A Qualitative Study of Parents With Children 6 to 12 Years Old: Use of Restaurant Calorie Labels to Inform the Development of a Messaging Campaign

Published:October 21, 2020DOI:



      US law mandates that chain restaurants with 20 or more locations post calorie information on their menus to inform consumers and encourage healthy choices. Few qualitative studies have assessed how parents perceive and use this information when ordering for their children and what types of accompanying messages might increase use of calorie labels when ordering food.


      We aimed to better understand parents’ perceptions and use of calorie labeling and the types of messages that might increase use.


      We conducted 10 focus groups (n = 58) and 20 shop-along interviews (n = 20). Focus group participants discussed their hypothetical orders and restaurant experiences when dining with their children, and shop-along participants verbalized their decision processes while ordering at a restaurant. Both groups gave feedback on 4 public service messages aimed to increase healthier ordering for children. All interviews were voice-recorded and transcribed.


      Participants were primary caregivers of at least 1 child between 6 and 12 years who reported having less than a college education at the time of screening and who commonly ate at chain restaurants. Focus groups were conducted in a conference room, and shop-alongs were conducted in quick-serve and full-service chain restaurants around Philadelphia between August 2016 and May 2017.


      A modified grounded theory approach was used to extract themes from transcripts.


      Thematic analysis of transcripts revealed 5 key themes: (1) parents’ use of calorie labels; (2) differences across restaurant settings; (3) nonjudgmental information; (4) financial value and enjoyment of food; and (5) message preferences. These themes suggested that nonjudgmental, fact-based messages that highlight financial value, feelings of fullness, and easy meal component swaps without giving up the treatlike aspect of eating out may be particularly helpful for consumers.


      These findings can inform current US Food and Drug Administration campaign efforts to support consumer use of calorie labels on menus.


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      S. V. Hua is a doctoral student, Harvard T.H. Chan School of Public Health, Department of Nutrition, Boston, MA; at the time of the study, she was a project manager, University of Pennsylvania Perelman School of Medicine, Philadelphia.


      A. A. Musicus is a doctoral candidate, Harvard T.H. Chan School of Public Health, Department of Nutrition, Boston, MA.


      K. Sterner-Stein is a program coordinator, Bridges to Wealth, University of Pennsylvania, Netter Center for Community Partnerships, Philadelphia; at the time of the study, she was a research assistant, University of Pennsylvania Perelman School of Medicine, Philadelphia.


      F. K. Barg is a professor of family medicine, community health and epidemiology, Department of Family Medicine and Community Health; University of Pennsylvania Perelman School of Medicine, Philadelphia.


      K. Glanz is a George A. Weiss University Professor, Department of Biostatistics and Epidemiology; University of Pennsylvania Perelman School of Medicine, Philadelphia.


      C. A. Roberto is an assistant professor of medical ethics and health policy, Department of Medical Ethics & Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia.


      M. B. Schwartz is a professor of human development and family studies, Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford.


      J. P. Block is an associate professor of population medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA.


      C. D. Economos is a professor in Public Health & Community Medicine, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.


      J. W. Krieger is clinical professor of health services, University of Washington Schools of Public Health and Medicine, Healthy Food America, Seattle.