Challenges in Understanding Health Food Labels in Japan

In Japan, there are many self-care products, particularly health foods. However, not all the information available about these products is correct or reliable. This can mislead consumers and might lead to poor health choices or unsafe use of the products.

A survey conducted in 2016 found that only a small number of people, about 16%, clearly understood the qualities of foods that have health claims. Another survey showed that some health food users, around 17%, reported feeling unwell after using these products. A tragic incident occurred in March 2024 when five people were poisoned by a health food made with a fermented rice product. While this was likely due to contamination, it highlighted the difficulties that consumers face in verifying the safety of these products, which are widely available. Therefore, it is very important to provide clear and simple information to help consumers make safe choices.

A study comparing consumer health literacy in Japan and Europe showed that a significant number of people struggle with understanding food labels. This gap in health knowledge between professionals and consumers shows that it is very important to create a communication system that meets the needs of consumers.

Previous research has looked into how well consumers understand nutrition facts and food labels. Some studies used online surveys, while others focused on how health claims influence consumer behavior. However, much of this research did not specifically focus on food with health claims. While there have been surveys in Japan on consumer awareness regarding foods with health claims, there has been no direct assessment of how providers and consumers view food labeling.

Currently, Japan lacks a system to assess how easy it is for consumers to use health information materials. To improve these materials, it is essential to evaluate information from both the providers’ and the users’ perspectives. A previous study created a usefulness evaluation index for labeling health foods from the perspective of healthcare professionals. This study aimed to assess food labeling from the viewpoint of consumers. Along with testing user comprehension, interviews were conducted to better understand consumer feedback. This combination of methods is a first step in examining how people understand health information related to foods with health claims.

#Labeling of Foods with Health Claims in Japan

In April 2015, a law called the Health Promotion Law was introduced to help people use health foods appropriately. This law created a system for Foods with Health Claims, which includes Foods for Specified Health Uses (FOSHU), Foods with Nutrient Function Claims, and Foods with Function Claims (FFC). FOSHU products must undergo strict reviews for safety and effectiveness, whereas FFC products can use scientific evidence to make claims, but the onus is on the manufacturers to ensure safety.

As of October 2023, there were over 7,500 notified FFC products in Japan, while over 1,000 FOSHU products had received approval. Labels for FFC must include 16 specific items such as the product name, storage method, expiration date, ingredients, and more. However, in practice, the arrangement, font size, and placement of this information can differ from the guidelines provided by authorities.

#Evaluation of FFC Labeling

Clear labeling is essential so that consumers with different levels of health knowledge can easily understand the information. In recent years, organizations in Europe and the United States have introduced standards for making Health Communication more straightforward for consumers. Tools like the Clear Communication Index have been developed to help evaluate public communication materials effectively.

Using a similar approach, a group of university staff members created their version of the Clear Communication Index to evaluate FFC labeling. They examined five FFC products and found that none met the set criteria for user-friendly communication. Many products used complex language, and important information was often hidden in less visible parts of the label.

To fully understand how consumers engage with FFC labeling, it is important to assess the labeling from the user’s standpoint. User Testing helps determine whether individuals can quickly find and comprehend the provided information. This method is widely used to evaluate various consumer health materials.

In Japan, initial user testing has been conducted on prescription drug information labels. This study further extends user testing to evaluate understanding of FFC labels through interviews with participants. During the testing, participants were asked questions related to the labeling to gauge their understanding.

#Methodology for User Testing

To assess a range of FFC products, specific search terms related to health concerns that affect middle-aged and older adults were used. After reviewing around 100 different labels, five products were selected for user testing. Each product had distinct claims about its health benefits.

Participants for the user testing were recruited with clear criteria to ensure diverse representation. Individuals aged 30 to 70 were included, and at least four individuals from each gender were represented. Since the aim was to gather genuine feedback, people with health profession backgrounds or experience with the tested FFC products were excluded.

The user-testing process involved crafting a protocol and preparing specific questions for each product. Interviewers underwent training to ensure consistency in their approach. A pilot test refined the questions and procedures before the main user testing began. The testing was structured to allow participants to respond in a comfortable environment.

Participants answered questions regarding the labeling, and their ability to locate and understand the information was measured. They were also asked to restate the information in their own words, allowing for assessment of their understanding.

#Results of the User Testing

When evaluating the FFC labels using a two-minute response time, only one product met the set threshold for all questions. However, in general, the results were relatively positive. Most products performed well, but one product showed poor results likely due to its small font size.

The testing results indicated challenges in comprehension across different products, especially with certain questions related to medication interactions. When questions were assessed using a one-minute cut-off, performance declined significantly, with no products meeting the 90% understanding criterion.

Comments from participants revealed a lack of knowledge about FFC and confusion about the differences between it and other health food categories. Many participants found technical terms used on the labels difficult to understand. For example, statements about whom the product is not intended for were confusing.

#Comparison of Current and Revised Labeling

Feedback from user testing showed that the existing wording on FFC labels was often unclear. In response, a revised version of the labeling was developed to enhance understanding. Participants were asked to compare the current labels with this revised version, and the revised labels received higher ratings across various aspects, from size and legibility to usefulness of the information.

This study highlights the need for improved labeling standards in Japan, particularly since many consumers do not have a strong understanding of FFC. It suggests that clearer and more accessible information should be provided to ensure that consumers can make safe and informed choices about their health options.

#Moving Forward

The findings of this study reveal that consumers struggle to find and understand important information on the current FFC labeling. It's crucial that key information, especially regarding safe use, is presented clearly.

Both provider and user perspectives must be considered when creating and evaluating health food labeling. There is a strong need for integrated methods to assess how useful these labels are, as they play a vital role in helping consumers make safer choices about health food products.

This research is a first step toward improving health communication in Japan. Ongoing efforts should focus on developing better practices for creating informational materials that are clear and easy to understand for all consumers, particularly in the context of health foods with claims.