no added sugar, and what you then have to do, it is look at the label and what they actually put in it..is worse than just having the sugar in it, which you know (eventually) your kids can burn it off…we literally had to stop drinking a particular dilute juice, because it went from being simply a syrup with sugar in it to then having added sugar (what they call them?!) natural flavours and sweeteners, which, you know, we do not want our children to have….
I don’t entirely have…I don’t have any issues at all against the media encouraging or promoting something as long as it’s healthy and it’s hygienic and its’ it’s not something that’s going to create problems
Similar statements of affect and non-affect were made by all participants, Table 3 summarising such findings. Perhaps one of the most significant results is that of acknowledgement and statement of affect of media, but not necessarily from a subjective perspective and rather from an objective perspective. It is noteworthy that four of our participants refer to media affect or non-affect and awareness of media campaigns with some statements that distinctively distances the participant from personal affect. Our participants offering almost an observer alternative of such account.
…..the media doesn’t really influence me choice I have…errr…I have my own beliefs and…errr…knowledge around what’s healthy and not healthy…errr…but…I can image some parents being affected by media campaigns and…errr…slick advertising and…errr…some children …would wana buy these drinks and pressurising the parents into buying them. But it’s not something I subscribe to
I think a lot of people (sighs)…uh…I could be wrong…but some people probably feed their children…oh uh…give their children coca cola, for the sake of…grab a coke, especially now with Christmas time…so…um…my personal choice is once again…um…yeah… I don’t drink gassy cold drinks or uh…soft drinks…um but I think the majority of people probably (laughs)…would probably be drawn to more popular famous brands…isn’t it… because they are just punting it out there all the time…
Table 3. Occurrences of statement of affect and statement of non-affect linked to media influence on parents’ perceptions and buying behaviour
Statement of affect/non-affect of media
MI1 % from total MI2 % from total
7 (17%) 87.5% 1 (9%) 12.5% 8
2 (5%) 40% 3 (27%) 60% 5
6 (14%) 100% 0 (0%) 0% 6
3 (7%) 43% 4 (37%) 57% 7
13 (31%) 81% 3 (27%) 19% 16
11 (26%) 100% 0 (0%) 0% 11
42 11 53
RESULTS Table 1. Frequency per category
Reported awareness/non-awareness of media
Factors influencing parental behaviour
Statement of affect/non-affect of media
A1 – PHD A2 – PUD
B1 – RAM B2-RNAM
C6-F6 MI1 MI2
IA1 4 3 7 1 1 2 1 0 11 9 7 1 47
I2 9 5 3 1 3 1 1 1 16 3 2 3 48
5 0 5 1 0 2 0 0 6 0 6 0 25
I3K 5 1 6 4 4 5 0 0 10 2 3 4 44
IA4 8 6 4 1 1 2 4 5 21 3 13 3 71
I5 2 8 4 1 1 0 2 1 4 3 11 0 37
category and % from total A 56
14% C 125
45% D 53
Total without I3D and % from the total 28 23 24 8 10 10 8 7 62 20 36 11 247
21% B 32
13% C 117
47% D 47
Table 2. Factors influencing parental behaviour
Health related issues % of F1 per participant
Financial % of F2 per participant C3-F3
Children’s pressure % of F3 per participant
% of F4 per participant
% of F5 per participant
Acquired knowledge of health % of F6
IA1 1 4% 2 8% 1 4% 0 0% 11 46% 9 38% 24
I2 3 12% 1 4% 1 4% 1 4% 16 64% 3 12% 25
I3D 0 0% 2 25% 0 0% 0 0% 6 75% 0 0% 8
I3K 4 19% 5 24% 0 0% 0 0% 10 48% 2 9% 21
IA4 1 3% 2 6% 4 11% 5 14% 21 58% 3 8% 36
I5 1 9% 0 0% 2 18% 1 9% 4 37% 3 27% 11
% of each factor of influence from total reported
Findings from the National Diet and Nutrition Survey in Britain (2010 and 2011) assert that we drink an average of 123ml of sugar-sweetened drinks per person per day, with an average energy intake of 206kJ per person per day. There is variation by age, with young people aged 16–29 years consuming an average 452kJ/person/day from sugar-sweetened drinks, four times more than those aged over 50 years, only consuming 96kJ per person per day (NDNS, 2010/2011). Each week we spend an average of 61.1p per person on sugar-sweetened drinks.
Prevalence of overweight and obesity was 26% in the Health Survey for England, and 28% for the Scottish Health Survey (NHS, 2013).
A study by Biggs et al (2013) introduces as one option for limiting consumption of sugar sweetened drink and preventing its negative effects a 20% tax. The tax is aiming to reduce consumption of concentrated sugar-sweetened drinks by 15% and non-concentrated sugar-sweetened drinks by 16% as to the effect of an average energy intake reduction of 16.7Kj/person/day. There was marked variation with people age 16-29 years predicted to reduce their energy intake by 56.3KJ/person/day significantly higher than those age 50 and over who are predicted to have a reduction of 1.7kj/person/day (Biggs, et al, 2013). Our findings suggest a clear awareness of media impact on parents’ behaviour with most of our participants even distancing themselves from a subjective point of view on healthy diet and adopting a more general standpoint as family members and part of a well-defined segment of the population that of being a parent of young children. There are several comments on parental responsibility of both educating the children and preventing bad habits to be established. The parental responsibility as both of factor influencing consumer behaviour and simultaneously educating their children on what it is healthy is the most significant finding of this research and resonates with findings from a study by Fitzgerald et al (2010) where parental control was apparent on children’s own choices of healthy eating with adolescent population expressing more and more disinterest and parental control diminishing. Another important finding is that of an acknowledgement and segregation between internal factors such as parents’ beliefs and background) and external factors, such as financial and marketing influences. Similarly, the study by Fitzgerald et al (2010) identifies intra-individual factors as the link between food preferences and awareness of healthy eating. A similar finding was reported by Hart et al (2003) in a study that highlights the importance of parental responsibility of educating own children and promoting healthy habits within their home environment, hence moving the emphasis from fact transmission to parental self-awareness. Such strategies were to be incorporated within larger sample of education programmes. Interesting to note that such arguments come across also from another study by James at al (2004) whose study concluded that school based education programmes can produce even if modest reduction in intake of carbonated drinks associating this intervention with a reduction in the number of overweight and obese children.
It has been argued that mass media reporting it is a relatively inexpensive way of exposing the population to health information and that such reporting has the potential to modify the attitudes and/ or knowledge of large sample of population simultaneously (MacDonald, 1998) The impact and the appropriateness of media reporting serving as a source of communicating health promotions or health insight it is subject of debate. It is well acknowledged that such dissemination of information it is subject to receiver’s interpretation, but also sometimes the information can be misleading as misreporting of research findings can and do occur. A well-known example of such incident has been analysed by Molitor (1993) in regards to a misreporting of a research study on the effect and use of Aspirin for the prevention of heart attacks. The erroneous reporting affected public consciousness in the US, Britain and the entire industrialized world within less than a week (MacDonald, 1998).
The review literature by Wakefield et al (2010) suggested an overall positive influence of the media health messages but highlights the need of concurrent services to be implemented such as availability of community based programmes and marketing factors. Their findings suggested a moderate benefit when specific healthy food choices were promoted.
On a similar approach, all our participants not only that they acknowledged media influence, but also remarked on possible positive aspects that media promoting of healthy drinks can and do have on all members of the public and especially on parents of young children.
Some limitations to our study come from limitations of content analysis itself. For instance, it has been stated that one of the weaknesses of content analysis is that it is ineffective in testing casual relationships between variables (Berg, 2001); hence it would be very difficult with our findings to conclude on a causal relationship between the various categories identified such as between factors influencing parental behaviour and media impact, nevertheless it is clear from our findings that there is a strong connection between media dissemination of health issues and parents responses and actions as consumers. Further research could attempt to a more in-depth analysis of such factors and perhaps account for socio-economic differences within the sample. A good research question for future studies in this area would perhaps be concerned and account for if not all but most elements involved in what can constitute parents’ personal health-related beliefs and how such knowledge was acquired. Like Guthman’s definition of obesity all such factors of influence need to be understood within a broader political-economic and cultural context
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Nutrition and wellbeing
Nutrition and wellbeing