Mothers' perceptions of marketing elements on infant formula packages: A mixed-methods exploration in Uruguay

The marketing and commercialization of infant formula have been identified as major barriers to breastfeeding, influencing parental feeding choices through a wide range of strategies that include persuasive packaging elements. This work explores how mothers in Uruguay perceive infant formula packaging and examines the influence of marketing elements on their perceptions and behavioral intentions. An exploratory sequential mixed-methods design was employed, combining semi-structured interviews with a randomized controlled trial. The qualitative component (Study 1) involved interviews with 34 mothers in Uruguay, analyzing their perceptions of packages of three commercial infant formula. The quantitative component (Study 2) assessed the impact of marketing elements with 544 participants randomly assigned to five experimental conditions corresponding to packages designed following a stepwise reduction approach in the number of different marketing elements, progressively removing elements from a fully branded package to a plain version. Participants were asked to rate their degree of agreement with a series of statements. The qualitative findings revealed that a wide range of packaging elements, including material, graphic design, branding, and textual claims, captured mothers' attention and influenced their perceptions of infant formula. Despite the strong influence of packaging elements on perceptions, participants' actual product choices were primarily determined by medical recommendations. Most participants responded more favorably to a commercial infant formula package with minimal marketing elements, whereas packages with prominent marketing claims were perceived as overly commercial and industrialized. The randomized controlled trial showed similar findings. The package featuring only a graphic design and brand logo was perceived more favorably than packages with extensive marketing claims, particularly among mothers who had previously used infant formula. Taken together, these results suggest that mandating plain packaging could further support informed decision-making.