Barriers to Adopting a Plant-Based Diet in High-Income Countries: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Information Sources/Search Strategy
2.2. Eligibility Criteria
- Study population: included human adults aged 18 to 65 years old. Studies were excluded if participants had diabetes, cardiovascular disease, high blood pressure, or obesity.
- Study setting: studies set in HICs were included, whereas those set in low- and middle-income countries (LMICs) were excluded. These were excluded due to large discrepancies in dietary patterns in middle-income countries. For example, on average, high-income countries consume too much meat and dairy. However, in middle-income countries, there is a much wider variation in dietary patterns. For example, many in Latin America consume high amounts of meat, whilst others (often in Asia) consume less. Therefore, including these countries would have likely introduced too much heterogeneity into the results; however, it would be useful to examine these countries and their different barriers in the future.
- Exposure: studies that included a perceived barrier to adopting a PBD were included. An example is a financial barrier. Studies that included PBDs were used, and these could be diets considered flexitarian or plant-forward but exclude exclusively plant-based/vegan diets. This type of diet was excluded as evidence on sustainable and healthy diets, including the EAT-Lancet Commission, recommends shifts to diets low in animal-source foods as being attainable for large parts of the population rather than diets where these foods are completely absent.
- Outcome: due to the nature of this review, defined outcomes were not a necessary part of the inclusion and exclusion criteria.
- Study design: all study designs were eligible; these included qualitative, mixed methods, and quantitative studies, both observational and experimental.
- Year: studies conducted before 2000 were excluded; any studies that fit all other eligibility criteria conducted after 2000 were included. The cut-off point for analysis of studies was May 2022.
- Type of publication: publications that were reviewed and not from the original publication source, such as systematic reviews and grey literature, were excluded.
- Language: Studies were only included if they were written in English.
- Studies with a focus on only meat alternatives were excluded.
2.3. Screening
2.4. Data Extraction and Analysis
2.5. Quality Assessment
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Results of Individual Studies
3.4. Synthesised Results
3.4.1. Financial
3.4.2. Lack of Knowledge
3.4.3. Emotional
3.4.4. Health
3.4.5. Convenience
3.4.6. Social
3.4.7. Enjoyment of Meat
3.4.8. Environmental
3.4.9. Accessibility
3.4.10. Personal Ability
3.4.11. Media
3.5. Quality Appraisal
3.5.1. Risk of Bias Assessment Results
3.5.2. Certainty Assessment Results
4. Discussion
4.1. Summary of Key Findings
4.2. Interpretation of Results in the Context of Previous Research
4.3. Strengths and Limitations
4.3.1. Strengths
4.3.2. Limitations
4.4. Recommendations on How to Overcome the Most Important Barriers
4.5. Implications for Policy
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Author, Title, and Year | Study Geographical Setting | Study Population Sample Size, Age, Sex, and Social Position | Study Design | Study Outcome | Data Analysis Method |
---|---|---|---|---|---|
Barr and Chapman. Perceptions and practices of self-defined current vegetarian, former vegetarian, and non-vegetarian women (2002) [38]. | Canada | Total n = 193. Vegetarian n = 90; former vegetarian n = 35; non- vegetarian n = 68. Age: 18–50-year-olds. Females: n = 193. University graduates: 49.7%; students: 40.1%; employed: 73.2%. | Mixed methods. Cross-sectional survey; qualitative interviews with a subsample. | Dietary intake patterns and dietary change; Perception of meat and dairy products. | Group comparisons: One-way ANOVA. Continuous variables: Post hoc testing. Categorical variables: Chi-squared. |
Faber, Castellanos-Feijoo, Van de Sompel, Davydova and Perez-Cueto. Attitudes and knowledge towards plant-based diets of young adults across four European countries (exploratory survey) (2020) [39]. | Belgium, Denmark, the Netherlands, and Spain | Total n = 438. Belgium n = 110; Denmark n = 119; Netherlands n = 116; Spain n = 93. Age: 18–30 years. Females: 56–82% across countries. Males comprise 18–44% of the population overall across countries. | Quantitative cross-sectional study. | Awareness of plant-based diets- perception and attitudes; The appeal of diet terminology. | Differences among countries: Pearson’ s Chi-squared test. Proportions: Fisher’ s exact test. Continuous variables: Kruskal–Wallis test. To test the association between knowledge and attitudes towards PB, vegan, and vegetarian diet terms. Adjusted for age, sex, etc.: logical regression. |
Kemper. Motivations, barriers, and strategies for meat reduction at different family lifecycle stages (2020) [40]. | New Zealand | Total n = 36. Age: 18–60 years. Females: n = 32. Males: n = 4. | Qualitative research with the use of focus group interviews. | Motivations; Barriers; Strategies; Meat reduction. | Thematic analysis. |
Kemper and White. Young adults’ experiences with flexitarianism: The 4Cs (2021) [41]. | New Zealand | Total n = 23. Age: 18–35 years. Females: n = 17. Males: n = 6. Students: 100%. | Qualitative research with an exploratory approach using semi-structured interviews. | Lived experiences; Motivations; Strategies; Barriers; Meat reduction and transition to a flexitarian diet. | Thematic analysis. |
Lea, Crawford, and Worsley. Public views of the benefits and barriers to the consumption of a plant-based diet (2006) [42]. | Australia | Total n = 415. Age: 20–65 years. Females: 59.4%. Males: 40.6%. Employed full-time: 31.5%; employed part-time: 17.8%; unemployed: 2%. | Quantitative cross-sectional survey study design. | Perception and attitudes towards dietary intake/change; Barriers; Benefits. | Frequency of responses: Pearson’ s Chi-squared test (adjusted by sex, age, and university education). |
Lim, Okine, and Kershaw. Health- or environment-focused text messages as a potential strategy to increase plant-based eating among young adults: an exploratory study (2021) [43]. | The United States of America | Total n = 159. Age: 18–26 years. Females: n = 107. Males: n = 49. Other: n = 3. | Quantitative 8-week text message pre- and post-intervention. | Dietary beliefs, intentions, behaviour, and intake. | Participant’ s characteristics group comparisons: Chi-squared test. Explore the effect of the interventions on dietary predictors, intentions, and behaviours: Paired samples t-test, from baseline and post-intervention answers. Differences between group intervention: Independent samples t-test. |
Macdiarmid, Douglas, and Campbell. Eating like there’ s no tomorrow: public awareness of the environmental impact of food and reluctance to eat less meat as part of a sustainable diet (2016) [44]. | Scotland | Total n = 83. Age: 25–56 years. Females: n = 43. Males: n = 40. | Qualitative research with the use of focus group interviews. | Public awareness; Public willingness to make dietary changes; Meat reduction. | Thematic analysis. Exploring deprivation, sex or urban/rural differences in attitudes towards reducing meat consumption: Framework analysis. |
Makiniemi and Vainio. Barriers to climate-friendly food choices among young adults in Finland (2014) [45]. | Finland | Total n = 350. Mean age: 24. Females: n = 280. Males: n = 70. Students: 100%. | Quantitative cross-sectional, questionnaire study. | Perception and attitudes, and barriers toward dietary intake/change. | Differences in men and women for perceived barriers: t-test. The impact of perceived barriers on climate-friendly food choices: multiple regression analysis. The impact of perceived barriers on climate-friendly food choices: multiple regression analysis. |
Markowski and Roxburgh. “If I became a vegan, my family and friends would hate me:” Anticipating vegan stigma as a barrier to plant-based diets (2019) [46]. | The United States of America | Total n = 34. Females: n = 26. Males: n = 8. Students: 100%. | Qualitative interviews with the use of focus groups. | Individual perceptions; Stigmatisation; Barriers; Meat consumption. | Coding of transcripts. |
Von Essen. Young adults’ transition to a plant-based diet as a psychosomatic process: A psychoanalytically informed perspective (2021) [47]. | Sweden | Total n = 9. Age: 18–35 years. | Qualitative semi-structured interviews. | Individual perceptions; Dietary transition; Challenges. | Descriptive phenomenological psychological method. |
Barrier Identified | References of the Studies That Included Each Barrier |
---|---|
Financial | |
1. Perception of high prices for plant-based foods; | 40, 45 |
2. Cost. | 40 |
Lack of knowledge | |
3. Lack of information on knowing what to eat; | 39, 40, 42, 45, 46 |
4. Lack of familiarity with plant-based foods/diets; | 39, 40, 43, 46 |
5. Nutritional knowledge; | 38, 40, 44, 47 |
6. Believing eating patterns are trivial; | 44 |
7. Education; | 40, 42 |
8. Confusion surrounding the terms and definitions of plant-based diets. | 39, 41, 44, 46 |
Emotional | |
9. Distrust/mistrust in food systems and suppliers; | 40, 44, 45 |
10. Stigma; | 39, 41, 46 |
11. Food neophobia; | 42 |
12. Gender stereotypes; | 40, 42 |
13. Fear of judgement; | 41, 46 |
14. Powerlessness over food choices. | 41, 44, 45, 47 |
Health | |
15. Nutritional deficiencies; | 38, 42, 47 |
16. Nutritional intake/requirements; | 38, 40, 41, 42, 46, 47 |
17. Dietary diversity; | 38, 41 |
18. Anxiety with the worry of not consuming the necessary nutrients. | 38, 47 |
Convenience | |
19. Time; | 38, 40, 41, 45 |
20. Food preparation; | 38, 40 |
21. More energy and effort needed; | 40 |
22. Difficulties with creating plant-based meals. | 38, 40 |
Social | |
23. Fear of missing out/not following social norms; | 41, 45, 46 |
24. Lack of support/a support network; | 38, 46 |
25. Living situation; | 38, 41 |
26. Traditions; | 44 |
27. Family and friend expectations and pressures. | 38, 40, 46 |
Enjoyment of meat | |
28. Personal and family enjoyment; | 38, 39, 40 |
29. Resisting temptations; | 46 |
30. Cravings; | 40, 41, 44 |
31. Taste. | 38, 41, 42 |
Environmental | |
32. Scepticisms around the dietary impact; | 44, 45 |
33. Disbelief in climate change. | 44 |
Accessibility | |
34. Lack of options, especially when eating out; | 41, 44, 46 |
35. Lack of plant-based options to buy; | 41, 45 |
36. No autonomy/opportunity over food purchases. | 38, 41, 42, 47 |
Personal ability | |
37. Lack of confidence in cooking ability and preparing plant-based meals; | 41 |
38. Cooking ability; | 38, 41 |
39. Habit. | 40, 42, 44, 45, 47 |
Media | |
40. Advertisements promoting meat consumption. | 40 |
Study | Score | Grading |
---|---|---|
Kemper (2020) [40]. | 9 | High |
Kemper and White (2021) [41] . | 9 | High |
Macdiarmid, Douglas, and Campbell (2016) [44]. | 9 | High |
Markowski and Roxburgh (2019) [46]. | 7 | Moderate |
Essen (2021) [47]. | 7 | Moderate |
Barr and Chapman (2002) [38]. | 6 | Moderate |
Faber, Castellanos-Feijoo, Sompel, Davydova, and Perez-Cueto (2020) [39]. | 9 | High |
Lea, Crawford, and Worsley (2006) [42]. | 8 | High |
Makiniemi and Vainio (2014) [45]. | 5 | Low |
Lim, Okine, and Kershaw (2021) [43]. | + | Moderate |
Barriers Identified | Level of Certainty | Times Mentioned |
---|---|---|
1. Perception of high prices for plant-based foods | Moderate | 40, 45 |
2. Cost | Low | 40 |
3. Lack of information on knowing what to eat | Moderate | 39, 40, 42, 45, 46 |
4. Lack of familiarity with plant-based foods/diets | Moderate | 39, 40, 43, 46 |
5. Nutritional knowledge | Moderate | 38, 40, 44, 47 |
6. Believing eating patterns are trivial | Low | 44 |
7. Education | Moderate | 40, 42 |
8. Confusion surrounding the term and definitions of plant-based diets | Moderate | 39, 41, 44, 46 |
9. Distrust/mistrust in food systems and suppliers | Moderate | 40, 44, 45 |
10. Stigma | Moderate | 39, 41, 46 |
11. Food neophobia | Low | 42 |
12. Gender stereotypes | Moderate | 40, 42 |
13. Fear of judgement | Moderate | 41, 46 |
14. Powerlessness over food choices | Moderate | 41, 44, 45, 47 |
15. Nutritional deficiencies | Moderate | 38, 42, 47 |
16. Nutritional intake/requirements | High | 38, 40, 41, 42, 46, 47 |
17. Dietary diversity | Moderate | 38, 41 |
18. Anxiety with the worry of not consuming the necessary nutrients | Moderate | 38, 47 |
19. Time | Moderate | 38, 40, 41, 45 |
20. Food preparation | Moderate | 38, 40 |
21. More energy and effort needed | Low | 40 |
22. Difficulties with creating plant-based meals | Moderate | 38, 40 |
23. Fear of missing out/not following social norms | Moderate | 41, 45, 46 |
24. Lack of support/a support network | Moderate | 38, 46 |
25. Living situation | Moderate | 38, 41 |
26. Traditions | Low | 44 |
27. Family and friend expectations and pressures | Moderate | 38, 40, 46 |
28. Personal and family enjoyment | Moderate | 38, 39, 40 |
29. Resisting temptations | Low | 46 |
30. Cravings | Moderate | 40, 41, 44 |
31. Taste | Moderate | 38, 41, 42 |
32. Scepticisms around the dietary impact | Moderate | 44, 45 |
33. Disbelief in climate change | Low | 44 |
34. Lack of options, especially when eating out | Moderate | 41, 44, 46 |
35. Lack of plant-based options to buy | Moderate | 41, 45 |
36. No autonomy/opportunity over food purchases | Moderate | 38, 41, 42, 47 |
37. Lack of confidence in cooking ability and preparing plant-based meals | Low | 41 |
38. Cooking ability | Moderate | 38, 41 |
39. Habit | Moderate | 40, 42, 44, 45, 47 |
40. Advertisements promoting meat consumption | Low | 40 |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Rickerby, A.; Green, R. Barriers to Adopting a Plant-Based Diet in High-Income Countries: A Systematic Review. Nutrients 2024, 16, 823. https://doi.org/10.3390/nu16060823
Rickerby A, Green R. Barriers to Adopting a Plant-Based Diet in High-Income Countries: A Systematic Review. Nutrients. 2024; 16(6):823. https://doi.org/10.3390/nu16060823
Chicago/Turabian StyleRickerby, Alice, and Rosemary Green. 2024. "Barriers to Adopting a Plant-Based Diet in High-Income Countries: A Systematic Review" Nutrients 16, no. 6: 823. https://doi.org/10.3390/nu16060823
APA StyleRickerby, A., & Green, R. (2024). Barriers to Adopting a Plant-Based Diet in High-Income Countries: A Systematic Review. Nutrients, 16(6), 823. https://doi.org/10.3390/nu16060823