Cueing healthier alternatives for take-away: a field experiment on the effects of (disclosing) three nudges on food choices

The role of attention and health goals in nudging healthy food choice

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.

Prompting vegetable purchases in the supermarket by an affordance nudge: Examining effectiveness and appreciation in a set of field experiments

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.

Testing the impact of overt and covert ordering interventions on sustainable consumption choices: A randomised controlled trial

Food products have significant impacts on the environment over their life cycle. We investigated whether displaying products in ascending order of carbon footprint in an online supermarket environment can shift consumer choices towards more sustainable options. We examined whether the effect of the ordering intervention differs when the ordering is overt (information about the ordering is explicit), compared to when it is covert (participants not told about the ordering). We conducted a three-arm parallel-group randomised trial using 1842 online participants from England, Wales, and Northern Ireland. Participants shopped for a meal, choosing one product from each of six product categories in a simulated online supermarket. Six products were listed vertically on each product-category page. Products were randomly ordered for the control arm but ordered by carbon footprint in the covert and overt ordering arms. In the overt ordering arm, a statement was displayed at the top of each product page about the ordering of products. The primary outcome was whether one of the three most sustainable products was chosen in each product category. There was no effect of the covert ordering on the probability of choosing more sustainable products compared with the control arm (OR = 0.97, 95% CI 0.88-1.07, p = 0.533). Furthermore, we did not find evidence that the effects of the covert ordering and overt ordering differed (p = 0.594). Within the control condition, products in different positions were chosen with similar frequencies, suggesting that product positioning does not have an impact on choices. This may explain why re-ordering products had no effect. In the overt condition, only 19.5% of people correctly answered that the products were ordered according to sustainability in a follow-up question, suggesting that they didn't notice the statement. Results suggest that choices for grocery products might be too ingrained to be changed by subtle rearrangements of choice architecture like the ordering interventions, and highlight the difficulty of conveying information effectively to consumers in the online grocery shopping environment.

The effects of default nudges on promoting approval of welfare cuts: An exploration during COVID-19

The global COVID-19 pandemic has created significant financial and operational challenges for some businesses. As a result, temporary welfare benefit reduction may be a tough but future-oriented choice for both employers and employees. The present study examined whether default nudges can be used to promote employees' approval of welfare-cutting policy while avoiding negative attitudes. Two online surveys were conducted during the first pandemic wave in China (February 2020). In the first study (N = 310), the participants were presented with a hypothetical welfare-cutting policy that used either an opt-in approach or an opt-out approach. We aimed to investigate how their approval and attitudes were different between two conditions. The results showed that the employees in the opt-out condition were more likely to accept the welfare-cutting policy than those in the opt-in condition, while participants' attitudes toward the policy employing opt-out approach were as negative as that employing opt-in approach. Study 2 (N = 1,519) involved a replication of Study 1 with two additional improved opt-out approaches (opt-out education and opt-out transparency). Compared with the opt-in approach and standard opt-out approach, the opt-out education approach both increased policy support and improved attitudes toward the welfare-cutting policy. The theoretical and practical implications of these findings are discussed.

Visual Cues and Optimal Defaults in Fast-Food Combo Meals Benefit Health-Concerned Consumers-A Randomized Scenario-Based Experiment

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.

Evaluation of two social norms nudge interventions to promote healthier food choices in a Canadian grocery store

The objective of this study was to determine the impact of two nudge interventions on customers’ produce purchases at a rural Canadian grocery store. A pre- and post-intervention observational study design was used. Sales data were gathered before and after the staggered implementation of two nudge-based interventions to encourage produce purchases: grocery cart dividers to encourage shoppers to fill one-third of their cart with produce and grocery cart plaques with information about how many fruits and vegetables were typically purchased in the store. The proportion of total sales accounted for by produce was compared between baseline and implementation of the first intervention (Phase 1), between implementation of the first intervention and the addition of the second intervention (Phase 2), and between baseline and post-implementation of both interventions together. There was a 5% relative increase (0.5% absolute increase) in produce spending between baseline and post-implementation of both interventions (10.3% to 10.8%, p < 0.001, 95% CI 0.2%, 0.7%). Intervention phase-specific produce spending showed no significant change in the percentage of produce spending from baseline to Phase 1 of the intervention, and an 8% relative increase (0.8% absolute increase) in the percentage of produce spending from Phase 1 to Phase 2 of the intervention (10.3% to 11.1%, p < 0.001, 95% CI 0.5, 1.1%). Simple, low-cost nudge interventions were effective at increasing the proportion of total grocery spend on produce. This study also demonstrated that partnerships with local businesses can promote healthier food choices in rural communities in Canada.

Are You "Nudgeable"? Factors Affecting the Acceptance of Healthy Eating Nudges in a Cafeteria Setting

Research has identified nudging as a promising and effective tool to improve healthy eating behavior in a cafeteria setting. However, it remains unclear who is and who is not “nudgeable” (susceptible to nudges). An important influencing factor at the individual level is nudge acceptance. While some progress has been made in determining influences on the acceptance of healthy eating nudges, research on how personal characteristics (such as the perception of social norms) affect nudge acceptance remains scarce. We conducted a survey on 1032 university students to assess the acceptance of nine different types of healthy eating nudges in a cafeteria setting with four influential factors (social norms, health-promoting collaboration, responsibility to promote healthy eating, and procrastination). These factors are likely to play a role within a university and a cafeteria setting. The present study showed that key influential factors of nudge acceptance were the perceived responsibility to promote healthy eating and health-promoting collaboration. We also identified three different student clusters with respect to nudge acceptance, demonstrating that not all nudges were accepted equally. In particular, default, salience, and priming nudges were at least moderately accepted regardless of the degree of nudgeability. Our findings provide useful policy implications for nudge development by university, cafeteria, and public health officials. Recommendations are formulated for strengthening the theoretical background of nudge acceptance and the susceptibility to nudges.

Nudgeability: Mapping Conditions of Susceptibility to Nudge Influence

Nudges are behavioral interventions to subtly steer citizens’ choices toward “desirable” options. An important topic of debate concerns the legitimacy of nudging as a policy instrument, and there is a focus on issues relating to nudge transparency, the role of preexisting preferences people may have, and the premise that nudges primarily affect people when they are in “irrational” modes of thinking. Empirical insights into how these factors affect the extent to which people are susceptible to nudge influence (i.e., “nudgeable”) are lacking in the debate. This article introduces the new concept of nudgeability and makes a first attempt to synthesize the evidence on when people are responsive to nudges. We find that nudge effects do not hinge on transparency or modes of thinking but that personal preferences moderate effects such that people cannot be nudged into something they do not want. We conclude that, in view of these findings, concerns about nudging legitimacy should be softened and that future research should attend to these and other conditions of nudgeability.

Equity Effects of Dietary Nudging Field Experiments: Systematic Review

Background: Dietary behaviours are among the key modifiable risk factors for non-communicable diseases. Importantly, dietary behaviours vary substantially between groups and individuals with different socioeconomic positions, with more disadvantaged groups and individuals being exposed to more dietary risk factors. The goal of this review is to summarise the existing research on equity effects of dietary nudging interventions. Methods: Systematic review of nudging interventions conducted in a field setting that report an observable indicator of dietary behaviour, include a control group, and report effect sizes stratified by indicators of socioeconomic status as outlined in the PROGRESS-Plus framework. Two databases (scopus, Pubmed) were searched (last search June 2021), and 18 articles with 19 studies (k = 46 equity comparisons) were included. Risk of bias was assessed using the ROBINS-I tool. Due to heterogeneity in equity dimensions and study outcomes, a harvest plot was used to summarise data. Results: The majority of equity comparisons (38 out of 46) were available for cognitive nudges. Most of these (22 out of 38 comparisons) found that cognitive nudges worked equally well in more and less disadvantaged populations; however, in 12 out of the 38 comparisons, they favoured those who were less disadvantaged. Two out of four comparisons on behavioural nudges favoured more disadvantaged persons. Conclusions: The differential effects of dietary nudging interventions in this review can contribute to increases in health inequalities. At the same time, a substantial number of interventions showed no equity effects. Importantly, this review suggests that more research on nudging interventions and health equity is needed. Future interventions should report effect sizes stratified by indicators of social inequality. Systematic Review Registration: PROSPERO (CRD42019137469).

A nudge in the right direction: the role of food choice architecture in changing populations' diets

Populations' diets typically fall short of recommendations. The implication of this on ill health and quality of life is well established, as are the subsequent health care costs. An area of growing interest within public health nutrition is food choice architecture; how a food choice is framed and its influence on subsequent food selection. In particular, there is an appeal to manipulating the choice architecture in order to nudge individuals' food choice. This review outlines the current understanding of food choice architecture, theoretical background to nudging and the evidence on the effectiveness of nudge strategies, as well as their design and implementation. Interventions emphasising the role of nudge strategies have investigated changes to the accessibility, availability and presentation of food and the use of prompts. Empirical studies have been conducted in laboratories, online and in real-world food settings, and with different populations. Evidence on the effectiveness of nudge strategies in shifting food choice is encouraging. Underpinning mechanisms, not yet fully explicated, are proposed to relate to salience, social norms and the principle of least effort. Emerging evidence points to areas for development including the effectiveness of choice architecture interventions with different and diverse populations, and the combined effect of multiple nudges. This, alongside further examination of theoretical mechanisms and guidance to engage and inspire across the breadth of food provision, is critical. In this way, the potential of choice architecture to effect meaningful change in populations' diets will be realised.

Can Healthy Checkout Counters Improve Food Purchases? Two Real-Life Experiments in Dutch Supermarkets

Most snacks displayed at supermarket checkouts do not contribute to a healthy diet. We investigated the effects of introducing healthier snack alternatives at checkouts in supermarkets on purchasing behavior. In Study 1, we investigated the effect of completely substituting less healthy with healthier snacks (one supermarket). In Study 2, we investigated the effect of placing and discounting healthier snacks while the less healthy snacks remain in place (two supermarkets). In both studies, the number of purchased snacks (per 1000 customers) was used as the outcome variable. Results for Study 1 showed that the absolute number of purchased checkout snacks was 2.4 times lower (95% confidence interval (CI): 1.9-2.7) when healthier snacks instead of less healthy snacks were placed at the supermarket checkouts. Results for Study 2 showed that when additional healthier snacks were placed near the checkouts, the absolute number of healthier purchased snacks increased by a factor of 2.1 (95% CI: 1.3-3.3). When additional healthier snacks were placed near the checkouts and discounted, the absolute number of healthier purchased snacks increased by a factor of 2.7 (95% CI: 2.0-3.6), although this was not statistically significant higher than placement only (ratio: 1.1, 95% CI: 0.7-1.9). Purchases of less healthy snacks did not decline, and even slightly increased, during the intervention period (ratio: 1.3, 95% CI: 1.1-1.5). If supermarkets want to promote healthier snack purchases, additional healthier products can be positioned near the checkouts. However, this does not discourages the purchase of less healthy snacks. Therefore, to discourage unhealthy snack purchases at supermarket checkouts, a total substitution of less healthy snacks with healthier alternatives is most effective.

Using nudges to promote physical activity and to reduce sedentary behaviour in the workplace: a scoping review protocol

INTRODUCTION

Physical inactivity and sedentary behaviour are associated with numerous health problems and increasing risks of premature morbidity and mortality. Workplace health promotion with a focus on increasing physical activity (PA) and reducing sedentary behaviour is of growing interest. The concept of choice architecture with the use of nudges is a promising approach to influence decision making regarding health behaviours. It can help to understand why people often fail to act in their best interest, to follow well-informed preferences or to achieve their set goals. Nudges, the way the choice is presented, can help to overcome these challenges by using the same habits, biases or boundaries to alter our decision-making in favour of the more preferred behaviour. Aims of the scoping review will be to analyse (a) to what extent the concept of choice architecture is used in workplace health promotion to promote PA and/or to reduce sedentary behaviour and (b) which instruments (nudges) are used to archive that.

METHODS AND ANALYSES

Medline, PsychInfo, Web of Science and CINHAL will be searched from 2009 until June 2020. Applying a two-level screening process, title and abstracts will be screened according to a set of predetermined inclusion and exclusion criteria. Included articles will be screened a second time to determine the extent to which choice architecture has been used. Analyses for publication year, location, setting and target group will be provided. Interventions will be analysed presenting the instruments used, number of studies per instrument, combinations of instruments and alteration of the environment. Outcome measures and results will be reported as they occur.

ETHICS AND DISSEMINATION

Due to the nature of the scoping review, ethical concerns are minimal. No patient data will be included. Results are published in peer-review journals.

Effect of Impulsivity Traits on Food Choice within a Nudging Intervention

Food choices are often driven by impulsive tendencies rather than rational consideration. Some individuals may find it more difficult resisting impulses related to unhealthy food choices, and low self-control and high impulsivity have been suggested to be linked to these behaviors. Recent shifts have been made towards developing strategies that target automatic processes of decision-making and focus on adjusting the environment, referred to as nudging interventions. Therefore, the purpose of this study was to investigate the effect of impulsivity traits on food choices within a nudging intervention (increased perceived variety). A total of 83 adults participated in an experimental study consisting of a self-service intelligent buffet. Impulsivity traits were measured using the UPPS-P impulsivity scale. General linear models were fitted to evaluate the effect of the five impulsivity traits on the difference of salad consumption (g) between the control and intervention situations. Results showed that impulsivity does not affect food choices in this nudging situation, suggesting that nudging works independently of the participant's impulsivity score. Results also showed a significantly higher consumption of salad in the nudging versus the control setting (17.6 g, p < 0.05), suggesting that nudging interventions can be effective in significantly increasing total vegetable consumption across the whole impulsivity scale.

Can unhealthy food purchases at checkout counters be discouraged by introducing healthier snacks? A real-life experiment in supermarkets in deprived urban areas in the Netherlands

BACKGROUND

The checkout area in supermarkets is an unavoidable point of purchase where impulsive food purchases are likely to be made. However, the product assortment at the checkout counters is predominantly unhealthy. The aim of this real life experiment was to investigate if unhealthy food purchases at checkout counters in supermarkets in deprived urban areas in the Netherlands can be discouraged by the introduction of the Healthy Checkout Counter (HCC). In addition, we examined customers' perceptions towards the HCC.

METHODS

The HCC was an initiative of a leading supermarket chain in the Netherlands that consisted of displays with a selection of healthier snacks that were placed at the checkouts. We used a real life quasi-experimental design with 15 intervention and 9 control supermarkets. We also performed a cross-sectional customer evaluation in 3 intervention  supermarkets using oral surveys to investigate customers' perceptions towards the HCC (n=134). The purchases of unhealthy and healthier snacks at checkouts were measured with sales data.

RESULTS

During the intervention period, customers purchased on average 1.7 (SD: 0.08) unhealthy snacks per 100 customers in the intervention supermarket and 1.4 (SD: 0.10) in the control supermarket. Linear regression analyses revealed no statistically significant difference in the change during the control and intervention period of sales of unhealthy snacks between the control and intervention supermarkets (B = - 0.008, 95% CI = - 0.15 to 0.14). The average number of healthier snacks purchased was 0.2 (SD: 0.3) items per 100 customers in the intervention supermarkets during the intervention period. Of the intervention customers, 41% noticed the HCC and 80% of them were satisfied or very satisfied with the intervention.

CONCLUSIONS

This real life experiment in supermarkets showed that the placement of healthier snacks at checkouts did not lead to the substitution of unhealthy snack purchases with healthier alternatives. Although supermarket customers positively evaluated the HCC, future studies are needed to investigate other strategies to encourage healthier food purchases in supermarkets.