Key Stakeholder Perspectives on Introducing a Front-of-Package Labelling Scheme on Package Foods in China: A Qualitative Study

Abstract

Background: Front-of-pack (FoP) labelling on foods is recommended by the World Health Organization (WHO) to address the growing global burden of diet-related non-communicable diseases, but this policy has not yet been implemented in China. The aim of this study was to ascertain key stakeholders’ views on the need for a FoP labelling scheme and understand barriers and facilitators to developing a feasible and acceptable FoP labelling policy in the Chinese context. Methods: Semi-structured interviews were used to elicit opinions about introducing FoP labelling in China from diverse representatives in roles of FoP labelling policy influence. Participants were identified by purposive and snowball sampling. The Consolidated Framework for Implementation Research (CFIR) was adopted to facilitate data collection and analysis. Interview recordings were transcribed verbatim and coded in NVivo 12. Themes and subthemes were generated using deductive and inductive approaches. Findings: Thirty participants were interviewed, representing government agencies (n=5), technical support agencies (n=8), professional associations (n=3), the food industry (n=7), the mass media (n=3), and consumer groups (n=4). Barriers and facilitators were identified across CFIR domains. The major barriers to FoP labelling development were the absence of national contextual analysis, perceived complexity of the process of policy development, disagreement on a preferred FoP labelling format, cost for the food industry, low priority compared to food safety policies, lack of existing regulatory framework or authorized nutrient profiling system, limited knowledge of FOP labelling, and the lack of planning and engagement with stakeholders. Facilitators included existing mandatory nutrient declarations on the back of food packages as a prerequisite for FoP labelling, experiences and lessons learned from piloting the “Healthier Choice” and “Smart Choice” logos, policy coherence with Healthy China 2030, and support from external agents (e.g., WHO). Interpretation: Although there is growing interest in FoP labelling in China, further efforts are required to develop and collate evidence to demonstrate the scientific, legal, and political feasibility of introducing effective FoP labelling. Facilitators and barriers identified in the study can potentially inform key considerations and steps to build support among stakeholders and contribute to the development of a FoP labelling scheme in China. Funding: The study was financed in part by WHO China Representative Office. The views expressed in this report are those of the authors and do not necessarily reflect the views or position of WHO. Declaration of Interest: None to declare. Ethical Approval: Ethical approval was received from the Chinese Centres for Disease Control and Prevention (Approval No.: 202024).