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Rantala E, Vanhatalo S, Valtanen M, Lindström J, Pihlajamäki J, Poutanen K, Absetz P, Karhunen L. Effectiveness of workplace choice architecture modification for healthy eating and daily physical activity. BMC Public Health 2024; 24:939. [PMID: 38561724 PMCID: PMC10986070 DOI: 10.1186/s12889-024-18482-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Modifying the choice architecture of behavioural contexts can facilitate health behaviour change, but existing evidence builds mostly on small-scale interventions limited in duration, targets, strategies, and settings. We evaluated the effectiveness of a one-year hybrid type 2 implementation-effectiveness trial aimed at promoting healthy eating and daily physical activity with subtle modifications to the choice architecture of heterogeneous worksites. The intervention was contextualised to and integrated into the routine operations of each worksite. Effectiveness was evaluated in a quasi-experimental pre-post design. METHODS Intervention sites (n = 21) implemented a median of two (range 1-9) intervention strategies for healthy eating and one (range 1-5) for physical activity. Questionnaires pre (n = 1126) and post (n = 943) intervention surveyed employees' behavioural patterns at work (food consumption: vegetables/roots, fruit/berries, nuts/almonds/seeds, sweet treats, fast food, water; physical activity: restorative movement, exercise equipment use, stair use). The post-intervention questionnaire also measured employees' perception of and response to three intervention strategies: a packed lunch recipe campaign, a fruit crew-strategy, and movement prompts. Multi- and single-level regression models evaluated effectiveness, treating intervention as a continuous predictor formed of the site-specific dose (n intervention strategies employed) and mean quality (three-point rating per strategy halfway and at the end of the intervention) of implementation relevant to each outcome. RESULTS Multinomial logistic regression models found the intervention significantly associated with a favourable change in employees' fruit and berry consumption (interaction effect of time and implementation p = 0.006) and with an unfavourable change in sweet treat consumption (p = 0.048). The evidence was strongest for the finding concerning fruit/berry consumption-an outcome that sites with greater dose and quality of implementation targeted by using strategies that reduced the physical effort required to have fruit/berries at work and by covering multiple eating-related contexts at the worksite. The quality of implementation was positively associated with the perception of (p = 0.044) and response to (p = 0.017) the packed lunch recipes, and with response to the fruit crew-strategy (p < 0.001). CONCLUSIONS The results suggest that a contextualised, multicomponent choice architecture intervention can positively influence eating behaviour in diverse real-world settings over a one-year period, and that higher implementation quality can enhance intervention perception and response. However, outcomes may depend on the type of intervention strategies used and the extent of their delivery.
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Affiliation(s)
- Eeva Rantala
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland.
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland.
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland.
| | - Saara Vanhatalo
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland
| | - Mikko Valtanen
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland
- Department of Mathematics and Statistics, University of Turku, 20014, Turku, Finland
| | - Jaana Lindström
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 KYS, Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33520, Tampere, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
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Rantala E, Järvelä-Reijonen E, Pettersson K, Laine J, Vartiainen P, Närväinen J, Pihlajamäki J, Poutanen K, Absetz P, Karhunen L. Sensory Appeal and Routines Beat Health Messages and Visibility Enhancements: Mixed-Methods Analysis of a Choice-Architecture Intervention in a Workplace Cafeteria. Nutrients 2022; 14:nu14183731. [PMID: 36145107 PMCID: PMC9505513 DOI: 10.3390/nu14183731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Easier recognition and enhanced visibility of healthy options supposedly increase healthy choices, but real-world evidence remains scarce. Addressing this knowledge gap, we promoted nutritionally favourable foods in a workplace cafeteria with three choice-architectural strategies-priming posters, point-of-choice nutrition labels, and improved product placement-and assessed their effects on visual attention, food choices, and food consumption. Additionally, we developed a method for analysing real-world eye-tracking data. The study followed a pretest-posttest design whereby control and intervention condition lasted five days each. We monitored visual attention (i.e., total number and duration of fixations) and food choices with eye tracking, interviewed customers about perceived influences on food choices, and measured cafeteria-level food consumption (g). Individual-level data represents 22 control and 19 intervention participants recruited at the cafeteria entrance. Cafeteria-level data represents food consumption during the trial (556/589 meals sold). Results indicated that the posters and labels captured participants' visual attention (~13% of fixations on defined areas of interest before food choices), but the intervention had insignificant effects on visual attention to foods, on food choices, and on food consumption. Interviews revealed 17 perceived influences on food choices, the most common being sensory appeal, healthiness, and familiarity. To conclude, the intervention appeared capable of attracting visual attention, yet ineffective in increasing healthier eating. The developed method enabled a rigorous analysis of visual attention and food choices in a natural choice setting. We discuss ways to boost the impact of the intervention on behaviour, considering target groups' motives. The work contributes with a unique, mixed-methods approach and a real-world setting that enabled a multi-dimensional effects evaluation with high external validity.
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Affiliation(s)
- Eeva Rantala
- VTT Technical Research Centre of Finland, 02044 Espoo, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Correspondence:
| | - Elina Järvelä-Reijonen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | - Kati Pettersson
- VTT Technical Research Centre of Finland, 02044 Espoo, Finland
| | - Janne Laine
- VTT Technical Research Centre of Finland, 02044 Espoo, Finland
| | - Paula Vartiainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | | | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, 02044 Espoo, Finland
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33520 Tampere, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
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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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Sandwich or long lunch? Lack of time and attendance of food outlets by French workers. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2021. [DOI: 10.1108/ijwhm-05-2020-0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PurposeThis study explores the relation between workers' choices of food outlets for lunch during the workday and their time constraints.Design/methodology/approachA cross-sectional survey was conducted among 1,132 French wage-earners in order to identify the dimensions indicative of lack of time among workers and to examine their associations with the likelihood of different food outlet choices.FindingsExploratory factor analysis revealed four dimensions indicative of lack of time. Binary logistic regressions revealed that each dimension was linked to at least one food outlet choice. This research suggests that the dietary practices of workers are associated with their time constraints.Practical implicationsTime constraints play a role in attendance of food outlets for lunch and should be taken into account when promoting healthier lunch behaviors among employees.Originality/valueThis is the first research investigating the links between time constraints and attendance of food outlets in the context of lunch during the workday.
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