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«Saoussen LAKHDAR Assistante contractuelle, ISCAE Tunis, Tunisie Doctorante en marketing, Faculté des Sciences Economiques et de Gestion, Tunis, ...»

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Saoussen LAKHDAR

Assistante contractuelle, ISCAE Tunis, Tunisie

Doctorante en marketing, Faculté des Sciences Economiques et de Gestion, Tunis, Tunisie

Membre de l’Unité de Recherche et Applications Marketing (URAM), FSEG Tunis, Tunisie Adresse : App5, Bloc E, rue des Morabites, El Menzah V, 2091 Ariana, Tunisie Tel : 00 216 71 312 233 Portable : 00 216 97 372 290 E-mail : sawssenlakhdar@yahoo.fr Néji BOUSLAMA Professeur en marketing, Faculté des Sciences Economiques et de Gestion, Tunis, Tunisie Responsable de l’Unité de Recherche et Applications Marketing (URAM), FSEG Tunis, Tunisie Adresse : Boulevard 7 Novembre (Campus Universitaire) El Manar II. 2092, Tunis Tel : 00 216 71 870 277 E-mail : neji.bouslama@yahoo.fr




Abstract This study aims to determine which cues consumers use to judge the healthiness of food, to assess the impact of food healthiness on the purchase intention and to determine the underlying dimensions that can predict consumers’ perception of healthiness and willingness to use functional food. Four focus groups and ten in-depth interviews were led involving three projective techniques: association techniques, analogy and story completion. The findings reveal that food’s healthiness is perceived through intrinsic and extrinsic cues of the food, demographic characteristics and personality traits. Moreover, it has been shown that healthiness can be a strong motive that may influence attitude toward functional foods and purchase behavior.

Key words: health perception, attitude, functional foods, projective techniques


Several authors describe food choice as a complex process which is influenced by a wide range of factors. For a better understanding of this process, Belk (1975), Bell and Meiselman (1995), Meiselman (1996), Shepherd and Raats (2006) and Sobal et al., (2006) merge the factors that influence food choice into three components: the person, the product (food), and the environment. This framework is useful as it helps to understand that food choice is influenced by the perceived product and environment through the personal characteristics (Rozin, 2007).

Referring to the food itself, the influences on food choice were summarized by Steptoe, Polland, and Wardle (1995) into nine forces related to intrinsic and extrinsic food attributes.

These motivational dimensions are health, mood, convenience, sensory appeal, natural component, price, weigh control, familiarity and ethical concern.

In most situations, it seems that sensory properties are the most powerful influence on food choice (Rozin, 2007). However, in the recent years, due to the prevalence of several noncommunicable diseases including obesity, diabetes, cardiovascular disease and cancer, there has been an increased interest in the health effects of the food. Moreover, recommendations of health authorities and communication industry have increased awareness of health issues (Tudoran, Olsen and Dopico, 2009). In fact, health influence becomes as important as taste influence in food choice and consumers increasingly demand healthy food.

In this context, functional foods play an important role because this new category of food products meets consumer demand for healthy eating. Such foods are commonly described as products that provide additional health benefits beyond basic nutrients. Diplock, Agget, Ashwell, Bornet, Fern, and Roberfroid, (1999) define functional food as food that “affect beneficially one or more target functions in the body, beyond adequate nutritional effects, in a way which is relevant to either the state of well-being and health or the reduction of the risk of a disease”.

Despite the economic recession which is impacting all food and beverage market, the global functional foods market is growing constantly worldwide. The consumers are increasingly focused on the desire to maintain and improve health to avoid becoming ill due to the economic downtown. Functional foods market was valued at $164 billion in 2007 and is expected to grow to $240 billion by 2012, which represent a compound annual growth rate of 7.9% during the five-year period (Marigny Research Group, Inc., 2009).

Although these optimistic figures, the success of functional food is not guaranteed because it depends on how consumer accept them. Moreover, functional foods are relatively emerging products that may require extensive research and novel processing technology. Consequently, marketers have to study consumers’ perception, attitudes, acceptance and how they decide to purchase such foods to ensure sufficient demand and to avoid major failures in investments.

The aims of the present study were (1) to determine which cues consumers use to judge the healthiness of food, (2) to assess the impact of food healthiness on the purchase intention and, (3) to determine the underlying dimensions that can predict consumers’ perception of healthiness and willingness to use functional foods.

Because such foods are emerging products, especially in Tunisia where the study is lead and because there is still no general agreement on what the term functional foods covers (“a large variety of products have been included under this umbrella”, Menrad, 2003), exploratory research methods, projective techniques in particular were used as a first step to unravel this confusion.

The article is organized as follows. Section 2 provides a literature review of the concepts studied. Section 3 introduces the method background. Section 4 presents the results and discusses them and section 5 presents the conclusion and the implications for further research.


Sensory proprieties were the most used attributes to judge food quality for a long time.

However in response to increasing consumer and public health concerns about diet and health relationships, health influence on food choice has become a central issue in many studies. The aim of this literature review is to give a multidisciplinary overview of studies carried out on health dimension in food products and its perception from a consumer point of view. We start by presenting the healthiness as multidimensional attribute. Then we present healthiness as credence attribute inferred from intrinsic and extrinsic cues and perceived through personal characteristics.

Healthiness as multidimensional attribute The term of health has not the same definition from scientists and consumers point of view.

While the scientific definition includes physical, mental and social dimensions as it is shown in the World Health Organization definition: "Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity", the consumers define health through many dimensions which vary considerably, including overall balance, nutrient balance, low fat, weight control, naturalness, disease management and disease prevention (Falk et al., 2001).

Many studies have been conducted to examine the way consumers perceive health dimensions of food. Bech-Larsen (2001) used laddering method to investigate Danes consumer’s perception and motives for buying apples. The findings of the study show that according to the interviewed consumers, dimensions used to evaluate apples’ healthiness are “organic / not spread”, “vitamins” and “wholesome”. Using the same method, Nielsen, Bech-Larsen and Grunert (1998) reported that “content of unsaturated fat”, “content of cholesterol”, “naturalness” are the dimensions used by consumer to evaluate vegetable oil’s healthiness.

Roininen et al. (1999) adapted also laddering method to investigate the way Finnish consumers perceived the health aspects of food. The findings reveal that “naturalness”, “good fat quality”, “vitamin”, “mineral”, “fiber” and “low fat” were the most important dimensions.

Oakes and “Slotterback (2001) demonstrated that “natural/unprocessed”, “freshness”, “vitamin and mineral content”, “fat content”, “caloric content”, protein content” are the main characteristics used by American to evaluate food’s healthfulness. The same study reveals that “freshness” and “fat content” are by far the characteristics most frequently chosen and that “protein” and “vitamin/mineral content” are the characteristics least frequently chosen.

Moreover, according to the same authors, Americans aged between 14 and 64 use “freshness” rather than “fat content” when determining food healthfulness as “freshness” has overtaken fat content for American consumers.

In another study, Martinez-Gonzales et al., (2000) reported that dimensions of healthiness depend on the country of origin of consumers. While “fiber” and “low fat” are the characteristics most chosen to judge food’s healthiness in Central European countries, “balance” and “variety” are the most important characteristics in Mediterranean countries.

Similarly, for Dutch consumers, “natural, “fresh”, “nutritious”, unprocessed”, “vitamin” and “low fat” are the characteristics most frequently chosen (Sijtsema, 2003). More recently, Tudoran et al. (2009) used “naturalness” and “less fat” to measure perceived healthiness as they are the most common conceptualizations of product healthiness in literature.

Healthiness as invisible attribute inferred from intrinsic and extrinsic cues When consumer is facing an evaluation of the healthiness of a considered food, he cannot judge directly if it is healthy or not. There will be almost always resort to mental representations and particularly credence. That’s why Oude Ophuis and Van Trij (1995) considered health as credence quality attribute. For them, the consumer has to rely on the judgment or information of others to believe that the product contains such a quality attribute as there is no direct relation between consumption and effect. In other words, consumer cannot measure the long term effect of the product on his health. In the same way, Burns et al., (2002) used the term ‘invisible product characteristic’ when talking about healthiness of food and attested that health “must therefore be inferred from more concrete intrinsic and extrinsic cues”.

Intrinsic cues are related to the physical food product. They include appearance, color, structure, shape and size. According to Oude Ophuis and Van Trijp (1995), the relevance of this type of cues is easy to recognize particularly in the case of fresh food such as fruits, vegetables, meat and fish. Intrinsic cues influence considerably the perceived “freshness” of the food which represents a strong antecedent of the perceived healthiness. Healthiness of meat for example can be perceived through its freshness which is influenced by the color, the visible fat, the texture, and the cut of the meat (Acbrón and Topico, 1999).

Extrinsic cues such as price, brand, country of origin, store, nutritional information and production information may influence the perceived healthiness. Quite obviously, the most used extrinsic cue to influence health perception is nutritional information. Several studies have focused on the understanding and use of the nutritional information by consumer (e.g.

Bruck, Mitchell, and Staelin, 1984; Bech-Larsen, Grunert, & Poulsen, 2001; Wansik, 2003;

Drichoutis, Lazaridis, and Nayga, 2005, 2006) and the influence of such information on the attitudes, preferences and the intention to purchase food (e. g. Jensen, Kesavan, and Johnson, 1992; Mazis and Raymond, 1997; Roe, Levy and Derby, 1999; Wansik, 2003; Roossen, Marette, Blanchemanche and Verger, 2007; Verbeke et al., 2009). In all this studies, there is a general belief that health information increases the perception of food healthiness and produces more positive attitudes toward it.

Production information is another extrinsic cue that can influence the perceived healthiness because consumers have become more aware that production methods may have negative impacts on human health (Da Costa, Deliza, Rosenthal, Hedderly, and Frewer, 2001). For example, the information that the product is organic influences considerably its health value.

Studies demonstrated clearly that organic foods are perceived as being healthier than conventional foods and showed that positive health beliefs represent the strongest predictor of attitudes and purchase of organic foods (Ekelund, 1989; Sparks and Shepherd, 1992; Davies, Titterington and Cochrane, 1995; Wandel and Budge, 1997; Shifferstein and Oude Opuis, 1998).

Moreover, brand represents an important extrinsic cue that can also influence perceived healthiness. As it was stated by many authors (e. g. Steenkamp, 1990; Erdem and Swait, 1998; Brdahl, 2003; Warlop et al. 2005; ), when consumer is unable to make judgment on food quality, brand name often becomes an important substitute quality indicator which may influence consumer’s quality perception and food choice. This is particularly true in the case of judgment of the healthiness of food which is credence characteristic. Consumer cannot be sure that he will be healthier if he purchases and ingests a considered food. To reduce this uncertainty, he has to rely on information such as brand name to evaluate its healthiness.

Conscious of this statement, many agribusiness companies have reinforced the associations between their brand and certain quality attribute such as health to differentiate their offer. By an effective communication strategy which consists on strengthening the link between the name of their brand and health attribute, firms like Danone or Nestlé have constructed a “healthy” brand name.

Finally, price is according to Oude Ophuis and Van Trijp (1995) “the probably best known extrinsic indicator of quality”. Doods and Monroe (1985) confirm that when comparing two similar products, the higher-priced alternative is usually expected to be of better quality.

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