Participants said that they are confronted with too many sources of diet-related information, which limits their capacities to make decisions about what foods to purchase and consume. Specifically, participants reported that the volume of information they were confronted with and the contradictory nature of information they received both within and external to medical practice, made it difficult to adhere to recommendations.
Many participants stopped following recommendations, from both healthcare professionals and external sources (the Internet, television etc.) because they found it difficult to know what information was accurate. Participants talked about being “bombarded” with information. As a result, participants suggested that they rely on ‘common sense’ rather than the dietary information they had been given.
“I think it’s just, it’s just too much. There’s too much information. It’s too difficult to, to sift so that I don’t do it.” (Interviewee 36)
“Well, I’ve, it was a sort of, you know, sat in the doctor’s surgery and he said ‘well you ought to try cutting out fats and…’. I might, he might have given me a couple of… but ah, I mean now you’re bombarded …” (Interviewee 34)
The above quotes were given by men ages 62 and 65. The difficulty with the volume of information was more prevalent in male respondents, especially those who were older. However, it was also noted in female participants. For example, interviewee 16 referred to society as being “overknowledged”, referring to the fact that we have access to so much information that making choices become too difficult.
Similarly, older participants reported that they were given advice to follow food labels as a way to eat healthy but did not know how to read them, or what to look for.
“Oh yeah. Too many numbers on them [food labels] still, you know, and you don’t know what they are.” (Interviewee 20)
“I stopped putting my glasses on [when grocery shopping] because I thought well if I can’t buy anything, I’ll just try to be sensible.” (Interviewee 11)
They identified that the information given about labels was too complex and difficult to follow. The latter quote was provided by a man who found that grocery shopping was difficult because of all of the label reading. As a result, he chose to stop reading labels all together. Many older participants were also sceptical of marketing ploys used to sell seemingly healthier products. This further complicated their choices about what they should be purchasing. For example, Interviewee 24 said: “You read these things [labels] when you go shopping – how much fat and all that but you don’t know what to believe half the time.”
In addition to too much information, participants across all demographic groups noted that the information they received about healthy eating was conflicting and contradictory, thus increasing the complexity of their decisions about what advice to follow:
“… I’d read all this information before from the Heart Foundation, they, they didn’t exactly gel together [with information he received at a dietitian’s session at cardiac rehabilitation].” (Interviewee 37)
Many participants also noted there to be certain foods, for example eggs, that are inconsistently ‘good’ or ‘bad’ to eat:
“Yes in some cases but it, it, every year it seems there is new studies so it brings out something else that you are supposed to follow, or not follow or change. So, it changes all the time.” (Interviewee 7)
“I was told that you shouldn’t eat too many eggs. Since then I’ve heard studies that said ah but you can have as many eggs as you want but I am still keeping it low because, well until they have absolutely confirmed I’d rather not.” (Interviewee 8)
Interviewee 8 later in the interview went on to discuss this in greater detail:
“But, she [a dietitian] said “ah, no, no, no. That’s out of date. It’s alright to have all these eggs”. Since then I have read in the paper that, you know, they’ve done further studies and they’ve said that eggs aren’t necessarily a bad think but I’m still – I’d rather ere on caution than worry – you know, that till it’s absolutely proven.” (Interviewee 8)
“I mean, at, when I, in 87  – I was told for instance, absolutely no avocado you know… but they’re good fats…So it’s changed.” (Interviewee 12)
Recent literature has identified a number of factors that act as barriers to dietary changes in patients with heart disease. These include: a lack of professional support, temptations or difficulty with self-discipline, food preference, insufficient knowledge, unhelpful social contacts (e.g. household members), personal problems (e.g. disruption of daily routines), the perception that lifestyle changes do not lead to improved health, and difficulties in managing added dietary requirements for comorbidities [12, 16–18]. However, novel in this research are the two most central barriers identified by interviewees: the volume and contradictory nature of information.
The barrier of ‘too much’ information has been identified with other chronic conditions. For example, Briggs et al. found that when patients consulted more than one medical professional, it lead to large quantities of information that was difficult for patients to digest. The finding that information from healthcare professionals and external sources (e.g. the Internet) is contradictorys (e.g. eggs) has also been noted elsewhere . This finding is consistent with research conducted by Ward et al. whereby participants said the confusing or conflicting information they received led them to ignore health messages about food as a means of reducing and managing uncertainty. Confusing and often contradictory information regarding food and nutrition has been demonstrated to lead to a sense of paralysis or stasis when making food choices [20, 21]. Therefore, when faced with diet-related diseases, an individual may adhere to existing and familiar food habits, rather than making the recommended changes.