Fortification of selected foodstuffs with folic acid in the UK: consumer research carried out to inform policy recommendations.
BACKGROUND
The UK Food Standards Agency Board identified four options to increase folate intake in women of reproductive age in order to reduce the risk of neural tube defect (NTD) affected pregnancies; these ranged from continuing with current policy, to mandatory fortification of bread or flour with folic acid. In order to appraise these options, the agency carried out a consultation, and also commissioned four pieces of research. This paper provides detailed information about two of the research studies, which used qualitative research approaches to gather consumer evidence.


METHODS
Study 1: This was carried out with people from a wide range of demographic backgrounds. A 'reconvened group' methodology was used, with five groups convened twice, in five geographical locations. In addition paired, in depth face-to-face interviews were conducted with female black and ethnic minority consumers. Study 2: This was carried out with young mothers living in deprived communities. The approach used for this study was in depth face-to-face interviews (n = 24). In addition, discussions were held in seven friendship groups.


RESULTS
Study 1: only a minority of participants knew about a link between spina bifida and folic acid, and these tended to be women with young families. After the provision of some information about the causes and impacts of NTDs, the majority were in favour of action to tackle the issue. Support for mandatory fortification increased considerably during the study, and at the final discussion, this option was most preferred. Study 2: In this group, there was a fatalistic approach to pregnancy and to health. The women were less likely to change established habits if this required effort, money or doing something unfamiliar. They tended to actively avoid thinking about risks, by rationalizing them. Mandatory fortification was preferred by the majority of respondents.


CONCLUSIONS
In this research, mandatory fortification was the preferred option. There were outstanding concerns about risk, and the maintenance of consumer choice, which would need to be addressed in policy recommendations.
Tedstone
Alison
A
Food Standards Agency, Aviation House, 125 Kingsway, London WC2B 6NH, UK.
Browne
Mark
M
Harrop
Lynda
L
Vernon
Claire
C
Page
Victoria
V
Swindells
Jill
J
Hayward
Wendy
W
Croft
Jeannette
J
Harris
Freda
F
Stockley
Lynn
L
D003258:Consumer Behavior; D003255:Consumer Organizations; D003710:Demography; D005260:Female; D005492:Folic Acid; D005527:Food, Fortified; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D009436:Neural Tube Defects / Q000517:prevention & control*; D009752:Nutritional Status; D011634:Public Health; D016135:Spinal Dysraphism / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D006113:United Kingdom
D005492:Folic Acid