1. Introduction
Global consumption and the market for functional foods pertain to, in large, consumers’ health consciousness [
1] and their awareness, as well as knowledge [
2]. As a result, studies that correlate between consumers’ knowledge in functional foods and their physical health are of great interest to researchers [
3]. Research evidence indicates that Asia-Pacific is the fastest growing market and is expected to grow at a rate more than an eighth per year [
4]. Similarly, the interest and demand for healthy food in the Bangladeshi market is projected to soar almost in the same manner [
4]. Side by side, as disposable income [
5] and organizations grow here [
6], health consciousness among people and the demand for functional foods are growing up in this country [
7]. Among functional foods, as the literature corroborates, milk is the most consumed and marketed processed dairy food product [
8]. According to the statistics, per capita 13 L of milk per year, that is, more or less 35 mL of milk per day, is available to a person in Bangladesh [
9], whereas at least 250 mL of milk per day is essential for every individual as per the standard of World Health Organization [
10]. To maintain this standard, therefore, the consumption of dairy milk in Bangladesh should be multiplied seven times [
11]. This large gap is the result of the inadequate supply of fresh liquid milk.
On the other hand, demand for liquid milk, according to the different reports in the literature, is affected negatively because the availability of pure and safe liquid milk (LM) from a reliable source is low in developing countries like Bangladesh [
12]. Research shows that although households are less price sensitive in purchasing functional foods, in this case, quality and safe LM, they cannot avail themselves of their desired milk [
13], since almost all of the milk samples, both raw and processed (both pasteurized and Ultra High Temperature (UHT)), are adulterated in many different ways, such as mixing water, cane sugar, powdered milk, starch, formalin or sodium bicarbonate [
14], and are highly contaminated with fecal organisms [
15]. Furthermore, since marketers have been supplying adulterated milk to meet the excess demand, regrettably, consumers are confused and they have less scope to believe that this LM is safe and fresh. Consequently, consumers prefer powdered milk to LM in order to avoid health risks [
5]. Additionally, incidence of milk scandals in Bangladesh [
16,
17] and consumers’ low perceived value of belief have made them unhappy and, in most cases, have caused them to be more conscious about the quality of milk.
After being smeared by the effect of the supply-demand gap and food safety crisis, the consumers, vendors, policy makers, and other stakeholders currently accredit the importance of perceiving knowledge [
18]. In case of purchasing LM, knowledge about the process and product is vital in explaining consumer behaviour [
19]. Again, knowledge acquired on the products and values perceived by the consumers play a key role in determining the intent to purchase [
20]. Literature revealed that health consciousness and information sources have an interacting effect on perceived knowledge in the use of nutrition labels [
21]. In addition, the association between consumers’ health consciousness and knowledge is necessary to promote functional food consumption [
2,
3,
22]. Then again, health consciousness is linked with subjects’ visits to health specialists [
23], and perceived product benefits [
24], indicating personal experiences. Again, personal experiences that subjects gather from different sources of information shape consumers’ belief [
25], meaning a link between their health consciousness and belief. Furthermore, health consciousness prompts positive public service announcements for the use of nutrition labels [
21]. Therefore, an urge from the demand side would be crucial to gauge the linkage between consumers’ Health Consciousness and Perceived Knowledge, and between Health Consciousness and Belief in predicting the behavioural intention of LM.
Consumers’ health consciousness and the necessity for functional foods are significantly correlated [
1]. A recent study by Nahid [
7] reported that health awareness is the only factor that influences the purchase intent of both processed and raw LM. Additionally, the ever-increasing awareness of gaining knowledge is mostly attributable to the health consciousness discerned by consumers [
26]. As investigated by Ching-Hsu Huang [
27], health consciousness does make changes to consumer preference, therefore influencing purchasing decisions of food. Numerous studies illustrate that health consciousness influences consumption [
2,
28,
29], attitude and behavior [
28,
30], and word of mouth (WOM) [
22]. However, the literature lacks information on how health consciousness influences consumers’ perceived knowledge and belief. Thus, the study aims to fill this knowledge gap.
In Bangladesh, around seventy percent people suffer from ‘Anaemia’ [
31], forty percent suffer from chronic energy deficiency and majority of women suffer from osteoporosis [
32]. As a fortified functional food, milk with vitamin D reduces risk of ‘osteomalacia’ and ‘osteoporosis’ [
1], and milk has a positive influence on cognitive behaviour of humans due to its high level of vitamin D [
33]. Additionally, the need for nutritional and quality food puts stress on vendors to supply unadulterated food [
27], since to reach our genetic potential we have to drink milk regularly [
34]. However, almost all sampled fresh milk traded on the Bangladeshi local market is adulterated [
15]. One study has revealed that Asian consumers are health conscious when they reconsider drinking wine [
35]. On the other hand, LM is considered to be the key functional dairy product for sale [
36], thus, to know to what extent they are health conscious in drinking LM and how this consciousness is linked with their perceived knowledge and belief of LM could be interesting. However, in the context of Bangladesh, a promising market for dairy business development in south Asia, the influence of Health Consciousness, Perceived Knowledge and Belief in determining consumer attitude and purchase intent is yet to be discovered. As little is known, the later problems and knowledge gap motivate us to carry out this study. Thus, this study, in this context, aims to shed light helping design effective dairy policy and examining how consumers’ Health Consciousness is associated with their Perceived Knowledge and Belief, and what determining role Health Consciousness, Belief, and Perceived Knowledge play in forming attitude towards LM and in determining the purchase intent of LM using Structural Equation Modelling (SEM). Moreover, the association between these outlined factors were evaluated.
The structure of the study is as follows. The literature review, hypotheses development, and the conceptual model are first demonstrated, followed by materials and methods. Then, the research results are discussed. Finally, the paper ends with concluding remarks, along with the limitations and directions for future research.
1.1. Literature Review and Hypotheses Development
People in developing countries currently consume an average of one-quarter of the milk and milk products per capita compared to the richer North, but this trend has been changing positively and rapidly. By 2020, developing countries are expected to consume 177 million metric tonnes more milk than they did in 1996–1998, and the success of the dairy industry presumably will depend on the protection of liquid milk [
37]. Currently, the milk consumption rate has been increasing fast in Asia [
38], where the 46 percent of total milk is consumed as LM [
39]. In Bangladesh, as emerging tiger of Asia, the growth of demand for fresh milk is increasing, which is not commensurate with that of the production of milk [
40]. Furthermore, the knowledge on the dairy field is scanty in this regard [
40]. Therefore, if consumers’ Health Consciousness has an influence on knowledge and belief, and the Perceived Knowledge and Belief on Attitude and Purchase intent (PI) of LM, would be noteworthy for the development of functional foods and the dairy sector both in general, and in the emerging market.
1.1.1. Health Consciousness
Health consciousness refers to the extent to which an individual tends to undertake health actions [
41]. Gould [
42] framed health consciousness into four dimensions: greater concerns to health, caring about health, engaging in searching for health information, and valuing healthy conditions. To maintain a healthy lifestyle, a good dietary meal is of very importance, especially a functional meal. Numerous studies [
43] have found that LM is a source of vitamins and nutrition that helps in maintaining good health. For instance, one glass (250 mL) of milk provides approximately 50% of the adult’s recommended dietary allowance [
44]. As stated in the Gould’s [
42] dimension, a health conscious individual should search for a source of healthy and fresh food. Therefore, we argue if a person is more health conscious, she/he is more likely to get involved in searching for fresh liquid milk that contains nutrition and vitamins, and in this way s/he might gather more knowledge.
Hypothesis 1a (H1a). More health conscious consumers will be more knowledgeable about LM than those who are relatively less health conscious.
The literature shows that people who are health conscious tend to visit health specialists more often [
23]. People who use media such as the internet, mass media, and interpersonal communication to gather health related information have proper health orientation, suggesting that the attitudes and behaviours [
45] are linked with pursuing a healthy life [
46]. Moreover, people with high concerns about health benefits consider LM as a source of diet and nutrition [
24]. According to Fishbein and Ajzen [
25], one of the bases that shape consumers’ belief is the personal experience they gather from different sources of information. Hence, it can be postulated that an individual’s knowledge [
27,
47] and thus, in turn, belief [
45] regarding consuming fresh food, in this case LM, is linked with health consciousness that they perceive. Hence, the following hypothesis is posited:
Hypothesis 1b (H1b). Consumers who are more health conscious will have a higher level of belief in LM than those who are less health conscious.
Health consciousness has been becoming a crucial factor while taking decision about consuming fresh food [
27]. Again, consumers’ behaviour changes due to changes taking place in their individual life, such as health conscious preference, desire for healthy lifestyle, and so on. [
27]. For this reason, providing information regarding nutritional value is important [
48] and vendors are increasingly becoming aware, and providing quality food that has high nutritional value [
27]. Hence, health consciousness influences attitude, and thus food purchasing decisions [
49]. Therefore, the following hypotheses are formulated:
Hypothesis 1c (H1c). Consumers’ health consciousness has a positive influence on their attitude towards LM.
Hypothesis 1d (H1d). Health consciousness affects consumers’ intention to purchase LM positively.
1.1.2. Perceived Knowledge
Consumer’s knowledge of food they purchase is crucial to explain consumer behaviour [
19]. This knowledge is decomposed into two categories: subjective and objective knowledge. While subjective knowledge refers to an individual’s perception of the information about a certain product or attributes, objective knowledge refers to individual’s accurate information about the same. The more knowledge consumers perceive about the product, the less risk they are deemed to bear on [
50]. Many researchers studied the interaction between knowledge and belief extensively [
51,
52]. Individuals’ knowledge about a certain event is shaped by the information they gain, while beliefs are based on knowledge an individual perceives [
53]. The literature has also revealed that the product knowledge has impacts on consumers’ taste perceptions [
54]. For the functional foods, consumers’ knowledge and their consumption frequency are significantly and positively correlated [
29], and the consumers who have higher knowledge buy and consume more functional foods than others do [
3]. In an emerging economy like Bangladesh, as a functional food, the extent to which consumers’ belief in LM is explainable by knowledge is yet to be measured. Thus, the following hypothesis is offered:
Hypothesis 2a (H2a). Consumers with high level of knowledge will have high level of belief in LM.
In the case of purchasing fresh LM, knowledge about the process by which LM is collected, handled, and processed is vital to consider, since knowledge about unsafe food handling process could negatively impact the attitude towards food consuming decisions [
55]. Consequently, in this study, consumers’ knowledge regarding LM is decomposed into two categories: product knowledge and procedural knowledge. Knowledge about the sources of collection (Raw or Processed etc.), quality, preservation status and so on is included in product knowledge [
56]. Procedural knowledge entails different methods of processing or collection of LM to make it drinkable [
56]. In addition, knowledge is expected to be highly correlated with consumption or expertise [
57]. Considering the above discussion, the following hypotheses are designed:
Hypothesis 2b (H2b). Consumers’ perceived knowledge has a positive impact on their attitude towards LM.
Hypothesis 2c (H2c). Consumers’ perceived knowledge has a positive impact on the purchase intent of LM.
1.1.3. Belief
That how consumers perceive a product or, how they react in the acceptance or rejection of a product is shaped by multidimensional factors [
58]. These factors include both sensory attributes and prepossessed thoughts, such as belief about the products [
59]. Studies suggest that consumers’ preferences regarding food choice can be greatly influenced by belief about the characteristics, as well as about the methods of processing [
60]. As LM is a functional food and a convenient source of nutrition, people find it a good alternative. Hence, their belief can be shaped by the characteristics and attributes of LM. Additionally, as the LM has to go through the various collection processes, consumers’ perceptions can also be influenced by beliefs about the method of processing.
Belief represents the information that a consumer possesses about an object and therefore links that object to some attributes [
26]. Also, according to Smith, Walker, and Hamidova [
61], belief can be represented as individual’s perception of the interaction between an object and the attributes related to it. Taylor [
62] defined two types of belief namely personal belief and commonly held belief. The former is held in individual, solely inscribed in them and not shared with others. On the other hand, the latter is formed by few individuals, a small group, a community, a society, a culture or by most of humanity. Shared belief explains social action, which influences belief [
62]. As a result, belief changes with the passage of time [
62] and often is specific to groups or cultures. These findings give rise to the question of how beliefs are formed [
63]. To address the factors constituting belief, Fishbein and Ajzen [
25] proposed three bases for belief formation: descriptive belief, inferential belief and informational belief, suggesting that belief is formed through a very long and vigorous process. As a consequence, we can argue that belief is greatly comprehended by various aspects which, in turn, determine the consumers’ attitude, preference and purchase intent [
60]. Hence, in the light of the above discussion, the following hypotheses are posited:
Hypothesis 3a (H3a). Consumers’ belief has a positive influence in forming their attitude towards LM.
Hypothesis 3b (H3b). Consumer’ belief has a positive influence in their purchase intent of LM.
1.1.4. General Attitude and Purchase Intent
The Theory of Planned Behaviour (TPB) is used to elucidate a person’s intention to show a particular behaviour [
64]. The stronger the intention, the higher the propensity to behave. The TPB assumes three independent factors, including the attitude toward the behaviour, the subjective norm and the perceived behavioural control (PBC) influencing the intention jointly [
64]. According to the TPB, attitude serves as a key determinant of behavioural intentions. The more favourable the attitude of an individual towards the behaviour, the stronger his/her intention to perform the behaviour. Therefore, the following hypothesis is formulated:
Hypothesis 4 Attitude positively influences the purchase intent of LM.
The study focuses on the role of Health Consciousness, Belief, and Perceived knowledge on consumers’ attitude towards LM and on their purchase intent. In doing so, the study develops a conceptual framework using structural equation modelling (
Figure 1).
1.1.5. Mediating Effect of Health Consciousness
In general, one should discuss the direct, indirect, and total effects among latent variables in “causal effect modelling”, following the theory and the model [
65]. An indirect effect implies the effect of an independent variable on a dependent variable through a mediating variable [
66]. In food products, informed liking, such as consumers’ evaluation of packaging, brand, product variety, region, consumers’ blind liking, and so on, can mediate the relationship between cues and purchase intent [
67]. As we are interested in testing the effect and relationship between consumers’ Health Consciousness and their Perceived Knowledge, and Health Consciousness and Belief, we assume the mediating effect can help in this regard. In doing so, the following four hypotheses have been posited.
Based on the H1a and H2b, Hypothesis 1e (H1e) is predicted:
Hypothesis 1e (H1e). Consumers’ perceived knowledge regarding LM can mediate the relationship between Health Consciousness and Attitude.
Assuming a true relationship between the hypothesis H1a and hypothesis H2c, The second mediating hypothesis (H1f) is estimated:
Hypothesis 1f (H1f). Consumers’ health consciousness has an indirect influence on the purchase intent through their perceived knowledge.
If the hypotheses, H1b and H3a are true, then we can posit the third mediating hypothesis:
Hypothesis 1g (H1g). Health consciousness can contribute to forming consumers’ attitude towards LM via their perceived belief.
Finally, last mediating hypothesis, H1h has been formed based on the previously formulated hypotheses namely, H1b and H3b:
Hypothesis 1h (H1h). Consumers’ health consciousness can influence the purchase intent positively through their perceived belief.
4. Discussion
The study aimed to investigate the role of consumers’ health consciousness on perceived knowledge and belief in the first place. Then, the influence of health consciousness, perceived knowledge, and belief in forming attitude and purchase intent of liquid milk has been examined. In doing so, a structured questionnaire was developed using various scales supported by previous literature, and was carried out in the two major cities of Bangladesh. To address the research objectives, firstly, a total of ten hypotheses were formulated and tested using Structural Equation Modelling. In addition, a mediating role played by the constructs has also been investigated to see which variables, if any, play an indirect effect to explain the purchase intent of liquid milk. The data, measurement model and structural model represented adequate fit, and the reliability was also significant for various constructs.
The hypothesis H1a supports the argument that health consciousness significantly increases the perceived knowledge. Again, in H1b health consciousness positively signifies Belief. Jayanti & Burns [
100] suggest that consumers with greater health knowledge displayed significant preventative health behavior, meaning that the purchase intent of liquid milk as a functional food was predicted by health consciousness. However, our findings contradicted theirs; after examining this issue in H1d we found that health consciousness does not have any significant effect on the purchase intent of liquid milk, although the impact of health consciousness is significantly positive on Attitude toward liquid milk (H1c). We argue that the milk adulteration incidence in recent decades in Bangladesh might have raised a negative concern among the consumers about the attributes of LM, and have a negative effect on the purchase intent.
Belief formation is an extensive process [
25] which is largely influenced by the perceived knowledge of a consumer [
53]. Hypothesis H2a supports that perceived knowledge significantly and positively influences the belief of the consumer, suggesting that consumers who have stronger belief in liquid milk tend to bear more knowledge than those who have lower belief. This might be caused by the search for information relating to health and nutritional benefits of liquid milk, because of its features as a functional product, which is defined as foods sold for health benefits and is characterized by functional ingredients deemed to help prevent various diseases, and dietary supplements [
101]. This finding is accentuated by testing hypothesis H2b and H2c, wherein H2b posits that perceived knowledge has no bearing on attitude toward liquid milk and H2c reports perceived knowledge has significant impact on the purchase intent of liquid milk. In line with these sorts of findings, Cazacu [
102] reported that in Greece the perceived knowledge plays a significant role in purchase intent of dairy functional foods.
Accordingly, H3a supports that consumers’ belief plays a significant positive role in determining attitude towards liquid milk. In addition, H3b posits that the purchase intent of liquid milk is significantly and positively influenced by the belief. In line with this, the literature reports that an individual’s response toward a particular idea or object, predisposed by an organization of belief, can be defined as attitude [
103], which, in turn, is hypothesized reflect on his behavior [
104]. Again, a study conducted by Lino et al. [
105] reported that underlying belief about dietary supplements significantly predicted the intention towards dietary supplement use. Moreover, belief regarding nutritional value, taste, freshness and appearance influenced organic food consumers’ attitudes and preferences [
106]. Finally, H4 reports that the attitude is a good predictor of purchase intent, which also corroborates the basic attitudinal research that attitude is the precedent of purchase intent [
107,
108].
However, to test the mediating relationship between health consciousness and attitude via perceived knowledge, hypothesis H1e was investigated, and the result shows that perceived knowledge does not mediate the effect of health consciousness and attitude. Although health consciousness has a significant effect on perceived knowledge, for the low level of knowledge about liquid milk, perceived knowledge cannot mediate the relationship between health consciousness and attitude. Again, in hypothesis H1f, perceived knowledge can mediate the relationship between health consciousness and purchase intent. However, the results revealed that perceived knowledge cannot mediate the relationship between health consciousness and attitude, and consumers’ perceived knowledge is average or low. Therefore, an indirect effect of health consciousness on purchase intent through perceived knowledge indicates that they are purchasing liquid milk against their willingness to buy. Evidence shows that the sensory perceptions of liquid milk can mediate the relationship between perceived knowledge and consumers’ purchase intent [
109]. Thus, perceived barriers influence consumers’ attitude negatively [
110]. The hypothesis H1g supports the claim that health consciousness has an indirect effect on attitude through belief as perceived knowledge has a significant effect on belief. However, the same relationship is not true via perceived knowledge, indicating that consumers’ level of belief toward liquid milk is higher than their perceived knowledge. Because, the availability of information on personal attitude and belief and the cultural context in which this information is derived can also facilitate comprehension of the relative importance of factors that influence food choice [
111]. Thus, for hypothesis H1h, the results support the hypothesis: belief can mediate the relationship between health consciousness and purchase intent.
5. Conclusions
The main theoretical contribution of the paper is to conceptualize and model the factors influencing consumers’ purchase intent for liquid milk based on a field survey, including Health Consciousness, Perceived Knowledge and Belief. To the best of our knowledge, the study is a pioneer in the field of consumer behavior analysis in that it includes these three factors exclusively for the first time to explain their role in forming attitude and purchase intent, to get a close insight into consumer perceptions of liquid milk as a functional food and to help make an effective dairy policy. Our study reveals that health-conscious people do bear a positive attitude toward liquid milk, but their health consciousness does not necessarily influence their purchase intent. Consumers are becoming more educated, health conscious, and thus have begun to consider food attributes more carefully when choosing food items [
112]. Again, health consciousness influences perceived knowledge and belief positively. Furthermore, perceived knowledge influences consumers’ belief positively, meaning that consumers’ health consciousness and their belief towards liquid milk have been developed based on their perceived knowledge. Thus, the marketers should focus on consumers’ knowledge about LM. Because the perceived knowledge of milk, like ‘taking responsibility for one’s health’, is the key to liquid milk commercialization [
109].
The results of the study demonstrate that the influence of belief on both attitude and purchase intent is significantly positive. Existing literature shows that belief is formed through a long comprehensive process, such as in the form of direct observation, inferences, or gathering information [
25,
61]. Therefore, stakeholders should take initiatives to disseminate all required information, specifically the nutritional facts [
109] that can help to increase the level of belief regarding their marketed liquid milk, since consumers perceive that behavioural belief can help producers, marketers and government in formulating effective dairy policies [
7]. Again, the study by Boniface and Umberger [
113] found that over hedonist consumers consider information regarding health, product, process, and convenience when they form certain perceptions regarding dairy product quality. That is the reason why manufacturers and marketers should know consumers’ perception toward the quality of a dairy product [
114] because consumers who perceive dairy products as a nice source of nutrients consume more dairy products than do others.
From managerial perspective, this study substantiates the fact that the stakeholders, including marketers, government and different community actors, are far from educating the consumers about liquid milk, suggesting that an efficacious public awareness strategy should be increased through effective means of communication. This finding would have several implications so far. For instance, a more engaging consumer knowledge enhancement plan should be framed with ensuring the cognitive evaluation process so that their sentimental mentality of fear and emotional responses arising from the food safety concern could be diverted towards a more discreet purchasing preference decision [
19].
The outcomes also report that health consciousness and belief influence consumer’s attitude towards liquid milk positively, but perceived knowledge does not have any statistically significant impact. However, perceived knowledge can affect purchase intent directly, meaning that consumers have little information regarding liquid milk that cannot help in building a significant feeling towards liquid milk. Evidence shows that in the Bangladeshi market, consumers are not satisfied with the quality of liquid milk [
7,
109]. In general, they consider the liquid milk to be a hedonic product [
109] and recommend it for their children because they prefer to consume functional foods in the natural form [
115]. Consumers' perceived value of naturalness and freshness of raw liquid milk are high [
109] and we argue that consumers perceived value of naturalness of liquid milk is higher than other types of milk, such as powdered milk. As their perceived knowledge is poor and they do not have a better alternative in the market within a liquid category, until now consumers’ perceived knowledge influenced their purchase behavior of liquid milk.
In the light of the following limitations, the future research scope can be identified. First, this study takes into account one dimension of health perception, namely physical health consciousness. Other dimensions such as mental, social, emotional, and spiritual health have not been considered. Future studies can examine these factors. In addition to this, the other important variables, such as the effect of emotion, specific belief, perceived risks, trust, and so on, can be used as an explanatory variable. For the convenience of the study, we administered a random sampling procedure; in the further research, a large sample with a greater range of cities should be used to ensure the efficacy of the model and to reduce the risk of spurious findings linking attitude and actual behaviour. In this study, we took into account the effect of subjective knowledge on attitude and purchase intent, but the magnitude of this discrepancy, namely, over and underestimation of knowledge, was not considered. However, future researchers should concentrate on their cautiousness about their insufficient knowledge regarding liquid milk by measuring and evaluating the subjective knowledge and objective knowledge separately. Hence, a further examination can consider this issue. Lastly, a cross-culture study should be undertaken to gain a deeper insight of the region and to design an effective strategy with a broader perspective.