Understanding consumer response to front-of-package labeling: Insights from a nationwide survey in Sri Lanka

Background: Non-communicable diseases are a leading cause of mortality globally, with unhealthy diets being a significant risk factor. Front-of-package labelling, particularly the traffic light system, has been proposed as a public health intervention to promote healthier dietary choices. This study investigated consumer awareness, understanding, and response to the traffic light system in Sri Lanka, where non-communicable diseases account for 83% of deaths. Methods: This descriptive cross-sectional study was conducted from November 2022 to April 2023 and involved 2,569 participants from 25 districts in Sri Lanka. Multistage cluster sampling was performed to ensure the representativeness of the sample. Data were collected via a self-administered online questionnaire in Sinhala, English, and Tamil, which assessed sociodemographic factors, knowledge, attitudes, and purchasing behaviours related to the traffic light system. Ordinal regression analysis was used to identify the factors influencing adherence to traffic-light system practices. Results: The study revealed a high awareness of the traffic light system, with 89.8% of the participants recognising the labelling system. Over 80% of the participants correctly identified the colour codes (red, amber, and green) associated with high, medium, and low levels of sugar, salt, and fat. The participants expressed satisfaction with the clarity, adequacy, and helpfulness of the traffic-light system information. Ordinal regression analysis indicated that Sinhalese ethnicity, age ≥ 30 years, higher household income (> Rs. 50,000), and higher education levels were positively associated with adherence to the traffic light system best practices. Positive attitudes toward and good knowledge of the traffic light system significantly influenced purchasing behaviour. Conclusions: These findings suggest that the traffic light system is an effective tool for guiding healthier food choices among Sri Lankan consumers. However, targeted educational campaigns are needed to address knowledge gaps, particularly among older, lower-income, and less-educated populations. Continuous evaluation and refinement of the traffic light system are recommended to maintain its efficacy and relevance in promoting public health.