 Welcome back to the third session of today at the Stanford Health final conference here in Brussels. My name is Derres Orrer-Frank, and I'll be moderating this session. We have five speakers who are key figures in the Stanford Health project. And we'll follow the same format as before. So we have about 10 minutes presentation for each speaker, and then five minutes of Q&A afterwards. And everyone who just joined and joined us online can visit slido.com and then type S4H, all capital, to submit their questions to the speakers. And the first speaker in this session is Professor Klaus Grunert. He's Professor of Marketing at Ohus University and founder of the MAP Center at Ohus University. And he specializes in consumer behavior research and has led the consumer studies in the Stanford Health project. Now I hand off to Klaus. OK, thank you, Darius. So I'll try to keep you awake now after the lunch break here. I will not talk about the nutrition science and the other natural science basics that you've heard about in the morning here. The project stands for health, as you have heard from the coordinator is innovation action. That means it's supposed also to lead in the end to something which can be introduced on the market. That is actually what I'm dealing about with here, because anything that you're developing in this project here will have an impact on public health only if it's actually adopted by consumers and it's being used by consumers. So a personalized nutrition is also a question of consumer acceptance and willingness to pay. And I'm breaking this down into six questions here that you can see here. Who is interested in personalized nutrition? Do people understand what that is? If they do and they're interested, how do they want to have it delivered? Then we can ask what are the barriers, both for the adoption and for the continued use, because that makes a difference, as I will show you. And then most specifically, what are the key features for an app like the one that is like the IDIAT app which has been developed here in this project here. And in the sense for health project, we've been doing consumer research to shed light and give answers to these questions. We've done a number of survey studies mostly in Germany and Spain as the main countries where this project has been working, and also some things in the UK. Also been doing some focus groups, qualitative research in the number of smaller studies, all of which, of course, has been reported. First of all, what I will show you here, this is something we did at the beginning, and this is not data generated by sense for health, this is data we found from a big European survey which measured people's life satisfaction and people's subjective perception of their health. We found that four groups differed not surprisingly, some are happy and healthy, some are unhappy and unhealthy, and some are either happy and unhealthy all the other way around. And which of these have most need for personalized nutrition? Of course, we would think that those that have most need for personalized nutrition are those on the right-hand side here, right, which have not so good health. On the other hand, we can see those on the right-hand side, they also have lower scores with regard to trying new things. So adopting something like personalized nutrition and especially app-based personalized nutrition may not be the most obvious solution for these people here. So this points already at an issue that I come back to which we encounter with this type of solution we are working with here, that the people who objectively may be most in need of this kind of thing may also be the people that are most difficult to reach with the kind of instruments we are working with here. We have done a study where we looked at use of nutrition apps, not the one we developed here, but any nutrition apps because lots of these are out on the market. We looked at people who have never used a nutrition app, those who have used one but stopped using it and those are still using it. And then we're looking at differences between these three groups and they mirror what I've just shown you in the previous slides, namely that those who have never used a nutrition app, they have less interest in healthy eating, they have less confidence in that they can do something which would improve the healthiness of their eating and they have also less interest in technology. And the health is also not as good. So those that do use nutrition apps, they have already a better health, are already eating more healthily and have also high interest in healthy eating and in technology. So if you look at people giving reasons for why they are using or not using or have stopped using nutrition apps, we can see them here. The top reasons for using it, not surprising to improve your health, improve what one eats. The top reason for not using them mostly related to what I just said. Now people think you don't need them or people think it's simply too difficult to use. So it's a lack of motivation, a lack of self-efficacy. Now also those that stopped using it, that these are a bit different. I mean lost interest can be also a motivational aspect but the other factors that we see here is that the thing is takes too much time to enter the data it's too confusing to use. So this is a different question. This is a question not about motivation to eat healthily, but a question about how difficult or easy it was to use this particular instrument and helping you to do so. And again, that is an issue that I will come back to. If you look at those that do use a nutrition app, they seem to be some pretty proficient users because most of them use it at least once a day. Many of them use it every time they use it for more than 10 minutes. So if you actually are a continued user of nutrition app people seem to be serious users of these apps here. So the answer to the first question is who is interested in personalized nutrition? It's people who are interested in healthy eating, have confidence in their ability to eat healthily and to already have a healthier diet. And I'm saying this not sort of to demotivate the importance of what we are doing here. It's only to say that if you bring a wonderful new app on the market here, it by itself is not enough for the huge impact on public health. We need to do something else. We need also to motivate people to be interested using this kind of app and that cannot be done by the app alone and in a way, of course, that should not be a surprise. The second question then was, do people understand the concept of personalized nutrition? And as I said, we did some focus groups that dealt with this issue, two major results. One is that the concept itself is not known. People have not heard about personalized nutrition. If you ask them, you have heard about it, the answer is mostly no. The good news is the concept is intuitive. If you then ask people, what do you think it means? People come up mostly with a right, pretty right sort of explanation. You see some of the examples here. Probably nutrition, no tailored to one specific needs, depending on someone's health condition based on what you can and cannot tolerate. That's pretty close to what we are working with. So people can make sense of it, even though the concept of such is not known to people. So do people understand the concept of personalized nutrition? There is an intuitive understanding of the concept if you prompt people, although the level of knowledge that people have at the moment is low. Then how do people want personalized nutrition delivered? And we have both some qualitative research from focus groups and some quantitative results that are relevant for this question here. These are here our results from the focus groups where we found that people differ in their approach to which kind of information they're willing to share. In the focus groups, most people had no issues with sharing a blood sample, but they had issues with sharing genetic information, and some also had issues with sharing detailed lifestyle information, including your medical history and the number of other things. Nobody knew about microbiome based personalized nutrition, but people found it very interesting and there was generally a reaction that people would be interested in hearing more about it. Generally, based on the focus groups, we found there were four key dimensions. Now that had an impact on the interest and personalized nutrition. One was not surprisingly how useful and beneficial we thought it was. And then there were three more. One is related to the kind of information you need to provide as I already have mentioned. And then there were some issues on how reliable people thought the underlying science was. Obviously, if you think the underlying science is reliable, you're more interested than if you aren't doubt about that. And then there are also some ethical concerns that mainly have something to do with sharing data and the privacy of the data and things like that. This is from the quantitative study and I think Darius will maybe say a few more words about that later on. But basically what we've been doing here, we've been showing people different hypothetical personalized nutrition services. They differed in how much effort people had to spend using them. Whether the advice was provided by a human agent like a doctor or an algorithm or a combination of both. Versus the degree of personalization was high or low and then which kind of information as input is needed last time, microbiotic or phenotypic. And people chose between these ones here and we found that there are three different groups of people who differ in their preferences. The first one, as you can see here on the left, the major factor for them is who's providing the advice. They want the advice from a human agent and not from an algorithm. The one in the middle, they are mainly concerned about which kind of information they want to share or need to share. Another lifestyle is acceptable but the two other ones are not. But the most interesting ones for us in our context here is the one on the right. It's also the biggest one. It's 55% of the population and the two samples here because here the one that is the most highly preferred is a combination of a human agent and the algorithm which in a way is close to the sense for health solution. It gives a high degree of personalization. The effort in using it is low and it involves sharing microbiotic information. So it's actually very close to the type of profile that we are working with in the sense for health project. So the good news here is there is a large segment of the population that seems to be interested in this particular solution here. So how do they want? How do people want personalized discretion delivered? Different people have different preferences but for about 50% a macroeum-based easy to use AI plus personal service solution is very good. And I think that's of course good news for the purposes of this project here. What are the barriers for adoption of personalized nutrition and pay attention to the word here because I have two slides on barriers. One is about an adoption and one is about continued use once you have adopted. And there are different answers to these. So this one here, what are the barriers for adoption? Start getting started with a personalized nutrition nutrition. As I already said, the two main factors here, a lack of motivation for healthy eating and a lack of confidence that you actually can eat more healthily even with the help of personalized nutrition. Now, based on that then, also a lack of insight into the benefits of personal nutrition skepticism is regarded as the underlying science and issues related to privacy and data security but the two most important ones are the two first ones here. Because if you look at the barriers for continued use, people who have started using a nutrition app, what are the factors that have an influence that they continue using it or drop out? That's what we can say here. And the major factor that's maybe not so surprising is whether the app delivers the benefits that have been promised, whether they experience those benefits leading to satisfaction with the app, which in turn is very much related to whether the app is easy to use. That's not surprising. I mean, that's what we would expect, of course. The interesting part here is what is not in the diagram. Because the motivation to eat healthily is no longer a factor. So the motivation is decisive for getting started but the ease of use is decisive for keep on going. And I think that's an important implication from these results here. So what are the barriers for the adoption, lack of motivation and confidence, mainly lack of insights concerns about privacy? What are the barriers for continued use that is difficult to use and therefore no benefits are forthcoming? Last question then, what are the key features for a personalized nutrition app? We did some research on that as input to the development of the eye diet. We looked at a number of different things and those three that came out as most important, you can see here on the left, the most important of them all is the first one, namely the possibility to add your own personal preferences, to individualize the advice that you get, have some flexibility that you can make sure that the recommendations you get are adapted to your personal preferences. That was clearly the most important one. Then we had two more, one is giving evaluated feedback and giving not only qualitative feedback, how often have you actually done what the app suggests that you're doing, but also saying good, this is, you're doing a good job in terms of your dietary choices here. And the third one then is gamification that we add some fun elements in terms of for example, rewards and levels of progress that help people and are valued by some people in the use of such a device here. So the key features for a personalized nutrition app according to our research here, taking into account individual preferences, feedback and gamification. Where does that leave us? What are the major implications for commercialization of a personalized nutrition app? First of all, an app-based personal nutrition is attractive for people who already have an interest in healthy eating. That is the main target group. Any commercialization attempt, of course, should aim at that target group and not at the ones who lack the motivation and the lack of self-efficacy because they need to be dealt with in other ways at least in the start. Secondly, an app-based personalized nutrition should include a component of human interaction like having access to nutritionists. And that can be just an option. Now if you want to, you can have contact with a human being here and it could be for an extra fee or something like that, but I think that just the option of having that possibility according to our results could have a major impact on people think this is a good solution. Third, a biome-based personalized nutrition solution is new to most people and needs explanation and giving that explanation. It is very important to be clear about what the underlying science is and to which extent you can trust in the underlying science. Of course, one should not accentuate and make promises that you cannot keep, but this thing about being clear about the underlying science, I think is very important. Then, as I said, the adoption is largely a question of motivation, but then having people keep on using it is mainly a question of how good the app is, whether the app is easy to use and delivers those benefits that have been promised. And in doing that, we have a number of recommendations for how that app should look like and of these the one about the individualization that the app can take into account personal food preferences is the most important one. And these were my conclusions. Thank you. Thank you, Klaus, for these deep insights. I don't have any more questions. It felt like you covered everything already, but does the audience have any questions to the consumer insight expert? We'll have a slight delay for the questions from Slido, so who wants to go first? Yes. Where? Yes. Klaus, thank you so much for your clear presentation. As usual, you focus on the main factors. And one of them is that using a personalized nutrition app is that you want to use it. You are open to it. Do you think that different passions with different pathologies could be open to use this kind of applications if they think that they could improve their health status related with that pathology? Yeah. Yeah, I mean, if people have a health condition, obviously, they are also more motivated to healthy eating. I mean, if we would have a diagnosis, there is specific health condition, people also usually have a higher motivation for healthy eating, and I think we know that. I don't think people necessarily think about using nutrition app in that context. Now, but that could change. I mean, it becomes more common doing this. And if we have also in the public arena discussion about the underlying science and not least about the positive effects of doing that, I think that could change. Because then these are people that have some motivation, but may not be familiar with using this type of tool here. So in that case, maybe we should combine the practitioners, the clinicians, to convince the patients before. Yeah, yeah, yeah. OK, nice. Question in the back. Thank you very much for this insightful presentation. I was wondering about something. I think the motivation issue, we see that a lot of times in nutrition, and that, for example, food supplement users are mostly those who are actually already quite healthy. Could it also work the other way around that having more of these nutrition apps and more of these personalized nutrition apps might also help to increase the motivation of people to become more healthy? Is there any other way that we can broaden this target audience? Yeah, yeah. One of the issues with the motivation is that many people perceive some kind of trade-off between viewing food as a bundle of nutrients on the one hand side and viewing food as a source of pleasure and a good life on the other side. And that is a major barrier. It's one of the reasons why some people are not interested. I think the way something like the eye diet works, and we'll see more of that here a little later on, is that it provides, in a way, a more holistic approach to giving nutritional recommendation because it's not advised with regard to specific nutrients and eats more of this and less of that, and then you need to compose your meals based on different nutrients and so on. I mean, the app does that for you. The app gives advice in terms of meals. And I think it's actually closer to this other view of having food as a source of pleasure and a good life. And therefore, once it becomes more well-known, becomes more popular, more widespread, could actually have that effect, yes. Another question in the back. It was spoken today also that a lot of new directions into nutrition are considering the food environment and all the lab innovation labs and so on. We do have one project which is addressing also some aspects like that. And one of the things which we do not really understand, and probably here you could give us some hints with regard to personalized nutrition. What about the ones which are not having such so large financial boundaries? Are they still willing to move towards a personalized diet, a personalized meal? Because I mean, we were just passing in Germany a time where one cucumber was two euros. Was it something which is considered by the consumer or was something which is considered is not related to the stance for health strictly, but is mostly related to the changing the food environment in the future? Yeah, that's a difficult question. I mean, the stance for health, of course, if it's a commercialized will come on the market, people will need to pay for it. Also, there is an expense. It may not be a huge expense, but there will be an expense, which is why the motivation is really crucial, because if it's an additional expense, if you're not motivated, you will not do it. I mean, generally, there is a lot of research about how healthy eating is related to income and things like that. And for some people, obviously, the income is a major restrictive factor. But I also think that, in some ways, it's probably more related to social class than to income. Because if you're depending on the kind of life you have, a low income life, it's not only the financial constraint. It's also where the pleasure in your life is. For some of these people, certain types of eating are a major source of pleasure in their life. And then somebody comes and says, you should do something else. It's very sort of very much uphill doing that. What I'm trying to say is it's not only the question of the financial constraint itself, because the food budget in Europe is not so enormous as a percentage of your overall disposable income. I don't know whether that answers your question. Well, we have two questions from the online audience. One not anonymous from Arno Greiling. Do you think that another barrier to use might be challenges of cooking and eating in a family context? How to solve this? Yeah, I mean, if people have difficulties cooking, obviously that is a challenge. Also here, because it assumes, I mean, the app is a home cooking app. It's not only it has a restaurant component there as well. But it's mainly a sort of home cooking app. I think what we have seen in the wake of the corona pandemic is that people have been doing more home cooking. I mean, people need to because they couldn't go out eating. But I mean, we've done research showing that people not only did prepare more meals at home, but they also enjoyed having more meals at home and enjoyed being in the kitchen. There was a boost in enjoyment of cooking in the kitchen. And we have some new research which is from last year, which shows that's still there. Even though the pandemic is largely gone, that is still there. It's nothing to do with the fact that we're talking about here. But I think there actually is a development after many, for many years, we've been saying this goes in the wrong direction. You may now have a development which goes in the opposite direction. First one question from the audience next. I was just wondering if there was any specific insight about what people wanted to know about the microbiome. Could you detect anything that, you know, any specific questions or? Yeah, I would need to go back to those results. I don't have any sort of specific quote here ready at the moment. But the reactions, as I remember them, were very basic. People had no idea. I mean, everybody has an idea of bacteria in your gut, right? But that's also where it ends now, so that you can use it in order to optimize your food intake, as I said. It was completely new to people. And as I said, people were very interested in, because it was also introduced as a new approach, right? Which it is, as you know here. And that sort of prompted the question, are you sure? I mean, can we trust on that if you tell us this is good for you, because of your microbiome that you actually are right in this? I can understand that. I mean, the first time in meetings that I saw the effects of the microbiome on mice behavior, it was hard to believe. It was like, you're cheating somehow. Why would that be? It's hard to believe that you can have so much of an effect. Yes, we have many more questions, but we're out of time. So thank you. Professor Klaus Grunert, everyone. Thank you.