Designing and validating an effective iconography for the dissemination of food-based dietary guidelines in Peru: A qualitative study

Changes in dietary patterns towards Western diets, along with unhealthy lifestyles, are causing a rapid increase in the rates of overweight, obesity, and non-communicable chronic diseases in the Peruvian population. Food-based dietary guidelines (FBDG) are supportive tools for public policies aimed at promoting healthier eating habits. This study aimed to present the process of designing and validating an iconography for the Peru FBDG. The design process involved an extensive review of dietary iconography in various countries of the LAC region. In accordance with the specific context of Peru, the decision was made to incorporate local elements into the iconography. Four image proposals were initially designed and subsequently subjected to expert validation. From these, two proposals were selected for population validation through focus groups. The validation process focused on qualitative evaluation criteria, including understanding, attraction, involvement, acceptance, and induction to action. The resulting final iconography consists of two concentric circles. The central circle represents the seven food groups distributed proportionally, while the outer circle signifies healthy lifestyles, encompassing physical activity, commensality, and daily water consumption, portrayed in vibrant colors. Surrounding the circles are icons representing ultra-processed foods depicted in black octagons. Additionally, icons for added sugar and salt are placed outside the circles, serving as prominent warnings to reduce their consumption, as recommended during the validation process. This study successfully developed an iconographic representation that fulfills both technical and population-level validation criteria. The incorporation of participants' contributions and recommendations further enhanced its efficacy. The validated iconography not only serves as an educational and awareness tool but also offers practical guidance for individuals to adopt healthier dietary practices and lifestyles. In conclusion, the FBDG iconography effectively communicated the importance of natural foods over ultra-processed ones, along with emphasizing healthy eating habits, as understood and embraced by focus group participants. The attraction and comprehension of the FBDG iconography looks promising for its implementation, suggesting improvements in the health and nutritional well-being of individuals of two years and above.