Journal of Sustainable Marketing

The effect of health consciousness

Health consciousness can be defined as “the extent to which an individual is aware of the influence of lifestyle on health” (Lee, Conklin, Cranage, & Lee.,2014, p.31). Extensive research has studied the effects of health consciousness on food-related attitudes and behaviors (see Table 1). According to these studies, health conscious consumers hold positive attitudes toward organic food (Büyükayman, Shaheen, & Ossom, 2022; Chen, 2009; Nagaraj, 2021), eco-friendly furniture (Xu, Wang, & Yu, 2020), functional food (Žeželj, Milošević, Stojanović, & Ognjanov, 2012), and natural food (Talwar et al., 2021). They also are satisfied with the quality of restaurants serving healthy food, want to revisit these restaurants, and to talk positively about them (Jin, Line, & Lee, 2017). Additional studies have shown that health-conscious consumers have a high intention to buy organic food (Nagaraj, 2021) and eco-friendly furniture (Xu et al., 2020). They are also willing to pay a premium at an eco-friendly restaurant (Nicolau, Guix, Hernandez-Maskivker, & Molenkamp, 2020). Health conscious consumers seek information about and purchase natural beauty products regularly (Kim & Seock, 2009).

Past research has also examined the effect of health consciousness on the consumption of PBMA. Hartmann, Ruby, Schmidt, and Siegrist (2018) found that participants consider consumers of insect and vegetarian food products to be more health conscious than meat consumers. Two additional studies agree that compared to meat consumers, vegetarians and consumers consuming PBMA are more aware of the impact of lifestyle on health (Hoek, Luning, Stafleu, & Graaf, 2004; Vainio, Niva, Jallinoja, & Latvala, 2016). A more recent study also found a positive correlation between health consciousness and consumption of PBMA (Siegrist & Hartmann, 2019). Additional studies have found a positive relationship between health consciousness and consumer awareness of certain foods. Consumers who care about health are aware of the ingredients of functional products (Bornkessel et al., 2014) and food safety regulations (Gedikoğlu & Gedikoğlu, 2021). The findings of these two studies suggest a possible link between health consciousness and awareness of PBMA. Nevertheless, prior research does not appear to have tested such an effect. Studying this relationship could help us better understand how consumers’ concerns about health impact awareness of a novel category of sustainable products (i.e., PBMA).

Consumer awareness can be defined as "consumers’ understanding and recognition of a product" (Li et al., 2022). Marsall et al. (2021) predict that higher levels of concern about health will be associated with higher levels of health literacy (i.e., being aware of treatments of illnesses that concern them). Health conscious consumers are prone to evaluate their health in greater detail and seek out health information from a variety of sources to determine their current state of health (Marsall et al., 2021). Hence, we propose that health-conscious consumers are likely to be more aware of PBMA. When consumers are concerned about the impact of their lifestyle and food choices on their health, they may be aware of the need to reduce meat consumption. They may be more aware of meal alternatives, such as PBMA available on the market. As such, our first hypothesis states:

H1. Health consciousness has a positive effect on awareness of PBMA.

The effect of awareness of PBMA and attitudes toward buying these products

Consumers who aware of a given product can explain what it means and recognize it among other products (Li, Wang, Li, & Liao, 2021). Consumer awareness is the first stage in considering a product, followed by knowledge, which may lead to a purchase or usage (Rayne, Leckie, & McDonald, 2020; Shaikh, Alharthi, & Alamoudi, 2020; Zandstra, Lion, & Newson, 2016). Communication campaigns and media are essential in making consumers aware of the availability and features of a product (Barroso & Llobet, 2012; Zandstra et al., 2016). Awareness implies knowing that a product exists (e.g., in supermarkets and grocery stores), while knowledge refers to what or how much consumers know about this product (Park, Mothersbaugh, & Feick, 1994; Shaikh et al., 2020). Dickinson and Shaver (1982) consider awareness a means for consumers to defend their rights. Consumers who are aware of a product’s features, laws, and means of recourse can solve problems affecting their level of satisfaction. For example, they can request the correction of a billing error on their account. Consumer awareness is therefore a precondition for acquiring knowledge of a product (Bornkessel et al., 2014; Rayne et al., 2020). 

The transtheoretical behavior change model posits that behavioral change is a process unfolding over time (Norcross et al., 2011; Prochaska & Diclemente, 1983). This process involves moving through five stages (i.e., precontemplation, contemplation, preparation, action, and maintenance). In the precontemplation stage, individuals are unaware of their problem while their relatives are. In the contemplation stage, individuals are aware of their problem and consider changing their behavior. However, they have difficulty committing and acting. In the preparation stage, individuals expect to act in the next month and adopt slight changes in their behavior. In the action stage, individuals modify their behavior, experience, and environment to overcome the problem. Action involves making drastic changes and requires investing time and energy. Individuals reach this stage when they have modified their behavior for 1-6 months. Finally, in the maintenance stage, individuals struggle to maintain the gains achieved through behavior change. 

Awareness-raising is necessary to progress from precontemplation and contemplation to preparation (Norcross et al., 2011; Prochaska & Diclemente, 1983). When individuals realize they are doing something wrong, they assess the benefits of changing their behavior and think about making small adjustments to their behavior. Subsequently, they are ready to change their behavior, but should struggle to avoid relapse. If individuals are not aware of the advantages of changing their behavior, this change will be temporary. Previous studies in the food domain have shown a positive relationship between awareness of foods and attitudes toward them. Huang, Qiu, Bai, and Pray (2006) found that consumers who had heard of genetically modified foods reported a more favorable attitude toward these products than consumers who had not heard of them. Carfora, Morandi, and Catellani (2022) found that participants’ attitudes toward eating PBMA were directly influenced by their awareness of the environmental effects of meat production. Hence, we propose that the more consumers are aware of PBMA, the more they accept the idea of buying these products. Once they are aware of the existence of the products (e.g., having seen the products in the supermarket or having heard about them), they recognize the advantages of consuming them (e.g., reducing meat consumption). We thus formulate the following hypothesis:

H2. Awareness of PBMA has a positive effect on attitudes toward buying these products.

(Nystrand & Olsen, 2020) found that more positive attitudes toward functional products are associated with increased consumer intentions to buy such products. These findings coincide with knowledge-attitude theory’s (Kallgren & Wood, 1986) postulate that attitudes can guide individuals’ behavioral responses. Consequently, we propose that the more consumers perceive the purchase of PBMA as positive, the more they are willing to consume them. We thus formulate the following hypothesis:

H3. Attitudes toward buying PBMA have a positive effect on willingness to eat these products.

Several studies suggest that consumer awareness is a necessary condition for the development and growth of a market as it influences purchase intention and willingness to pay. Two studies found that consumers who are aware of the availability of organic products and understand their characteristics are more likely to purchase them (Briz & Ward, 2009) and to pay a premium (Li et al., 2022). Two studies also showed that consumers who are aware of environmental certifications are more willing to pay for a certified versus non-certified food product (Aprile & Punzo, 2022; Valenciano-Salazar, André, & Soliño, 2021). Another study found that the more consumers understand the benefits of remanufactured products, the more they are willing to buy them (Silva, Wang, & Kuah, 2021). Bi (2019) found that customers are more inclined to choose a given service provider when they are aware of efforts made by the company to build an online community. A more recent study found that consumers who are aware of the environmental impact of meat consumption are capable of progressing from not having the intention to reduce meat consumption to consider eating less meat (Hielkema & Lund, 2021). The findings of the aforementioned studies are in line with the transtheoretical model of behavioral change (Norcross et al., 2011; Prochaska & Diclemente, 1983). As discussed, this model posits that awareness-raising is a necessary condition for behavioral change. Hence, we propose that the more consumers are aware of the existence of PBMA, the greater their willingness to purchase these products. Once consumers are aware of the availability of the products and understand their benefits, they are better able to accept them and contemplate eating them. We thus formulate the following hypothesis:

H4. Awareness of PBMA has a positive effect on willingness to eat these products.

The sequential mediating effect of awareness of PBMA and attitudes toward buying these products

Given the theoretical basis of our previous hypotheses, we further expect that the relationship between health consciousness and willingness to eat PBMA is sequentially mediated by awareness of and attitudes toward PBMA. When consumers are concerned about the impact of their lifestyle and food choices on their health, they may be aware of the need to reduce meat consumption. Consequently, they may seek to inform themselves about the alternatives available on the market to replace meat, such as PBMA (Kemper, 2020). Such information may increase their awareness of and positive attitudes toward PBMA and, as a result, willingness to consume such meat alternatives. H5 formalizes our prediction of sequential mediation:

H5. Awareness of PBMA and attitudes toward buying PBMA sequentially mediate the effect of health consciousness on willingness to eat these products.

Data collection and sample

Three-hundred and seventeen participants, who received a small monetary compensation for answering our online survey, took part in this study. We defined the sample size by applying the ’10 times rule,’ which is based on the assumption the size of the sample should be 10 times the maximum number of paths hypothesized in a structural model (Hair, Hair, Hult, Ringle, & Sarstedt, 2017). The survey first asked respondents their opinions about meat substitutes like steaks, sausages, and cutlets made with cereals or vegetables. These examples were given to make it clear that we were referring to processed food products made from vegetable proteins. Most respondents indicated that they had eaten meat substitutes (61.5%). Among these consumers, 24.1% reported eating tofu, tempeh, seitan or vegetable-based patties (i.e., traditional PBMA), while 2.6% had eaten texturized soy-based products (i.e., first generation PBMA), and 78.5% had consumed products such as meat-like textured burger patties and sausages (i.e., second generation PBMA). A small minority of consumers claimed to have eaten lentils and beans (7.7%) and seaweed (0.5%). Several national and private label brands (e.g., Sojasun, Bjorg, Herta, Céréal Bio, Jardin Bio, Beyond Meat, Beyond Burger, and Carrefour Veggie) were mentioned by 7.2% of consumers. Then, respondents rated their awareness of, attitudes toward buying, and willingness to eat PBMA. A fourth scale measured consumers’ health consciousness. Finally, respondents provided socio-demographic data (see Table 2; 49.5% female and 39.4% between ‘25-39 years’). We opted for a cross-sectional research design to facilitate examination of a model that explored the relationship between health consciousness, two sequential mediators, and willingness to eat PBMA while ruling out potential alternative explanations (Spector, 2019). We recruited participants from the Foule Factory panel, and screened all the responses to increase the reliability of our data (Chmielewski & Kucker, 2020).

Measurement scales

We measured all constructs using 5-point Likert scales (1 = strongly disagree to 5 = strongly agree). We used two items to measure willingness to eat PBMA (Tan, Fischer, Trijp, & Stieger, 2016; Wilks, Phillips, Fielding, & Hornsey, 2019). Awareness of PBMA was measured using two items (Verbeke, Sans, & Loo, 2015). A three-item scale measured attitudes toward buying PBMA (Koklic, Golob, Podnar, & Zabkar, 2019). A scale used byOphuis (1989) and Sakib et al. (2020) gauged health consciousness as it demonstrated reliability and validity in both studies. The items were translated from English into French and then back-translated by another person to ensure a consistent translation. Table 3 presents the measurement scales.

Common method variance

We tested the constructs for common method bias (CMB) by applying two different techniques, (Kock, 2015). First, we ran a single-factor test (Harman, 1976). The results showed the unrotated solution with all items included produced one factor accounting for 38.50% of the variance (KMO = 0.84; Bartlett’s test p < 0.001; number of factors extracted = 1). Then, we ran a common latent factor test, which consists of adding a latent variable modeled to be measured by all items (Podsakoff, Mackenzie, Lee, & Podsakoff, 2003). The results showed the common variance, estimated as the square of the common factor of each path before standardization, was equal to 10.89%. Both tests indicated that CMB bias did not have a meaningful impact on the study results.

Measurement model assessment

We tested the validity and reliability of the measurement instruments. Item AT2 and HC1 were removed because of collinearity issues (VIF > 5) and non-significant standardized loading respectively. Item HC4 was also removed because we could not achieve adequate fit via modification indices and standardized residual covariance was above the threshold of 2.58 recommended by Jöreskog and Sörbom (1995). Constructs reflecting the remaining measured items showed adequate reliability (Table 3). Cronbach alphas and composite reliability coefficients were above the threshold of 0.7 (Hair et al., 2017). The measures showed convergent and discriminant validity (Fornell & Larcker, 1981). The average variance extracted of each construct was above the threshold of 0.5. AVE values were higher than the $R^2$ observed for the relationships between the constructs, which provided evidence of discriminant validity (Table 4). Assessment of the cross-loadings (Table 5) also confirmed the discriminant validity of the constructs (Hair, Sarstedt, Hopkins, & Kuppelwieser, 2014).

Model and direct hypothesis testing

Confirmatory factor analysis using the package ‘Lavaan’ in R (Rosseel, 2012) indicated that the hypothesized structural model fit the data well ( $x^2$ = 54.218, df = 23, p = < 0.001; RMSEA = 0.065; CFI = 0.980; TLI = 0.969; χ/df = 2.357). We compared the hypothesized model (M1) to an alternative model that included two additional relationships (M2). In M2, health consciousness was related to attitudes toward buying PBMA and willingness to eat ( $x^2$ = 52.407, df = 21, p < 0.001; RMSEA = 0.069; CFI = 0.980; TLI = 0.966; χ/df = 2.495). A chi-square difference test did not indicate a better fit for any of the models (∆χ/df = 1.8114/5, p = 0.404). However, the values of the AIC and BIC showed a better fit of M1 (AIC = 7132.2; BIC = 7214.9) compared to M2 (AIC = 7134.4; BIC = 7224.6).

After validating the model, we tested the research hypotheses. We tested direct effects using SMARTPLS 4. This solution is suitable for testing structural equation models on small-size samples, and as in our situation, data that are not normally distributed (Hair, Ringle, & Sarstedt, 2011). As Figure 2 shows, the results supported all five hypotheses. Health consciousness had a direct positive effect on awareness of PBMA (ß = 0.173; p < 0.010), in support of H1. Awareness of PBMA had a direct positive effect on attitude toward buying PBMA (ß = 0.294; p < 0.001), in support of H2. Awareness of PBMA had a direct positive effect on willingness to eat these products (ß = 0.115; p < 0.005), supporting H4. The findings also showed attitudes toward buying PBMA had a direct positive effect on willingness to eat these products (ß = 0.758; p < 0.001), which supported H3.

Mediation hypothesis testing

We tested simple and sequential mediation effects using Hayes PROCESS macro (2018). We ran Model 6 with parameter estimates based on 10,000 bootstrap samples. The predictor variable for the analysis was health consciousness (HC). The mediators for the analysis were awareness of PBMA (AW) followed by attitude toward buying PBMA (AT). The outcome variable was willingness to eat PBMA (WT), and the covariates were gender and age.

We identified the indirect effects of health consciousness on willingness to eat by using letters (see Figure 2 ). We examined the role of the first mediator (i.e., awareness). We found a positive indirect effect of awareness on the link between health consciousness and willingness to eat $\left(a x b=.031\right)$ . This effect was significant as zero did not fall in the 95% confidence interval [.009 to .059]. In the indirect path, a unit increase in health consciousness increased subjective knowledge by .284 units ( $a$ , 95% CI [.177 to .390]), on a 0 to 1 scale. Holding constant health consciousness, a unit increase in awareness increased willingness to eat by .111 units ( $b,$ 95% CI [.039 to .183]). On the contrary, the direct effect of health consciousness on willingness to eat was not significant (c = .048, CI 95% [-.018 to .116]). As the indirect effect was significant but the direct effect was not, the results showed an indirect-only mediation (Zhao, Lynch, & Chen, 2010).

Finally, we assessed the effect of both mediators. We found a positive sequential mediation effect of awareness and attitude toward buying the products on the link between health consciousness and willingness to eat $\left(a x d x e=.074\right)$ . This effect was significant as zero did not fall in the 95% confidence interval [.042 to .113], supporting H5. In the indirect path, a unit increase in health consciousness increased awareness by .284 units ( $a$ , 95% CI [.177 to .390]). Holding constant health consciousness, a unit increase in awareness increased attitude by .351 units ( $d,$ 95% CI [.243 to .459]), which unitary increase strengthened willingness to eat by .749 units ( $e,$ 95% CI [.679 to .819]). Rather than being direct, the effect of health consciousness on willingness to eat was indirect only. Finally, neither gender or age had a significant effect on the hypothesized relationships.

Theoretical contributions

The present research makes two contributions to the literature on PBMA. First, it provides a better understanding of health-conscious consumers by revealing a positive effect of health consciousness on awareness of PBMA. These results add to previous literature that had shown health-conscious consumers are aware of functional food ingredients and food safety regulations (Aprile & Punzo, 2022; Valenciano-Salazar et al., 2021). The results suggest that the more consumers care about their health, the more they are likely to be aware of PBMA as they may seek information about the composition and benefits of consuming such products. Health-conscious consumers may be receptive to communication campaigns by companies promoting PBMA, as they need to gain enough understanding to contemplate consuming the products.

Second, this research highlights the importance of awareness of PBMA in the consumption of these products. While prior research had examined the effect of environmental awareness on the consumption of PBMA (Carfora et al., 2022; Hielkema & Lund, 2021), this research studied a different form of awareness, that is product awareness. The results showed that awareness of PBMA mediated the effect of health consciousness on willingness to eat PBMA. They also showed its positive effect on attitudes toward buying the PBMA and willingness to eat them. The results indicate that health-conscious consumers should be made aware of PBMA. Learning about PBMA may encourage some health-conscious consumers to try the products, whereas others may want to assess their benefits first. Additionally, our findings indicate that awareness of PBMA and attitudes toward their purchase sequentially mediated the association between health consciousness and willingness to eat PBM. By creating awareness about PBMA benefits, health-conscious consumers can be encouraged to develop positive attitudes and become willing to eat them. Together, these results correspond to the transtheoretical model of behavioral change (Norcross et al., 2011; Prochaska & Diclemente, 1983), which highlights the role of awareness in shaping attitudes and behavioral change, and facilitate extension of this theory to the context of PBMA consumption. Our study adds to the research on how consumer consciousness affects behavior, as requested by Williams and Poehlman (2017).

Managerial implications

We address some recommendations for companies (e.g., producers, retailers, and restaurants) to develop a long-term communication strategy to raise consumer awareness on PBMA. Companies are advised to promote PBMA as food products compatible with basic foodstuffs (e.g., bread, butter, and pasta) and easy to cook. Product packaging and restaurant menus should emphasize those attributes.The exact composition of the products should be better highlighted on the packaging to give a ‘value’ of proof to advertising claims. The packaging should display photos of the products accompanied by other everyday foodstuffs. Providing consumers with additional information complementing information from the packaging could encourage them to feel positive about PBMA and try them (Martin et al., 2021).

Companies may also use online (e.g., social media, internet websites) and offline channels (e.g., magazine ads, television ads) to promote PMBA. The messages should emphasize the experiential benefits of PBMA, like the joy of discovering new flavors and savoring plant-based foods. One idea could be to make a social media campaign that shows viewers different plant-based foods from around the world. Consumers reactions (i.e., attitudes and purchase intention) are more favorable when they are exposed to messages using figurative rather than literal language to describe the benefits of a product (Polyorat, Alden, & Kim, 2007; Ye & Mattila, 2021).

Retailers may want to organize events such as cooking classes with chefs who specialize in alternative protein. Chefs should choose simple recipes that look good and use PBMA with basic ingredients and sauces to enhance flavor (Michel, Hartmann, & Siegrist, 2021). Popular dishes like plant-based burgers, tacos, or pasta dishes could be considered. Small portions of the finished dishes could encourage consumer try PBMA. Customers may also get recipe cards and coupons for discounts to reproduce the dishes and share them with others.

Main conclusions of the study

We studied the role of health consciousness in the consumption of PBMA. We conducted a literature review and applied two theories (the health consciousness model;Marsall, Engelmann, Skoda, Teufel, & Bäuerle, 2021) and (the transtheoretical model of behavioral change; Norcross, Krebs, & Prochaska, 2011; Prochaska & Diclemente, 1983). We conducted a cross-sectional study among a sample of 317 consumers in France. The findings revealed that awareness of PBMA mediated the link between health consciousness and willingness to eat the products. This link was also sequentially mediated by awareness of PBMA and attitudes toward buying them. Health-conscious consumers may require additional information (e.g., composition, health effects) to hold positive attitudes toward buying this novel category of products and contemplate eating them. Awareness of the products’ benefits and characteristics reduces consumers’ uncertainty about the outcomes of the consumption experience (e.g., unnatural taste and texture) and enhances their attitudes toward buying the products and willingness to eat them. We thus provide, for the first time, empirical evidence of the significance of this effect in the context of PBMA. Companies should market PBMA as easy-to-use and compatible with basic foods. They should also increase awareness through long-term communication campaigns emphasizing the experiential value of PBMA, and cooking events and tastings.

Limitations and avenues for further research

Like all research, our work has certain limits. We conducted a cross-sectional study to understand the relationship between health consciousness, awareness of PBMA, attitudes toward buying PBMA, and intention to eat them. We focused on variables related to the individual. However, food consumption and food choice also depend on product attributes (i.e., product naturalness, quality, and price fairness), social eating norms, and situational factors (i.e., product availability; Konuk, 2019; Mancini, Marchini, & Simeone, 2017; Salmivaara, Lombardini, & Lankoski, 2021 ). We can learn more about how health awareness and attitudes towards PBMA affect people’s willingness to eat through a study including moderating variables. Additionally, we concentrated on personal factors that positively influence PBMA. Extensive research shows food neophobia and disgust also represent barriers to the consumption of PBMA (Onwezen et al., 2021). Studying the interaction between the tendency to avoid new foods and health consciousness could help us provide additional insights for companies to target consumers who are reluctant to try new foods. Finally, the relationships in the model could be conditioned by the type of PBMA consumed by the respondents. Additional data is required to compare the responses of individuals eating traditional PBMA and those eating first- and second-generation PBMA.

Future studies could explore the effect of the eating behavior of socially connected peers on the consumption of PBMA and product characteristics like perceived naturalness, quality, and price fairness. They could shed light on the situational and product-related factors that better predict purchase intention and intake of PBMA. Based on a well-being perspective (Wünderlich et al., 2021), further studies could also explore how the interaction with animals and attitudes toward them influence the consumption of PBMA. It could also be interesting to study the role of health consciousness in the consumption of PBMA in developing countries, determine to what extent this variable influences the consumption of these products in less mature markets, and test the generalizability of the results. Finally, other studies could investigate the barriers to the consumption of PBMA. For instance, they could explore the effect of perceived health risks and distrust in food technology (Weinrich, 2018), factors highlighted by consumers aiming to either reduce the consumption of meat or avoid it.