Choice-architecture Strategies Research Articles

Acceptability of workplace choice architecture modification for healthy behaviours

BackgroundAltering the choice architecture of decision contexts can assist behaviour change, but the acceptability of this approach has sparked debate. Considering hypothetical interventions, people generally welcome the approach for promoting health, but little evidence exists on acceptance in the real world. Furthermore, research has yet to explore the implementers’ perspective, acknowledging the multidimensionality of the acceptability construct. Addressing these knowledge gaps, this study evaluated the acceptability of a quasi-experimental implementation-effectiveness trial that modified the worksite choice architecture for healthy eating and daily physical activity.MethodsFifty-three worksites participated in the 12-month intervention and implemented altogether 23 choice architecture strategies (Mdn 3/site), including point-of-choice prompts and changes to choice availability or accessibility. Retrospective acceptability evaluation built on deductive qualitative content analysis of implementer interviews (n = 65) and quantitative analysis of an employee questionnaire (n = 1124). Qualitative analysis examined implementers’ thoughts and observations of the intervention and its implementation, considering six domains of the Theoretical Framework of Acceptability: ethicality, affective attitude, burden, intervention coherence, opportunity costs, and perceived effectiveness. Quantitative analysis examined employees’ acceptance (7-point Likert scale) of eight specific intervention strategies using Friedman test and mixed-effects logistic regression.ResultsImplementers considered the choice architecture approach ethical for workplace health promotion, reported mostly positive affective attitudes to and little burden because of the intervention. Intervention coherence supported acceptance through increased interest in implementation, whereas low perceived utility and high intensity of implementation reduced cost acceptance. Perceived effectiveness was mixed and varied along factors related to the implementer, social/physical work environment, employer, and employee. Employees showed overall high acceptance of evaluated strategies (Mdn 7, IQR 6.4–7), though strategies replacing unhealthy foods with healthier alternatives appeared less supported than providing information or enhancing healthy option availability or accessibility (p-values < 0.02). Greater proportion of male employees per site predicted lower overall acceptance (OR 4.4, 95% CI 1.2–16.5).ConclusionsWork communities appear to approve workplace choice architecture interventions for healthy eating and physical activity, but numerous factors influence acceptance and warrant consideration in future interventions. The study contributes with a theory-based, multidimensional evaluation that considered the perspectives of implementers and influenced individuals across heterogeneous real-world settings.

Nudges and choice architecture to promote healthy food purchases in adults: A systematized review.

Consistent with behavioral economic models that emphasize the context-dependance of behavioral choice, choice architecture strategies change the environmental context to promote or nudge healthier choices including the healthfulness of food purchases that may help reduce disease and premature death. This review summarizes research that investigated nudging interventions to promote healthful food purchase choices among adults. A comprehensive systematized search strategy identified research published since 2009 that investigated the role of nudges and choice architecture interventions on adult food purchasing decisions with behavioral outcomes. Study data were extracted and summarized regarding nudge characteristics, design features, study quality, and food purchasing outcomes. The search identified 1,129 articles, 33 of which met inclusion criteria. Twelve studies were rated as high quality, 21 as neutral, and none as low quality. Some evidence of effectiveness was found for priming nudges that manipulated physical, verbal, or sensational cues to promote healthy choices (8 of 11 studies); salience and affect nudges that used novel or personally relevant cues to direct attention to healthy choices (3/3); messenger nudges that presented information on socially normative food choices (2/2), and default nudges that made healthy options the preset choice (1/2). In studies that combined nudge types, combining priming and salience and affect nudges was at least partially effective in 5 of 5 studies. Nudge applications in food purchasing settings, particularly priming, offers a promising public health strategy to encourage healthier food choices among adults. More research is needed to determine optimal nudge combinations and contexts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The efficacy of a multi-strategy choice architecture intervention on improving the nutritional quality of high school students’ lunch purchases from online canteens (Click & Crunch High Schools): a cluster randomized controlled trial

BackgroundHigh school canteens are an ideal setting for public health nutrition intervention, and choice architecture strategies that facilitate the purchase of healthier foods and beverages from school canteens are recommended by the World Health Organization. The rapid uptake of online lunch ordering within school canteens provides a unique opportunity to implement choice architecture strategies that support healthier food choices with high fidelity. Despite this, no trial has tested the efficacy of choice architecture strategies within an online lunch ordering system on improving the nutritional quality of high school student lunch purchases. The objective of this study was to assess the impact of embedding choice architecture strategies into an online lunch ordering system on the nutritional quality of the school canteen lunch purchases of high school students (aged 12–19 years).MethodsA cluster randomized controlled trial was conducted with nine high schools in one Australian state. Schools were randomized to receive either a 2-month choice architecture intervention (involving menu labelling, prompts, item positioning, and feedback), or usual online ordering. Nutrient quality of online canteen lunch purchases was assessed using routine data collected by the online ordering system. Primary outcomes were the proportion of ‘Everyday’, ‘Occasional’, and ‘Should not be sold’ items purchased, categorized using the state healthy canteen policy. Secondary outcomes were the mean energy, saturated fat, sugar, and sodium content of purchases and the mean weekly revenue from online lunch orders. Linear mixed models were analyzed to assess outcomes.ResultsAnalysis of the student cohort (Intervention: 4 schools, 656 students; Control: 5 schools, 675 students) showed significant between group differences over time for the intervention group for the mean percentage of online lunch items per student that were ‘Everyday’ (+ 5.5%; P < 0.001) and ‘Should not be sold’ (− 4.4%; P < 0.001). There were no between group differences over time in the mean percentage of online lunch items that were ‘Occasional’; the average energy, saturated fat, sugar, or sodium content of lunch orders. There was also no difference in mean weekly revenue from high school student online lunch orders (P = 0.23).ConclusionsThese findings suggest that a low intensity, choice architecture intervention embedded within an online ordering system can increase the purchase of healthier food items for high school students in one Australian state without any adverse impact on canteen revenue.Trial registrationThis trial was prospectively registered on Open Science Framework on 23rd October 2020 as osf.io/h8zfr.

Long-term Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students' Online Lunch Orders: 18-Month Follow-up of the Click & Crunch Cluster Randomized Controlled Trial.

BackgroundSchool food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online.ObjectiveThis study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students’ lunch orders 18 months after baseline.MethodsThis cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as everyday, occasional, and caution) were assessed over an 8-week period at baseline and 18-month follow-up.ResultsIn all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (–74.1 kJ; 95% CI [–124.7, –23.4]; P=.006) and saturated fat (–0.4 g; 95% CI [–0.7, –0.1]; P=.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing everyday items increased significantly (odds ratio [OR] 1.2; 95% CI [1.1, 1.4]; P=.009, corresponding to a +3.8% change) and the odds of purchasing caution items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9]; P=.002, corresponding to a –2.6% change). There was no between-group difference over time in canteen revenue.ConclusionsThis is the first study to investigate the sustained effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally; however, more research is required.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075

Choice architecture for young adult blood donor recruitment – a feasibility study

ABSTRACT Blood shortages remain an ongoing challenge, ameliorable by increasing blood donations. Choice architecture is an emerging concept in psychology dealing with the targeted presentation of options to encourage a desired decision. A pilot study was designed to test the feasibility of implementing six choice architecture strategies on a Midwest high-school blood drive. These include framing, conformity, mere measurement, availability heuristic, loss aversion and status quo bias. A pre-post interrupted time-series evaluation was performed to evaluate for an immediate impact on blood donations. All six of the intended choice architecture strategies were successfully implemented. The pre-intervention 5-year average number of blood donations per blood drive was 15 (4.3% of age eligible donors) whereas post intervention, the number of blood donors rose to 25 (7.1% of age eligible donors; p-value = .0013). The application of choice architecture to blood donor recruitment strategies is feasible and has the potential to reduce the burden of blood shortages.

Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students' Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial.

BackgroundSchool food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these routinely used systems provides the opportunity to impact the purchasing decisions of many users simultaneously and warrants investigation.ObjectiveThis study aims to assess the effectiveness of a multistrategy behavioral intervention implemented via a web-based school canteen lunch ordering system in reducing the energy, saturated fat, sugar, and sodium content of primary students’ web-based lunch orders.MethodsThe study used a parallel-group, cohort, cluster randomized controlled trial design with 2207 students from 17 Australian primary schools. Schools with a web-based canteen lunch ordering system were randomly assigned to receive either a multistrategy behavioral intervention that included choice architecture strategies embedded in the web-based system (n=9 schools) or the standard web-based ordering system only (n=8 control schools). Automatically collected student purchasing data at baseline (term 2, 2018) and 12 months later (term 2, 2019) were used to assess trial outcomes. Primary trial outcomes included the mean energy (kJ), saturated fat (g), sugar (g), and sodium (mg) content of student lunch orders. Secondary outcomes included the proportion of all web-based lunch order items classified as everyday, occasional, and caution (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue.ResultsFrom baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1; P=.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4; P<.001) than the control lunch orders, but they did not have significantly lower sugar or sodium content. There was also a small significant between-group difference in the percentage of energy from saturated fat (−0.9%, 95% CI −1.4% to −0.5%; P<.001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9%; P=.02). Relative to control schools, intervention schools had significantly greater odds of having everyday items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0; P<.001), corresponding to a 9.8% increase in everyday items, and lower odds of having occasional items purchased (OR 0.7, 95% CI 0.6-0.8; P<.001), corresponding to a 7.7% decrease in occasional items); however, there was no change in the odds of having caution (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0; P=.05). Furthermore, there was no change in schools’ revenue between groups.ConclusionsGiven the evidence of small statistically significant improvements in the energy and saturated fat content, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075.International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2019-030538

The effect of a shelf placement intervention on sales of healthier and less healthy breakfast cereals in supermarkets: A co-designed pilot study.

Supermarkets are the principal source of grocery food in many high-income countries. Choice architecture strategies show promise to improve the healthiness of food choices. A retailer-academic collaboration was formed to co-design and pilot selected commercially sustainable strategies to increase sales of healthier foods relative to less healthy foods in supermarkets. Two co-design workshops, involving supermarket corporate staff and public health nutrition academics, identified potential interventions. One intervention, more prominent shelf placement of healthier products within one category (breakfast cereals), was selected for testing. A pilot study (baseline, intervention and follow-up, 12-weeks each) was undertaken in six supermarkets (three intervention and three control) in Auckland, New Zealand. Products were ranked by nutrient levels and profile, and after accounting for the supermarkets' space management principles, healthier products were placed at adult eye level. The primary outcome was change in sales of healthier products relative to total category sales. Secondary outcomes were nutrient profile of category sales, in-store product promotions, customer perceptions, and retailer feedback. There was no difference in proportional sales of more prominently positioned healthier products between intervention (56%) and control (56%) stores during the intervention. There were no differences in the nutrient profile of category sales. A higher proportion of less healthy breakfast cereals were displayed in intervention versus control stores (57% vs 43%). Most customers surveyed supported shelf placement as a strategy (265, 88%) but noted brand preferences and price were more salient determinants of purchases. Retailers were similarly supportive but balancing profit, health/nutrition and customer satisfaction was challenging. Shelf placement alone was not an effective strategy to increase purchases of healthier breakfast cereals. This study showed co-design of a healthy eating intervention with a commercial retailer is feasible, but concurrent retail environment factors likely limited the public health impact of the intervention.

Healthy by Design: Utilizing Choice Architecture to Improve Food Environments

Abstract Objectives To codify evidence-based design strategies and best practices for designing food environments that make the healthiest choice the easiest choice. Methods Choice architecture refers to the practice of influencing choice by “organizing the context in which people make decisions.” Designers and architects are well-versed in choice architecture as it pertains to active design guidelines, such as the placement and promotion of stairs to encourage movement. However, there is little guidance on how to incorporate choice architecture interventions to nudge food choices and promote the health and well-being of the individuals who work, learn and live in these spaces. The WELL Building Standard version 2™ (WELL v2™) pilot is a global building certification program that addresses the intersection of health and the built environment across ten concepts. The WELL Nourishment concept codifies several evidence-based choice architecture interventions in an effort to empower architects and designers to construct dining spaces and eating environments conducive to health. WELL requires that fruits and vegetables are positioned in high-visibility locations to optimize their visibility and selection, recommends optimal dishware sizes to help guide appropriate portion sizes and reduce food waste, and promotes healthy food choices through intentional menu design. Results There are over 4000 projects currently applying the design, policy and operational strategies of WELL, encompassing over 500 million square feet across 58 countries. Each project is committed to optimizing the food environment through various choice architecture strategies designed to make the healthiest choice the easiest choice. Post-occupancy survey data from certified projects will help elucidate the impact of the design of our built spaces on human health and inform the continuous evolution of the standard. Conclusions Building standards and rating systems are guiding the future of our built world and how we interact with the spaces in which we spend the majority of our time. We must continue to educate and empower designers and architects to create healthy eating environments. Funding Sources None.

Availability of Supplemental Nutrition Assistance Program-authorised retailers' voluntary commitments to encourage healthy dietary purchases using marketing-mix and choice-architecture strategies.

To examine public commitments for encouraging United States consumers to make healthy dietary purchases with their Supplemental Nutrition Assistance Program (SNAP) benefits among of prevalent SNAP-authorised retailers. National SNAP-authorised retail landscape in addition to stores located in California and Virginia, two states targetted for a Partnership for a Healthier America pilot social marketing campaign. SNAP-authorised retailers with the most store locations in selected settings. A review of retailers' publicly available business information was conducted (November 2016-February 2017). Webpages and grey literature sources were accessed to identify corporate social responsibility (CSR) reports and commitments describing strategies to encourage healthy consumer purchases aligned with the 2015-2020 Dietary Guidelines for Americans. Evidence was organised using a marketing-mix and choice-architecture (MMCA) framework to characterise strategies used among eight possible types (i.e. place, profile, portion, pricing, promotion, priming, prompting and proximity). Of the SNAP-authorised retailers (n 38) reviewed, more than half (n 20; 52·6 %) provided no information in the public domain relevant to the research objective. Few retailers (n 8; 21·1 %) had relevant CSR information; grey literature sources (n 52 articles across seventeen retailers) were more commonly identified. SNAP-authorised retailers in majority committed to increasing the number of healthy products available for purchase (profile). Substantial improvements are needed to enhance the capacity and commitments of SNAP-authorised retailers to use diverse strategies to promote healthy purchases among SNAP recipients. Future research could explore feasible approaches to improve dietary behaviours through sector changes via public-private partnerships, policy changes, or a combination of government regulatory and voluntary business actions.

Cluster randomised controlled trial of an online intervention to improve healthy food purchases from primary school canteens: a study protocol of the ‘click & crunch’ trial

IntroductionSchool canteens are the most frequently accessed take-away food outlet by Australian children. The rapid development of online lunch ordering systems for school canteens presents new opportunities to deliver novel...

Qualitative Assessment of School Nutrition Professionals' Acceptance of Choice Architecture Strategies in Middle School Settings

Qualitative Assessment of School Nutrition Professionals' Acceptance of Choice Architecture Strategies in Middle School Settings