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Choice architecture interventions to improve diet and/or dietary behaviour by healthcare staff in high-income countries : a systematic review

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Al-Khudairy, Lena, Uthman, Olalekan A., Walmsley, Rosemary, Johnson, Samantha Ann and Oyebode, Oyinlola (2019) Choice architecture interventions to improve diet and/or dietary behaviour by healthcare staff in high-income countries : a systematic review. BMJ Open, 9 (1). e023687. doi:10.1136/bmjopen-2018-023687 ISSN 2044-6055.

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Abstract

Objectives

We were commissioned by the behavioural insights team at Public Health England to synthesise the evidence on choice architecture interventions to increase healthy purchasing and/or consumption of food and drink by National Health Service (NHS) staff.

Data sources

MEDLINE, EMBASE, CINAHL, Cochrane Central register of Controlled Trials, PsycINFO, Applied Social Sciences Index and Abstracts and Web of Science were searched from inception until May 2017 and references were screened independently by two reviewers.

Design

A systematic review that included randomised experimental or intervention studies, interrupted time series and controlled before and after studies.

Participants

Healthcare staff of high-income countries.

Intervention

Choice architecture interventions that aimed to improve dietary purchasing and/or consumption (outcomes) of staff.

Appraisal and synthesis

Eligibility assessment, quality appraisal, data abstraction and analysis were completed by two reviewers. Quality appraisal of randomised trials was informed by the Cochrane Handbook, and the Risk of Bias Assessment Tool for Nonrandomized Studies was used for the remainder. Findings were narratively synthesised.

Results

Eighteen studies met the inclusion criteria. Five studies included multiple workplaces (including healthcare settings), 13 were conducted in healthcare settings only. Interventions in 10 studies were choice architecture only and 8 studies involved a complex intervention with a choice architecture element. Interventions involving a proximity element (making behavioural options easier or harder to engage with) appear to be frequently effective at changing behaviour. One study presented an effective sizing intervention. Labelling alone was generally not effective at changing purchasing behaviour. Interventions including an availability element were generally reported to be successful at changing behaviour but no included study examined this element alone. There was no strong evidence for the effect of pricing on purchasing or dietary intake.

Conclusion

Proximity, availability and sizing are choice architecture elements that are likely to be effective for NHS organisations.

Trial registration number

CRD42017064872.

Item Type: Journal Article
Subjects: R Medicine > RA Public aspects of medicine
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor: Library Publications Router
Library of Congress Subject Headings (LCSH): Medical personnel -- Food, Diet
Journal or Publication Title: BMJ Open
Publisher: BMJ Publishing Group
ISSN: 2044-6055
Official Date: January 2019
Dates:
DateEvent
January 2019Published
23 January 2019Available
23 November 2018Accepted
Volume: 9
Number: 1
Article Number: e023687
DOI: 10.1136/bmjopen-2018-023687
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Date of first compliant deposit: 4 February 2019
Date of first compliant Open Access: 4 February 2019
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDPublic Health Englandhttp://dx.doi.org/10.13039/501100002141
UNSPECIFIED[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
UNSPECIFIEDUniversity of Warwickhttp://dx.doi.org/10.13039/501100000741
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