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Delaney T, Jackson J, Lecathelinais C, Clinton-McHarg T, Lamont H, Yoong SL, Wolfenden L, Sutherland R, Wyse R. Long-Term Effectiveness of a Multi-Strategy Choice Architecture Intervention in Increasing Healthy Food Choices of High-School Students From Online Canteens (Click & Crunch High Schools): Cluster Randomized Controlled Trial. J Med Internet Res 2024; 26:e51108. [PMID: 38502177 PMCID: PMC10988364 DOI: 10.2196/51108] [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: 07/21/2023] [Revised: 10/01/2023] [Accepted: 01/30/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND School canteens are a recommended setting to influence adolescent nutrition due to their scope to improve student food choices. Online lunch ordering systems ("online canteens") are increasingly used and represent attractive infrastructure to implement choice architecture interventions that nudge users toward healthier food choices. A recent cluster randomized controlled trial demonstrated the short-term effectiveness (2-month follow-up) of a choice architecture intervention to increase the healthiness of foods purchased by high school students from online canteens. However, there is little evidence regarding the long-term effectiveness of choice architecture interventions targeting adolescent food purchases, particularly those delivered online. OBJECTIVE This study aimed to determine the long-term effectiveness of a multi-strategy choice architecture intervention embedded within online canteen infrastructure in high schools at a 15-month follow-up. METHODS A cluster randomized controlled trial was undertaken with 1331 students (from 9 high schools) in New South Wales, Australia. Schools were randomized to receive the automated choice architecture intervention (including menu labeling, positioning, feedback, and prompting strategies) or the control (standard online ordering). The foods purchased were classified according to the New South Wales Healthy Canteen strategy as either "everyday," "occasional," or "should not be sold." Primary outcomes were the average proportion of "everyday," "occasional," and "should not be sold" items purchased per student. Secondary outcomes were the mean energy, saturated fat, sugar, and sodium content of purchases. Outcomes were assessed using routine data collected by the online canteen. RESULTS From baseline to 15-month follow-up, on average, students in the intervention group ordered significantly more "everyday" items (+11.5%, 95% CI 7.3% to 15.6%; P<.001), and significantly fewer "occasional" (-5.4%, 95% CI -9.4% to -1.5%; P=.007) and "should not be sold" items (-6%, 95% CI -9.1% to -2.9%; P<.001), relative to controls. There were no between-group differences over time in the mean energy, saturated fat, sugar, or sodium content of lunch orders. CONCLUSIONS Given their longer-term effectiveness, choice architecture interventions delivered via online canteens may represent a promising option for policy makers to support healthy eating among high school students. TRIAL REGISTRATION Australian Clinical Trials ACTRN12620001338954, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380546 ; Open Science Framework osf.io/h8zfr, https://osf.io/h8zfr/.
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Affiliation(s)
- Tessa Delaney
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Christophe Lecathelinais
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Tara Clinton-McHarg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Hannah Lamont
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Sze Lin Yoong
- Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
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Caso G, Vecchio R. Nudging low-medium income mothers towards healthy child options in an online restaurant scenario. Appetite 2023; 180:106360. [PMID: 36343869 DOI: 10.1016/j.appet.2022.106360] [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: 09/19/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Helping mothers make the healthiest choices for their children when eating out can contribute to preventing the prevalence of childhood overweight and obesity, particularly in economically disadvantaged classes. Herein, we tested whether two different nudges (a default option and a social norm prompt) could guide low- and middle-income mothers towards healthier children's menu choices in a fictive restaurant setting and investigated the drivers of healthy child menu selection. A cross-sectional online survey was performed among 809 Italian mothers with children aged between 3 and 12 years, and a between-subjects design (control, nudge 1, and nudge 2) was applied. The findings revealed that both nudges had no significant effect on the number of healthy menu selections compared with the healthy choices made in the control condition. Furthermore, considering the entire sample, the results show that certain characteristics of a mother (e.g., authoritative parenting style) and child (younger age) duo increase the likelihood of the former selecting a healthy children's menu. Similarly, a positive correlation between the likelihood of choosing a healthy children's menu and the mother's involvement in the child's nutrition (meal preparation and weekly diet) was observed.
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Affiliation(s)
- Gerarda Caso
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy
| | - Riccardo Vecchio
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy.
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Moran LJ, Tan ZQ, Bayer S, Boyle JA, Robinson T, Lim SS. Perspectives of Allied Health Professionals on Implementation of the Lifestyle Polycystic Ovary Syndrome Guidelines: A Qualitative Study. J Acad Nutr Diet 2021; 122:1305-1316. [PMID: 34800697 DOI: 10.1016/j.jand.2021.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 11/07/2021] [Accepted: 11/12/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common condition affecting up to 13% of reproductive-aged women. Weight and lifestyle management are key initial treatment strategies for individuals with PCOS, as recommended in international evidence-based guidelines. Allied health professionals, including dietitians, exercise physiologists, and psychologists, are crucial in delivering support for lifestyle and weight management. OBJECTIVE Our aim was to explore the barriers and enablers to lifestyle and weight management for individuals with PCOS from the perspectives of allied health professionals. DESIGN This was a qualitative study using a phenomenology approach to understand the allied health professionals lived experiences managing the lifestyles of individuals with PCOS. Semi-structured interviews were conducted with allied health professionals (ie, dietitians, exercise physiologists, and psychologist). Interviews were audio-recorded and professionally transcribed. Transcripts were coded inductively and analyzed thematically. PARTICIPANTS/SETTING Participants were 15 allied health professionals (ie, 9 dietitians, 5 exercise physiologists, and 1 psychologist) involved in the management of PCOS in Australia (n = 10 in Victoria, n = 5 in other states) and interviewed between June and September 2019. MAIN OUTCOME MEASURES Barriers and enablers of allied health professionals relating to the provision of lifestyle and weight management in individuals with PCOS were analyzed. RESULTS Barriers relating to individuals with PCOS included insufficient knowledge on lifestyle management; lack of time; socioeconomic disadvantage preventing access to lifestyle support; and psychological issues, such as eating disorders or depression. Barriers relating to health professionals included insufficient knowledge about PCOS and insufficient time during consultation. Barriers relating to the health system included lifestyle recommendations in the PCOS guidelines that are too general and weight-focused, funding system that does not facilitate long-term care, and low integration of care among health professionals. CONCLUSIONS Barriers for the individual, health professional, and health system all need to be addressed to improve the implementation of lifestyle management in PCOS care to optimize consistency with the PCOS international evidence-based guidelines.
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Affiliation(s)
- Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Zhi-Qing Tan
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Senay Bayer
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Tracy Robinson
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia; School of Nursing, Midwifery & Indigenous Health, Charles Sturt University, Bathurst, NSW, Australia
| | - Siew S Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia.
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