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Background: Nutrition labels are a potentially valuable tool to assist consumers in making healthy food choices. Front-of-pack labels are a relatively new format and are now widely used across many European countries, but it is unclear which of the many formats in use are best understood by consumers. It is also unclear whether the existence of multiple formats impedes understanding and use. This article addresses this question with findings from a study commissioned by the UK Food Standards Agency to provide evidence to inform policy decisions in this area., Methods: In-depth qualitative interviews were used to explore consumers' decision-making processes when using two different front-of-pack label formats to judge the relative healthiness of a pair of products. Participants were presented with product pairs differently labelled and a series of structured prompts were used to access their internal dialogues and to identify any difficulties encountered., Results: The interviews revealed that making product comparisons using different label formats was challenging for participants and particularly for those product pairs where there was not an obvious answer. When the label formats on the product pairs lacked a common element, such as text, this also caused difficulties and misinterpretation. The comparisons also took time and effort that would be a deterrent in real-life situations., Conclusions: These findings indicate that the existence of multiple front-of-pack label formats in the marketplace may impede consumer comprehension and discourage use. They suggest that a single format may encourage consumers to use front-of-pack labels in making healthy food choices.