Abstract
This study examines the potential for point-of-decision prompts (PDPs) to promote healthier food choices among shoppers in a rural, low-income, minority community. We hypothesized that a narrowly defined PDP (focused on fresh produce) would be easier for shoppers to remember than a broadly defined PDP (focused on any healthy items), resulting in a higher proportion of healthy items purchased. PDPs were placed at the entrance to a supermarket in Mission, South Dakota, United States of America, on the Rosebud Sioux Reservation for alternating time periods, July 9–10, 2017. Sales records from 653 transactions were retrieved from the supermarket, comprising periods in which PDPs were in place and control periods. We examined the proportion of selected items and proportion of total expenditures that were a) any healthy foods and b) fresh fruits and vegetables. Data were analyzed in 2018. The narrowly defined prompt consistently resulted in a higher proportion of items and expenditures on healthy foods than either the broad prompt or the control condition. Shoppers in the narrow prompt condition purchased and spent significantly more on any healthy foods and fresh produce than shoppers in the control condition. While shoppers in the narrow prompt condition purchased more healthy foods and fresh produce than shoppers in the broad prompt condition, the differences were not statistically significant. Shoppers exposed to the narrow PDP consistently purchased more healthy foods than shoppers in a control group, while shoppers in the broad PDP did not, highlighting the importance of considering cognitive processes when designing health promotion messages.
Highlights
Obesity, which has increased steadily in the US in recent decades [1], is linked to diverse negative consequences, which include poorer health; increased risks of non-communicable diseases, such as type-2 diabetes, various cancers, and heart disease; and decreased life expectancy [2]
In the B-Point-ofdecision prompts (PDPs) condition, 31% of the difference in healthy food purchases relative to the control condition is attributable to Fruits and Vegetables (F&V), while the remaining 69% comes from other healthy foods
In the N-PDP condition, 75% of the difference in healthy food purchases comes from F&V, while the remaining one-quarter is attributable to other healthy foods
Summary
Obesity, which has increased steadily in the US in recent decades [1], is linked to diverse negative consequences, which include poorer health; increased risks of non-communicable diseases, such as type-2 diabetes, various cancers, and heart disease; and decreased life expectancy [2]. Certain populations, including members of some ethnic groups as well as rural and poorer individuals, experience higher rates of obesity on average [5,6]. A few studies suggest that PDPs that explicitly prompt individuals to consider health when making food decisions—in contrast to PDPs that present objective information—lead to healthier choices [14,24,25]. When individuals are prompted to consider health when making a food choice, they choose healthier items and exhibit different patterns of neural activation [24]. We report the results of a grocery store-based field experiment that examines the efficacy of PDPs that explicitly encourage shoppers to consider health while making food choices in a predominantly low-income, minority population in the rural Midwest. We hypothesize that shoppers in the N-PDP condition will increase their purchases of healthy foods more than shoppers in the B-PDP condition, and that purchases of healthy foods in each intervention condition will be higher than items purchased by shoppers in a control condition
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