A scoping review of assessment of front-of-pack labeling policy implementation and response in low-and middle-income countries

Abstract

Objective: Despite growing front-of-pack labelling (FOPL) policy implementation in low-and middle-income countries (LMIC), research approaches for evaluating these policies remain poorly characterized, hindering evidence-based policy development and methodological gaps. This study explored research approaches, frameworks, and methods used in assessing FOPL policy implementation and response in LMIC. Design: Systematic search of five databases, including Medline, Web of Science, Scopus, Global Health, and CINAHL, for peer-reviewed articles published between 2014-2025. Studies on FOPL policy implementation or response in LMIC were included. Data on study characteristics, methods, and findings were extracted and synthesized. Setting: LMIC. Participants: All populations. Results: Thirty-one studies revealed significant research imbalances. Implementation studies (n=3) used qualitative approaches with policy theories, while response studies (n=28) predominantly employed quantitative methods including surveys, experiments, and modeling. Pronounced geographical bias emerged, with 24 studies conducted in Latin America while other LMIC regions remained underrepresented. Common limitations included non-representative sampling, self-reported data, and short timeframes. Mandatory FOPL policies achieved higher compliance than voluntary schemes, though implementation faced challenges including inadequate monitoring, limited resources, and industry resistance. Consumer awareness was generally high but varied significantly across population groups, revealing substantial equity gaps. Conclusions: This review reveals critical gaps in FOPL implementation research in LMIC, with evidence heavily skewed toward consumer responses and geographically concentrated in Latin America. Future research should prioritize implementation science approaches, geographical diversity, and understanding policy processes in resource-constrained settings to develop effective, context-appropriate FOPL policies.