Abstract
BackgroundHospitals in the UK offer snacks for sale to patients, staff and visitors. Despite the NHS’s health promoting role, and tightening of regulations around which foods can be sold in hospitals, many snacks purchased in this setting are unhealthy. The present project tests the effectiveness of theory-based point of purchase prompts (PPPs; a form of cognitive nudge) designed to make it cognitively easier for consumers to compare available products and choose healthier options.MethodsHospital shops in Scotland (n = 30) were recruited into a cluster randomised controlled trial to test whether a PPP could reduce the average calorie, fat and/or sugar content of purchased snacks. Inclusion criteria stated that eligible sites; sold food; were located in a hospital; and were accessible to staff, patients and visitors. The PPP intervention was a theory-based sign (tailored to the available range in each location) designed to cognitively simplify healthier snack choices by facilitating cross-product comparison. Shops were randomised to display PPPs (intervention; n = 15) or not (control; n = 15) using block randomisation controlling for shop size. Data on all snacks purchased from participating shops were obtained from retailers for a 12-week baseline and 12-week follow-up period. Primary outcomes were the average calorie (kcals), fat(g) and sugar(g) content of snacks purchased each day. Secondary outcomes were the average customer spend per item purchased (£,p) and the total number of snacks purchased daily. Shop staff were not blinded to group assignment but data providers were. Data were analysed using mixed effects multi-level regression models.ResultsData from > 1 million snack purchases were analysed. Snacks purchased from intervention sites were on average significantly lower in calorie (γ = − 1.84, p < .001) and sugar (γ = − 0.18, p = .030) at follow up relative to baseline but only the reduction in calories was significantly different to control. Average spend per item also reduced significantly in intervention (but not control) sites (γ = − 0.89, p < .001). The intervention had no effect on the fat content of snacks or the number of snacks sold.ConclusionsSimple, theory-based point of purchase prompts can produce small but statistically significant reductions in the energy content of snack purchases from hospital shops.Trial registrationRetrospectively registered (8/Oct/2018) with ISRCTN (ID: ISRCTN90365793).
Highlights
Hospitals in the UK offer snacks for sale to patients, staff and visitors
Design A 2-arm cluster randomised controlled trial comparing the nutritional content of snacks purchased from hospital shops randomised (1:1) to display purchase prompts (PPPs) or not
Sites were randomly allocated to intervention or control and individually tailored PPP interventions were prepared for sites allocated to intervention
Summary
Despite the NHS’s health promoting role, and tightening of regulations around which foods can be sold in hospitals, many snacks purchased in this setting are unhealthy. When unhealthy foods are readily available in the surrounding environment, they are likely to be opportunistically selected and consumed [10]. Numerous empirical studies have demonstrated that consumers are more likely to choose healthy options when such options are (relative to unhealthy options) more readily available within an environment. Van Kleef and colleagues [12] demonstrated in both a controlled laboratory experiment and an observational field study of snack choices in a hospital canteen that consumers chose healthier options when the available range was modified to contain 75% rather than 25% healthy options. A recent systematic review of healthy choice interventions in vending machines [13] demonstrated that interventions which altered availability were effective in increasing selection of healthy options
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
