The role of health-related claims and health-related symbols in consumer behaviour: Design and conceptual framework of the CLYMBOL project and initial results

Abstract

Health claims and symbols are potential aids to help consumers identify foods that are healthier options. However, little is known as to how health claims and symbols are used by consumers in real-world shopping situations, thus making the science-based formulation of new labelling policies and the evaluation of existing ones difficult. The objective of the European Union-funded project Role of health-related CLaims and sYMBOLs in consumer behaviour (CLYMBOL) is to determine how health-related information provided through claims and symbols, in their context, can affect consumer understanding, purchase and consumption. To do this, a wide range of qualitative and quantitative consumer research methods are being used, including product sampling, sorting studies (i.e. how consumers categorise claims and symbols according to concepts such as familiarity and relevance), cross-country surveys, eye-tracking (i.e. what consumers look at and for how long), laboratory and in-store experiments, structured interviews, as well as analysis of population panel data. EU Member States differ with regard to their history of use and regulation of health claims and symbols prior to the harmonisation of 2006. Findings to date indicate the need for more structured and harmonised research on the effects of health claims and symbols on consumer behaviour, particularly taking into account country-wide differences and individual characteristics such as motivation and ability to process health-related information. Based on the studies within CLYMBOL, implications and recommendations for stakeholders such as policymakers will be provided.

Full text

NEWS FROM EU RESEARCH
The role of health-related claims and
health-related symbols in consumer
behaviour: Design and conceptual framework
of the CLYMBOL project and initial results
S. Hieke*, N. Kuljanic*, J. M. Wills*, I. Pravst†, A. Kaur‡, M. M. Raats§, H. C. M. van Trijp¶,
W. Verbeke** and K. G. Grunert††
*European Food Information Council (EUFIC), Brussels, Belgium;
†University of Ljubljana and Nutrition Institute, Slovenia;
‡University of Oxford, UK;
§University of Surrey, Guildford, UK;
¶Wageningen University, The Netherlands;
**Department of Agricultural Economics, Ghent University, Belgium;
††MAPP Centre for Research on Customer Relations in the Food Sector, Aarhus University, Denmark
Abstract Health claims and symbols are potential aids to help consumers identify foods that
are healthier options. However, little is known as to how health claims and symbols
are used by consumers in real-world shopping situations, thus making the science-
based formulation of new labelling policies and the evaluation of existing ones
difficult. The objective of the European Union-funded project Role of health-related
CLaims and sYMBOLs in consumer behaviour (CLYMBOL) is to determine how
health-related information provided through claims and symbols, in their context,
can affect consumer understanding, purchase and consumption. To do this, a wide
range of qualitative and quantitative consumer research methods are being used,
including product sampling, sorting studies (i.e. how consumers categorise claims
and symbols according to concepts such as familiarity and relevance), cross-country
surveys, eye-tracking (i.e. what consumers look at and for how long), laboratory
and in-store experiments, structured interviews, as well as analysis of population
panel data. EU Member States differ with regard to their history of use and
regulation of health claims and symbols prior to the harmonisation of 2006.
Findings to date indicate the need for more structured and harmonised research on
the effects of health claims and symbols on consumer behaviour, particularly taking
into account country-wide differences and individual characteristics such as
motivation and ability to process health-related information. Based on the studies
within CLYMBOL, implications and recommendations for stakeholders such as
policymakers will be provided.
Keywords: consumer behaviour, food choice, food labelling, health claim, health symbols
Correspondence: Dr. Sophie Hieke, Head of Consumer Research, European Food Information Council (EUFIC), rue Paul-Emile Janson 6,
B-1000 Brussels, Belgium.
E-mail: sophie.hieke@eufic.org
bs_bs_banner
DOI: 10.1111/nbu.12128
66 © 2015 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation Nutrition Bulletin,40, 66–72
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium,
provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Introduction
In 2006, the European Commission (EC) introduced a
new regulation (EC 1924/2006) on nutrition and health
claims made on foods (EC 2006) to harmonise the rules
governing the use of nutrition and health claims on
foods and drinks throughout the European Union (EU)
and to ensure a high level of consumer protection. The
use of such information may be further underpinned by
nutrient profiles, setting out more detailed criteria for
the provision of nutrition and health claims on different
food and drink products. The importance of this regu-
lation is threefold. Firstly, bearing in mind the public
health implications of inadequate diets and unhealthy
lifestyles, this approach has significant potential to help
guide consumers towards healthier food choices. Sec-
ondly, it ensures a higher level of consumer protection
by enabling consumers to make informed food choices.
Lastly, it is intended to stimulate innovation and com-
petitiveness among European food producers.
Although the process of approval [including the sci-
entific substantiation evaluated by the European Food
Safety Authority (EFSA)] for the use of health claims is
highly regulated, consumer understanding, acceptance
and use of such claims and symbols is less clear
(Verhagen et al. 2010). Nonetheless, select aspects of the
role of health claims and symbols in consumer behaviour
have received considerable attention in research, includ-
ing understanding of different types of claims, percep-
tion of products carrying such claims and effects on
purchase and consumption behaviour (Verbeke et al.
2009; Harris et al. 2011; Lynam et al. 2011; Bilman
et al. 2012; Dean et al. 2012; Gallicano et al. 2012;
Roberto et al. 2012; Hoefkens & Verbeke 2013). For
recent reviews on health claims research, we refer to
Lähteenmäki (2013) as well as Wills et al. (2012).
However, given the complexity of the topic, diversity
of the research designs, methodologies and stimuli
employed, the findings are difficult to compare across
populations and limited conclusions can be made about
the actual impact the provision of such information has
on consumer understanding, purchasing and consump-
tion. Point of departure for the analysis of these claims
and symbols and their effects on consumer behaviour
will be the EU-funded project FLABEL (2008–2011)
(Storcksdieck genannt Bonsmann et al. 2010a). Among
other things, findings will be compared with the EU-wide
audit of food labels in 5 product categories that was
carried out in 2008–2009 where researchers found on
average 2–4% of products to contain health claims and
1–2% of products to carry health logos (Storcksdieck
genannt Bonsmann et al. 2010b).
The EU-funded project CLYMBOL (Role of health-
related CLaims and sYMBOLs in consumer behaviour)
aims to provide a comprehensive assessment of the role of
health-related information on food and drink products in
consumers’ food choices and to derive implications for
the provision and communication of such information.
This is to be achieved by a set of five research work
packages (WPs 1–5), supported by dissemination activ-
ities (WP6) and project management (WP7) (see Fig. 1).
To the authors’ knowledge, this is the most comprehen-
sive study in this field to date, both in terms of the number
of countries covered and the scope of research. This
contribution describes the overall design and conceptual
framework of the project. In addition, first results and
insights are provided where available.
Methods/design
Work Package 1 – Current status of health claims
and symbols: Product supply
At the start of the project, the consortium created a
benchmark by identifying differences in the history of
use of health claims and symbols across Europe. In 26
EU Member States, 53 key informants from up to three
different stakeholder groups were interviewed: national
food authorities, representatives of the food industry
and consumer organisations. Although 14 Member
States reported (at least partial) regulation of the use of
health claims and/or symbols before the introduction of
the regulation on nutrition and health claims made on
foods (EC 1924/2006; EC 2006), mandatory reporting
of use had only been in place in three EU Member
States. A number of voluntary codes of practice for
health claims and/or symbols (i.e. pre-approval or jus-
tification when challenged) was said to be in use in 15
Member States. There are only a few national databases
on health claims and symbols available, the data for
which is often incomplete. Only seven Member States
reported having some form of database from which
information about health claims and symbols could be
extracted. The stakeholders interviewed expressed a
strong interest in evaluating the impact of health claims
and symbols. The main areas that were considered to
need monitoring were (1) the role of health claims and
symbols in consumer behaviour; (2) their impact on
public health; and (3) economic effects. Reasons for not
measuring such impacts included scepticism concerning
the general effectiveness of claims and symbols but also
a lack of knowledge as to how this could be done.
Based upon already existing classification schemes
(Rayner et al. 2013), a taxonomy of food labelling
CLYMBOL – Role of health-related CLaims and sYMBOLs in consumer behaviour 67
© 2015 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation Nutrition Bulletin,40, 66–72

components was developed, including product informa-
tion and (expressed) claims as the main components
available at the point of purchase. Product information
comprised mandatory food information (i.e. the infor-
mation required according to Regulation EC 1169/
2011; EC 2011) and other information (i.e. value chain
information, marketing-related information, package
design and other). Claims on-pack were either worded
(i.e. nutrition and health claims) or symbolic (i.e. nutri-
tion and health symbols). Possible claim types included
nutrition, health or health-related ingredient claims. All
other claims were categorised as miscellaneous claims.
For each category, detailed categorisation schemes were
developed. Health claims, as well as health and nutrition
symbols, form the core of analysis in the CLYMBOL
project, while all other information available at the
point of purchase is being considered as context factors.
To map current consumer exposure to claims and
symbols across Europe, a five-country prevalence study
was undertaken. On the basis of a randomised sampling
protocol, a total of 2034 products were sampled in The
Netherlands, Germany, Slovenia, Spain and the United
Kingdom, in three different store types each, and all
available product packaging information was extracted
and reported according to the classification scheme
developed for the preliminary taxonomy. The number
and types of claims were recorded into a database,
including information on the nutrients and other sub-
stances mentioned, whether claims were worded and/or
symbolic, and whether the health claims were specific
or non-specific, i.e. whether they specified which com-
pound was responsible for the health effect claimed or
not. Using the product categorisation scheme according
to Dunford et al. (2012), the claims were further classi-
fied by product category in order to analyse the preva-
lence of claims by food type. In addition to this, the
context in which claims and symbols appeared was ana-
lysed. All available information on-pack was extracted
and classified according to the types of images appearing
on the packaging, as well as the position and the size of
the claims. Detailed results will be published in a sepa-
rate paper.
In the next step, the nutritional composition of the
foods sampled that carried health claims and symbols
were analysed and compared against the Food Stand-
ards Agency Australia and New Zealand’s (FSANZ)
nutrient profile model used for regulating health claims.
Analysis of the nutritional composition of those foods
bearing health claims and health symbols showed that
foods that carry a health-related claim are slightly
healthier than foods that do not carry a claim. On
average, when carrying a health claim, foods had lower
Figure 1 Structure of the CLYMBOL project.
WP, Work Package.
68 S. Hieke et al.
© 2015 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation Nutrition Bulletin,40, 66–72

saturated fatty acid levels, energy and sodium than those
without a health claim. Using the FSANZ nutrient
profile model’s nutrient profile scoring criteria (NPSC),
the scores of foods with and without claims were cal-
culated. It was found that the majority of foods with a
health claim pass the NPSC. Detailed results will be
published in a separate paper.
Furthermore, three health symbols (the Nordic
Keyhole, the Finnish Heart Symbol and the Choices
International logo) (Fig. 2) were selected based on
their prevalence in the European market and the fact
that their ‘criteria for use’ were available publicly. The
food products contained in the database were assessed
against the criteria for these symbols in order to deter-
mine which foods would be allowed to carry one or
more of the three symbols. This was amended by a
comparison against the aforementioned NPSC and the
most recent version of a model developed by the EC
for the regulation of health claims across the EU. First
results show that there is only slight or fair agreement
between the nutritional criteria supporting the health-
related symbols while there is substantial agreement
between the EU model and the NPSC. Both the EU
model and the NPSC would allow approximately half
of the foods to carry health and nutrition claims,
whereas the health-related symbols are much more
restrictive. Detailed results will be published in a sepa-
rate paper.
Work Package 2 – Current status of health claims
and symbols: Consumer needs and wants
Having set the scope in WP1, WP2 will examine differ-
ences in consumer motivation and ability to process
health-related claims and symbols (i.e. consumer
wants), as well as differences in consumers’ nutritional
and health status that may have an impact on whether
food products with specific health effects will indeed be
beneficial to consumers (i.e. consumer needs).
A series of semi-structured interviews, sorting exer-
cises and recall and recognition tasks have been
conducted in order to provide insight into how consum-
ers categorise various health claims and symbols within a
specific context (images and other information), how
they use their subjective causal models of health to
interpret them and the extent to which the presence of
health-related images on packaging can affect the infer-
ences consumers derive about the health properties
of products. Detailed results will be published in a sepa-
rate paper.
Additionally, a ten-country online survey (United
Kingdom, Germany, The Netherlands, Spain, Slovenia,
Czech Republic, France, Denmark, Greece and Lithua-
nia) has been carried out to assess how motivated and
able European food shoppers are to process health claims
and symbols on food products, and whether there are
country-specific or segment-specific differences. More
than 5000 participants were surveyed on familiarity with
and attitudes towards selected health claims and health
symbols. Motivation and ability to process these claims
and symbols differed across countries with the highest
scores seen among Spanish consumers and the lowest
among Dutch. Results were similar for all claims tested
(heart, brain, digestion, immunity, bone and dental
health-related claims) with a slightly higher motivation
to process bone-related claims and a slightly lower moti-
vation towards digestion-related claims. In general,
European consumers’ motivation and ability to process
health claims differs little between claims and symbols.
Consumers’ perceived need for information emerges as
the main factor correlated with their motivation to
process health-related claims, whereas subjective knowl-
edge about the healthiness of food emerges as the
main correlate of consumers’ ability to process such
claims. Cross-country differences in consumers’ reac-
tions towards, and their motivation and ability to process
health claims and symbols, will be discussed against the
prevalence of claims and symbols in the corresponding
countries as assessed in WP1. Detailed results will be
published in a separate paper.
Building on these insights, differences in nutritional
needs will be analysed by means of routinely collected
The Nordic Ke
y
hole Finnish Heart Choices International
Figure 2 Examples of health-related symbols
studied in the CLYMBOL project.
CLYMBOL – Role of health-related CLaims and sYMBOLs in consumer behaviour 69
© 2015 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation Nutrition Bulletin,40, 66–72

health statistics, notably indicators of consumers’ nutri-
tional and health status. These will be compared with
the health claims and symbols identified in the data
sample in WP1, studying (in)consistencies between con-
sumer needs and what is currently on the market. Data
analysis and reporting will be finalised by mid-2015.
Combined results of WPs 1 and 2 will serve as a basis
for revising the preliminary taxonomy of food labelling
components with a special focus on health claims,
symbols and their context, taking into account both the
expert and the consumer point of view. This final clas-
sification scheme will be the point of departure for all
further empirical research in this project.
Work Package 3 – Methodological toolbox:
Measuring the effect of health claims and symbols
on understanding, purchasing and consumption
The CLYMBOL consortium has developed a set of cri-
teria against which 40 methods have been evaluated
regarding their suitability for assessing consumer under-
standing, purchase and consumption. The criteria were
developed based on theories of consumer behaviour,
literature on validity and reliability, existing quality
assessment tools, seven key informant interviews (with
public policy and industry representatives), input from
consumer researchers and prior tasks in CLYMBOL
(WP1 and WP2). The criteria pertain to three main
groups:
(1) Theory-driven criteria ensuring that potential
methods are in accordance with theoretical insights
relevant for the study of impacts of health claims and
symbols on consumer understanding, purchase and
consumption;
(2) General methodological criteria ensuring validity
and reliability of methods; and
(3) Feasibility-related criteria ensuring usability of
methods.
Reviews of methods to measure understanding of
health claims and symbols and their impact on purchase
and consumption have been carried out and inventories
of the methods have been developed. All methods were
compared and tested individually, as well as in combi-
nation, in order to assess applicability and internal and
external validity. Outcomes of this analysis will serve as
a basis for formulating recommendations on the use of
methodologies in measuring understanding of health
claims and symbols in their context, and the effects on
purchase and consumption behaviour. Detailed results
will be published in a separate paper.
Work Package 4 – Investigation of effects: The effect
of health claims and symbols on understanding,
purchasing and consumption
A combination of quantitative and qualitative research
methodologies will be applied within different studies to
determine and quantify the effects of health claims and
symbols on consumer understanding, purchase and
consumption. Four experimental studies measuring the
effect on purchase will employ systematically varied
assortments of products on computer screens and/or
in a virtual supermarket. Four additional studies will
explore the effects of claims and symbols, in their
context (e.g. packaging design) and on actual intake
during consumption situations (e.g. buffet context).
Both of these types of studies will consider consumer
understanding of claims as a mediator of any effects on
purchasing and consumption. Several of these studies
will be replicated in different countries to explore dif-
ferences and similarities across Europe. Furthermore,
the effects of claim-symbol-context combinations on
food choice will be validated in experimental in-store
scenarios in Germany and Slovenia, enabling the collec-
tion of additional information for a deeper understand-
ing of the effects on purchase. Econometric modelling of
household purchase data from both Denmark and The
Netherlands will be applied to analyse changes in house-
hold purchases following the market introduction of a
health symbol (i.e. the Nordic Keyhole and the Choices
International logo, respectively). Based on the detailed
information of the nutritional composition of the food
products purchased by the Danish household panel, the
effects on individual food and nutrient intake will be
assessed. This research will be completed by early 2016.
Work Package 5 – Public policy implications:
Stimulating healthy food choices for the consumer
and innovation within the industry
Part of the CLYMBOL project is to turn methodological
and empirical findings into actionable implications and
recommendations for different stakeholders [consum-
ers, industry, retailers, non-governmental organisations
(NGOs), policy makers and others]. Analyses will
explore the role of social media in communicating with
the public and assisting consumers in making informed
and healthy food choices. By means of evaluating the
‘Choices’ logo campaign in The Netherlands (which ran
from July to December 2014), the effectiveness of a
real-life campaign using social media will be studied.
Data analysis is currently ongoing. Together with input
obtained via industry consultations on social innovation
strategies and the use of social media in the communi-
70 S. Hieke et al.
© 2015 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation Nutrition Bulletin,40, 66–72

cation of health-related information, these outcomes
will lead to the identification of new communication
tools for information provision on health claims and
symbols. Based on a series of workshops with diverse
stakeholder groups, guidelines will be developed for
public and private policy makers, identifying best prac-
tices for the provision of health claims and symbols that
will result in desirable effects on consumer food choice.
Recommendations will be provided for implementing
and assessing the impact of future food labelling
schemes on consumer understanding, purchase and con-
sumption. This work is still in its early phase, relying
heavily on the results that will become available towards
the end of the project.
Work Package 6 – Communication, stakeholder
engagement and public dissemination
An initial communication and dissemination plan has
been developed to underpin all of the project’s research
activities. Stakeholder engagement has been successful
with the creation of a balanced stakeholder advisory
board comprised of regulators and national authorities,
representatives of consumer and patient organisations,
and industry and retail associations. Dissemination
tasks completed so far include the creation of a pro-
ject logo (Fig. 3) and graphical identity as well as a
web presence (www.clymbol.eu). Various dissemination
materials have been created, including a leaflet and an
article in the magazine Food Today (EUFIC 2013). Dis-
semination via websites and web technology is ongoing,
with broad outreach through media relations, tradi-
tional newsletters and new technologies (i.e. CLYMBOL
Facebook and Twitter accounts, and podcasts). In addi-
tion to these activities, by the end of 2014, more than
225 presentations were given at various scientific and
stakeholder conferences. First abstracts have been pre-
sented at the World Congress on Public Health (Brown
et al. 2014) and the European Childhood Obesity
Group conference (Hieke et al. 2014). Further abstracts
have been submitted to international public health,
nutrition, consumer behaviour and food marketing and
policy conferences, while a range of manuscripts will be
submitted to peer-reviewed journals in the future.
Expected final results
Upon project completion, the CLYMBOL consortium
will have achieved the following:
• Creation of the first EU-wide benchmark study on
consumer exposure to health claims and symbols on
foods, leading to insights into the extent to which health
claims and symbols are prevalent in Europe;
• Provision of evidence on how consumers form opin-
ions about the healthfulness of products, and how they
interpret health claims and symbols in this regard;
• Mapping of differences in consumer motivation and
ability to process health-related claims and symbols
(consumer wants), as well as differences in consumers’
nutritional and health status that may have an impact
on whether food products with specific health effects
will indeed be beneficial to consumers (consumer needs);
• Provision of a taxonomy of health-related claims,
symbols and their context, taking into account both
expert and consumer perspectives;
• Development of best practice methods for measuring
how health claims and symbols, in their context, are
understood by consumers and how they affect consumer
food choice;
• Provision of the scientific evidence on how health
claims and symbols, in their context, are understood by
consumers, contribute to healthier food choices at the
point of purchase and their potential to induce healthier
consumption patterns;
• Conversion of the methodological and empirical find-
ings gathered in CLYMBOL into actionable implica-
tions, recommendations and communication guidelines
for the different stakeholders identified (consumers,
industry, retailers, NGOs, policy makers).
Discussion
There is widespread interest among stakeholders in
Europe to measure the effect of health claims and
symbols, particularly with regards to consumer under-
standing, purchasing and consumption behaviour,
public health outcomes and economic impact. As part of
the labelling information that is available for food and
drink products, claims can be divided into worded and
symbolic, with health claims, nutrition and health
symbols forming the focus of analysis in the CLYMBOL
project. Taking the insights obtained from the
EU-funded project FLABEL as a point of departure and
once the data from WPs 1 to 5 become available, a
Figure 3 Project logo.
CLYMBOL – Role of health-related CLaims and sYMBOLs in consumer behaviour 71
© 2015 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation Nutrition Bulletin,40, 66–72

holistic analysis of the role of health claims and symbols
in consumer behaviour will be possible, ultimately pro-
viding a solid information basis for future research and
public policy.
Acknowledgements
CLYMBOL (Role of health-related CLaims and
sYMBOLs in consumer behaviour) has received funding
from the European Union’s Seventh Framework Pro-
gramme for research, technological development and
demonstration under grant agreement no. 311963.
Conflict of interest
The authors have no conflict of interest to disclose.
CLYMBOL project partners
• Aarhus University (Denmark) – Scientific Advisor
• Agrifood Research and Technology Centre of Aragon,
CITA (Spain)
• Corvinus University Budapest (Hungary)
• European Food Information Council (Belgium) –
Coordinator
• Ghent University (Belgium)
• Globus SB-Warenhaus Holding GmbH &Co. KG
(Germany)
• Saarland University (Germany)
• Schuttelaar & Partners NV (The Netherlands)
• Swedish National Food Agency (Sweden) – partici-
pated from September 2012 to February 2014
• University of Copenhagen (Denmark)
• University of Oxford (UK)
• University of Surrey (UK)
• University of Ljubljana (Slovenia)
• Wageningen University (The Netherlands)
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