Consumer Understanding, Preferences, and Acceptance of Front-of-Pack Labels in Thailand: Foundational Evidence for Policy Development

Objective: This study aimed to assess the understanding, perceptions, and preferences of different front-of-pack labeling (FOPL) formats among Thai consumers. Design: We conducted a mixed-methods study comprising a cross-sectional online survey and semi-structured interviews between February -March 2022. The survey assessed comprehension and preferences for six FOPL formats (Guideline Daily Amounts (GDA), Healthier Choice logo (HCL), Warning Labels (WLs), Nutri-Score, Health Star Rating (HSR), and Traffic Light labels (TLL)). Quantitative data were analyzed using descriptive statistics, chi-square tests, and multiple logistic regression. Qualitative data underwent thematic analysis. Setting: Bangkok and metropolitan areas Participants: Thai residents aged 12-78 years (n=410) Results: While awareness of existing labels was high (GDA: 95.4%, HCL: 82.4%), only 23.9% regularly read GDA labels. WLs and Nutri-Score were the most effective at providing information to consumers in a format that translated into choosing healthier products. WLs demonstrated the highest effectiveness in guiding healthier choices. HCL received the highest agreement across multiple attributes, including packaging inclusion preference (59.8%), visibility (58.5%), and visual appeal (57.3%), although effectiveness was not tested. Qualitative findings revealed preferences for color-coded systems but identified barriers including time constraints, small font sizes, and difficulty interpreting numerical information. Conclusions: While interpretive labels, particularly warning labels, are most effective for guiding consumers to healthier choices, successful implementation requires consideration of both consumer preferences and real-world usage constraints. Findings support replacing the current GDA system with an interpretive design, accompanied by comprehensive public education campaigns. These results provide evidence-based recommendations for FOPL policy development in Thailand.