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Djojosoeparto SK, Poelman MP, Eykelenboom M, Beenackers MA, Steenhuis IHM, van Stralen MM, Olthof MR, Renders CM, van Lenthe FJ, Kamphuis CBM. Do financial constraint and perceived stress modify the effects of food tax schemes on food purchases: moderation analyses in a virtual supermarket experiment. Public Health Nutr 2024; 27:e38. [PMID: 38224250 PMCID: PMC10897579 DOI: 10.1017/s1368980024000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 12/07/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To investigate whether financial constraint and perceived stress modify the effects of food-related taxes on the healthiness of food purchases. DESIGN Moderation analyses were conducted with data from a trial where participants were randomly exposed to: a control condition with regular food prices, an sugar-sweetened beverage (SSB) tax condition with a two-tiered levy on the sugar content in SSB (5-8 g/100 ml: €0·21 per l and ≥8 g/100 ml: €0·28 per l) or a nutrient profiling tax condition where products with Nutri-Score D or E were taxed at a 20 percent level. Outcome measures were overall healthiness of food purchases (%), energy content (kcal) and SSB purchases (litres). Effect modification was analysed by adding interaction terms between conditions and self-reported financial constraint or perceived stress in regression models. Outcomes for each combination of condition and level of effect modifier were visualised. SETTING Virtual supermarket. PARTICIPANTS Dutch adults (n 386). RESULTS Financial constraint or perceived stress did not significantly modify the effects of food-related taxes on the outcomes. Descriptive analyses suggest that in the control condition, the overall healthiness of food purchases was lowest, and SSB purchases were highest among those with moderate/high levels of financial constraint. Compared with the control condition, in a nutrient profiling tax condition, the overall healthiness of food purchases was higher and SSB purchases were lower, especially among those with moderate/high levels of financial constraint. Such patterns were not observed for perceived stress. CONCLUSION Further studies with larger samples are recommended to assess whether food-related taxes differentially affect food purchases of subgroups.
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Affiliation(s)
- Sanne K Djojosoeparto
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
- Chair group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Michelle Eykelenboom
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mariëlle A Beenackers
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ingrid HM Steenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Margreet R Olthof
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carlijn BM Kamphuis
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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Huse O, Backholer K, Nguyen P, Calibo A, Guirindola M, Desnacido JP, Sacks G, Bell AC, Peeters A, Angeles-Agdeppa I, Ananthapavan J. A comparative analysis of the cost-utility of the Philippine tax on sweetened beverages as proposed and as implemented. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 41:100912. [PMID: 37780636 PMCID: PMC10534259 DOI: 10.1016/j.lanwpc.2023.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/01/2023] [Accepted: 09/10/2023] [Indexed: 10/03/2023]
Abstract
Background In response to increasing overweight and obesity, the Philippine government introduced a tax on sweetened beverages (SBs) in 2018. Evidence suggests that the beverage industry influenced the final tax design, making it more favourable for industry than the initially proposed bill. This study aimed to compare the relative health and economic benefits of the proposed SB tax with the implemented SB tax. Methods Philippine dietary consumption data were combined with price elasticity data from Mexico and data from Australia adapted to the Philippine context to estimate reductions in SB purchases and changes in body mass index (BMI) following the implementation of the tax. A multi-state, multiple-cohort Markov model was used to estimate the change in health-adjusted life years (HALYs) due to reduction in the epidemiology of obesity-related diseases, healthcare cost savings and government taxation revenue, resulting from both the proposed and implemented tax policies, over the lifetime of the 2018 Philippine population. Findings The proposed and implemented taxes were modelled to be dominant (cost-saving and improving health). Intervention costs were modelled to be PHP305.2 million (M) (approximately US$6M). Compared to the proposed tax, the implemented tax was modelled to result in a 43.0% smaller reduction in targeted beverage intake (51.1 ml/person/day vs. 89.7 ml/person/day), a 43.5% smaller reduction in BMI (0.35 kg/m2 vs. 0.62 kg/m2), 39.7% fewer HALYs gained (2,503,118 vs. 4,149,030), 39.9% fewer healthcare cost savings (PHP16.4 billion (B) vs. PHP27.3B), and 27.7% less government taxation revenue (PHP426.3B vs. PHP589.4B). Interpretation While the implemented tax in the Philippines will benefit population health, it is likely to yield less benefit than the proposed tax. The influence of the food and beverage industry on policy processes has the potential to lessen the benefits of population NCD prevention policies. Funding OH was supported to conduct this research by an Australian Government Research Training Program Stipend Scholarship. The funding body had no role in data collection and analysis, or manuscript preparation.
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Affiliation(s)
- Oliver Huse
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Phuong Nguyen
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Anthony Calibo
- Child Health Division, Department of Health, Medical Specialist IV, Disease Prevention and Control Bureau, Manila (2011-2020), Philippines
- Institute of Pediatrics and Child Health, St. Luke's Medical Center, Quezon City, Philippines
| | - Mildred Guirindola
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Josie P. Desnacido
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Gary Sacks
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Andrew Colin Bell
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Anna Peeters
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Imelda Angeles-Agdeppa
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Jaithri Ananthapavan
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
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Wood B, Robinson E, Baker P, Paraje G, Mialon M, van Tulleken C, Sacks G. What is the purpose of ultra-processed food? An exploratory analysis of the financialisation of ultra-processed food corporations and implications for public health. Global Health 2023; 19:85. [PMID: 37957671 PMCID: PMC10644600 DOI: 10.1186/s12992-023-00990-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/08/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND In recent decades there has been a global rise in consumption of ultra-processed foods (UPFs) to the detriment of population health and the environment. Large corporations that have focused heavily on low-cost manufacturing and extensive marketing of UPFs to maximise profits have driven this dietary transition. The same corporations claim to serve the interests of multiple 'stakeholders', and that they are contributing to sustainable development. This paper aimed to test these claims by examining the degree to which UPF corporations have become 'financialised', focusing on the extent to which they have prioritised the financial interests of their shareholders relative to other actors, as well as the role that various types of investors have played in influencing their governance. Findings were used to inform discussion on policy responses to improve the healthiness of population diets. METHODS We adopted an exploratory research design using multiple methods. We conducted quantitative analysis of the financial data of U.S. listed food and agricultural corporations between 1962 and 2021, share ownership data of a selection of UPF corporations, and proxy voting data of a selection of investors between 2012 and 2022. We also conducted targeted narrative reviews using structured and branching searches of academic and grey literature. RESULTS Since the 1980s, corporations that depend heavily on manufacturing and marketing UPFs to generate profits have been increasingly transferring money to their shareholders relative to their total revenue, and at a level considerably higher than other food and agricultural sectors. In recent years, large hedge fund managers have had a substantial influence on the governance of major UPF corporations in their pursuit of maximising short-term returns. In comparison, shareholders seeking to take steps to improve population diets have had limited influence, in part because large asset managers mostly oppose public health-related shareholder proposals. CONCLUSIONS The operationalisation of 'shareholder primacy' by major UPF corporations has driven inequity and undermines their claims that they are creating 'value' for diverse actors. Measures that protect population diets and food systems from the extractive forces of financialisation are likely needed as part of efforts to improve the healthiness of population diets.
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Affiliation(s)
- Benjamin Wood
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Ella Robinson
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Guillermo Paraje
- Business School, Universidad Adolfo Ibañez, Santiago de Chile, Chile
| | - Mélissa Mialon
- Trinity Business School, Trinity College, Dublin, Ireland
| | | | - Gary Sacks
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
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Silva P, Araújo R, Lopes F, Ray S. Nutrition and Food Literacy: Framing the Challenges to Health Communication. Nutrients 2023; 15:4708. [PMID: 38004102 PMCID: PMC10674981 DOI: 10.3390/nu15224708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Nutrition and food literacy are two important concepts that are often used interchangeably, but they are not synonymous. Nutrition refers to the study of how food affects the body, while food literacy refers to the knowledge, skills, and attitudes necessary to make informed decisions about food and its impact on health. Despite the growing awareness of the importance of food literacy, food illiteracy remains a global issue, affecting people of all ages, backgrounds, and socioeconomic status. Food illiteracy has serious health implications as it contributes to health inequities, particularly among vulnerable populations. In addition, food literacy is a complex and multidisciplinary field, and there are numerous challenges to health communication that must be addressed to effectively promote food literacy and improve health outcomes. Addressing food illiteracy and the challenges to health communication is essential to promote health equity and improve health outcomes for all populations.
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Affiliation(s)
- Paula Silva
- Laboratory of Histology and Embryology, Department of Microscopy, School of Medicine and Biomedical Sciences (ICBAS), University of Porto (U.Porto), Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
- iNOVA Media Lab, ICNOVA-NOVA Institute of Communication, NOVA School of Social Sciences and Humanities, Universidade NOVA de Lisboa, 1069-061 Lisbon, Portugal
| | - Rita Araújo
- Departamento de Artes e Humanidades, Escola Superior de Comunicação, Administração e Turismo, Instituto Politécnico de Bragança, Campus do Cruzeiro—Avenida 25 de Abril, Cruzeiro, Lote 2, Apartado 128, 5370-202 Mirandela, Portugal;
| | - Felisbela Lopes
- Centro de Estudos de Comunicação e Sociedade, Instituto de Ciências Sociais, Universidade do Minho, Campus de Gualtar, 4710-057 Braga, Portugal;
| | - Sumantra Ray
- NNEdPro Global Institute for Food, Nutrition & Health, Cambridge CB4 0WS, UK;
- School of Biomedical Sciences, Ulster University at Coleraine, Coleraine BT52 1SA, UK
- Fitzwilliam College, University of Cambridge, Cambridge CB3 0DG, UK
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Sukartini NM, Purwono R, Surjaningrum ER, Win T, Wangge G, Chrisnahutama A, Husna A, Handayani T. Do tax and subsidy on unhealthy food induce consumer consumption for healthy food? Evidence from experiment in Surabaya, Indonesia. J Public Health Res 2023; 12:22799036221147362. [PMID: 36686586 PMCID: PMC9850130 DOI: 10.1177/22799036221147362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/08/2022] [Indexed: 01/18/2023] Open
Abstract
Background This study investigates the impact of price changes on decision to buy particular foods among adults in Surabaya, East Java, Indonesia. Tax and subsidy were introduced for influencing decision buy particular foods, especially unhealthy foods that are predicted have consequences on health outcome. Unhealthy foods such as fast foods or junk foods, sugar sweetened beverages (SSB), salty, and fatty foods are reported as one of main causes of obesity incidence in most countries, such as Indonesia. Design and method Computer laboratory experimental is designed for investigating the impacts of difference rates of taxes and subsidy on decision to buy foods. Taxes and subsidies rate are designed from low (5%), moderate (15%), and high rates (25%). Results The findings are as follows. Firstly, participants do not respond immediately to price changes, that is, higher prices due to taxes and lower prices due to subsidies. Economic theory suggests that consumers demand for basic need such as foods is sensitive with change in price, they respond inversely to the price changes. However, the finding in this experimental study do not support this theory prediction. Secondly, 15% and subsidies are the threshold and the larger taxes and rate for changing consumer's choices on targeted foods. Conclusion This study concludes that low rates of taxes and subsidies for unhealthy and healthy foods make these targeted foods affordable for majority of consumers. Besides introducing higher rates of taxes and subsidies, promoting and encouraging healthy life style such as consuming fresh and healthy foods is another alternative policy option.
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Affiliation(s)
- Ni Made Sukartini
- Departement Ilmu Ekonomi, FEB
Universitas Airlangga and Magister Ekonomi Kesehatan, Sekolah Pascasarjana,
Universitas Airlangga, Surabaya, Indonesia
- Ni Made Sukartini, Departement Ilmu Ekonomi
FEB Unair and Magister Ekonomi Kesehatan Sekolah Pascasarjana Unair; Kampus B
Unair Jl. Airlangga No. 4-6 Surabaya, Jawa Timur, 60286, Indonesia.
| | - Rudi Purwono
- Departement Ilmu Ekonomi, FEB
Universitas Airlangga and Magister Ekonomi Kesehatan, Sekolah Pascasarjana,
Universitas Airlangga, Surabaya, Indonesia
| | | | - Thinzar Win
- Department of Economics, University of
Mandalay, Republic of Union of Myanmar
| | - Grace Wangge
- Fakultas Kedokteran Universitas
Indonesia and SEAMEO RECFON
| | | | - Afanin Husna
- Magister Ilmu Ekonomi, FEB Universitas
Airlangga, Surabaya, Indonesia
| | - Triwuli Handayani
- Magister Ilmu Ekonomi, FEB Universitas
Airlangga, Surabaya, Indonesia
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Sugar reduction in beverages: Current trends and new perspectives from sensory and health viewpoints. Food Res Int 2022; 162:112076. [DOI: 10.1016/j.foodres.2022.112076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/08/2022] [Accepted: 10/22/2022] [Indexed: 11/22/2022]
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Wierzejska RE. The Impact of the Sweetened Beverages Tax on Their Reformulation in Poland-The Analysis of the Composition of Commercially Available Beverages before and after the Introduction of the Tax (2020 vs. 2021). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14464. [PMID: 36361345 PMCID: PMC9658175 DOI: 10.3390/ijerph192114464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study was to estimate changes in the composition of carbonated and non-carbonated sugar-sweetened beverages before and after the introduction of the beverage tax in Poland. Based on the labels of 198 drinks, the composition and nutritional values of the drinks were compared. The nonparametric Mann-Whitney test was applied to compare the differences in the sugar and juice content as well as energy value. After the introduction of the tax, the median sugar content in the carbonated beverages decreased from 8.6 g to 6.9 g/100 mL (p = 0.004), while in the non-carbonated beverages, it decreased from 5.5 g to 4.8 g/100 mL (p < 0.001). In the entire beverage group, there was a significant drop in the proportion of beverages that contained >5 g of sugars/100 mL (44.4% in 2021 vs. 70.2% in 2020). The median juice content in the carbonated beverages increased from 1.0% to 3.3% (p = 0.121), but totalled 20.0% for both periods in the non-carbonated beverages. The percentage of beverages with a tax-exempt composition (juice content ≥ 20% and sugar content ≤ 5 g/100 mL) almost tripled. After the introduction of the tax, beneficial changes in the compositions of 62% of the analysed beverages were observed in terms of their sugar and/or juice content.
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Affiliation(s)
- Regina Ewa Wierzejska
- Department of Nutrition and Nutritional Value of Food, National Institute of Public Health NIH-National Research Institute, Chocimska St. 24, 00-791 Warsaw, Poland
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Barbour L, Bicknell E, Brimblecombe J, Carino S, Fairweather M, Lawrence M, Slattery J, Woods J, World E. Dietitians Australia position statement on healthy and sustainable diets. Nutr Diet 2022; 79:6-27. [PMID: 35233909 PMCID: PMC9311218 DOI: 10.1111/1747-0080.12726] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/12/2022]
Abstract
It is the position of Dietitians Australia that to promote human and planetary health, a food system transformation is needed that enables the population to adopt healthy and sustainable diet-related practices. A healthy and sustainable diet must (i) be nutritionally adequate, healthy and safe, (ii) have low environmental impact and be protective of natural resources and biodiversity, (iii) be culturally acceptable and (iv) be accessible, economically fair and affordable. Dietitians Australia acknowledges that it is critical to prioritise Indigenous knowledges in consultation, policy-making and implementation processes to achieve these recommendations. In facilitating the uptake of healthy and sustainable diets, dietitians are contributing to the transformation of our current food system that is urgently required to nourish present and future generations within planetary boundaries. In developing this position statement, opportunities for future research have been identified including those to advance the professions' capacity to improve environmental sustainability outcomes across all areas of practice. To achieve a population-level shift towards this diet, Dietitians Australia recommends: (i) the development of a National Food and Nutrition Strategy which honours Indigenous knowledges on food systems, (ii) the integration of sustainability principles in Australia's dietary guidelines, (iii) the reorientation of our food environment to prioritise access to healthy and sustainable foods, and (iv) investment in capacity building activities to equip the current and future nutrition and dietetics workforce.
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Affiliation(s)
- Liza Barbour
- Department of Nutrition, Dietetics & FoodMonash UniversityNotting HillVictoriaAustralia
| | | | - Julie Brimblecombe
- Department of Nutrition, Dietetics & FoodMonash UniversityNotting HillVictoriaAustralia
| | - Stefanie Carino
- Department of Nutrition, Dietetics & FoodMonash UniversityNotting HillVictoriaAustralia
| | | | - Mark Lawrence
- Deakin UniversityInstitute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition SciencesGeelongAustralia
| | | | - Julie Woods
- Deakin UniversityInstitute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition SciencesGeelongAustralia
| | - Elizabeth World
- Dietitians AustraliaDeakinAustralian Capital TerritoryAustralia
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Rantala E, Vanhatalo S, Tilles-Tirkkonen T, Kanerva M, Hansen PG, Kolehmainen M, Männikkö R, Lindström J, Pihlajamäki J, Poutanen K, Karhunen L, Absetz P. Choice Architecture Cueing to Healthier Dietary Choices and Physical Activity at the Workplace: Implementation and Feasibility Evaluation. Nutrients 2021; 13:nu13103592. [PMID: 34684592 PMCID: PMC8538928 DOI: 10.3390/nu13103592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 01/14/2023] Open
Abstract
Redesigning choice environments appears a promising approach to encourage healthier eating and physical activity, but little evidence exists of the feasibility of this approach in real-world settings. The aim of this paper is to portray the implementation and feasibility assessment of a 12-month mixed-methods intervention study, StopDia at Work, targeting the environment of 53 diverse worksites. The intervention was conducted within a type 2 diabetes prevention study, StopDia. We assessed feasibility through the fidelity, facilitators and barriers, and maintenance of implementation, building on implementer interviews (n = 61 informants) and observations of the worksites at six (t1) and twelve months (t2). We analysed quantitative data with Kruskall-Wallis and Mann-Whitney U tests and qualitative data with content analysis. Intervention sites altogether implemented 23 various choice architectural strategies (median 3, range 0-14 strategies/site), employing 21 behaviour change mechanisms. Quantitative analysis found implementation was successful in 66%, imperfect in 25%, and failed in 9% of evaluated cases. These ratings were independent of the ease of implementation of applied strategies and reminders that implementers received. Researchers' assistance in intervention launch (p = 0.02) and direct contact to intervention sites (p < 0.001) predicted higher fidelity at t1, but not at t2. Qualitative content analysis identified facilitators and barriers related to the organisation, intervention, worksite environment, implementer, and user. Contributors of successful implementation included apt implementers, sufficient implementer training, careful planning, integration into worksite values and activities, and management support. After the study, 49% of the worksites intended to maintain the implementation in some form. Overall, the choice architecture approach seems suitable for workplace health promotion, but a range of practicalities warrant consideration while designing real-world implementation.
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Affiliation(s)
- Eeva Rantala
- VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044 Espoo, Finland; (S.V.); (M.K.); (K.P.)
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland;
- Correspondence:
| | - Saara Vanhatalo
- VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044 Espoo, Finland; (S.V.); (M.K.); (K.P.)
| | - Tanja Tilles-Tirkkonen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
| | - Markus Kanerva
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
- D Department, Tikkurila Campus, Laurea University of Applied Sciences, Ratatie 22, 01300 Vantaa, Finland
| | - Pelle Guldborg Hansen
- Department of Communication, Business & Information Technologies, Universitetsvej 1, Roskilde University, 4000 Roskilde, Denmark;
| | - Marjukka Kolehmainen
- VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044 Espoo, Finland; (S.V.); (M.K.); (K.P.)
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
| | - Reija Männikkö
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
| | - Jaana Lindström
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland;
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, P.O. Box 100, 70029 Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044 Espoo, Finland; (S.V.); (M.K.); (K.P.)
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
- Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
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