Abstract
BackgroundChoice architecture interventions, which subtly change the environment in which individuals make decisions, can be used to promote behavior change. This systematic review aimed to summarize studies on micro-environmental choice architecture interventions that encouraged physical activity or discouraged sedentary behavior in adults, and to describe the effectiveness of those interventions on these behaviors – and on related intentions or health outcomes – in presence of the intervention and after removal of the intervention (i.e. post-intervention, regardless of the time elapsed).MethodsWe systematically searched PubMed, Embase, PsycINFO and the Cochrane Library for (quasi) experimental studies published up to December 2019 that evaluated the effect of choice architecture interventions on physical activity and sedentary behavior, as well as on intentions and health outcomes related to physical activity/sedentary behavior. Studies that combined choice architecture techniques with other behavior change techniques were excluded. All studies were screened for eligibility, relevant data was extracted and two independent reviewers assessed the methodological quality using the QualSyst tool.ResultsOf the 9609 records initially identified, 88 studies met our eligibility criteria. Most studies (n = 70) were of high methodologic quality. Eighty-six studies targeted physical activity, predominantly stair use, whereas two studies targeted sedentary behavior, and one targeted both behaviors. Intervention techniques identified were prompting (n = 53), message framing (n = 24), social comparison (n = 12), feedback (n = 8), default change (n = 1) and anchoring (n = 1). In presence of the intervention, 68% of the studies reported an effect of choice architecture on behavior, whereas after removal of the intervention only 47% of the studies reported a significant effect. For all choice architecture techniques identified, except for message framing, the majority of studies reported a significant effect on behavioral intentions or behavior in presence of the intervention.ConclusionsThe results suggest that prompting can effectively encourage stair use in adults, especially in presence of a prompt. The effectiveness of the choice architecture techniques social influence, feedback, default change and anchoring cannot be assessed based on this review. More (controlled) studies are needed to assess the (sustained) effectiveness of choice architecture interventions on sedentary behavior and other types of physical activity than stair use.
Highlights
An important public health challenge of the twenty-first Century is to increase individuals’ levels of physical activity and to reduce their sedentary behavior
The effectiveness of the choice architecture techniques social influence, feedback, default change and anchoring cannot be assessed based on this review
We did not assess the risk of publication bias [132]. This systematic literature review extends the work of Forberger et al (2019) [31] and Hollands et al (2013) [14] by providing a systematic and comprehensive overview of studies that used choice architecture interventions to encourage physical activity or to discourage sedentary behavior in adults
Summary
An important public health challenge of the twenty-first Century is to increase individuals’ levels of physical activity and to reduce their sedentary behavior. One third of the adult population worldwide does not reach the public health guidelines for recommended levels of physical activity [1], and almost one in five Europeans report sitting more than 7.5 h per day [2]. This is worrisome, given that physical inactivity and excessive sedentary behavior independently increase the risk of non-communicable diseases, and can shorten life expectancy [3–7]. Choice architecture is built on the principle that human decision making is often based on automatic and/or heuristic thought processes, rather than effortful deliberate processes alone [15–18] These automatic thought processes play a considerable role in daily behavior, including habits [19]. This systematic review aimed to summarize studies on microenvironmental choice architecture interventions that encouraged physical activity or discouraged sedentary behavior in adults, and to describe the effectiveness of those interventions on these behaviors – and on related intentions or health outcomes – in presence of the intervention and after removal of the intervention (i.e. postintervention, regardless of the time elapsed)
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