This study revealed that residents of deprived neighbourhoods view price as a chief factor in food choice. Price was also experienced as a proficient tool to stimulate healthier food choices. Still, consumers indicated that significant effects could only be achieved by combining price with information and promotion techniques. Overall, pricing strategies focusing on encouraging healthy eating were considered to be more constructive than pricing strategies that focused on discouraging unhealthy eating. Highly regarded strategies were: making healthy foods cheaper combined with making unhealthy foods more expensive; providing a healthy food discount card exclusively for low-income groups; and combining price discounts on healthier foods with other marketing techniques such as displaying cheap and healthy foods at the cash desk.
Like previous findings on physical activity, this study showed that finances are a key factor in food selection . Most participants stated they consider the cost when purchasing food; some of the respondents even indicated price to be the most important criterion. Similar results have been reported in previous studies indicating that price, as well as taste and quality, is the most important factor in food selection [16, 31] or is the determining factor in buying a certain product or not . This price consideration is important because dietary quality and dietary costs were found to be positively related and because more price-sensitive consumers are less concerned about the health aspects of food [33–36]. Cost conscious consumers may therefore be more inclined to buy unhealthy food alternatives, since those are the lowest cost dietary options . Participants in our study confirmed this statement by arguing that they considered the purchase of vegetables carefully, and that they omit the purchase of organic food owing to its high price.
As price appears to influence food choice, pricing strategies can be a potentially useful tool in steering food choices in a healthy direction. Experiments in controlled settings showed that price reductions are effective in changing food purchases . Studies on fiscal incentives revealed that taxes and subsidies on food may also be effective [19, 20, 22]. Furthermore, Herman et al. (2006) found that the provision of extra money to low-income consumers to buy fruits and vegetables led to a significant increase in purchases in this category . However, these studies include small, controlled settings and little is known about how consumers would react to larger-scaled pricing strategies. To our knowledge, the recently published Supermarket Healthy Options Project (SHOP) is the first randomized trial on the effect of price incentives on food purchasing behaviour in a real-life setting. This study found significant effects of discounts on the purchase of healthier food items, however no effect was found on nutrient purchases . It remains unclear how the effects of pricing strategies can be enlarged and what contextual variables should be taken into account when implementing such strategies. This focus group study provides additional insight in these issues.
Pricing strategies receiving the most positive responses were: (a) putting healthy foods more frequent on offer; (b) providing discount cards for low-income consumers; (c) making healthy food items cheaper while making unhealthy food items more expensive; and (d) offering little extras with healthy food (in particular when directed at children). When these results are linked to the outcomes of our previously conducted Delphi Study, it can be observed that the experts and the consumers agree on the potential success of making healthy foods cheaper by either discounts or price cuts, as well as offering little extras with healthy foods. In addition to being effective, the experts judged these strategies to be feasible and affordable. Combining price raises of unhealthy foods with price discounts for healthier foods was also viewed to be effective by the expert panel, but was considered to be less feasible and was indicated as not being accepted by the industrial/processing food sector. In contrast with the consumers, the experts did not view the discount card as being effective. The expert panel also rejected a food allowance for low-income groups. The focus groups responded mixed upon this strategy, and did not agree on whether such an allowance would actually lead to the purchase of higher amounts of healthy foods .
Next to price, we found that there is a great need for clear-cut information in relation to the healthiness and production processes of food. Healthy products were perceived as being too expensive, but also their genuine healthiness was doubted among the participants. Other authors emphasized similar concerns, stating that price changes will not improve dietary habits because consumers have difficulty in understanding the health effects of food , have a poor immediate reflection of prices  and do not recognize their diet as being unfavourable . On the other hand, a study comparing the effects of health messages and pricing incentives on food found that pricing alone has a significant effect on choosing healthy foods . Based on our results we suggest that pricing strategies may be most effective when provided with clear nutritional information. A common consensus was that discounts on healthy foods should be supported by widespread commercials and advertisements which inform the consumer about the healthiness of the product along with the fact that it is on offer. This strategy can be combined with marketing strategies making the healthier food more appealing and attractive (e.g., shelf placement, packaging). Eikenberry et al., reported related conclusions in a study on perceptions and motivations for healthy eating and stated that: "focusing on quick and easy, healthy, less expensive food preparation or selection of more convenient yet inexpensive food may help overcome barriers" .
To our knowledge, this is the first study that gives an insight into the perception of residents of deprived neighbourhoods with regard to food pricing strategies. Due to the use of the focus group technique we were not only able to study if pricing strategies may be effective, but also how they may be most effective. The results are a good starting point for future price intervention studies. Still, some limitations of this study must be noted. Since pricing strategies were the main interest in this study, more focus was put on this than on other interventions. This may have led to an over-estimation of the perceived potential effectiveness. In addition, the discussed strategies were formulated by the researchers, and were not selected by the participants themselves. However, we made an effort to propose the strategies in a neutral manner, without being suggestive. Also, respondents came up with pricing strategies in answering an open-ended question, and indicated price as being important without it being suggested to them. Secondly, we believe that the use of the nine pricing strategies that resulted from a previously conducted Delphi study is a merit of our study. Those nine strategies represented approaches that were viewed as potentially successful by a group of carefully selected experts and had already been tested on perceived feasibility, effectiveness and affordability issues . Proposing these strategies to the target population enabled us to gain a unique insight into which strategies are evaluated positively by both experts and consumers. Thirdly, it must be mentioned that we included residents of deprived neighbourhoods, which can not be regarded equal to residents with a low SES. Of the total sample (n = 59), 22 participants were low educated; 18 were unemployed, and 26 had an income below standard. A final limitation is that no 100% data saturation was achieved at the end of this study. One or two additional focus groups may have led to full data saturation. However, we specifically sampled different cultural backgrounds and in two different cities to ensure a large variation in data. In this setting a data saturation of 96% can be viewed as satisfactory.