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Kawabata T, Nakamura M, Takemi Y, Hayashi F, Yamada T. Impact of a nudge-based food environment intervention in a hospital convenience store on staff's food intake and Na/K. BMC Nutr 2024; 10:113. [PMID: 39152518 PMCID: PMC11328372 DOI: 10.1186/s40795-024-00920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 08/02/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND A food environment intervention using nudge tactics was implemented at a hospital convenience store (CVS) in Tokyo to improve employees' eating habits. The objective of this study was to evaluate its effects on the urinary sodium-to-potassium ratio (Na/K), food intake, eating attitude, and behavior. METHODS Using a pre-post design; the intervention incorporated nudge tactics, healthier options, easy-to-pick food placement, and eye-catching information. We also used price incentives. The primary outcomes included changes in Na/K and sodium and potassium excretion assessed using spot urine samples at health checkups. Secondary outcomes were changes in staff food intake, eating attitude, and behavior which were assessed using questionnaire surveys. All outcomes were evaluated statistically. Furthermore, we investigated how the intervention led to outcomes using path analysis. RESULTS A total of 140 participant (52men and 88women) were analyzed. Significant changes were observed in Na/K (3.16 to 2.98 in median, p = 0.02) and potassium excretion (43.4 to 45.2 mmol/day in mean, p = 0.03). However, sodium excretion did not change significantly. The intake of fruits and dairy products increased with improved self-efficacy. The most influential factor for lowering Na/K and increasing potassium excretion was information from the CVS; purchasing "balanced meals" to lower Na/K and salads to increase potassium excretion were second. CONCLUSIONS Food environment intervention using nudge tactics can improve staff's food intake and lower Na/K. TRIAL REGISTRATION Registration number: UMIN000049444 (UMIN-CTR). Date of registration: November. 7. 2022.
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Affiliation(s)
- Teruko Kawabata
- Japan Association for Development of Community Medicine, F15 Todofuken-Kaikan Bldg. 2-6-3 Hirakawa-Chou, Chiyoda-Ward, Tokyo, 102-0093, Japan
| | - Masakazu Nakamura
- Japan Association for Development of Community Medicine, F15 Todofuken-Kaikan Bldg. 2-6-3 Hirakawa-Chou, Chiyoda-Ward, Tokyo, 102-0093, Japan
| | - Yukari Takemi
- Kagawa Nutrition University Graduate School, Saitama-Pref, 3-9-21 Chiyoda, Sakado-City, 350-0288, Japan.
| | - Fumi Hayashi
- Kagawa Nutrition University Graduate School, Saitama-Pref, 3-9-21 Chiyoda, Sakado-City, 350-0288, Japan
| | - Takashi Yamada
- Japan Association for Development of Community Medicine, F15 Todofuken-Kaikan Bldg. 2-6-3 Hirakawa-Chou, Chiyoda-Ward, Tokyo, 102-0093, Japan
- Taito Municipal Hospital, 3-20-5 Senzoku, Taito-Ward, Tokyo, 111-0031, Japan
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Hendrie GA, Anastasiou K, Brindal E, Wiggins B, Baird DL, Johnson BJ, Bell LK, Gardner C, Arguelles JC, Kelaart A, Cox DN, Golley RK. Increasing Children's Vegetable Consumption: Translating a Review of the Evidence Base to Develop Best Practice Guidelines. AJPM FOCUS 2024; 3:100229. [PMID: 38770236 PMCID: PMC11103422 DOI: 10.1016/j.focus.2024.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Introduction Dietary guidelines worldwide emphasize the importance of consuming vegetables as part of a healthy diet. Despite this, translating this information into messages for consumers that change behavior has been difficult. There have been population-level social marketing campaigns as well as several smaller campaigns directed specifically toward children, which have demonstrated small increases in consumption. However, achieving meaningful and sustained increases in children's vegetable consumption remains a challenge. This article describes the process of synthesizing the published literature and translating these findings to inform the development of 7 best practice guidelines to increase children's vegetable intake. Methods The first step in this process was a systematic review of scientific literature to identify the components of interventions that were associated with successfully increasing vegetable intake. The synthesis of effective intervention components was guided by the Behavior Change Wheel. These scientific findings were translated to guidelines for best practice. This process involved a team of nutrition and behavioral researchers and nutrition practitioners translating the science into actionable advice that could be adopted by a range of stakeholders. The 6 selected stakeholders included long daycare centers, after-hours school care providers, primary schools, industry groups and growers, researchers, and government policy makers. Stakeholders were involved in the development process through surveys and interviews to understand their requirements for resources to support adoption of the best practice guidelines within each setting and within the context of existing practice. Results The guidelines center on coordination of effort, with a focus on components such as planning, environmental restructuring, barrier reduction, feedback, and monitoring. In consultation with key stakeholders, a range of resources were developed for each setting to support the implementation of best practice, with the aim of achieving meaningful increases in intake. The resources and tools have been made available at http://www.vegkit.com.au. Conclusions The translation of knowledge into practice is not traditionally included as part of the research process. Therefore, combining the process of reviewing the science and translating the evidence to stakeholder resources to influence practice in 1 research study is novel, and the study could be used to guide future research translation activities within and beyond the field of public health nutrition.
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Affiliation(s)
- Gilly A. Hendrie
- Human Health Program, CSIRO Health and Biosecurity, Adelaide, Australia
| | - Kim Anastasiou
- Human Health Program, CSIRO Health and Biosecurity, Adelaide, Australia
| | - Emily Brindal
- Human Health Program, CSIRO Health and Biosecurity, Adelaide, Australia
| | - Bonnie Wiggins
- Human Health Program, CSIRO Health and Biosecurity, Adelaide, Australia
| | - Danielle L. Baird
- Human Health Program, CSIRO Health and Biosecurity, Adelaide, Australia
| | - Brittany J. Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lucinda K. Bell
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Claire Gardner
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Amber Kelaart
- Nutrition Australia Victoria Branch, Carlton, Australia
| | - David N. Cox
- Human Health Program, CSIRO Health and Biosecurity, Adelaide, Australia
| | - Rebecca K. Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Cain J, Behal M, Richter LM. An Integrative Scoping Review of Behavioral Economics Applications in Higher Education: Opportunities for Academic Pharmacy. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100732. [PMID: 38852679 DOI: 10.1016/j.ajpe.2024.100732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/28/2024] [Accepted: 06/01/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES This integrative scoping review explores the applications of behavioral economics within higher education, particularly, through the lens of nudging (a concept that leverages insights from economics and psychology to guide individuals' decisions subtly). The primary objective is to provide a broad overview of interventions that use behavioral economics principles and, secondarily, discuss their potential to improve pharmacy education and create a foundation for future research in this area. FINDINGS The review analyzed 89 studies that applied behavioral economics principles in higher education settings. Reminders and prompts were the most frequently used principles, with generally positive outcomes, especially in enrollment management. Framing, incentives, and salience also demonstrated effectiveness, depending on the context. Social norms and simplification showed mixed results, whereas priming, loss aversion, feedback, comparison, and commitment had varying degrees of success in influencing behavior. SUMMARY Behavioral economics principles offer valuable insights and tools for enhancing various aspects of education. The review highlights the potential for using these principles to improve student engagement, enrollment processes, and health and well-being initiatives. However, it emphasizes the importance of context-specific design and careful implementation when applying these interventions. Future research opportunities exist to further explore the applications of behavioral economics in pharmacy education and beyond.
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Affiliation(s)
- Jeff Cain
- University of Kentucky College of Pharmacy, Department of Pharmacy Practice & Science, Lexington, KY, USA.
| | - Michael Behal
- University of Tennessee Medical Center, Department of Pharmacy, Knoxville, TN, USA
| | - Lisa M Richter
- North Dakota State University College of Health and Human Sciences, Department of Pharmacy Practice, Fargo, ND, USA
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Forberger S, Reisch LA, van Gorp P, Stahl C, Christianson L, Halimi J, De Santis KK, Malisoux L, de-Magistris T, Bohn T. 'Let me recommend… ': use of digital nudges or recommender systems for overweight and obesity prevention-a scoping review protocol. BMJ Open 2024; 14:e080644. [PMID: 39089719 PMCID: PMC11293388 DOI: 10.1136/bmjopen-2023-080644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 06/24/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Recommender systems, digital tools providing recommendations, and digital nudges increasingly affect our lives. The combination of digital nudges and recommender systems is very attractive for its application in preventing overweight and obesity. However, linking recommender systems with personalised digital nudges has a potential yet to be fully exploited. Therefore, this study aims to conduct a scoping review to identify which digital nudges or recommender systems or their combinations have been used in obesity prevention and to map these systems according to the target population, health behaviour, system classification (eg, mechanisms for developing recommendations, delivery channels, personalisation, interconnection, used combination), and system implementation. METHODS AND ANALYSIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline was used to inform protocol development. The eligibility criteria are based on the PCC framework (Population: any human; Concept: recommender systems or digital nudges; Context: obesity prevention). MEDLINE, PsycINFO, Web of Science, CINHAL, Scopus, ACM Digital Library and IEEE Xplore were searched until September 2023. Primary studies with any design published in peer-reviewed academic journals and peer-reviewed conference papers will be included. Data will be extracted into a pre-developed extraction sheet. Results will be synthesised descriptively and narratively. ETHICS AND DISSEMINATION No ethical approval is required for the scoping review, as data will be obtained from publicly available sources. The results of this scoping review will be published in a peer-reviewed journal, presented at conferences and used to inform the co-creation process and intervention adaptation in the context of a HealthyW8 project (www.healthyw8.eu).
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Affiliation(s)
- Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Department of Health Science, University of York, York, UK
| | - Lucia A Reisch
- Cambridge Judge Business School, University of Cambridge, Cambridge, UK
| | - Pieter van Gorp
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Christoph Stahl
- Luxembourg Institute of Science and Technology, Esch-sur-Alzette, Luxembourg
| | - Lara Christianson
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Jihan Halimi
- Instituto Agroalimentario de Aragón, IA2 (CITA-Universidad de Zaragoza), Zaragoza, Spain
| | | | | | - Tiziana de-Magistris
- Instituto Agroalimentario de Aragón, IA2 (CITA-Universidad de Zaragoza), Zaragoza, Spain
| | - Torsten Bohn
- Luxembourg Institute of Health, Strassen, Luxembourg
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Banihashem Rad SA, Esteves-Oliveira M, Kazemian A, Azami N, Khorshid M, Sohrabi A, Attaran Khorasani A, Campus G. Evaluating the Effectiveness of the Nudge Theory in Improving the Oral Self-Care of Schoolchildren with Refugee and Immigrant Backgrounds in Mashhad, Iran. Dent J (Basel) 2024; 12:228. [PMID: 39057015 PMCID: PMC11276547 DOI: 10.3390/dj12070228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Nudge theory proposes using subtle interventions to encourage individuals to make better decisions. The aim of this study was to evaluate the effectiveness of the Nudge theory in plaque control and assess caries experience among third-grade primary schoolchildren with refugee and immigrant backgrounds in Mashhad, Iran. Moreover, Afghan and Iranian schoolchildren were compared to assess differences in oral health outcomes. A quasi-experimental field trial was conducted in three public primary schools, comprising 309 participants approximately 9 years old. Interventions were randomly assigned to three schools: School I Messages based on Social Norms (MSN), School II Messages based on Fear of Negative Outcome (MFNO), and School III control group (C). MSN and MFNO received customized motivational video clips at baseline, while C only received Oral hygiene instruction (OHI). All participants received OHI, a brush, and toothpaste. Baseline plaque index (PI) and caries experience in primary and permanent dentition (dmft/DMFT) were recorded. PI was reassessed at two weeks, two months, and six months post-intervention. All data were subjected to statistical analysis. The mean PI decreased significantly in all three groups at the two-week follow-up (p < 0.01). The PI improvements declined over a six-month follow-up period in all groups, and the mean PI difference after six months compared to the pre-intervention was significant only in MSN and MFNO (p < 0.01), while C reverted almost to the pre-study level. Schoolchildren with at least one filled tooth or Iranian nationality showed a greater PI reduction (p < 0.01, p = 0.05). The overall mean ± SD dmft and DMFT were 4.24 ± 2.11 and 1.70 ± 1.24, respectively. Among all the examined participants, 32 (10.40%) individuals were caries-free. The mean dmft was statistically significantly higher in Afghan children than in Iranians (p = 0.01). MSN was more effective on PI reduction in the short term, while MFNO was more long-lasting. Using the Nudge theory via visual aids was more effective in motivating children to perform better oral self-care than solely traditional OHI.
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Affiliation(s)
- Seyed Ahmad Banihashem Rad
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland; (S.A.B.R.); (M.E.-O.)
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Marcella Esteves-Oliveira
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland; (S.A.B.R.); (M.E.-O.)
- Department of Restorative Dentistry and Endodontology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
- Department of Conservative Dentistry, Periodontology and Endodontology, University Centre of Dentistry, Oral Medicine and Maxillofacial Surgery (UZMK), University of Tübingen, 72076 Tübingen, Germany
| | - Ali Kazemian
- Department of Community Oral Health, School of Dentistry, Mashhad University of Medical Sciences, Mashhad 9177948959, Iran;
| | - Negar Azami
- Department of Dentistry, Mashhad University of Medical Sciences, Mashhad 9177948959, Iran; (N.A.); (M.K.); (A.S.); (A.A.K.)
| | - Mehrzad Khorshid
- Department of Dentistry, Mashhad University of Medical Sciences, Mashhad 9177948959, Iran; (N.A.); (M.K.); (A.S.); (A.A.K.)
| | - Aylin Sohrabi
- Department of Dentistry, Mashhad University of Medical Sciences, Mashhad 9177948959, Iran; (N.A.); (M.K.); (A.S.); (A.A.K.)
| | - Amir Attaran Khorasani
- Department of Dentistry, Mashhad University of Medical Sciences, Mashhad 9177948959, Iran; (N.A.); (M.K.); (A.S.); (A.A.K.)
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland; (S.A.B.R.); (M.E.-O.)
- Department of Cariology, Saveetha Dental College and Hospitals, SIMATS DEEMED University, Chennai 600077, India
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
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Zhang Q, Zhang Y, Long T, Wu Y, Zhang Y, Li M. Effects of Nudge Strategy-Based Dietary Education Intervention in Patients with Type 2 Diabetes Mellitus: A Cluster Randomized Controlled Trial. DIABETES & METABOLISM 2024:101563. [PMID: 38981568 DOI: 10.1016/j.diabet.2024.101563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES We aimed to assess the clinical effects of dietary education intervention utilizing the nudge strategy in individuals with type 2 diabetes mellitus (T2DM). BACKGROUND The global prevalence of T2DM and its associated complications presents a significant health challenge. While the benefits of dietary education intervention for blood glucose management are widely acknowledged, patients often struggle to adhere to dietary recommendations. The implementation of the nudge strategy may offer a promising solution to change unhealthy dietary behavior and enhance diabetes control among individuals with T2DM. METHODS This is a sub-study within a broader cluster-randomized trial that evaluated the effects of nudge-based dietary education and traditional dietary education intervention. Measurements of HbA1c, fasting blood glucose (FBG), body mass index (BMI), blood lipid levels, blood pressure, dietary behavior, and diabetes distress were assessed at baseline and 3 months after the intervention in 147 individuals with T2DM from six primary care practices in Beijing, China. RESULTS All outcome measurements were complete at two time points for 134 participants. Results showed that compared to the control group, the intervention group achieved a significantly greater reduction in HbA1c, FBG, BMI, total cholesterol, low-density lipoprotein cholesterol, blood pressure, total energy intake, carbohydrate intake, fat intake, and protein intake and had lower diabetes distress. The intervention group also maintained HDL-C levels and had a significantly greater increase in vegetable intake, while changes in triglycerides were similar in the two groups . CONCLUSION The present study provides evidence that nudge strategy-based dietary education intervention is effective in improving blood glucose, BMI, blood lipid levels, and blood pressure and facilitating changes in patients' dietary behavior and diabetes distress. These findings suggest that implementing nudge strategies can contribute to the optimization of T2DM dietary management and overall patient well-being.
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Affiliation(s)
- Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Tianxue Long
- School of Nursing, Peking University, Beijing, China
| | - Yi Wu
- School of Nursing, Peking University, Beijing, China
| | - Yiyun Zhang
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China.
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Ruby MB, Graça J, Olli E. Vegetarian, vegan, or plant-based? Comparing how different labels influence consumer evaluations of plant-based foods. Appetite 2024; 197:107288. [PMID: 38467193 DOI: 10.1016/j.appet.2024.107288] [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: 01/09/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
Market actors have a role to play in enabling sustainable food transitions. One challenge for these actors is how to promote plant-based foods in ways that appeal to a growing number of consumers. Here we test how different plant-based related labels affect consumer appraisals of a range of foods (cookies, sausages, cheese, chocolate, pasta). In two studies (pre-registered; NUSA = 1148, NGermany = 491), we examined the effects of a 'vegetarian', 'vegan', or 'plant-based' label (compared to no label) on five attributes (healthy, tasty, ethical, pure, environmentally friendly) related to the products. We also measured self-reported likelihood to purchase the products. Overall, the results indicated that the 'plant-based' label was slightly more appealing to participants than the 'vegetarian' and 'vegan' labels. However, contrary to our expectations, neither consumers' information-seeking tendencies nor their pre-existing attitudes toward plant-based foods influenced (i.e., moderated) the effects of the labels. Anticipated taste was a strong and consistent predictor of purchase likelihood for all labeled products, but the ethical and pure attributes also accounted for unique variance in this outcome variable. Taken together, our findings and discussion provide insights into the role of labels and label terminology on consumer appraisals of plant-based foods.
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Affiliation(s)
- Matthew B Ruby
- Department of Psychology, Counselling and Therapy, La Trobe University, Bundoora, Australia.
| | - João Graça
- University of Groningen, Groningen, the Netherlands; Instituto de Ciências Sociais da Universidade de Lisboa (ICS-ULisboa), Lisboa, Portugal
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Weingarten N, Bach L, Roosen J, Hartmann M. Every step you take: Nudging animal welfare product purchases in a virtual supermarket. Appetite 2024; 197:107316. [PMID: 38492582 DOI: 10.1016/j.appet.2024.107316] [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: 07/11/2023] [Revised: 02/06/2024] [Accepted: 03/14/2024] [Indexed: 03/18/2024]
Abstract
Animal welfare (AW) is a growing concern for consumers in Germany; however, not all consumers regularly purchase products that have been produced according to high AW standards. The goal of the present study is to test the effect of a multilayered nudge to increase the availability and improve the visibility of AW products in a 3D online virtual supermarket (VS). The nudge included a shelf with AW products (referred to as AW shelf) which was made visible through banners and footsteps on the floor of the VS. The sample of this pre-registered experiment consisted of n = 374 German consumers who regularly purchase meat, milk, and eggs. The results demonstrated that the multilayered nudge was highly effective: the percentage of AW products purchased in the nudging condition was almost twice as high as in the control group. Furthermore, we investigated variables that mediate (ease of finding AW products in the VS) and moderate (price sensitivity) the effectiveness of the multilayered nudge, but no evidence for an effect was obtained. We conclude that multilayered nudges may be a promising tool to increase consumers' AW product purchases. More research is needed to replicate this finding with a field study in a real supermarket.
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Affiliation(s)
- Nina Weingarten
- University of Bonn, Institute for Food and Resource Economics, Chair of Agricultural and Food Market Research, Germany.
| | - Leonie Bach
- University of Bonn, Institute for Food and Resource Economics, Chair of Agricultural and Food Market Research, Germany
| | - Jutta Roosen
- Technical University of Munich, TUM School of Management, Chair of Marketing and Consumer Research, Germany; Technical University of Munich, HEF World Agricultural Systems Center, Germany
| | - Monika Hartmann
- University of Bonn, Institute for Food and Resource Economics, Chair of Agricultural and Food Market Research, Germany
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Kay E, Kemps E, Prichard I, Tiggemann M. Effectiveness of visual nudges for encouraging healthier beverage choices from vending machines. Health Promot J Austr 2024. [PMID: 38570711 DOI: 10.1002/hpja.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 04/05/2024] Open
Abstract
ISSUES ADDRESSED Research suggests visual nudging techniques can subtly encourage healthier consumption. Two experiments explored the effect of four visual primes for nudging drink choices from a vending machine display. METHODS Participants (17-25 years) were randomly assigned to view vending machine advertising posters containing pictorial nudges of water, soft drink, general health (runner), or a text-only control, for nudging vending machine choices. Participants then selected an item from a vending machine display containing drinks only (Experiment 1; n = 164), or both drinks and snack foods (Experiment 2, n = 684). RESULTS In both experiments, nudging condition predicted beverage choice. Specifically, the water image nudged healthier beverage choices in both experiments. However, there was no effect on food choice in Experiment 2. Furthermore, in both experiments, liking and habitual consumption of chosen items were also significant predictors of choice, but condition predicted beverage choice over and above these. CONCLUSION A water prime may be an effective means of encouraging healthier beverage choices in a vending machine environment. SO WHAT?: Findings have the potential to inform strategies for encouraging healthier beverage choices from vending machine environments.
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Affiliation(s)
- Enola Kay
- Psychology, College of Education, Psychology, and Social Work, Flinders University, Adelaide, South Australia, Australia
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Eva Kemps
- Psychology, College of Education, Psychology, and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Ivanka Prichard
- Health and Exercise Sciences, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Marika Tiggemann
- Psychology, College of Education, Psychology, and Social Work, Flinders University, Adelaide, South Australia, Australia
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Cha E, Choi Y, Bancks M, Faulkner MS, Dunbar SB, Umpierrez GE, Reis J, Carnethon MR, Shikany JM, Yan F, Jacobs DR. Longitudinal changes in diet quality and food intake before and after diabetes awareness in American adults: the Coronary Artery Risk Development in Young Adults (CARDIA) study. BMJ Open Diabetes Res Care 2024; 12:e003800. [PMID: 38453235 PMCID: PMC10921527 DOI: 10.1136/bmjdrc-2023-003800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/15/2023] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Limited longitudinal research is available examining how American adults make dietary changes after learning they have diabetes. We examined the associations between diabetes awareness and changes in dietary quality and food intake in a prospective cohort from the Coronary Artery Risk Development in Young Adults (CARDIA) study. RESEARCH DESIGN AND METHODS A nested case-control design was used. In the original CARDIA study, black and white participants were recruited from four US urban areas and partitioned into one control group (no diabetes over 30-year follow-up) and three case groups (early-onset, intermediate-onset, later-onset diabetes groups) based on timing of diagnosis and first awareness of diabetes. Estimated mean A Priori Diet Quality Score (APDQS), and food subgroup intake were examined at three CARDIA examinations (year (Y)0, Y7, and Y20). The mean APDQS with 95% CIs and food intake (servings/day) were compared across the one control group and three case groups using exam-specific and repeated measures linear regression. RESULTS Among 4576 participants (mean age: 25±4 years; 55% female; 49% black race), 653 incident cases (14.3%) of diabetes were observed over 30 years. APDQS was lowest at Y0 when the diabetes-free participants were aged 18-30 years (61.5-62.8), but increased over 20 years with advancing age across all groups (64.6-73.3). Lower APDQS in young adulthood was associated with a higher incidence of diabetes later in life. Diabetes awareness was associated with a net increase of 2.95 points in APDQS. The greatest increase of APDQS was when people learned of their diabetes for the first time (an increase of 5.71 in early-onset and 6.64 in intermediate-onset diabetes groups, respectively). CONCLUSIONS Advancing age and diabetes awareness were associated with more favorable dietary changes leading to improved diet quality. Optimal diet quality and healthy food intake in young adulthood seem important to prevent diabetes later in life.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, The Republic of Korea
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Yuni Choi
- Columbia University Irving Medical Center, New York, New York, USA
| | - Michael Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | | | - Jared Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University, Evanston, Illinois, USA
| | - James M Shikany
- The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Fengxia Yan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - David R Jacobs
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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Li X, Wang H, Manafe H, Braakhuis A, Li Z, Roy R. Assessing food availability and healthier options in an urban Chinese university: a case study using the Chinese Nutrition Environment Measurement Survey for Stores (C-NEMS-S). BMC Public Health 2024; 24:15. [PMID: 38167012 PMCID: PMC10759656 DOI: 10.1186/s12889-023-17415-8] [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: 06/29/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Young adults (18-24 years) in universities are frequently exposed to an environment that promotes unhealthy eating behaviors. Using a validated tool, the Chinese Nutrition Environment Measurement Survey for Stores (C-NEMS-S), we assess the food availability and healthier options in a large, urban Chinese university. We employed C-NEMS-S for scoring criteria and weighting. A total of 52 on-campus canteen outlets were audited in an urban university located in Shijiazhuang City, China. General food outlets (n 43) and self-served food outlets (n 7) were further categorized into eight subtypes. Beverage outlets (n 2) were discussed separately from food outlets. C-NEMS-S scores were significantly different across food outlet types (P = 0.0024), especially between noodle and rice outlets (P = 0.0415). Food availability scores for starchy tubers (P < 0.001), dry beans (P < 0.001), vegetables (P = 0.0225), and fruits (P < 0.001) were significantly different across food outlet subtypes. Healthier options were scarce and only appeared in "grains" (n 2) and "meat and poultry" (n 2) categories. Further research on improving the accustomed audit tool and assessing university student diet quality is warranted.
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Affiliation(s)
- Xingbo Li
- Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, 1010, New Zealand
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, China
- Hebei Province Key Laboratory of Nutrition and Health SZX2021021, Shijiazhuang, Hebei, 050031, China
| | - Haiyue Wang
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, China
- Hebei Province Key Laboratory of Nutrition and Health SZX2021021, Shijiazhuang, Hebei, 050031, China
| | - Hendra Manafe
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, China
- Hebei Province Key Laboratory of Nutrition and Health SZX2021021, Shijiazhuang, Hebei, 050031, China
| | - Andrea Braakhuis
- Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, 1010, New Zealand
| | - Zengning Li
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, China.
- Hebei Province Key Laboratory of Nutrition and Health SZX2021021, Shijiazhuang, Hebei, 050031, China.
| | - Rajshri Roy
- Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, 1010, New Zealand.
- Charles Perkins Centre, University of Sydney, Sydney, 2006, Australia.
- Nutrition and Dietetics, Sydney School of Nursing, Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia.
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12
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Auer M, Griffiths MD. Nudging Online Gamblers to Withdraw Money: The Impact of Personalized Messages on Money Withdrawal Among a Sample of Real-World Online Casino Players. J Gambl Stud 2023:10.1007/s10899-023-10276-1. [PMID: 38110761 DOI: 10.1007/s10899-023-10276-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/20/2023]
Abstract
A number of scholars have argued that online gambling can be more problematic than land-based gambling. Motivating gamblers to withdraw money from their online gambling account could lower losses because there would be less money available to lose. Therefore, the present study investigated whether personalized messages are an effective way of 'nudging' gamblers to withdraw money from their online gambling account. The authors were given access to a secondary dataset by Nederlandse Loterij (the national Dutch Lottery operator) comprising 4049 online gamblers. Two types of messages were used to 'nudge' gamblers to withdraw money from their gambling account (i.e., a 'winning streak' message and a 'withdrawal' message). The findings indicated that (i) 38% of gamblers reading the 'winning streak' messages withdrew money from their gambling account on the same day, and (ii) 18% of gamblers reading the 'withdrawal' messages withdrew money from their gambling account on the same day. Gamblers who read personalized messages also withdrew larger amounts of money from their gambling accounts compared to gamblers who did not read personalized messages. The findings suggest that the personalized messages can have an impact on both the likelihood to withdraw money as well as the amount of money which was withdrawn and could help reduce gambling-related harm.
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Affiliation(s)
- Michael Auer
- Neccton GmbH, Gertrude-Fröhlich-Sandner-Strasse, 21100, Vienna, Austria
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK.
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Sumner J, Bundele A, Lim HW, Phan P, Motani M, Mukhopadhyay A. Developing an Artificial Intelligence-Driven Nudge Intervention to Improve Medication Adherence: A Human-Centred Design Approach. J Med Syst 2023; 48:3. [PMID: 38063940 PMCID: PMC10709244 DOI: 10.1007/s10916-023-02024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023]
Abstract
To improve medication adherence, we co-developed a digital, artificial intelligence (AI)-driven nudge intervention with stakeholders (patients, providers, and technologists). We used a human-centred design approach to incorporate user needs in creating an AI-driven nudge tool. We report the findings of the first stage of a multi-phase project: understanding user needs and ideating solutions. We interviewed healthcare providers (n = 10) and patients (n = 10). Providers also rated example nudge interventions in a survey. Stakeholders felt the intervention could address existing deficits in medication adherence tracking and were optimistic about the solution. Participants identified flexibility of the intervention, including mode of delivery, intervention intensity, and the ability to stratify to user ability and needs, as critical success factors. Reminder nudges and provision of healthcare worker contact were rated highly by all. Conversely, patients perceived incentive-based nudges poorly. Finally, participants suggested that user burden could be minimised by leveraging existing software (rather than creating a new App) and simplifying or automating the data entry requirements where feasible. Stakeholder interviews generated in-depth data on the perspectives and requirements for the proposed solution. The participatory approach will enable us to incorporate user needs into the design and improve the utility of the intervention. Our findings show that an AI-driven nudge tool is an acceptable and appropriate solution, assuming it is flexible to user requirements.
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Affiliation(s)
- Jennifer Sumner
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore.
| | - Anjali Bundele
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Hui Wen Lim
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Phillip Phan
- Johns Hopkins Carey Business School and the Department of Medicine, Baltimore, USA
| | - Mehul Motani
- Department of Electrical & Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Amartya Mukhopadhyay
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Kazemian A, Hoseinzadeh M, Banihashem Rad SA, Jouya A, Tahani B. Nudging oral habits; application of behavioral economics in oral health promotion: a critical review. Front Public Health 2023; 11:1243246. [PMID: 38145077 PMCID: PMC10739307 DOI: 10.3389/fpubh.2023.1243246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Background Oral health disorders significantly contribute to the global incidence of chronic diseases. Nudge interventions have demonstrated effectiveness in enhancing people's decision-making and self-management capacities in a cost-efficient manner. As a result, these interventions could be valuable tools for fostering improved oral care habits. This critical review explores potential behavioral nudges applicable to promoting oral health. Methods A thorough electronic literature search was conducted on Scopus, Embase, and PubMed databases for papers published post-2008. The search focused on empirical evidence concerning the direct and indirect application of Nudge theory in oral health enhancement. In addition, the investigation included the nudge intervention's role in managing common non-communicable disease risk factors (tobacco, alcohol, and sugar) and their use in other health sectors. Results and conclusion There is a dearth of studies on behavioral economics, particularly those involving reward and reminder techniques. However, various successful nudge interventions have been identified in other sectors that aim to improve health decisions. These include strategies encouraging healthier nutritional choices, tobacco and alcohol cessation, medication compliance, routine physical activity, and regular health check-ups. Such interventions can also have direct or indirect positive impacts on oral health. Implementing these interventions within an oral care framework could promote oral health due to similar underlying cognitive mechanisms. However, different types of nudge interventions have varying degrees of effectiveness. Furthermore, factors such as the method of delivery and the characteristics of the targeted population significantly influence the outcome of the intervention. Hence, it is imperative to conduct extensive studies in diverse socioeconomic settings to fully understand the potentials, limitations, and impacts of nudge interventions in promoting oral health.
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Affiliation(s)
- Ali Kazemian
- Department of Community Oral Health, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Melika Hoseinzadeh
- Dental Research Center, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ahmad Banihashem Rad
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Anahid Jouya
- Department of Community Oral Health, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahareh Tahani
- Department of Oral Public Health, Dental Research Center, School of Dentistry, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Wilson LB, Pryce R, Moore EC, Burke L, Breeze P. Does cutting down on your food consumption lead to a net improvement in nutritional intake? A panel data approach using data from the UK Biobank. BMC Public Health 2023; 23:2274. [PMID: 37978364 PMCID: PMC10656843 DOI: 10.1186/s12889-023-17217-y] [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: 04/25/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Food diets are complex and a policy targeting one item of a person's diet does not affect their nutritional intake in a solely additive or subtractive manner. Policies tackling unhealthy diets are more likely to be adopted by governments if there is robust evidence to support them. To evaluate dietary policies, it is important to understand the correlations and interdependencies between food groups, as these can lead to unintended negative consequences. We aimed to see whether reductions in consumption of a particular group is related to a net improvement in nutritional intake, after taking into account patterns of consumption and substitution across food groups. METHODS Detailed dietary data was collected using a 24-h online dietary assessment from the UK Biobank and Oxford Web Q (n = 185,611). We used panel data fixed effects methods to estimate changes in energy, saturated fat, total sugar, and fibre following a 100gram reduction across 44 food groups. We compare these estimates against the average nutritional value of that food group from the UK National Diet and Nutrition Survey. RESULTS We find evidence of variation in whether a food is compensated between the main confectionery products. Crisps, savoury snacks, and sugar confectionery are less likely to be compensated, whereas chocolate confectionery, biscuits, and buns/cakes/pastries and pies are compensated. The result is particularly striking for chocolate confectionery which shows that while chocolate confectionery often has a high energy content, eating less chocolate confectionery is not associated with an equal reduction in energy. Instead, we find individuals switch or compensate for their reduction in chocolate confectionery consumption with other high energy food items. CONCLUSIONS We find that sugar confectionery and crisps and savoury snacks are less likely to result in substitution than chocolate confectionery. This would suggest that food policies aiming to reduce the consumption of these food groups are more likely to result in overall lower consumption of unhealthy foods.
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Affiliation(s)
- Luke B Wilson
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
| | - Robert Pryce
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Esther C Moore
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Lucy Burke
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Penny Breeze
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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16
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van Rookhuijzen M, de Vet E, Gort G, Adriaanse MA. When nudgees become nudgers: Exploring the use of self-nudging to promote fruit intake. Appl Psychol Health Well Being 2023; 15:1714-1732. [PMID: 37335055 DOI: 10.1111/aphw.12464] [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: 11/23/2022] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
The current study explored (1) the immediate and prolonged effects of self-nudges promoting fruit intake in the home environment, (2) whether the effect of self-nudges on fruit intake persists after self-nudges are no longer used (i.e. a temporal spillover effect) and (3) whether self-nudges can install healthy eating habits that, in turn, explain the temporal spillover effect. Participants (N = 331) were randomly assigned to either a control or self-nudge condition in which they had to choose a self-nudge promoting fruit consumption for 8 weeks. Thereafter, participants were asked to remove the self-nudge for 1 week to assess a possible temporal spillover effect. Results showed a positive effect of the self-nudges on fruit consumption right after implementation that continued during the 8 weeks in which the self-nudge was implemented, which was accompanied by an increase in fruit intake habit strength. However, a mixed picture emerged regarding the temporal spillover effect and no support was found for a mediation effect of habit strength. Although this study is only a first exploration of self-nudging to increase healthy food consumption, results indicate that self-nudging may be a promising extension of traditional nudging that can influence behaviour beyond out-of-home settings.
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Affiliation(s)
- Merije van Rookhuijzen
- Consumption and Healthy Lifestyles Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Emely de Vet
- Consumption and Healthy Lifestyles Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Gerrit Gort
- Biometris, Wageningen University and Research, Wageningen, The Netherlands
| | - Marieke A Adriaanse
- Health, Medical and Neuropsychology, Leiden University and Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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17
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Guedes D, Brazão V, Roque L, Campos L, Godinho C, Truninger M, Vinnari M, Graça J. Promoting plant-based eating in meat-centric meal contexts: a field study. Public Health Nutr 2023; 26:2619-2627. [PMID: 37712383 DOI: 10.1017/s1368980023001763] [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] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Shifting from meat-centric to plant-rich diets may help to enable healthier and more sustainable food systems. Here we present the results of a 1-week intervention to promote plant-based eating in a meat-centric food context (i.e. canteen). DESIGN The intervention included environmental restructuring strategies (e.g. promotional materials and menu redevelopment) and improvements to the offer of plant-based meals. The evaluation (sales data; pre-registered) spanned 3 weeks prior to the intervention (baseline), 1 week during the intervention (immediate/short-term impact) and 3 weeks after the intervention (follow-up). Opinion surveys were also used to collect data with customers during the intervention. SETTING Canteen unit of a university campus in Portugal (Lisbon metropolitan area). PARTICIPANTS In addition to sales data (baseline: 7965 meals; immediate/short-term: 2635 meals; follow-up: 7135 meals), we used opinion surveys to assess customers' meal appraisals during the intervention (n = 370). RESULTS The odds of a sold meal being vegetarian were 24 % higher in the intervention week compared with the pre-intervention period [OR = 1·24, 95 % CI (1·10, 1·40)] and 9 % higher in the post-intervention period compared with the pre-intervention period [OR = 1·09, (95 % CI (1·00, 1·19)]. Survey data showed that vegetarian meals compared favourably to meat and fish alternatives in liking, sustainability and satiety. CONCLUSIONS A short-term, theory-driven, operationally feasible intervention was effective in promoting increased plant-based meal choices in a collective meal context. Nevertheless, these changes were not entirely sustained over time. Future studies could test whether prolonged or more transformative interventions are necessary to unlock entrenched food practices more effectively in meat-centric collective meal contexts.
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Affiliation(s)
- David Guedes
- Iscte - Instituto Universitário de Lisboa, CIS_Iscte, Lisboa, Portugal
- Instituto de Ciências Sociais da Universidade de Lisboa (ICS-ULisboa), Lisboa, Portugal
| | | | - Lisa Roque
- Iscte - Instituto Universitário de Lisboa, CIS_Iscte, Lisboa, Portugal
| | - Lúcia Campos
- Iscte - Instituto Universitário de Lisboa, CIS_Iscte, Lisboa, Portugal
- Instituto de Ciências Sociais da Universidade de Lisboa (ICS-ULisboa), Lisboa, Portugal
| | - Cristina Godinho
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Monica Truninger
- Instituto de Ciências Sociais da Universidade de Lisboa (ICS-ULisboa), Lisboa, Portugal
| | | | - João Graça
- Instituto de Ciências Sociais da Universidade de Lisboa (ICS-ULisboa), Lisboa, Portugal
- University of Groningen, Groningen, The Netherlands
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18
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Gillebaart M, Blom SSAH, Benjamins JS, de Boer F, De Ridder DTD. The role of attention and health goals in nudging healthy food choice. Front Psychol 2023; 14:1270207. [PMID: 37928596 PMCID: PMC10620715 DOI: 10.3389/fpsyg.2023.1270207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Nudging is a promising intervention technique that supports people in pursuing their healthy eating goals. Recent research suggests that, despite previous assumptions, disclosure of the presence of a nudge does not compromise nudge effectiveness. However, it is unknown whether attention to a nudge affects nudge effects. We assessed the role of attention systematically, by examining explicit and implicit attention to nudges, while also exploring healthy eating goals as a potential moderator. Methods Participants were assigned to a nudge (i.e., a shopping basket inlay with pictures of healthy items) or control condition (i.e., a shopping basket inlay with neutral pictures) and chose a snack in an experimental supermarket field study. Explicit and implicit attention (with a mobile eye-tracker) to nudges, healthiness of snack choice, and healthy eating goals were assessed. Results Results showed that attention to the nudge did not hamper the nudge's effect. Furthermore, individuals with strong healthy eating goals made healthier food choices in the nudge condition. Individuals with weak to non-existent healthy eating goals were not influenced by the nudge. Discussion Findings are in line with the viewpoint that nudging does not by definition work 'in the dark', and suggests that nudges support people in adhering to their healthy eating goal.
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Affiliation(s)
- Marleen Gillebaart
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, Netherlands
| | - Stephanie S A H Blom
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, Netherlands
| | - Jeroen S Benjamins
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, Netherlands
- Department of Experimental Psychology, Utrecht University, Utrecht, Netherlands
| | - Femke de Boer
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, Netherlands
| | - Denise T D De Ridder
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, Netherlands
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Heeren FAN, Darcey VL, Deemer SE, Menon S, Tobias D, Cardel MI. Breaking down silos: the multifaceted nature of obesity and the future of weight management. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220215. [PMID: 37482785 PMCID: PMC10363700 DOI: 10.1098/rstb.2022.0215] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/04/2023] [Indexed: 07/25/2023] Open
Abstract
The continued global increase in the prevalence of obesity prompted a meeting at the Royal Society of London investigating causal mechanisms of the disease, 'Causes of obesity: theories, conjectures, and evidence' in October 2022. Evidence presented indicates areas of obesity science where there have been advancements, including an increased understanding of biological and physiological processes of weight gain and maintenance, yet it is clear there is still debate on the relative contribution of plausible causes of the modern obesity epidemic. Consensus was reached that obesity is not a reflection of diminished willpower, but rather the confluence of multiple, complex factors. As such, addressing obesity requires multifactorial prevention and treatment strategies. The accumulated evidence suggests that a continued focus primarily on individual-level contributors will be suboptimal in promoting weight management at the population level. Here, we consider individual biological and physiological processes within the broader context of sociodemographic and sociocultural exposures as well as environmental changes to optimize research priorities and public health efforts. This requires a consideration of a systems-level approach that efficiently addresses both systemic and group-specific environmental determinants, including psychosocial factors, that often serve as a barrier to otherwise efficacious prevention and treatment options. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part I)'.
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Affiliation(s)
- Faith Anne N. Heeren
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL 32611-7011, USA
| | - Valerie L. Darcey
- Laboratory of Biological Modeling, Integrative Physiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA
| | - Sarah E. Deemer
- Integrative Metabolism & Disease Prevention Research Group, Department of Kinesiology, Health Promotion & Recreation, University of North Texas, Denton, TX 76203, USA
| | - Sarada Menon
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL 32611-7011, USA
| | - Deirdre Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA
- Nutrition Department, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Michelle I. Cardel
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL 32611-7011, USA
- WW International Inc, New York, New York 10010, USA
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Franchini C, Bartolotto C, Scazzina F, Carpenter CL, Slusser W. Increasing the Consumption of Environmentally Friendly Foods in a University Dining Hall Using Menu Item Placement. Nutrients 2023; 15:3873. [PMID: 37764657 PMCID: PMC10537694 DOI: 10.3390/nu15183873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Creating a decision-making environment that promotes sustainable food choices is a priority for both the individual and society. This study aimed at encouraging plant-based menu choices by re-ordering the menu according to the carbon footprint values. The project was conducted in a grab-and-go eatery at a large United States public university, where students could order their meals choosing among different menu options that were customizable with various ingredients. The order of menu ingredients was changed twice: for five weeks, from the most to the least impactful in terms of carbon footprint; subsequently, for another five weeks the order was reversed. At both times, all sales data were recorded. A total of 279,219 and 288,527 items were selected, respectively, during the first and the second intervention. A significant association was found between menu re-ordering and customers' choices for almost all food categories considered. Overall, despite beef choices not changing, results showed that students were more likely to choose low-carbon options when these were placed at the beginning, emphasizing that food selections were impacted by ingredient placement on the menu list. These findings highlight the need for a multi-level strategy focused on raising students' awareness of the environmental impact of animal-based foods, particularly beef.
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Affiliation(s)
- Cinzia Franchini
- Human Nutrition Unit, Department of Food and Drug, University of Parma, 43121 Parma, Italy; (C.F.); (F.S.)
| | - Carole Bartolotto
- UCLA Housing, University of California at Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Francesca Scazzina
- Human Nutrition Unit, Department of Food and Drug, University of Parma, 43121 Parma, Italy; (C.F.); (F.S.)
| | - Catherine L. Carpenter
- Division of Clinical Nutrition, Center for Human Nutrition, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA 90095, USA
- School of Nursing, University of California at Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Wendelin Slusser
- Department of Pediatrics, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA 90095, USA;
- Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles (UCLA), Los Angeles, CA 90095, USA
- Semel Healthy Campus Initiative Center, University of California at Los Angeles (UCLA), Los Angeles, CA 90095, USA
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Schulte EA, Winkler G, Brombach C, Buyken AE. Choice architecture interventions promoting sustained healthier food choice and consumption by students in a secondary school setting: a systematic review of intervention studies. Public Health Nutr 2023; 26:1896-1906. [PMID: 37293811 PMCID: PMC10478061 DOI: 10.1017/s1368980023001118] [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: 06/13/2022] [Revised: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To systematically review the impact of choice architecture interventions (CAI) on the food choice of healthy adolescents in a secondary school setting. Factors potentially contributing to the effectiveness of CAI types and numbers implemented and its long-term success were examined. DESIGN PUBMED and Web of Science were systematically searched in October 2021. Publications were included following predefined inclusion criteria and grouped according to the number and duration of implemented interventions. Intervention impact was determined by a systematic description of the reported quantitative changes in food choice and/or consumption. Intervention types were compared with regard to food selection and sustained effects either during or following the intervention. SETTING CAI on food choice of healthy adolescents in secondary schools. PARTICIPANTS Not applicable. RESULTS Fourteen studies were included; four randomised controlled trials and five each of controlled or uncontrolled pre-post design, respectively. Four studies implemented a single CAI type, with ten implementing > 1. Three studies investigated CAI effects over the course of a school year either by continuous or repeated data collection, while ten studies' schools were visited on selected days during an intervention. Twelve studies reported desired changes in overall food selection, yet effects were not always significant and appeared less conclusive for longer-term studies. CONCLUSIONS This review found promising evidence that CAI can be effective in encouraging favourable food choices in healthy adolescents in a secondary school setting. However, further studies designed to evaluate complex interventions are needed.
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Affiliation(s)
- Eva Andrea Schulte
- Public Health Nutrition, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn33098, Germany
| | - Gertrud Winkler
- Department of Life Sciences, University of Applied Sciences Albstadt-Sigmaringen, Sigmaringen, Germany
| | - Christine Brombach
- Forschungsgruppe für Lebensmittel-Sensorik, Life Sciences and Facility Management, Züricher Hochschule für Angewandte Wissenschaften, Zürich, Schweiz
| | - Anette E Buyken
- Public Health Nutrition, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn33098, Germany
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Hecht CA, Murphy MC, Dweck CS, Bryan CJ, Trzesniewski KH, Medrano FN, Giani M, Mhatre P, Yeager DS. Shifting the mindset culture to address global educational disparities. NPJ SCIENCE OF LEARNING 2023; 8:29. [PMID: 37644082 PMCID: PMC10465593 DOI: 10.1038/s41539-023-00181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
Educational outcomes remain highly unequal within and across nations. Students' mindsets-their beliefs about whether intellectual abilities can be developed-have been identified as a potential lever for making adolescents' academic outcomes more equitable. Recent research, however, suggests that intervention programs aimed at changing students' mindsets should be supplemented by programs aimed at the changing the mindset culture, which is defined as the shared set of beliefs about learning in a school or classroom. This paper reviews the theoretical and empirical origin of the mindset culture and examines its potential to reduce group-based inequalities in education. In particular, experiments have identified two broad ways the mindset culture is communicated by teachers: via informal messages about growth (e.g., that all students will be helped to learn and succeed), and formal opportunities to improve (e.g., learning-focused grading policies and opportunities to revise and earn credit). New field experiments, applying techniques from behavioral science, have also revealed effective ways to influence teachers' culture-creating behaviors. This paper describes recent breakthroughs in the U.S. educational context and discusses how lessons from these studies might be applied in future, global collaborations with researchers and practitioners.
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Affiliation(s)
| | | | | | | | | | | | - Matt Giani
- The University of Texas at Austin, Austin, TX, USA
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23
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Yi S, Kanetkar V, Brauer P. Campus food service users' support for nudge strategies for fruit and vegetable-rich items: findings from a large Canadian national sample. J Nutr Sci 2023; 12:e93. [PMID: 37744641 PMCID: PMC10511820 DOI: 10.1017/jns.2023.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/21/2023] [Indexed: 09/26/2023] Open
Abstract
Although customer support is critical to the wider uptake of nudging strategies to promote fruits and vegetables (FV) in institutional food service (FS) settings, empirical research is sparse and typically based on small convenience samples. An online survey was conducted to assess support, perceived effectiveness and intrusiveness of nine nudge types drawn from Münscher et al.'s Taxonomy of Choice Architecture. We focused on the setting of campus FSs across Canada. A national sample of post-secondary students regularly using campus FSs was used (N 1057). Support for changing the range of options (B3) was the highest, closely followed by changing option-related effort (B2) and changing option-related consequences (B4). Facilitating commitment (C2), changing default (B1) and providing a social reference point (A3) received lowest support. Furthermore, we extracted three clusters of respondents based on perceived effectiveness and intrusiveness of nudge types. Characterised by a relatively low level of perceived effectiveness and moderately high level of intrusiveness, Cluster 1 (61⋅7 % of the sample) reported the lowest support for nudges. Cluster 2 (26⋅6 %), characterised by intermediate effectiveness and low intrusiveness of nudging, reported a high level of support for nudges. Lastly, Cluster 3 (11⋅7 %), characterised by high perceived effectiveness of as well as high perceived intrusiveness, reported the highest level of support for nudges. Findings confirm overall support for FV nudging, with significant differences across nudge types. Differences in customers' acceptance and perception across nudge types offer campus FS operators initial priors in selecting nudges to promote FV.
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Affiliation(s)
- Sunghwan Yi
- Department of Marketing & Consumer Studies, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Vinay Kanetkar
- Department of Marketing & Consumer Studies, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Paula Brauer
- Department of Family Relations & Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
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Khan A, Evangelista AU, Varua ME. Evaluating the impact of marketing interventions on sugar-free and sugar-sweetened soft drink sales and sugar purchases in a fast-food restaurant setting. BMC Public Health 2023; 23:1578. [PMID: 37596602 PMCID: PMC10439673 DOI: 10.1186/s12889-023-16395-z] [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: 09/04/2022] [Accepted: 07/26/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Beverages high in added sugar, such as sugar-sweetened soft drinks, continue to be associated with various health issues. This study examines the effects of a manufacturer-initiated multicomponent intervention on the sales of sugar-free (SFD) and sugar-sweetened (SSD) soft drinks and the amount of sugar people purchase from soft drinks in a fast-food restaurant setting. METHODS A database of monthly sales data of soft drinks from January 2016 to December 2018 was obtained from three treatment and three control fast-food restaurants. A multicomponent intervention consisting of free coupons, point-of-purchase displays, a menu board, and two sugar-free replacements for sugar-sweetened soft drinks was introduced in August 2018 for five months in Western Sydney, Australia. A retrospective interrupted time series analysis was used to model the data and examine the effects of the interventions on SFD and SSD sales and their consequential impact on sugar purchases from soft drinks. The analyses were carried out for volume sales in litres and sugar in grams per millilitre of soft drinks sales. A comparison of these measures within the treatment site (pre- and post-intervention) and between sites (treatment and control) was conducted. RESULTS The interventions had a statistically significant impact on SFDs but not SSDs. On average, SFD sales in the treatment site were 56.75% higher than in the control site. Although SSD sales were lower in the treatment site, the difference with the control site was not statistically significant. The net reduction of 6.34% in the amount of sugar purchased from soft drinks between sites during the experimental period was attributed to the interventions. CONCLUSIONS The interventions significantly increased SFD sales and reduced sugar purchases in the short run. Aside from free coupons, the findings support the recommendation for fast food restaurants to nudge customers towards choosing SFDs through point-of-purchase displays and the replacement of popular SSDs with their SFD counterparts.
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Affiliation(s)
- Aila Khan
- School of Business, Hospitality, Marketing and Sport, Western Sydney University, Sydney, Australia
| | - Anna Uro Evangelista
- School of Business, Economics, Finance and Property, Western Sydney University, Sydney, Australia.
| | - Maria Estela Varua
- School of Business, Economics, Finance and Property, Western Sydney University, Sydney, Australia
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van Leunen MMCJ, de Lathauwer ILJ, Verstappen CCAG, Visser-Stevelink DMG, Brouwers RWM, Herkert C, Tio RA, Spee RF, Lu Y, Kemps HMC. Telerehabilitation in patients with recent hospitalisation due to acute decompensated heart failure: protocol for the Tele-ADHF randomised controlled trial. BMC Cardiovasc Disord 2023; 23:379. [PMID: 37516829 PMCID: PMC10386674 DOI: 10.1186/s12872-023-03407-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation in patients with chronic heart failure (CHF) has favourable effects on exercise capacity, the risk at hospital (re-)admission and quality of life. Although cardiac rehabilitation is generally recommended it is still under-utilised in daily clinical practice, particularly in frail elderly patients after hospital admission, mainly due to low referral and patient-related barriers. Cardiac telerehabilitation (CTR) has the potential to partially solve these barriers. The purpose of this study is to evaluate the effects of CTR as compared to standard remote care after hospital admission on physical functional capacity in CHF patients. METHODS In this randomised controlled trial, 64 CHF patients will be recruited during hospitalisation for acute decompensated heart failure, and randomised to CTR combined with remote patient management (RPM) or RPM alone (1:1). All participants will start with RPM after hospital discharge for early detection of deterioration, and will be up titrated to optimal medical therapy before being randomised. CTR will start after randomisation and consists of an 18-week multidisciplinary programme with exercise training by physical and occupational therapists, supported by a (remote) technology-assisted dietary intervention and mental health guiding by a physiologist. The training programme consists of three centre-based and two home-based video exercise training sessions followed by weekly video coaching. The mental health and dietary programme are executed using individual and group video sessions. A wrist-worn device enables remote coaching by the physical therapist. The web application is used for promoting self-management by the following modules: 1) goal setting, 2) progress tracking, 3) education, and 4) video and chat communication. The primary outcome measure is physical functional capacity evaluated by the Short Physical Performance Battery (SPPB) score. Secondary outcome measures include frailty scoring, recovery after submaximal exercise, subjective health status, compliance and acceptance to the rehabilitation programme, and readmission rate. DISCUSSION The Tele-ADHF trial is the first prospective randomised controlled trial designed for evaluating the effects of a comprehensive combined RPM and CTR programme in recently hospitalised CHF patients. We hypothesize that this intervention has superior effects on physical functional capacity than RPM alone. TRIAL REGISTRATION Netherlands Trial Registry (NTR) NL9619, registered 21 July 2021.
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Affiliation(s)
- Mayke M C J van Leunen
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands.
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Ignace L J de Lathauwer
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Cindy C A G Verstappen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | - Rutger W M Brouwers
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Cyrille Herkert
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - René A Tio
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Ruud F Spee
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Yuan Lu
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
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Michiura N, Matsuda Y, Suwa H, Yasumoto K. A self-management system for preventing hyperglycemia through blood glucose level prediction and nudge-based food amount reduction. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-7. [PMID: 38082991 DOI: 10.1109/embc40787.2023.10340402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
In recent years, the number of diabetic patients has been increasing rapidly all over the world. Diabetes cannot be completely cured once it develops, so it is important to prevent diabetes before it develops. To prevent the onset of diabetes, it is necessary to avoid prolonged hyperglycemia after meals. In this paper, we propose a self-management system to help users prevent diabetes. The system monitors blood glucose levels in real time, calculates foods to be reduced taking into account the user's preferences, and presents them to the user as soon as the system predicts that the planned diet will cause high blood glucose. We designed and conducted two experiments to show the effectiveness of the proposed system. Experiment 1 was to construct and evaluate a model for predicting blood glucose levels two hours later. Experiment 2 was to evaluate the degree of satisfaction with the food and recommendations, and the acceptability of the recommendations by participants who actually used the proposed system. The results of Experiment 1 showed that the constructed model was able to predict blood glucose levels with an RMSE of 7.66 and MAE of 4.66. As a result of Experiment 2, we found the recommended intake was more acceptable if it reflected the user's preferences.
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Sugimoto M, Tajiri E, Nakashima N, Sakamoto T. Effects of Using a Perforated Spoon on Salt Reduction When Consuming Ramen Noodles: A Randomized Crossover Study of Japanese Male University Students. Nutrients 2023; 15:2864. [PMID: 37447190 DOI: 10.3390/nu15132864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Salt reduction is a public health priority for the Japanese population. We focused on the effect of salt reduction by changing eating utensils to reduce salt consumption. As a test meal, we used ramen, which is commonly eaten by Japanese individuals and has a high salt content. In this randomized crossover study, we hypothesized that eating ramen with a perforated spoon would reduce the quantity of ramen soup and salt consumed compared to using a regular spoon without holes. Soup intake, after-meal fullness, and deliciousness were compared between eating with chopsticks and a regular spoon, and with chopsticks and a perforated spoon. In total, 36 male university students (mean age, 20.7 [standard deviation, 1.8] years) were included in the analyses. The median salt intake (25th and 75th percentiles) was significantly lower with perforated spoons (1.8 [1.5, 4.3] g) than with regular spoons (2.4 [1.8, 4.8] g; p = 0.019). There were no significant differences in after-meal fullness or deliciousness for both spoon conditions (p > 0.05). For young men, the soup intake when eating ramen with a perforated spoon was lower than that with a regular spoon; this suggests a reduction in salt intake.
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Affiliation(s)
- Maiko Sugimoto
- Graduate School of Environmental & Symbiotic Sciences, Prefectural University of Kumamoto, 3-1-100, Tsukide, Higashi-ku, Kumamoto 862-8502, Japan
- Public Health and Disease Prevention Division, Ariake Public Health Center, Kumamoto Prefectural Government, 1004-1, Iwasaki, Tamana, Kumamoto 865-0016, Japan
| | - Eri Tajiri
- Graduate School of Environmental & Symbiotic Sciences, Prefectural University of Kumamoto, 3-1-100, Tsukide, Higashi-ku, Kumamoto 862-8502, Japan
| | - Nana Nakashima
- Graduate School of Environmental & Symbiotic Sciences, Prefectural University of Kumamoto, 3-1-100, Tsukide, Higashi-ku, Kumamoto 862-8502, Japan
| | - Tatsuaki Sakamoto
- Graduate School of Environmental & Symbiotic Sciences, Prefectural University of Kumamoto, 3-1-100, Tsukide, Higashi-ku, Kumamoto 862-8502, Japan
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Gillebaart M, Blom S, De Boer F, De Ridder D. Prompting vegetable purchases in the supermarket by an affordance nudge: Examining effectiveness and appreciation in a set of field experiments. Appetite 2023; 184:106526. [PMID: 36889509 DOI: 10.1016/j.appet.2023.106526] [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: 12/14/2022] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023]
Abstract
The supermarket is a promising location for stimulating healthier food choices by nudging interventions. However, nudging healthy food choices in the supermarket has shown weak effects to date. The present research introduces a new nudge based on the concept of affordances - i.e., an animated character - that invites interaction with healthy food products and examines its effectiveness and appreciation in a supermarket context. We present findings of a series of three studies. In Study 1, evaluations of the new nudge were collected, revealing that the nudge was appreciated. In Studies 2 and 3, field experiments were conducted to test the nudge's effect on vegetable purchases in a real-life supermarket. Study 3 demonstrated that vegetable purchases increased significantly (up to 17%) when the affordance nudge was placed on the vegetable shelves. Furthermore, customers appreciated the nudge and its potential for implementation. Taken together, this set of studies presents compelling findings illustrating the potential of the affordance nudge for increasing healthy choices in the supermarket.
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Affiliation(s)
- Marleen Gillebaart
- Utrecht University, Department of Social, Health and Organizational Psychology, the Netherlands
| | - Stephanie Blom
- Utrecht University, Department of Social, Health and Organizational Psychology, the Netherlands
| | - Femke De Boer
- Utrecht University, Department of Social, Health and Organizational Psychology, the Netherlands
| | - Denise De Ridder
- Utrecht University, Department of Social, Health and Organizational Psychology, the Netherlands.
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Caso G, Rizzo G, Migliore G, Vecchio R. Loss framing effect on reducing excessive red and processed meat consumption: Evidence from Italy. Meat Sci 2023; 199:109135. [PMID: 36796286 DOI: 10.1016/j.meatsci.2023.109135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/14/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
A reduction of meat consumption is crucial for addressing public health problems, especially in industrialized countries. Among low-cost interventions, emotionally provocative health-information strategies could be effective options in fostering meat reduction. Through an online experimental survey, administrated to a quota-based national sample (N = 1142), this study analysed the profile of Italians consuming red/processed meat above World Health Organization (WHO) recommended amounts. Via a between-subjects design, the research tested whether two health frame-nudges (societal impact and individual impact of over consumption) persuaded these individuals to reduce future meat consumption. Results showed that adhering to an omnivore diet, higher consumption of meat than peers, household size (larger) and positive moral perception of meat consumption increased the likelihood of overconsumption. In addition, both nudges proved to be effective in positively impacting future intentions to reduce meat consumption among individuals exceeding WHO recommended amounts. The two frame-nudges were more effective among females, respondents with children in the household and individuals with a low health status perception.
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Affiliation(s)
- Gerarda Caso
- Department of Agricultural Sciences, University of Naples Federico II, Via Università 96, Portici, Naples 80055, Italy.
| | - Giuseppina Rizzo
- Department of Agricultural, Food and Forest Sciences, University of Palermo, Viale delle Scienze, Building 4, Palermo 90128, Italy.
| | - Giuseppina Migliore
- Department of Agricultural, Food and Forest Sciences, University of Palermo, Viale delle Scienze, Building 4, Palermo 90128, Italy.
| | - Riccardo Vecchio
- Department of Agricultural Sciences, University of Naples Federico II, Via Università 96, Portici, Naples 80055, Italy.
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Yoshino CA, Sidney-Annerstedt K, Wingfield T, Kirubi B, Viney K, Boccia D, Atkins S. Experiences of conditional and unconditional cash transfers intended for improving health outcomes and health service use: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 3:CD013635. [PMID: 36999604 PMCID: PMC10064639 DOI: 10.1002/14651858.cd013635.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND It is well known that poverty is associated with ill health and that ill health can result in direct and indirect costs that can perpetuate poverty. Social protection, which includes policies and programmes intended to prevent and reduce poverty in times of ill health, could be one way to break this vicious cycle. Social protection, particularly cash transfers, also has the potential to promote healthier behaviours, including healthcare seeking. Although social protection, particularly conditional and unconditional cash transfers, has been widely studied, it is not well known how recipients experience social protection interventions, and what unintended effects such interventions can cause. OBJECTIVES: The aim of this review was to explore how conditional and unconditional cash transfer social protection interventions with a health outcome are experienced and perceived by their recipients. SEARCH METHODS: We searched Epistemonikos, MEDLINE, CINAHL, Social Services Abstracts, Global Index Medicus, Scopus, AnthroSource and EconLit from the start of the database to 5 June 2020. We combined this with reference checking, citation searching, grey literature and contact with authors to identify additional studies. We reran all strategies in July 2022, and the new studies are awaiting classification. SELECTION CRITERIA We included primary studies, using qualitative methods or mixed-methods studies with qualitative research reporting on recipients' experiences of cash transfer interventions where health outcomes were evaluated. Recipients could be adult patients of healthcare services, the general adult population as recipients of cash targeted at themselves or directed at children. Studies could be evaluated on any mental or physical health condition or cash transfer mechanism. Studies could come from any country and be in any language. Two authors independently selected studies. DATA COLLECTION AND ANALYSIS: We used a multi-step purposive sampling framework for selecting studies, starting with geographical representation, followed by health condition, and richness of data. Key data were extracted by the authors into Excel. Methodological limitations were assessed independently using the Critical Appraisal Skills Programme (CASP) criteria by two authors. Data were synthesised using meta-ethnography, and confidence in findings was assessed using the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. MAIN RESULTS: We included 127 studies in the review and sampled 41 of these studies for our analysis. Thirty-two further studies were found after the updated search on 5 July 2022 and are awaiting classification. The sampled studies were from 24 different countries: 17 studies were from the African region, seven were from the region of the Americas, seven were from the European region, six were from the South-East Asian region, three from the Western Pacific region and one study was multiregional, covering both the African and the Eastern Mediterranean regions. These studies primarily explored the views and experiences of cash transfer recipients with different health conditions, such as infectious diseases, disabilities and long-term illnesses, sexual and reproductive health, and maternal and child health. Our GRADE-CERQual assessment indicated we had mainly moderate- and high-confidence findings. We found that recipients perceived the cash transfers as necessary and helpful for immediate needs and, in some cases, helpful for longer-term benefits. However, across conditional and unconditional programmes, recipients often felt that the amount given was too little in relation to their total needs. They also felt that the cash alone was not enough to change their behaviour and, to change behaviour, additional types of support would be required. The cash transfer was reported to have important effects on empowerment, autonomy and agency, but also in some settings, recipients experienced pressure from family or programme staff on cash usage. The cash transfer was reported to improve social cohesion and reduce intrahousehold tension. However, in settings where some received the cash and others did not, the lack of an equal approach caused tension, suspicion and conflict. Recipients also reported stigma in terms of cash transfer programme assessment processes and eligibility, as well as inappropriate eligibility processes. Across settings, recipients experienced barriers in accessing the cash transfer programme, and some refused or were hesitant to receive the cash. Some recipients found cash transfer programmes more acceptable when they agreed with the programme's goals and processes. AUTHORS' CONCLUSIONS: Our findings highlight the impact of the sociocultural context on the functioning and interaction between the individual, family and cash transfer programmes. Even where the goals of a cash transfer programme are explicitly health-related, the outcomes may be far broader than health alone and may include, for example, reduced stigma, empowerment and increased agency of the individual. When measuring programme outcomes, therefore, these broader impacts could be considered for understanding the health and well-being benefits of cash transfers.
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Affiliation(s)
- Clara A Yoshino
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristi Sidney-Annerstedt
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tom Wingfield
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Clinical Infection, Microbiology, and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Beatrice Kirubi
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Public Health Research (CPHR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Kerri Viney
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Research School of Population Health, Australian National University, Canberra, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Delia Boccia
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Salla Atkins
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Global Health and Development, Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
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Yamalakonda S, Nilakantan R, Iyengar D, Rao S. On subsistence‐type rural independent retailers and crowdfunded microfinance—Prosocial lending, nudges, and unintended consequences. JOURNAL OF BUSINESS LOGISTICS 2023. [DOI: 10.1111/jbl.12340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Nudge-Based Interventions on Health Promotion Activity Among Very Old People: A Pragmatic, 2-Arm, Participant-Blinded Randomized Controlled Trial. J Am Med Dir Assoc 2023; 24:390-394.e5. [PMID: 36529275 PMCID: PMC9754120 DOI: 10.1016/j.jamda.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Social distancing due to the coronavirus disease 2019 crisis can exacerbate inactivity in older adults. Novel approaches for older adults must be designed to improve their activity and maintain their health. This study examined the effect of nudge-based behavioral interventions on health-promoting activities in older adults in Japan. DESIGN Two-arm, participant-blinded randomized controlled trial. SETTING AND PARTICIPANTS Japanese continuing care retirement community residents (n = 99, median age 82 years, 73% women) INTERVENTION: Two-step nudge-based behavioral intervention promoting tablet usage. METHODS We enrolled participants from an ongoing Internet of Things project in a retirement community in Japan. For the health promotion program, tablet computers were installed in a common area for participants to receive information about their health. The intervention group received a 1-time loss-emphasized nudge (first step), followed by asking questions about when they planned to use it again (second step). The control group used the tablet computers without being asked those questions. The main outcome was the participants' mean daily tablet activity every 4 weeks for the next 16 weeks. RESULTS Ninety-nine individuals were randomly assigned to the intervention or control group. The rate ratios for tablet use were significantly higher in the intervention group in the second and third periods. The subgroup analysis showed that these effects were largely attributable to men. CONCLUSIONS AND IMPLICATIONS Nudge-based interventions can be effective in promoting activities for older adults, especially older men. The finding of this study indicates a possible intervention to engage people who are socially isolated.
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Venema TAG, Jensen NH. We meat again: a field study on the moderating role of location-specific consumer preferences in nudging vegetarian options. Psychol Health 2023:1-15. [PMID: 36840618 DOI: 10.1080/08870446.2023.2182896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/10/2023] [Accepted: 02/15/2023] [Indexed: 02/26/2023]
Abstract
This field study set out to test whether consumers' history of making decisions in a particular choice context moderated the effectiveness of a nudge intervention to reduce meat consumption. In a Danish hospital canteen that served both staff members and visitors, a combination of nudges (Chef's recommendation sticker + prominent positioning) was implemented to promote vegetarian sandwiches. The sales of these sandwiches increased from 16.45% during the baseline period to 25.16% during the nudge intervention period. Most notably, this increase was caused by the visitors, who had weak location-bound preferences. Hospital staff members (who had strong location-bound preferences) were unaffected by the nudge in their choice. This is an important finding because the two consumer groups did not differ on their person-bound preferences for meat. It seems that behaviour change is best predicted by location-bound preferences, whereas the behaviour itself is best predicted by person-bound preferences. These findings can help organizations in estimating whether a nudge intervention has enough potential for behaviour change, or whether more directive policies are required.
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Affiliation(s)
- Tina A G Venema
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Niels Holm Jensen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Murayama H, Takagi Y, Tsuda H, Kato Y. Applying Nudge to Public Health Policy: Practical Examples and Tips for Designing Nudge Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3962. [PMID: 36900972 PMCID: PMC10002044 DOI: 10.3390/ijerph20053962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Given the cost-effective nature of promoting desirable behaviors among individuals and societies, national and local governments have widely applied the nudge concept in various public policy fields. This viewpoint briefly explains the concept of nudge and presents the trend of nudge application in public health policy with illustrative examples. While most academic evidence on its effectiveness has been derived from Western countries, there is a significant accumulation of cases of nudge practices in non-Western countries, including the Western Pacific nations. This viewpoint also provides tips for designing nudge interventions. We introduce a simple, three-step procedure for this purpose: (1) identify target behavior, (2) determine friction and fuel of the behavior, and (3) design and implement a nudge-as well as the behavioral process map and the EAST framework.
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Affiliation(s)
- Hiroshi Murayama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
- Yokohama Behavioral insights and Design Team, Kanagawa 231-0005, Japan
| | - Yusuke Takagi
- Yokohama Behavioral insights and Design Team, Kanagawa 231-0005, Japan
- City of Yokohama, Yokohama 231-0005, Japan
| | - Hirokazu Tsuda
- Ministry of Finance, Tokyo 100-8940, Japan
- PolicyGarage, Kanagawa 231-0005, Japan
| | - Yuri Kato
- PolicyGarage, Kanagawa 231-0005, Japan
- Ministry of the Environment, Tokyo 100-8975, Japan
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Meeusen REH, van der Voorn B, Berk KA. Nudging strategies to improve food choices of healthcare workers in the workplace cafeteria: A pragmatic field study. Clin Nutr ESPEN 2023; 53:126-133. [PMID: 36657903 DOI: 10.1016/j.clnesp.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Dutch healthcare workers experience the highest workload and absenteeism rates compared to all other professions. This has been associated with a more unhealthy diet. Nudging strategies in the workplace have been shown to improve food choices. We studied the potential of a combination of evidence and practice-based nudging strategies; determined their feasibility in a real-life setting; and explored their effectiveness on healthier purchases over a two-month period in a hospital workplace cafeteria. METHODS We conducted an explorative, prospective field study. Based on information gathered through a literature search and a qualitative field study, we selected the potentially most effective and feasible nudges. These were subsequently implemented in a commercial workplace cafeteria of a Dutch academic medical centre. The selected nudging strategies included product placement, increasing the ratio of healthy to unhealthy product options, and providing nutritional information and motivational statements. Data on the products purchased was collected using photographs of the lunch trays of healthcare workers, with the products then labelled and their nutritional value calculated. Effects were evaluated after one and two months. Chi-square analyses were used to analyse differences over time. RESULTS A total of 905 photographs of lunches were analysed (approximately 300 at each time point). The nudging strategies implemented resulted in a 41% increase in the purchase of whole-wheat products at the expense of non-whole-wheat products, between baseline and final measurement (p = 0.012). The purchases of healthy and unhealthy bread fillings and beverages did not significantly change during the study period. CONCLUSION This explorative study showed that a combination of three nudging strategies partly improved healthy food choices for lunch in a Dutch healthcare setting. These results may help guide other professionals to implement nudging strategies to improve employee food choices. Future research should evaluate the effect over a longer period of time, thereby identifying the most effective combination of nudging strategies and investigate how these effect the health of hospital employees.
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Affiliation(s)
- Renate E H Meeusen
- Department of Internal Medicine, Obesity Center CGG, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Internal Medicine, Division of Dietetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bibian van der Voorn
- Department of Internal Medicine, Obesity Center CGG, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Kirsten A Berk
- Department of Internal Medicine, Division of Dietetics, Erasmus Medical Center, Rotterdam, the Netherlands.
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Efficiently exploring the causal role of contextual moderators in behavioral science. Proc Natl Acad Sci U S A 2023; 120:e2216315120. [PMID: 36577065 PMCID: PMC9910482 DOI: 10.1073/pnas.2216315120] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Behavioral science interventions have the potential to address longstanding policy problems, but their effects are typically heterogeneous across contexts (e.g., teachers, schools, and geographic regions). This contextual heterogeneity is poorly understood, however, which reduces the field's impact and its understanding of mechanisms. Here, we present an efficient way to interrogate heterogeneity and address these gaps in knowledge. This method a) presents scenarios that vividly represent different moderating contexts, b) measures a short-term behavioral outcome (e.g., an academic choice) that is known to relate to typical intervention outcomes (e.g., academic achievement), and c) assesses the causal effect of the moderating context on the link between the psychological variable typically targeted by interventions and this short-term outcome. We illustrated the utility of this approach across four experiments (total n = 3,235) that directly tested contextual moderators of the links between growth mindset, which is the belief that ability can be developed, and students' academic choices. The present results showed that teachers' growth mindset-supportive messages and the structural opportunities they provide moderated the link between students' mindsets and their choices (studies 1 to 3). This pattern was replicated in a nationally representative sample of adolescents and did not vary across demographic subgroups (study 2), nor was this pattern the result of several possible confounds (studies 3 to 4). Discussion centers on how this method of interrogating contextual heterogeneity can be applied to other behavioral science interventions and broaden their impact in other policy domains.
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Diaz-Beltran M, Almanza B, Byrd K, Behnke C, Nelson D. Visual Cues and Optimal Defaults in Fast-Food Combo Meals Benefit Health-Concerned Consumers-A Randomized Scenario-Based Experiment. J Acad Nutr Diet 2023; 123:52-64.e1. [PMID: 35710044 DOI: 10.1016/j.jand.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of low-calorie menu items as optimal defaults and visual cues may nudge consumers to healthier choices at restaurants. However, little is known regarding their effects on emotions and behavioral intentions, particularly among people with different levels of health concern. OBJECTIVE Evaluate optimal defaults and visual cues' effect on anticipated pleasure and order intention depending upon consumers' health concern level. DESIGN Between-subjects randomized scenario-based experiment. PARTICIPANTS/SETTING In all, 636 US adults recruited through an online crowdsourcing platform in July 2020. INTERVENTION Participants saw 1 of 6 menu boards in a fast-food drive-through simulation. Half the menu boards included meal photos with (1) menu items to be arranged as a combo by choice (ie, create-your-own combo); (2) traditional combos that included high-calorie default items; or (3) optimal combos that included low-calorie default items. The remaining 3 boards were identical without photos. MAIN OUTCOME MEASURES Anticipated pleasure, order intention, and health concern were evaluated with 7-point Likert scales. ANALYSIS Statistical tests included multiple regression, Kruskal-Wallis, χ2, and analysis of variance. Education and sex were tested as potential confounders. RESULTS Optimal combos negatively affected anticipated pleasure (P = .003) and order intention (P < .001) compared with choice combos. Order intention reduction was the same for traditional and optimal combos (P = .128). The presence of photos changed order intention for optimal combos but varied by consumer's health concern level. When health concern was lower, photos decreased the likelihood of ordering the optimal combos (B = -3.06, P = .001), but when health concern was higher, photos enhanced ordering intention compared with the choice group (B = 0.60, P = .001). The photos did not affect anticipated pleasure for any level of health concern. CONCLUSIONS The adverse effect of optimal defaults and how visual cues may reduce their negative effect should be considered in menu design.
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Affiliation(s)
- Monica Diaz-Beltran
- Nutrition and Biochemistry Department, Pontificia Universidad Javeriana, Bogota, Colombia.
| | - Barbara Almanza
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Karen Byrd
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Carl Behnke
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Douglas Nelson
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
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A Bibliometric Analysis and Review of Nudge Research Using VOSviewer. Behav Sci (Basel) 2022; 13:bs13010019. [PMID: 36661591 PMCID: PMC9854859 DOI: 10.3390/bs13010019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
With growing demands of decision making in the current era, the impact of the drivers behind individuals' preferences and institutional strategies becomes prominent. Coined in 2008, nudge is used to describe incentives for individuals' choices with foreseeable outcomes but without exclusion of alternative choices or reliance on financial stimuli. Consequently, nudge and its application in real-world situations led to a prosperous surge of studies in multiple disciplines. However, we are still facing a dearth of in-depth understanding of the status quo and future directions of research on nudge in a comprehensive fashion. To address the gap in knowledge, the present study adopted a bibliometric analysis of the existing literature related to the investigation and application of nudge by analyzing 1706 publications retrieved from Web of Science. The results indicated that (a) being a relatively newly developed theory, interest in nudge in academia has expanded both in volume and disciplines, with Western scholars and behavioral economists as the backbones; (b) future studies in nudge-related fields are expected to consolidate its current frontiers in individual behaviors while shedding light on new territories such as the digitalized environment. By incorporating state-of-the-art technologies to investigate extant research, the present study would be pivotal for the holistic understanding of the studies on nudge in recent years. Nevertheless, the inclusiveness and comprehensiveness of the review were limited by the size of the selected literature.
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Iwasa-Madge K, Sesbreno E. A Proposed Conceptual Sport Nutrition Approach for Athlete Development and Assessment: The Athlete Nutrition Development Approach. SPORTS MEDICINE - OPEN 2022; 8:142. [PMID: 36480056 PMCID: PMC9732172 DOI: 10.1186/s40798-022-00532-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 11/12/2022] [Indexed: 12/13/2022]
Abstract
Appropriate dietary intake can improve athletes' health and sport performance and is a direct result of eating behaviours. Therefore, assessing and shaping athletes' eating behaviours and dietary intake is critical to the provision of sport nutrition services. As such, nutrition practitioners must also consider the determinants of eating behaviours. However, dietary intake, eating behaviours, and its determinants are inconsistently defined in the literature, requiring nutrition practitioners to navigate a complicated landscape of concepts and terminology. This is further complicated by limitations in practically measuring and influencing eating behaviours and dietary intake. The proposed Athlete Nutrition Development Approach was developed to aid practitioners in servicing decisions through the athlete development process, through a three-tiered approach to sport nutrition service delivery. Tier 1 addresses the determinants of eating behaviours, Tier 2 directly addresses eating behaviours and dietary intake, and Tier 3 addresses the consequences of dietary intake in relation to health and sport performance. Each tier includes tools for assessment and development.
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Affiliation(s)
| | - Erik Sesbreno
- Institut National du Sport du Quebec, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649McGill University, Montreal, QC Canada ,French-Speaking Research Network for Athlete Health Protection and Performance (ReFORM), Montreal, QC Canada
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Kocher E, Wood D, Lim SC, Jackson-Morris A, Kataria I, Ngongo C, Sham Z, Chandran A, Nugent R, Mustapha FI. Community priorities for obesity prevention among low-income adults in Kuala Lumpur: a discrete choice experiment. Health Promot Int 2022; 37:6823575. [PMID: 36367424 PMCID: PMC9651037 DOI: 10.1093/heapro/daac156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Non-communicable diseases and associated risk factors, such as obesity, are prevalent and increasing in Malaysia. To address this burden and the heightened vulnerability of low-income communities to these risk factors, the Better Health Programme Malaysia conducted a partial-profile discrete choice experiment (DCE) to inform the design of a community-based obesity-prevention programme. The DCE survey was conducted with community members (n = 1453) from three publicly supported low-cost, high-rise flat complexes in urban Kuala Lumpur. In the survey, community members were asked to choose between different sets of potential evidence-based interventions for obesity prevention. Their responses to these choice tasks were analysed to quantify preferences for these different health interventions using a random utility maximization model. Based on these results, we determined participants’ relative prioritization of the different options. The most preferred interventions were those that reduced the price of fruit and vegetables; altered cooking practices at restaurants and food vendors to reduce salt, sugar and oil; and offered reward incentives for completing online educational activities. Community members did not prioritize several evidence-based interventions, including changes to product placement or product labelling, suggesting that these effective approaches may be less familiar or simply not preferred by respondents. The DCE enabled the clear articulation of these community priorities for evidence-based interventions that focus on the supply and promotion of affordable healthy foods within the local food environment, as well as community demand for healthier food options.
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Affiliation(s)
- Erica Kocher
- Global Health Division, Center for Global Noncommunicable Diseases, RTI International , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Dallas Wood
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Shiang-Cheng Lim
- RTI International, Global Health Division, Suite 5.2 & 5.3, Level 5, Nucleus Tower, Jalan PJU 7/2 Mutiara Damansara, 47820, Petaling Jaya, Selangor , Malaysia
| | - Angie Jackson-Morris
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Ishu Kataria
- Global Health Division, RTI International, 6th Floor, Commercial Tower, Pullman Hotel, Aerocity New Delhi 100037 , India
| | - Carrie Ngongo
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Zhi Sham
- RTI International, Global Health Division, Suite 5.2 & 5.3, Level 5, Nucleus Tower, Jalan PJU 7/2 Mutiara Damansara, 47820, Petaling Jaya, Selangor , Malaysia
| | - Arunah Chandran
- Non-Communicable Disease (NCD) Section, Disease Control Division, Ministry of Health , Level 2, Block E2, Complex E, Federal Government Administration Centre, 62590 Putrajaya , Malaysia
| | - Rachel Nugent
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Feisul Idzwan Mustapha
- Non-Communicable Disease (NCD) Section, Disease Control Division, Ministry of Health , Level 2, Block E2, Complex E, Federal Government Administration Centre, 62590 Putrajaya , Malaysia
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Brown C, Cook JA, Jonikas JA, Steigman PJ, Burke-Miller J, Hamilton MM, Rosen C, Tessman DC, Santos A. Nutrition and Exercise for Wellness and Recovery: A Randomized Controlled Trial of a Community-Based Health Intervention. Psychiatr Serv 2022; 74:463-471. [PMID: 36377367 DOI: 10.1176/appi.ps.202200038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the efficacy of the Nutrition and Exercise for Wellness and Recovery (NEW-R) intervention for improving competency and behaviors related to diet, physical activity, and weight management. METHODS Participants with psychiatric disabilities were recruited from four community mental health agencies and a hospital-based psychiatric outpatient clinic and randomly assigned to the NEW-R intervention (N=55) or control condition (N=58). Outcome measures included the Perceived Competence Scale, Health-Promoting Lifestyle Profile (HPLP), and weight change; random-effects regression models were used. A follow-up analysis examined the interactions of group, time, and site. RESULTS Fifty of the 55 intervention participants and 57 of the 58 control participants completed the study. The two groups did not differ significantly on any measured baseline characteristic. The intervention group had statistically significant improvements, compared with the control group, in perceived competence for exercise and healthy eating, total HPLP score, and scores on two HPLP subscales (nutrition and spiritual growth). No significant difference between groups was found for weight loss. A study condition × time × site effect was observed: at the three sites where mean weight loss occurred, NEW-R participants lost significantly more weight than did control participants. CONCLUSIONS NEW-R offers promise as an intervention that can initiate the change to healthy lifestyle behaviors and boost perceived competence in a healthy lifestyle. It may also be effective for weight loss when administered in supportive settings.
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Affiliation(s)
- Catana Brown
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Judith A Cook
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Jessica A Jonikas
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Pamela J Steigman
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Jane Burke-Miller
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Marie M Hamilton
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Cherise Rosen
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Dorothy Clare Tessman
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Alberto Santos
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
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Nanema S, Adjei A, Amevinya GS, Laar A. "Some are healthy and others not": Characterization of vended food products by Accra-based food retailers. Front Public Health 2022; 10:941919. [PMID: 36408024 PMCID: PMC9669954 DOI: 10.3389/fpubh.2022.941919] [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: 05/12/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background and objectives Increasing the availability of healthy foods within food retail outlets can improve consumers' food environments. Such actions or inactions by food retailers may affect people's food purchasing and consumption behavior. This study explored Accra-based food retailers' perceptions and appreciation of "healthiness of food" as a concept. It also documented measures that food retailers adopt to encourage healthy food choices. Methods In-person semi-structured interviews were conducted with owners and managers of Accra-based supermarkets (n = 7) and corner stores (n = 13) in March 2021. The interviews were recorded, transcribed, coded, and analyzed thematically. Results The retailers' understanding of healthy food, or lack thereof, is exemplified by such expressions as "health, absence of disease, longevity, balanced diet, diversity, sanitation, and certification." A handful of retailers described what they sell as "products that meet consumer needs," "harmless," or "generally good." Very few retailers described the food they sell as "junk," high in sugar, fat, and salt, or energy-dense but nutrient poor foods, or as food that could pose some health risk to consumers. However, some retailers indicated that they advise their customers against the overconsumption of some foods. Conclusion Overall, Accra-based retailers have a fair understanding of what constitutes healthy food - exhibiting limited knowledge of the connection between very salty, very sugary, and very fatty foods and health outcomes. Retailers in Accra require interventions that improve their food, health, and nutrition literacy. Improving retailers' food and nutrition literacy may improve the availability of healthier options in food retail outlets in Accra.
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Affiliation(s)
| | | | | | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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Bukoye OT, Ejohwomu O, Roehrich J, Too J. Using nudges to realize project performance management. INTERNATIONAL JOURNAL OF PROJECT MANAGEMENT 2022. [DOI: 10.1016/j.ijproman.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Applying Behavioral Nudges in a Dietary Comparator for Surgical Trials: Developing the MediDiet. J Surg Res 2022; 279:540-547. [DOI: 10.1016/j.jss.2022.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/09/2022] [Accepted: 06/28/2022] [Indexed: 11/20/2022]
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McKay E, Kemps E, Prichard I, Tiggemann M. Small, Regular or Large? The Effect of Size Options on Online Food Choices. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2022.104768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fildes A, Lally P, Morris MA, Dalton A, Croker H. Impact on purchasing behaviour of implementing ‘junk free checkouts’: A pre‐post study. NUTR BULL 2022; 47:333-345. [DOI: 10.1111/nbu.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Phillippa Lally
- Research Department of Behavioural Science and Health University College London London UK
| | - Michelle A. Morris
- Leeds Institute for Data Analytics & School of Medicine University of Leeds Leeds UK
| | - Alexandra Dalton
- Leeds Institute for Data Analytics & School of Medicine University of Leeds Leeds UK
| | - Helen Croker
- UCL Great Ormond Street Institute of Child Health, UCL Population, Policy and Practice Research and Teaching Department London UK
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Tan YWB, Tan ER, Sin KY, AshaRani PV, Abdin E, Roystonn K, Wang P, Devi F, Vaingankar J, van Dam RM, Sum CF, Lee ES, Chow WL, Chong SA, Subramaniam M. Acceptance of healthy lifestyle nudges in the general population of Singapore. BMC Public Health 2022; 22:1297. [PMID: 35790920 PMCID: PMC9258182 DOI: 10.1186/s12889-022-13668-x] [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: 11/27/2021] [Accepted: 06/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background In recent years, behaviourally driven policies such as nudges have been increasingly implemented to steer desired outcomes in public health. This study examines the different nudges and the socio-demographic characteristics and lifestyle behaviours that are associated with public acceptance of lifestyle nudges. Methods The study used data from the nationwide Knowledge, Attitudes and Practices study (KAP) on diabetes in Singapore. Three types of nudges arranged in increasing order of intrusiveness were examined: (1) information government campaigns, (2) government mandated information and (3) default rules and choice architecture. Acceptance was assessed based upon how much respondents ‘agreed’ with related statements describing heathy lifestyle nudges. Multivariable linear regressions were performed with socio-demographics and lifestyle behaviours using scores calculated for each nudge. Results The percentage of respondents who agreed to all statements related to each nudge were: 75.9% (information government campaigns), 73.0% (government mandated information), and 33.4% (default rules and choice architecture). Respondents of Malay/Others ethnicity (vs. Chinese) were more likely to accept information government campaigns. Respondents who were 18 – 34 years old (vs 65 years and above), female, of Malay/Indian ethnicity (vs Chinese), were sufficiently physically active, and with a healthier diet based on the DASH (Dietary Approach to Stop Hypertension) score were more likely to accept nudges related to government mandated information. Respondents of Malay/Indian ethnicity (vs Chinese), and who had a healthier diet were more likely to accept default rules and choice architecture. Conclusion Individuals prefer less intrusive approaches for promoting healthy lifestyle. Ethnicity and lifestyle behaviours are associated with acceptance of nudges and should be taken into consideration during the formulation and implementation of behaviourally informed health policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13668-x.
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Affiliation(s)
- Yeow Wee Brian Tan
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore.
| | - Edward Ryan Tan
- Yong Loo Lin School of Medicine, 10 Medical Drive, Singapore, 117597, Singapore
| | - Koh Yen Sin
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - P V AshaRani
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Kumarasan Roystonn
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Fiona Devi
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Janhavi Vaingankar
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, 12 Science Drive, Singapore, 117549, Singapore
| | - Chee Fang Sum
- Admiralty Medical Centre, Khoo Teck Puat Hospital, 676 Woodlands Drive 71, Singapore, 730676, Singapore
| | - Eng Sing Lee
- National Healthcare Group Polyclinics, 3 Fusionopolis Link. Nexus@One-North, Singapore, 138542, Singapore
| | - Wai Leng Chow
- Epidemiology and Communicable Diseases Division, Ministry of Health, Singapore, 169854, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore.,Saw Swee Hock School of Public Health, 12 Science Drive, Singapore, 117549, Singapore
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48
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Joachim S, Forkan ARM, Jayaraman PP, Morshed A, Wickramasinghe N. A Nudge-Inspired AI-Driven Health Platform for Self-Management of Diabetes. SENSORS 2022; 22:s22124620. [PMID: 35746402 PMCID: PMC9227220 DOI: 10.3390/s22124620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/10/2022]
Abstract
Diabetes mellitus is a serious chronic disease that affects the blood sugar levels in individuals, with current predictions estimating that nearly 578 million people will be affected by diabetes by 2030. Patients with type II diabetes usually follow a self-management regime as directed by a clinician to help regulate their blood glucose levels. Today, various technology solutions exist to support self-management; however, these solutions tend to be independently built, with little to no research or clinical grounding, which has resulted in poor uptake. In this paper, we propose, develop, and implement a nudge-inspired artificial intelligence (AI)-driven health platform for self-management of diabetes. The proposed platform has been co-designed with patients and clinicians, using the adapted 4-cycle design science research methodology (A4C-DSRM) model. The platform includes (a) a cross-platform mobile application for patients that incorporates a macronutrient detection algorithm for meal recognition and nudge-inspired meal logger, and (b) a web-based application for the clinician to support the self-management regime of patients. Further, the platform incorporates behavioral intervention techniques stemming from nudge theory that aim to support and encourage a sustained change in patient lifestyle. Application of the platform has been demonstrated through an illustrative case study via two exemplars. Further, a technical evaluation is conducted to understand the performance of the MDA to meet the personalization requirements of patients with type II diabetes.
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Affiliation(s)
- Shane Joachim
- Department of Computing Technologies, School of Science, Computing and Engineering, Swinburne University of Technology, Melbourne 3122, Australia; (A.R.M.F.); (P.P.J.)
- Correspondence: ; Tel.: +61-392-148-150
| | - Abdur Rahim Mohammad Forkan
- Department of Computing Technologies, School of Science, Computing and Engineering, Swinburne University of Technology, Melbourne 3122, Australia; (A.R.M.F.); (P.P.J.)
| | - Prem Prakash Jayaraman
- Department of Computing Technologies, School of Science, Computing and Engineering, Swinburne University of Technology, Melbourne 3122, Australia; (A.R.M.F.); (P.P.J.)
| | - Ahsan Morshed
- College of Information and Communications Technology, School of Engineering and Technology, Central Queensland University, Melbourne 3000, Australia;
| | - Nilmini Wickramasinghe
- Department of Health Sciences and Biostatistics, School of Health Sciences, Swinburne University of Technology, Melbourne 3122, Australia;
- Epworth Healthcare, Richmond 3121, Australia
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Tentori K, Pighin S, Giovanazzi G, Grignolio A, Timberlake B, Ferro A. Nudging COVID-19 Vaccine Uptake by Changing the Default: A Randomized Controlled Trial. Med Decis Making 2022; 42:837-841. [PMID: 35658775 DOI: 10.1177/0272989x221101536] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although vaccination against SARS-CoV-2 is considered the central strategy against the pandemic, uptake lags behind target rates. METHOD To explore whether this rate could be enhanced by a nudging strategy that exploits the status quo bias, we conducted a randomized controlled trial in northern Italy comparing vaccination acceptance among 2000 adults, ages 50 to 59 years, who were either invited to set an appointment (opt-in group) or assigned an individual appointment (opt-out group). RESULTS Results indicate a difference of 3.2 percentage points, which represents a 32% relative increase in the vaccination rate for the opt-out group compared with the opt-in group. CONCLUSIONS A significant portion of those who remain unvaccinated may not hold strong beliefs against vaccination but rather tend to inaction and may therefore be nudged toward vaccination with a reduction of action required. HIGHLIGHTS Reluctant adults (50-59 years), who had not yet received vaccines against COVID-19, were sent letters announcing appointment availabilityIn an RCT, the status quo option in the notices influenced the rate of vaccine acceptanceNudging via pre-scheduled appointments encouraged vaccine uptake more than invitations to schedule didSwitching the default option yielded a 32% relative increase (13.1% vs. 9.9%) in vaccination.
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Affiliation(s)
- Katya Tentori
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy.,Centre for Medical Sciences (CISMed), University of Trento, Trento, Italy
| | - Stefania Pighin
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy
| | - Giulia Giovanazzi
- Provincial Authority for Health Services (APSS), Autonomous Province of Trento, Italy
| | - Andrea Grignolio
- International MD Program, Vita-Salute San Raffaele University, Milan, Italy.,Interdepartmental Center for Research Ethics and Integrity, National Research Council (CNR)
| | - Benjamin Timberlake
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy
| | - Antonio Ferro
- Provincial Authority for Health Services (APSS), Autonomous Province of Trento, Italy
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50
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Gynell I, Kemps E, Prichard I. The effectiveness of implicit interventions in food menus to promote healthier eating behaviours: A systematic review. Appetite 2022; 173:105997. [DOI: 10.1016/j.appet.2022.105997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 11/02/2022]
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