Given the well established relationship between dietary intakes and the heath (1–4), food-based dietary guidelines (FBDG) are established in many countries to help consumers make healthy dietary choices and adopt a healthy lifestyle, thus allowing them to achieve a satisfactory nutritional state. FBDG have been adapted to specific nutritional, geographical, economic, and cultural conditions (5).

In France, FBDG were issued for the first time in 2001 when the Ministry of Health initiated the National Nutrition and Health Program. In 2019, Santé publique France, the National Public Health Agency, updated and published new French FBDG for adults (6). These recommendations take into account the evolution of scientific research regarding the association between nutrition and health as well as the knowledge, beliefs, and dietary consumptions of the French population (6–8). The new guidelines notably include specific recommendations for the consumption of whole grains and pulses, the reduction of meat consumption (excluding poultry), and the consumption of local and seasonal foods to limit the environmental impact.¹

The most recent representative survey conducted in France in 2014–2016 reported the poor consumption of pulses and whole grains despite their high fiber content (9). Indeed, 60% of French adults do not include whole grains in their diet, even though dietary guidelines recommend their consumption at least once a day, and more than 85% do not follow the recommendation to eat pulses at least twice a week. However, the current scientific evidence indicates that eating foods containing fiber is associated with a reduction in some chronic diseases (2, 10–12), including inflammatory diseases, cancers, cardiovascular diseases or type 2 diabetes, and indirectly reduces the risk of overweight and obesity (13).

Given the non-compliance of French adults with the fiber-related guidelines despite the health benefits (2, 10–13), guidelines to promote pulse and whole grain consumption were defined as a priority to be promoted, because these food groups are naturally rich in fiber, affordable, and easily available in food stores (14).

To promote the new French FBDG, and in particular the consumption of pulses and whole grains, Santé publique France implemented a social marketing campaign in 2019. The food literacy conceptual model was used to design the campaign (15) and, more specifically, the intrinsic component of the model that includes food skills, food and nutrition knowledge, self-efficacy, and confidence (including the self-perceived ability to apply nutritional, food, and cooking skills and the positive attitude toward healthy food) as determinants of behavior change. Women aged 25–49 years were the main target of this campaign, because women usually prepare meals, while women of low socio-professional status and with low educational level were particularly targeted given that they are specifically at risk of an unhealthy diet (9).

The main aims of this social marketing campaign were (1) to increase knowledge about the high fiber content of pulses and whole grains, (2) to improve self-efficacy by addressing perceived barriers (ease and time required to prepare these foods, pleasure of eating them, etc.), and (3) to encourage a healthier diet with more pulses and whole grains. The objectives of this study were therefore to evaluate the impact of the campaign on variations in (1) people’s knowledge, (2) self-efficacy (ease of preparation and pleasure of eating), and (3) consumption of pulses and whole grains between before and after campaign.

This longitudinal study conducted among 2,422 French adults provided interesting findings about the effectiveness of a French social marketing campaign to promote pulse and whole grain consumption. Almost 60% of subjects reported recalling the campaign, with a higher recall prevalence among people with a low socio-professional category and low educational level. Overall, this first broadcast of the campaign had limited effects on pulse and whole grain consumption as well as on the determinants studied here (i.e., knowledge, self-efficacy). However, among subjects with low educational level, a positive association was observed between campaign recall and variation of their knowledge about the fiber content of whole grains. Moreover, when focusing on the small consumers of pulses, those recalling the campaign improved their knowledge about the fiber content of pulses and consumed more pulses in the immediate aftermath of the campaign and 8 months later.

Social marketing is a method used to analyze, plan, execute, and evaluate programs to influence the behavior of the target audiences in order to improve their personal welfare or that of society (17). The “Eating for the Better” review (18) identified the success factors and potential barriers to social marketing for healthy eating behaviors based on 34 empirical studies. The observed healthy eating behaviors were eating fruit and vegetables, low-fat food, low-salt food, and choosing healthy foods. Of the 16 studies considered to be social marketing according to the criteria of Andreasen (17), all measured positive changes for at least two of the measured indicators such as fruit and vegetable intake or better knowledge. Diet-related social marketing campaigns or mass media campaigns generally aimed to increase fruit and vegetable consumption (19–21). However, to our knowledge, no study to date has evaluated the impact of a social marketing campaign targeting pulse or whole grain consumption. The CVD Prevention Through Policy review and the American Heart Association (22, 23) concluded that communication campaigns were effective in improving dietary behaviors, particularly for fruit and vegetable consumption and salt reduction, which were the main outcomes of these campaigns. However, some reviews (24, 25) found that although communication campaigns do raise awareness about dietary recommendations, they fail to translate the message into behavior changes. For the authors, social marketing campaigns should be repeated over a long period to achieve eating behavior changes. One possible explanation is that the environment in which individuals live includes various factors that continuously encourage unhealthy behaviors (26). All the reviews investigating the effectiveness of diet-based interventions, including social marketing campaigns, concur that too few studies evaluate these interventions, thus leading to a publication bias (18, 22, 24, 27).

Our results point to improved knowledge about the fiber content of whole grains among participants with low educational level who recalled the campaign, although this knowledge did not translate into eating behavior changes. In addition to improved knowledge, this social marketing campaign aimed to influence other barriers to the consumption of whole grains such as a lack of cooking skills or desire to eat them. The campaign could not address the cost issue, which is another important barrier to their consumption (28–30). Unfortunately, no variations in the perceived ease or pleasure of eating whole grains were observed, excepted among those who had no pleasure to eat whole grain at T0, for which a positive association with campaign recall was found at T1. One possible explanation is the low recall of the videos broadcast on social networks and in the waiting room of health professionals (14%), as they aimed to overcome these barriers.

Our results are in accordance with previous reviews showing that knowledge improvement alone is insufficient to improve eating behavior (24, 25). Regarding other countries, lessons can be learned from Denmark, where the consumption of whole grains increased significantly from an average of 36 g per day in 2007 to 63 g in 2014 (31). This improvement might be related to the implementation of the Danish Whole Grain Partnership (DWGP) in the mid-2000s, a public-private partnership aiming to boost whole grain consumption (32). The actions of this partnership included educational campaigns and events, the promotion of whole grains as a climate-positive food, the increased availability of whole grain products, and their promotion through front-of-pack labelling to allow consumers to easily identify whole grain foods (33).

Another interesting result of our study relates to the small consumers of pulses who increased their consumption of pulses. This increase was only observed among the small consumers for whom the campaign improved their knowledge about fiber richness, which could partly explain this result. This increase in consumption might be surprising, since the campaign had no impact on self-efficacy (namely, ease and pleasure of eating pulses), even though these determinants have been described in the literature as important barriers to pulse consumption (34, 35) and were thus taken into account when designing the campaign. Indeed, two recent French studies (36, 37) published during and after the campaign confirmed that the perceived difficulty of cooking pulses as well as taste preferences could be among the main obstacles to their consumption. As previously mentioned, one possible explanation for the absence of self-efficacy variations in our study may be the low recall of the video broadcast on social networks and in the waiting rooms of health professionals. To explain the increase in pulse consumption among small consumers, it is important to acknowledge that positive communication and actions around pulse consumption have been undertaken in France in the last few years. This notably occurred following some political initiatives such as the weekly meat-and fish-free meal in French school canteens and communication campaigns regarding the impact of consumption choices on the environment. Therefore, the “Commencez par” campaign initiated in this favorable context may have changed people’s perception of pulses (being difficult to cook, not tasty, etc.) and increased their consumption.

One major strength of this study was the prospective evaluation of pulse and whole grain consumption as well as their determinants, collected before and after the broadcast of the social marketing campaign with detailed information regarding potential confounding factors.

However, several limitations should be acknowledged. First, as the cohort involved volunteers, it included a potential selection bias, as volunteers are more often concerned about their health status and dietary behaviors. Their level of whole grain and pulse consumption was higher than in the general population, which limited their scope for improvement. Despite multiple adjustments regarding the measurement of associations with campaign recall, confounding bias cannot be completely eliminated. Furthermore, only 60% of respondents at T0 completed the questionnaires at T1 and T2. Despite performing post-stratification weighting, we can assume a potential attrition bias.

In conclusion, this first French social marketing campaign promoting pulses and whole grains highlighted some positive impacts for specific subgroups of particular interest in terms of public health. The campaign improved people’s knowledge about the fiber content of whole grains, although this did not change the level of consumption among people with low educational level. Nonetheless, this latter group is a priority target to reduce health inequalities. The campaign also increased pulse consumption among small consumers, probably by increasing their knowledge, which may have been bolstered by the favorable context to consume pulses with other structural initiatives undertaken in the same period such as the introduction of weekly meat-and fish-free meals in school canteens. However, these changes were observed among participants who were exposed to a single social marketing campaign, even though it is known that longer campaigns are more effective to change eating behaviors (25). These encouraging results highlight the interest of rebroadcasting the campaign while taking into account the lessons learned from this evaluation and adapting the communication materials for the second wave. Thus, the ease of preparing of whole grains and pulses and their tastiness were identified as key messages to be reinforced to encourage behavior change. Further evaluations will be needed to investigate the effects of the redesigned campaign after a second edition.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethical approval was not provided for this study on human participants because participation in this study was on a voluntary basis. Electronic informed consent was obtained from each participant before starting the questionnaire. Participants were given small incentives for participating and received compensation in the form of points, which could be accumulated and converted into different types of gifts. Personal data treatment was in accordance with French law n°78–17 of January 6, 1978, and European regulation n°2016/679, known as the General Data Protection Regulation. The patients/participants provided their written informed consent to participate in this study.

A-JS and PD designed the research and conducted the research. AR and PF performed the statistical analysis and wrote the paper. A-JS, AR, PD, and PF analyzed the data, revised paper for important intellectual content, and read and approved final manuscript. PF had primary responsibility for final content. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.